It’s now likely that the pandemic has, as feared, moved out of urban areas into India’s vast, and crowded, rural hinterland. Here, health services will be far less equipped for a surge in cases — and a distant state machinery itself may not know of localised outbreaks till it is too late.
The government, faced with a crashing economy and with its cupboards completely bare, has no real way to directly improve the welfare of those most affected. Programs like Britain’s furlough scheme or the U.S.’s $600 per week unemployment aid are a distant dream in India. Even if the government had the money — which, thanks to its tax botch-up, it does not — it couldn’t be sure of getting it to the people in need.
So, as far as officials are concerned, the only way to get people back on their feet is to gradually lift pandemic-related restrictions. That is precisely what is happening: Restrictions are being removed without any consideration for the increasing caseload and with minimal information about possible infection clusters.
Strangely, there’s very little panic in India, either among policymakers or the public in general. Perhaps that’s because the case fatality rate, as far as the government can tell, is well below 2% and thus among the lowest in the world.
We don’t know why — are we missing cases, as the Lancet suggests? India is increasingly using buggy antigen tests, so that is certainly a possibility. It’s also possible that Covid-related deaths aren’t being recorded as such.
While there are no signs yet that the health system is overloaded, it may be getting there. Delhi’s most prestigious state-run hospital recently tried to shut down all outpatient work to focus on hospitalisations. In any case, climbing case rates will inevitably increase the stress on India’s inadequate health systems. So it’s entirely possible that the case fatality rate may also, tragically, increase.
Worryingly, the drumbeat for a big “stimulus” has begun. Pressure is growing on the finance ministry — which has so far been impressively careful — to start shelling out more cash to business. Some sectoral associations have even gone to the Supreme Court demanding the judges ensure they don’t have to pay interest on their loans.
The fact is, however, that a “second stimulus” — especially one directed at business — would be fiscally dangerous. It would also be wasted money, because neither consumer nor business sentiment is going to revive while case numbers are growing so fast. Everyone can see the curve and nobody knows how bad it may still get.
Meanwhile, as the Delhi hospital’s attempt to cut off routine health services indicates, the silent costs of the pandemic are building up. The immunisation program, for example, has essentially been halted, which means that a generation of children will be particularly vulnerable to communicable diseases such as measles.
Millions of kids who already receive an education that is not up to global standards cannot go to school. And, unlike in the West, only a quarter of students in India can access online classes. Given that this generation is the one that will have to take India’s last shot at prosperity, that’s especially bad news.
India won’t get a proper sense of the extent of these silent costs for some time, certainly not before next year. The finance ministry and the government more broadly should resist calls to spend money now that it does not have. It’s going to need that ammunition even more soon.
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