Cordoning corona pandemic: Unorganized workers 'highly vulnerable' to infection

By Dr S Jayaprakash, Bharathy, Dr Simi Mehta, Dr Balwant Singh Mehta, Dr Arjun Kumar, Dr Manish Priyadarshi*
We have had an information overdose on the novel coronavirus (COVID-19), possible precautions, and treatments from this infection. The major facilitator for this has been the print, electronic and social media. This article focuses on the need for next level planning that is needed to protect the unorganized and informal labourers and those at the bottom of the ladder in India. Ascertaining these measures will answer the basic question whether the humanity still retains its rationality.

Impact on human and economic health

In the past, various parts of the world have frequently been gripped by spread of different epidemics. Along with mortality, the fear psychosis of succumbing to the epidemic has often had negative consequences on the overall economy. For instance, the Spanish flu epidemic of 1918, which infected 500 million people, which was about quarter of world population at that point of time.
It has been just four months of the outbreak of COVID-19 from Wuhan City in Hubei province of China, and over 300,000 confirmed cases of infections and has cost around 17,000 human lives. However, the panic and paranoia that has ensued can be linked to majorly unscientific and baseless information circulating on social media- the access to which most Indians have.
The livelihood of daily wagers, self-employed and lower middle classes have already begun to be hit hard due to the panic and preventive measures and it will take several months to restore normalcy in their lives. As per the latest available official statistics, The Economic Survey of 2018-19, released on July 4, 2019, says "almost 93%" of the total workforce is 'informal' and major measures put forward by national and state government is for the organized sector.

As India moves from stage 2 to stage 3 or 4 of COVID-19, only affluent sections will be able to receive treatment from available options

Though Government has advised the private sector to ensure that salaries to their employees are paid during these trying times, the fate of unorganized labourers will be a pity here as neither they have such employer relationship nor they have enough funds or access to government facilities (which will always be crowded) to take care of the health needs of their families and themselves.
The health infrastructure of India is inadequate and inept. It is evident through the following insights: as per the national health profile, 2019, there are 7.14 lakh government hospital beds available in the country, which turns out to just less than about 6 beds per 10,000 population. 

Senior citizens (60 years and above) are more vulnerable to coronavirus, the availability of beds for elderly population is again just 52 beds per 10,000 population. At least 5-10 % of the patients will need ventilator support, and however, only of the government hospital beds only 5-8% have ICU beds, assuming all ICU beds have ventilator we arrive at 30 to 35 thousand ICU beds to cater the growing number of coronavirus patients.
As India moves from stage 2 to stage 3 or 4 of the COVID-19, those who are affluent will be able to receive treatment from different available options. But it the public health facilities and the government hospitals that are the last resort for the informal labour force and those belonging to the lower middle class. 

The question whether the meagre allocation of INR 69,000 crore for the health sector- just 1% of GDP be sufficient to take care of the health care needs during pandemic? Similarly, the Ayushman Bharat scheme allocation that has been slashed from the previous year’s INR 6400 crore to INR 3200 crore in 2020-21 will be a peanut to tackle this national health emergency like COVID-19.
The labourers of lower middle class and unorganized labourers are highly vulnerable to get infected and they are the people whom every Indian citizen in one way or other will be contacting at least once in a day, thus transmission through them is highly possible when it comes to pandemics.

The Ayushman Bharat scheme allocation will be a peanut to tackle this national health emergency like COVID-19

Considering this grim situation predicted to worsen in the coming days, India needs to augment its actions to protect these sections of the population. Some of the important areas of urgent government intervention are:
A) Funds for their health: Apart from the allocated funds for their health under various schemes, government can consider the following:

• All unused funds that has accumulated by the way of cess/levy, a portion of it can be diverted to focus on their health urgently.
• Swachh Bharat fund, education cess etc. 
• ESIC, EPFO funds. 

B) Funds for their livelihood: It needs to be understood that majority of package initiated by Government of India are for organized sector and the so unorganized sector remains ignored. For those who have migrated back to their villages in absence of work, no announcements for relief have been made at this time of health exigency. To cater to this challenge, the government must explore funding options, for example:

• While the government claims that financial inclusion has reached a recorded percentages and direct beneficiary transfer mechanisms are in place already, it is time for the insurance industry to plan for a temporary job loss insurance to cater to such pandemics, through Jan Dhan accounts, MUDRA loans, etc.
• Such social insurance is possible and even feasible through a government reinsurance mechanism as well. 
• During the normal period, a small money can be bundled along with the bank fees and deposited for such insurance. It can be partially funded by Central and State Governments as well. 
• The pattern of pandemics happens once in several decades and that can give a good corpus for paying a small amount to the unorganized e.g. Rs. 2000 per week per person of job loss or shut down. 
• As it is done through social reinsurance treaty, the risk is spread throughout the world. 
• This is the best time to launch such insurance product when 90% of the world countries are facing shutdown for few weeks, best time to realize for the need for such insurance product. It will go a long way in generating the much-needed trust with the functioning of government mechanisms. 

C) Technological framework focused on them (scalable for other segments of population): While we feel proud to develop so many applications, there is no use if we have not yet developed a technological framework to alert human beings when any threats that can wipe out the entire human race is in place. When barriers of access are broken in technology, it produces wonderful results through creative ideas and innovations.

COVID-19 has provided us the thought to think again about our development and redo it in sync with sustainable development

Even in the case of coronavirus, the first case was suspected during the first week of November. In this situation, a text mining algorithm could have easily located such news and disseminated to the entire world through Application Programming Interface (API) or through an SMS blast, which could have alerted people to control the epidemic within the Great Wall of China.
Almost all the hospitals in India have their own applications and tech support systems in place. The government must make it mandatory to share a list of diseases and cases on regular basis through API for continuous analysis of data and machine learning perspective to understand the trend, whenever the analysis or predictive models sense any alarming range, it should do a SMS blast to respective stakeholders.
Integrated disease surveillance system needs to be revamped to cater the needs and magnitude of COVID-19. Today, our surveillance system is trying hard to counter the local transmission with the limited usage of technology.

Conclusion

Though many big nations are having nuclear bombs that are more powerful than the one blasted in World War II, usage is restricted as it has the potential to take back our civilization by at least 50 years. 

Similarly, though we have all the economic applications (i.e. products like social insurance, cess/levy concepts, financial inclusion, human medical applications like Artificial Intelligence robots, medical devices etc. and technological applications (like machine learning, SMS blast, cloud concepts etc.), living on the illusion of the permanence of living systems will eventually prove to be a bane as the government fails to coordinate and cooperate with its citizens. 

COVID-19 has provided us the thought to think again about our development and redo it in sync with sustainable development, not just in words but also in deeds.
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*With the Impact and Policy Research Institute (IMPRI), New Delhi