In a background paper on understanding the COVID-19 epidemic in the context of India health rights organizations, Jan Swasthya Abhiyan (JSA) and All India People’s Science Network (AIPSN), have argued that, faced with such a disaster on this scale, “governments often resort to blaming the victims and use authoritarian exercise of power that would distract from its failures. This has happened in the past, and it could happen again.”
Stating that there is a tendency to place “unreasonable restrictions on people’s movements and even repressive forms of mass quarantines”, the paper says, such measures “would have far more adverse consequences on the poor than the epidemic itself.” While such measures may have some role in containment in the first few weeks, lack of necessary healthcare facilities lead to blaming the spread on allegedly “irresponsible” behaviour of some sections.
Insisting that there is a need to expose such calls and expose the class bias underlying the dynamics of labeling people like this, the paper says, “Given the nature of authoritarianism that has characterized many so-called democratic governments world-wide, and given the huge economic crisis that was already in place before the epidemic began, there is a great danger that the epidemic becomes another reason to ban protest gatherings.”
Asserting that collective actions of different sections of minorities and those marginalized by religion, caste and class would particularly suffer, the paper says, “There are already instances of violence against immigrants and such ‘others. Such ‘others’ tend to be those marginalized by reason of their occupation or geography or ethnicity. It could also include tourists.”
Excerpts:
In India, currently, only about 7,000 persons have been tested since the epidemic began. By definition testing has been limited to those with typical symptoms who have either travelled abroad and returned, or their contacts. By World Health Organisation (WHO) case definition, those patients with typical symptoms requiring hospitalization are suspect cases, even if there is no history of contact with those travelling abroad. In India, they are currently not being tested.Even the immediate plan for expanding testing is only to the 52 Integrated Disease Surveillance Programme (IDSP) laboratories, which is only about two or three per state testing centers. This would be far too low to identify the uneven and unpredictable clusters of high intensity spread. The South Korean example shows how mass testing not only identified community spread, it showed large clusters in unexpected areas and this helped focus mitigation action.
The implication of community transmission is that the objective of all containment measures, including isolation of cases, quarantine and social distancing, is now to delay and lower the peak of the epidemic, not altogether prevent it.
This delay is important -- because it would give time to the government to gear up. But it also means that we are going in for a prolonged period of remaining on alert. The full peak in a nation like India, if we were successful in the containment measures can get pushed to June-July 2020 or even later.
Currently most containment measures seem geared to the short run -- but we are well advised to think about measures and ways of changing our lives and routines so that we are able to manage for six months at least.
And we will need to plan our economic and social policies accordingly. Paradoxically, if we let the disease run its course, the surge of patients on healthcare systems and hospitals may be large, but the epidemic may run out sooner, and its damage on the economy could be less. But the number of lives lost would be unacceptable.
Most such epidemics eventually run out when the population has such a large population of infected and therefore immune people, that transmission slows down and ultimately stops. This of course assumes that once infected, the resulting immunity is lifelong. But that is a relatively safe assumption.
Why is public hospital preparedness low?
The main problem is that over 30 years of structural adjustment, the government has failed to increase public hospital beds and services. The services that exist are also skewed and concentrated in few urban centers.Over the years, the government has also failed to add necessary human resources for health. “Keeping the regular salaried workforce small” has been projected in economic and social policy as a virtue. Further public health systems are designed by ideological choice to provide a very selective set of services.
The principle of design of public health services at the primary level is that it should provide only the minimum required, leaving the rest to the private sector. Therefore government medical college hospitals and district hospitals, which have a wider range of services are already seriously over-crowded with floor beds. But such minimalist design cannot handle a pandemic like this, which is a maximum event.
Ideally public hospital networks should be built with excess capacity i.e a considerable degree of unused beds and equipment. A certain planned “slack” or “redundancy” is essential so that at times of crisis such as this (or during disasters) the surge in cases can be addressed. The failure to do this is a serious failure of past governments.
There was some attempt to address this under the National Health Mission, but far too little, and far too focused on just maternal and child survival. The present government has accelerated the weakening of public health services by cutting back expenditure for strengthening public hospitals and signaling that they would like to outsource district hospitals as profit generating venues.
If fortunately the crisis passes us by we may be saved a catastrophe. But if it hits India, the way it is playing out in Italy, and there is a surge of patients seeking care in public hospitals, it could be an unprecedented disaster.
Beware authoritarian government actions
Faced with such a disaster, governments often resort to blaming the victims and use authoritarian exercise of power that would distract from its failures. This has happened in the past, and it could happen again. It could well begin with a call for a responsible behavior of the population. It would then go on to unreasonable restrictions on people’s movements and even repressive forms of mass quarantines that would have far more adverse consequences on the poor than the epidemic itself.Such measures may have some role in containment in the first few weeks, when most cases can be traced back to contacts. But once we are into community transmission phase, and the aim is to delay, not prevent the epidemic, and the weeks have become months, such moves to blame the spread on irresponsible behaviour would be unfair and unhelpful.
Fake news is another problem. One example is that eating poultry or non-vegetarian food is dangerous. This is just not true
There would a great need to expose such calls and expose the class bias underlying the dynamics of labeling the people who are at sick or at increased risk as irresponsible.
Given the nature of authoritarianism that has characterized many so-called democratic governments world-wide, and given the huge economic crisis that was already in place before the epidemic began, there is a great danger that the epidemic becomes another reason to ban protest gatherings, collective actions of different sections of minorities and those marginalized -- by religion, caste and class, and impose more restrictions on them.
There are already instances of violence against immigrants and such “others”. Such “others” tend to be those marginalized by reason of their occupation or geography or ethnicity. It could also include tourists. Such trends could grow if not curbed at the very onset.
Fake news is another problem. One example of such damaging fake news is that eating poultry or non-vegetarian food is dangerous. This is just not true. But the poultry industry has been hit badly by this fake news. While fake news about the epidemic must be actively curbed, this should not become a reason for blanket curbs on reporting on the epidemic and public discussion on the same.
Similarly people under quarantine have rights that must be protected. Historically, conditions under quarantine have always required independent monitoring by civil society and human rights organizations to protect rights against a state that empowers itself with huge, often unnecessary powers under the epidemic acts. In most situations taking community into trust, with measures like self-quarantine backed by local community and social support works the best.
Furthermore, migrants (documented or undocumented) and stateless citizens have health rights that must be acted on -- and they should not be pushed out of necessary healthcare.
Additionally governments have a responsibility to address the economic crisis that this epidemic has brought about.
The large number of deaths during the 1918 flu epidemic was an immediate consequence of the vulnerability of populations due to the consequences of the First World War. There are many nations which are in such a war-torn environment which are particularly vulnerable.
There are already instances of violence against immigrants and such “others”. Such “others” tend to be those marginalized by reason of their occupation or geography or ethnicity. It could also include tourists. Such trends could grow if not curbed at the very onset.
Fake news is another problem. One example of such damaging fake news is that eating poultry or non-vegetarian food is dangerous. This is just not true. But the poultry industry has been hit badly by this fake news. While fake news about the epidemic must be actively curbed, this should not become a reason for blanket curbs on reporting on the epidemic and public discussion on the same.
Similarly people under quarantine have rights that must be protected. Historically, conditions under quarantine have always required independent monitoring by civil society and human rights organizations to protect rights against a state that empowers itself with huge, often unnecessary powers under the epidemic acts. In most situations taking community into trust, with measures like self-quarantine backed by local community and social support works the best.
Furthermore, migrants (documented or undocumented) and stateless citizens have health rights that must be acted on -- and they should not be pushed out of necessary healthcare.
Additionally governments have a responsibility to address the economic crisis that this epidemic has brought about.
The large number of deaths during the 1918 flu epidemic was an immediate consequence of the vulnerability of populations due to the consequences of the First World War. There are many nations which are in such a war-torn environment which are particularly vulnerable.
Moreover, even when there are no wars, austerity measures due to economic crisis, and inequity in economic policies have led to large swathes of population living on the brink- and therefore very vulnerable to an epidemic.
Further concessions to corporate industry and the financial sector are not going to make much of a difference at a time when all productive activity is under siege. What would be needed is a sweeping demand side support. Measures are required to support the large unorganized work force whose livelihoods are being hit.
If visionary measures like universal basic income, or a more substantial form of employment guarantee could be introduced, we can still turn this pandemic-disaster into a civilizational opportunity. The rapid expansion in public health infrastructure and healthcare that is required will itself generate a large amount of employment support.
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Click here for full paper
Further concessions to corporate industry and the financial sector are not going to make much of a difference at a time when all productive activity is under siege. What would be needed is a sweeping demand side support. Measures are required to support the large unorganized work force whose livelihoods are being hit.
If visionary measures like universal basic income, or a more substantial form of employment guarantee could be introduced, we can still turn this pandemic-disaster into a civilizational opportunity. The rapid expansion in public health infrastructure and healthcare that is required will itself generate a large amount of employment support.
---
Click here for full paper
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