Huge challenge to lock down 1.3b people in a democracy

Archana Chaudhary and Lisa Du, Tribune News Service

It’s something that has never been tried before: 1.3 billion people — a fifth of the globe’s population — locked down in one place for 21 straight days. Indian Prime Minister Narendra Modi ordered the unprecedented move this week in a bid to replicate China’s relative success containing the coronavirus outbreak. But he faces perhaps more obstacles than his neighbour President Xi Jinping, who leveraged the Communist Party’s centralized control to isolate some 60 million people in the province of Hubei, where COVID-19 first emerged.

India’s biggest advantage over China right now has been taking action before the health system became overwhelmed and makeshift hospitals have to be constructed, according to Paul Ananth Tambyah, the Singapore-based president of the Asia Pacific Society of Clinical Microbiology and Infection.

“If the Indian effort works, the impact on the world will be tremendous,” Tambyah said by email. “It is bold and unprecedented. It is also risky in that unintended consequences may result with people missing out on care for other illnesses.”

Although Modi won the biggest political mandate in decades, India’s federalist system means he must work with powerful state leaders to implement his orders — some of whom have recently sparred with him over a law discriminating against the Muslim minority that spawned nationwide protests. The country’s vibrant democracy, with a diverse ethnic makeup, also has few of the advanced technologies that the Communist Party deploys to keep troublemakers in line.

While India has 724 confirmed cases of COVID-19, experts fear that number could increase dramatically over the next few weeks, presenting an unprecedented test for its health system. China, which has seen more than 80,000 cases, is getting back to work while seeking to prevent a second wave by blocking almost all foreigners from entering the country.

“If by the social isolation that India has gone ahead with, the infection is slowed, all credit has to go to the government,” said T. Jacob John, a senior virologist and former government adviser, who warned that a 10% infection rate — conservative in some countries — means 130 million people could catch the virus. “But if people die, the entire blame is also the central government’s. There was no need to take this gamble.”

Although China started relatively later than India, partly because it punished doctors who initially sounded the alarm about the disease, it was able to quickly mobilize all levels of government once it acknowledged the threat. More than 2,000 migrant workers built two new hospitals, with 2,600 beds in total, in just 10 days. Stadiums, offices and hotels were converted into isolation units.

China then flew in thousands of doctors into Hubei to treat the sick, while barricading residents indoors to prevent the spread. Mobile-phone carriers complied with government requests to track movements of people who had been in Wuhan — the capital of Hubei Province and the original epicentre of the disease — and office buildings used facial recognition and automatic temperature gauges to monitor suspected cases.

All of that could prove much harder in India. And the need is even greater: Whereas China has 4.3 hospital beds for every 1,000 people, India’s ratio is just 0.5, according to the Organisation for Economic Cooperation and Development. Its population is also poorer, lives in closer proximity and suffers worse air pollution that makes people more prone to lung disease.

With more than a decade of experience running the state of Gujarat, Modi would appear to be ideally placed to work with state governments. Yet even during his television address on Tuesday imposing the three-week lockdown, he failed to emphasize that people could continue to buy essential groceries and medicines. That left leaders of state governments like Maharashtra, whose capital is the financial centre of Mumbai, to try and assuage public fears.

And no matter how well the states cooperate with Modi’s emergency directives, the situation can unravel very quickly on the ground. Already there have been reports of police beating to death a man who left his house to buy groceries, while India’s efforts to scale up the availability of vital medical equipment — including virus testing kits and personal protective equipment for health-care workers — has been hampered by local authorities implementing strict curbs on movements.

Modi’s government announced a 1.7 trillion rupee ($22.6 billion) spending plan on Thursday that includes cash support benefiting farmers and migrant workers, as well as free cooking gas for the poor. Migrant workers, the homeless and slum-dwellers are among the most likely to move about during the lockdown to find income, according to Prachi Singh, a Delhi-based associate fellow at Brookings India.

Some states have taken matters into their own hands.

In Kerala, a coastal state on the Arabian Sea, the local government has followed its own experience of dealing with a 2018 outbreak of the Nipah virus, which originates from fruit bats and can lead to brain swelling. The state’s chief minister, Pinarayi Vijayan, has won praise for a 200 billion rupee ($2.7 billion) relief package that is separate from the federal government.

In the capital New Delhi, meanwhile, local media reported landlords were kicking out critical staff like doctors, nurses and paramedics over infection fears. That led to an intervention from Home Minister Amit Shah and Delhi Chief Minister Arvind Kejriwal, who called for an end to the evictions.

“When dealing with a major health crisis like this, you still need New Delhi leading from the front to coordinate responses,” said Michael Kugelman, senior associate for South Asia at the Wilson Center in Washington. The fact it’s a “messy democracy” undercuts India’s ability to act as forcefully as China did in compelling its population to observe social distancing, said Kugelman.

There are signs of strain. Unlike in China, where so-called “green corridors” ensured online grocery services and supermarkets were able to feed the country’s 1.4 billion people, Indian authorities have been stopping food trucks on highways, and shutting down warehouses and rice mills. The country’s largest online retailers — including Amazon Inc., Walmart Inc.-owned Flipkart and BigBasket, a fresh grocery delivery service backed by Alibaba Group Holding Ltd. — are also struggling to navigate the now-closed borders between India’s 29 states and territories.

Modi’s federal government “has so far looked good” with decisive measures to shut borders and restrict people’s movements, but there’s a long way to go, according to Akhil Bery, Washington-based analyst with Eurasia Group.

“It will require an all-hands-on-deck approach to save the situation — and he will have to cooperate with regional leaders,” Bery said of Modi. “Frankly how it will pan out will depend on how many people die in India because of coronavirus.”