‘Lockdown’ labours lost; People left out in the cold 

According to the website run by the Union Ministry of Health and Family Welfare, as of 8 AM on 20 April, there were 14175 active cases of COVID-19 in the country. And 543 deaths can were attributed to the pandemic. By April 22, the figure of positive cases went up close to 20,000 and over a hundred more deaths were also recorded.

However, no statistics are being compiled on patients who have died or are in grave danger of dying because they can’t access proper medical care as hospital resources get tied up in the Coronavirus pandemic. These include cancer and HIV patients, women about to give birth and others like those with heart or other conditions.

For many, the lockdown has meant that hospitals are simply turning them away. For others, it is a case of being stuck waiting for their turn to come as overworked hospitals like AIIMs and Deen Dayal Upadhyay in Delhi and similar hospitals across the country can no longer function to normal capacities because of the pandemic. And for still others, it could mean not being able to reach the hospital on time. There are also reports of hospitals shutting down after doctors and other staff get the infection while treating Coronavirus patients. There are no authentic estimates of how many healthcare facilities are now not functioning or functioning at a very limited strength because of the pandemic. Or how many have simply voluntarily closed all non-epidemic treatment to reduce risks of transmission. But reports suggest that the numbers are significant – between a quarter and a third of all healthcare facilities in the country. India’s healthcare system is woefully inadequate – a Brookings Institute report suggests that we have only 0.55 government beds per 1000 population. Now many of these have been rendered unavailable because of the Coronavirus pandemic. The longer the lockdown continues and the longer OPD departments and surgery rooms remain shut and hospitals turn away patients in order to focus all attention on Coronavirus, the numbers of such non-Coronavirus deaths will only increase.

Already, reports of patients dying as they are turned away by hospitals are being reported in every state. Mansi Mandal, an assistant professor in Delhi put up a post on the social media platform Facebook about her mother’s death on April 6 in Darbhanga because every private hospital turned her away saying the administration had instructed them against taking in critical patients. The government hospital was of no help either. Mansi, stranded in Gurgaon, could do nothing as her mother passed away after being denied treatment by one medical facility after another.

Facebook has several posts similar to this one. And these are people who can afford private healthcare. Those purely dependent on government facilities are far worse off.

A recent report in India Today by Ajay Kumar and Gulam Jeelani talked about how the situation has gone out of hand in Delhi itself. According to the report, there are about 57,709 beds across private and government hospitals in the capital city. With several hospitals being designated only for the treatment of Coronavirus patients, and dozens of others closing their OPDs, and several clinics and hospitals that had to be shut down after doctors and nurses contracted the infection, many non COVID-19 patients have been left out in the lurch.

Some of these are poor patients who have come for cancer or other critical ailment treatment to AIIMS or the other government-run hospitals in the city from other states. The sudden lockdown has left them stranded in the city, with money running out, while also unable to get treatment. Some cancer patients have undergone several rounds of chemotherapy or radiation before they were told not to come to the hospital because they were at risk of getting infected.

Kolkata-based journalist Sohini Chattopadhyay wrote an article in Mint newspaper about the crisis building up in blood banks across the country. Donors are finding it difficult to come to hospitals and blood collection drives are postponed because of the scare of infection. The level of blood donation in most states has seen a steep drop since the second half of February. Currently, blood donations are less than half of what they were in January. Sohini talks about cases where families of patients requiring blood have had to scramble to find donors because of the lockdown and shortage of specific blood types.

As several commentators have pointed out, the crisis of nonCOVID-19 patients who are critically ill but are being denied proper treatment will only increase as the lockdown rolls on. And there seems no immediate solution in sight either as states and the central government mull extending the lockdown further.

The Health Equipment Issue: An extended lockdown serves no purpose if the time is not used to rapidly build up capacities and facilities for treatment, ramp up supply of essentials like PPEs, and development of test kits, etc. While states are largely responsible for healthcare, the union government plays two crucial roles. One, it creates policies – from procurement of imported stuff to higher production incentives and tax breaks for domestic manufacturers – to improve the stockpile and ensure it reaches the places it needs to. The union government has been tardy in this respect and there is also n o central monitoring to see whether test kits and PPEs are reaching the places where there are shortages. This needs to change if the country needs to fight the pandemic properly

Sinking into Debt: One of the under-reported stories of the lockdown is the despair of the urban lower-income groups. Many of them do not fall under the current definition of extremely poor. They are part of the informal economy but, till the lockdown, enjoyed a relatively stable income. They are maids and drivers and private guards, Ola and Uber entrepreneurs, restaurant staff, beauticians, AC repair technicians and carpenters among others.

Many of them not only had steady jobs but earned between Rs 20,000 and Rs 60,000 a month. Their prospects have dimmed after the lockdown. Many of them had little savings but have EMIs to pay. Many of them were investing in assets and training for a better future when the pandemic came rolling by. Now they are scrambling to meet their EMI and other obligations.

This group also includes the many entrepreneurs of Dharavi in Mumbai, which is Asia’s biggest slum with an estimated million people crammed into tiny homes, in unhygienic conditions, with often hundreds sharing one common toilet. Dharavi has entrepreneurs running shops and manufacturing facilities for everything from leather products to plastic recycling. Now all that is gone and all that is left is a completely locked down hotspot from where no one can do anything.

The problem with this group is that they mostly do not get the benefits of the various schemes of the government. So, they lose out both ways. They do not have any benefits of the formal sector and they are often not considered poor enough to get benefits reserved for the very poor. Many of them can hold out for a month or two, but it seems likely that at least a significant portion of these will be driven to poverty by the time things start getting back to a semblance of normalcy. Their stories will unfold over the next couple of months. The income inequality between the rich and the poor will only increase as the lockdown continues.

The Coronavirus started as an upper-class disease – initially infecting only people who were travelling abroad. But since then, it has spread to everyone. And as it always does, the poor are the worst off. They are also slowly losing patience. Unless solutions are found in double quick time, the tensions rising among India’s poor and deprived could lead to a truly ugly situation very soon.

(This abridged piece was first published in Prosaicview.com. The author is former Editor of Business Today and BusinessWorld)