India Staggers Under the Coronavirus Burden

It took four months for the virus to arrive at Ajay Kumar Sinha’s clinic. Things remained quiet there as the pandemic got underway, he says, but in July, the situation suddenly grew serious. Sinha is 58 years old and works at Nalanda Medical College & Hospital in the city of Patna, located in northeastern India. It is one of four corona facilities serving a city of more than 2 million people.

As they so often do, monsoon rains brought flooding to Patna, with the flood waters even pushing into the hospital. A murky, brackish slop swirled around the beds of the patients.

At the same time, the number of coronavirus patients was on the rise, and suddenly there weren’t enough beds for all of them. There were increasing reports of sick people being turned away, and of people collapsing dead in front of the hospital. “My residents would call me crying that they are losing patients,” says Sinha. Videos from this period show bodies covered with blankets lying unattended for hours in the same room with patients.

“The media criticized us for not disposing the bodies,” says Sinha. “We were told that the government will help us in cremating bodies, but there was no disposal team in place for some time.”

Sinha’s voice is calm over the phone as he relates his story. He is on the way home from work and you can hear honking and other traffic sounds in the background. He says he didn’t have any illusions from the very beginning. “When I saw the images from Europe in March, we knew we were in for a challenge with our limited infrastructure.” If the best health systems in the world were struggling, what would happen in Patna?

It was this fear that dominated the initial weeks of the pandemic in India and informed the government’s actions. In early March, India ceased issuing visas, even before the World Health Organization (WHO) warned of a developing pandemic. On March 24, the government of Prime Minister Narendra Modi imposed the strictest lockdown in the world, imposing immediate stay-at-home orders for more than a billion people.

Health experts were full of praise for the steps taken by India, as was WHO. Now, though, hardly half a year later, it looks as though the severity of that lockdown may have laid the groundwork for the explosion in COVID-19 cases the country is now experiencing.

Officially, over 6 million people in India have become infected with the SARS-CoV-2 virus, peaking recently at an average of 90,000 new cases reported each day – more than any other country in the world. Since early September, more than 1,000 people have been dying each day as a result of the pandemic.

Epidemiologists believe that the true extent of COVID-19’s spread in India is even worse, with the number of infections potentially even as high as 100 million. According to the official numbers, the country will take over the number one spot in the coronavirus rankings from the United States. In reality, though, India is likely already home to the largest outbreak of the virus in the world.

Just as threatening, though, are the mid-term and long-term effects of the pandemic on the country. Because SARS-CoV-2 is hitting India at a critical moment in its development.

Following his re-election in May 2019, Modi set an ambitious goal for his country: Within the next five years, he promised, India would become a $5 trillion economy. That would essentially mean a doubling of the country’s gross domestic product, making India the fourth largest economy in the world behind the U.S., China and Japan. To reach that goal, however, the economy would have to see annual growth rates of 9 percent.

Strictest Lockdown in the World

That seems illusory in the middle of a global pandemic, but for India’s future, it is badly needed. Some 600 million people in India are younger than 25 years of age, with a million people entering the labor market each month. India’s economy must grow to ensure that the country can meet the needs of its younger citizens for a place to live, enough to eat and perhaps a scooter to get around.

The coronavirus is now chipping away at that dream. It is threatening the conviction, which has been developing for years, that India is on the brink of prosperity and that the impoverished country could become a wealthy one. Perhaps even a superpower if it tries hard enough.

India’s lockdown, which was announced by Prime Minister Modi in March, was the largest and strictest in the world. Trains and buses stopped running, flights and taxis were banned – and all that with hardly four hours of lead time. Entire city districts were sealed off, with police roadblocks making sure that nobody went in or came out without permission. But within 48 hours, it became clear what everybody should have already known: It isn’t possible to lock in a billion people.

Millions of people in India live in slums, and many are migrant workers. They became jobless essentially overnight. Afraid of going hungry, hundreds of thousands set off on the risky journey back home. They clogged the highways, backpacks on their shoulders and plastic bags in their hands, most of them trudging along in thin-soled sandals. The police initially tried to stop them, but following a series of protests, officials made trains available to take them home. The result was train platforms jammed with hundreds of people and compartments full to overflowing, the best possible conditions for the spread of the virus. And for the next six months, the virus was able to advance into every corner of the country.

It seems fair to say that exactly what the government had hoped the lockdown would prevent has now become reality: The migrant workers brought the virus from the cities into the villages. That is likely how the virus made significant inroads in the state of Bihar, and how it found its way into Sinha’s hospital.

Bihar is one of India’s poorest states and it is the home of a huge number of the country’s migrant workers. In June, according to one survey, 75 percent of them were infected with SARS-CoV-2, and it took just a few more weeks before the first wave crashed over Patna.

Chaotic Conditions

At the height of the epidemic, Sinha, who was responsible for the treatment of the hospital’s COVID-19 patients, worked for up to 16 hours a day, and he found himself working under chaotic conditions. There was a lack of protective clothing and his family was pleading with him not to risk his life. His wife and daughter, both of whom are also medical doctors, would examine each other every evening for symptoms. At the same time, the hospital’s personnel were also afraid: Only eight of the staff of 1,200 were initially willing to care for COVID-19 patients.

Sinha tried to encourage his colleagues. In response, he was told: “If something happens to us, our families will not spare you.” The panic was rising.

For the last few weeks, though, Sinha has been able get some rest. At the moment, only a third of the beds in his clinic are occupied. But that is hardly the case in other parts of the country. Indeed, it helps to look at India – which, with 1.37 billion people, has a greater population than all of Africa – as a continent rather than as a country. Even as one region rebounds, infection numbers rocket upwards in another. Because of its size, India isn’t experiencing a single large wave, but a number of smaller waves that have joined together into a tsunami.

Which is why Sinha doesn’t trust the current lull. He believes that the virus will be back. In the interim, at least, he says his hospital now has enough masks and ventilators, and staff members are no longer as panicked as they were before. “Slowly, it is becoming clear that COVID-19 may not be as bad as we initially thought.”

It is a hope that many other health professionals in the country share, one that has become a ray of hope: India’s death rate seems to be relatively low. According to an antibody study conducted in August and into September, a third of the population of Delhi has already had the virus. That would be the equivalent of more than 6 million people, or 33 times as many cases as have been officially reported in the Delhi metropolitan area. In some of the slums in Mumbai, meanwhile, more than half of residents have allegedly contracted the infection. If that is true, certain neighborhoods could be approaching the numbers necessary for herd immunity.

Such findings show clearly just how quickly the virus has spread through the country, without officials even being aware of it. And in some respects, it is good news, because it shows that the disease isn’t as deadly as initially feared. One reason for that could be the country’s demographic structure: India’s median age is 28, while in Germany, it is almost 45.

In the eyes of the government, at least, the virus itself is no longer the most pressing problem facing the country. Despite rising infection rates, officials have begun loosening the measures imposed to slow the pandemic. Temples, mosques and churches have once again opened their doors, though social distancing rules are in effect. The Delhi subway is operating again, and for the first time in half a year, visitors may once again enter the Taj Mahal.

Evaporated Euphoria

Modi’s government, though, didn’t really have much of a choice. Even before the pandemic, the Indian economy was suffering. But in the 2nd quarter, it plunged by almost 25 percent, experiencing a deeper drop than any other G-20 member state. According to official estimates, 140 million people in the country lost their job, at least temporarily, though it was likely more than that. By the end of the year, India’s economy could have shrunk by 10 percent relative to 2019.

They are numbers of the kind the country hasn’t seen in decades. India has not experienced recession in 40 years, and only recently, it was the fastest growing large economy in the world. Within just a single decade, 271 million people were pulled out of extreme poverty.

The euphoria from those impressive achievements, though, has by now evaporated. Cities like the IT capital of Bangalore, whose population had doubled in the previous 20 years, are shrinking again, with those unable to afford high rents leaving for cheaper alternatives. Some shops have no light because their owners are unable to afford the electricity bill.

One might think that many Indians would have soured on their government. Instead, surveys show that Prime Minister Modi is extremely popular, with Indians generally satisfied with his management of the crisis.

“In retrospect, it is always easy to say that something was a mistake,” says Vinay Jain. “Modi had to take a difficult decision and the nation stood behind him.” Jain is sitting in his office with golden deities on the wall above his head. The 38-year-old came to Bangalore as a young man. He had an MBA and a deep interest in cars, and his uncle suggested he combine the two. Jain began producing seat covers that emulated race car interiors. He pulls a piece of faux leather off the shelf and runs his finger along the soft material. “India is a country of opportunity,” he says. “All you need is the right product for the right niche.” Since the lockdown, he says, fewer customers have been coming into his shop, but that, he continues, isn’t his biggest problem.

He leads the way into a space on the other side of the street that is filled with the clacking of sewing machines. The floor is covered with bits of material. Many of the workers are hardly older than 20, but Jain is focused more on the empty tables. Seven of his 32 employees didn’t return after the lockdown, he says, a problem that many companies are now facing.

Many migrants would like to return to their jobs, Jain says, but sometimes their families won’t let them for fear of a second lockdown. Plus, there still aren’t enough trains heading into the cities from rural areas.

Jain says patience is needed. The lockdown gave the country time to prepare for the outbreaks that were likely approaching, he says. “Now, individual responsibility is necessary. You can’t just lean on the government to do the job.”

“Just How People Are Here”

Outside the window, five men are huddled around a dented-up compact. All of them are wearing their masks around their chins, with mouth and nose uncovered. It was, perhaps, predictable that it would be difficult to get people to wear masks in a country where moped riders frequently carry their helmets in their hand when driving.

Jain smiles. “Most people only pull up their masks when they see a police officer. That’s just the mindset in India.”

His shop in on a side street just off JC Road in the city center, a maze of lanes and tight garages that make up Bangalore’s used car market. It is full of workers hammering and welding, most of them part of the shadow economy, a euphemism for that part of the economy where only cash is accepted and where deals are sealed with a handshake – and which employs a majority of Indian workers.

Expectations from the state are low here. At best, the state is something to be avoided, with many Indians learning early on that it is better not to depend on the government and rely instead on yourself and your family. Indeed, it is one reason why many observers believe the country might recover from the coronavirus more rapidly that widely assumed. People in India have grown used to being flexible. In Hindi, it is called “Jugaad,” or the ability to find a way out of any situation, no matter how hopeless it may seem.

The problem is that opportunity is unequally distributed. It is primarily affluent Indians who are in a position to secure an advantage from a crisis such as this one. By contrast, there are many people who could really use a helping hand from the state. Fully 200 million people now find themselves at risk of sinking into poverty or are already there. They are people like Palerimeethal Babu.

Babu was a teacher and spent 18 years teaching English literature at a private college in Kerala, a state in southern India. He earned the equivalent of around 350 euros per month. In March, though, his school closed its doors because of the pandemic and stopped paying its employees’ salaries. Classes have yet to resume. Babu had a family to support and a loan to pay off. He waited for three months, and then he had to look around for an alternative. All he could find was a construction job, and now Babu, who used to teach children Dickens, is hauling stones. For around 10 euros a day. It is tough work for the 55-year-old. “I have to stand under the hot sun or heavy rain. It doesn’t matter, I will do it. My mother taught me how to survive no matter what.”

He says he didn’t hesitate for a moment to accept the job. “Every work has its dignity,” he says in our phone conversation. He switches on the video function to show his home and introduce his family – one of his two sons and his wife. But the internet connection is too slow, as so often happens during the monsoon season when the rains pound against the window and transform the village into a sea of mud.

The Promise of a Hefty Salary

Babu’s village of Onchiyam is located in one of the best developed regions in the country where almost everyone can read and write. Babu grew up with six siblings and his father worked as a stone cutter. To help out with a bit of extra money, Babu got a job in the city as a 15-year-old serving tea. Only later did he study English literature, a rather unconventional choice for someone like himself who was yearning to climb the social ladder. Young Indians usually study engineering or computer science, both of which are highly respected in society and carry the promise of a hefty salary. But Babu had become addicted to reading.

“I have so many books in my house,” he says. “I love Shakespeare and Samuel Beckett, poetry just as much as plays.” For him, being a teacher is “an art, an inborn talent.” When his students learned what had happened to him, they started collecting money to help him out. “The government has done nothing to help us,” says Babu. “There are many people like me who have no jobs anymore.”

The cities these days are full of unemployed people. Many who used to work in an office everyday are now selling vegetables on the street. Families report having to skip meals to make ends meet and the number of beggars has spiked. Aid organizations, meanwhile, are warning that the government’s aid package – which is worth the equivalent of $260 billion and includes state loans for small businesses – won’t be enough.

According to the Centre for Monitoring Indian Economy, a think tank based in Mumbai, it is primarily younger workers who have lost their jobs. The good news is that many of them have found work since. But not in areas one might expect for an economy seeking to compete on the global stage. The only economic sector that grew in the first quarter is agriculture. Young men and women who had dreams of becoming engineers are now working the fields.