As India will obviously not be able to follow the South Korean strategy of systematizing screening, it has pogressively adopted a strategy of containment. In his first speech on the matter on March 19th, Narendra Modi merely advised the Indian people to stay home the following Sunday. This "Janata curfew" (people's curfew) was all the more unevenly observed as some states of the Indian Union (governed by opposition parties) refused to join in and Indian citizens, who saw it as a voluntary measure, refused to comply with injunctions from the police when it intervened. It should also be noted that many of those quarantined have left their confinement because of the often unhealthy condition of isolation wards.
One day of confinement – even more so on a Sunday – was in any case not an adequate response to the scale of the problem and finally, on the following Monday, Prime Minister Modi announced a 21-day lockdown. Surprisingly, the Indian population was only given four hours between the announcement and its implementation. This decision was made on March 24, after Delhi had banned gatherings of more than five people while Maharashtra, Punjab, Tamil Nadu and Orissa had already decreed an official containment.
What risks does India face in the medium term?
India's vulnerability to an epidemic of this kind is aggravated by several factors:
- the country's population densities, including in rural areas where they sometimes exceed 1,000 people per square kilometer;
- the crowded conditions in which poor families live, starting with slum dwellers, who make up 25-30% of the population of the largest cities;
- hygiene-related issues which have led personalities such as Priyanka Gandhi (the daughter of Rajiv and Sonia Gandhi) to broadcast videos showing how to wash hands – a rare occurrence for those with only random access to water points in a country where an estimated 45% of Indian households have a tap;
- the prevalence of particularly high-risk populations, whether victims of diabetes or those affected by tuberculosis or other lung diseases: there are more than 6% of diabetics in India and 2.7 out of 10 million tuberculosis patients worldwide are in India according to the WHO.
Second, the epidemic is set to spread from cities, where it originated, to the countryside because of several push factors: the lockdown has resulted in the closure of factories and the suspension of most of the means of transport, whereas social distancing measures promoted by the Indian government has resulted in the layoff of many domestic workers – a plentiful workforce. All these people have been forced to return to villages in Bihar, Uttar Pradesh, Orissa and elsewhere, where these migrants often come from and where they are taking the coronavirus, an urban phenomenon till then.
Thirdly, India's health system is one of the most deficient in the world. According to the OECD, India has only 0.5 hospital beds per 1,000 inhabitants, compared to 3 in Italy, 6 in France and 12 in South Korea. Similarly, India has 0.8 doctors per 1,000 inhabitants, compared to 1.8 in China, 3.2 in France and 4.2 in Germany. And still, much of this concerns the private sector, with a limited access to the approximately 20% of the population that makes up the country’s middle class. Stagnation of public investment in the health sector – which has never exceeded 1.2% of GNP (compared to an average health expenditure in Low Income Countries, which include India, at 1.57% of GDP according to the World Bank) and represents 4% of the state budget since the end of the 1980s – has only been partially offset by the growth of the private sector, which now accounts for 51% of hospital beds.
Under these circumstances, it appears likely that the Indian healthcare system will soon face a massive influx of patients that it will not be able to treat.
Sanitary, political, economic and social implications
The human toll of the epidemic is likely to be very high in terms of the number of people infected, although the youthfulness of India's population will undoubtedly mitigate its impact (today, 46% of Indians are under 25 years old). If 5% of adult Indians contract the disease, the number of patients to be treated would amount to 40 million – with only 710,000 hospital beds.
Economically, the pandemic comes at a time when India's growth rate has fallen below 5%, compared to 7-8% two years ago. The slowdown, which is reflected in a consumption and investment drop, is linked to the serious difficulties of a banking sector plagued by bad debts. On the one hand, public authorities, deprived of tax revenues, are facing a budget deficit of around 10% of GDP (all actors combined, including federated states and public enterprises). On the other hand, banks are not in a position to ease credit access – especially following the bankruptcy of one of them, the Yes Bank, last February. Not only will New Delhi not be able to implement the huge privatization program that was included in the Finance Law – who would consider the acquisition of Air India today? – but above all the Modi government lacks the resources to support companies and individuals.
Today the government of India is not in a position to execute a massive relief program for this very reason. The package announced last week by the finance minister for helping the economically endangered represents about 1 % of the GDP. With a mere transfer of Rs. 500 (5,93 euros) to women Jan Dan account holders or a minimal increase of MGNREGA wages from Rs. 182 (2,16 euros) to Rs. 202 (2,40 euros) a day, the package will not help the poor much. Similarly, the SMEs in India, which employ over 40% of the Indian workforce, are facing the biggest hit due to the lockdown as the relief package does not cover their fixed costs, which make up to 30-40% of the total cost. This has resulted in cutting costs by dismissing workers, all the more so as they are now redundant during the lockdown period. It is important to note that the relief package initiated by the central government is also rather limited in comparison to those of some states of the Indian Union, including Kerala, a model in terms of welfare state.