The side effects

The abrupt, unprecedented cessation of economic and public life to fight Covid-19 has been driven by necessity, but the Centre and state governments may need to urgently focus on the unintended side effects on public health and livelihoods too. The first— and the most obvious — is the need to revive existing medical infrastructure to enable the treatment of non-Covid-19 medical conditions, which may worsen because the health care system is focused on the pandemic. Most hospitals have closed their operating theatres since all elective surgeries have been postponed indefinitely, and outpatient departments are accepting mostly Covid-19 cases. Although these closures are driven by the crisis of the moment, postponed surgeries or other medical procedures could well have life-saving dimensions — for cancer patients, organ transplants that tend to be time-bound, or dialysis for diabetic patients. 

India has long been the world’s ground zero for diabetes and heart disease. If medical facilities remain closed to such patients indefinitely, the fatalities from these could shoot up and these ailments may well become the country’s biggest public health crisis going forward. Tuberculosis and HIV patients have also been casualties of the crisis. The case for a phased reopening of hospitals, therefore, is strong —albeit with more stringent precautionary norms since several key facilities in major cities have been quarantined owing to Covid-19 outbreaks among medical staff. The other dimension of the health problem concerns child nutrition. India’s record on juvenile malnutrition remains among the worst in the world; the cessation of the midday meal schemes by several state governments is likely to worsen this situation. Some states, such as West Bengal, Andhra Pradesh, Kerala and Madhya Pradesh and the Union Territory of Jammu & Kashmir, have found a way around the problem by distributing dry rations. It is unclear, however, whether the coverage of such modified schemes is as wide or, indeed, as effective as the earlier model of providing a cooked meal every day. 

The plight of rural India also demands immediate attention with the economic lockdown closing employment avenues. In sectors such as real estate, which was in dire straits before the Covid-19 pandemic, and in discretionary services such as retail, for which rural and semi-urban India produces the bulk of housekeeping and security services, the disruption is likely to be long lasting.  The impact is already evident in reports of dramatic reductions in remittances, not only from the Gulf, a global Covid-19 hotspot, but also from urban to rural India from the millions of migrant workers. As a result, rural demand, that was ailing because of falling farm incomes before the Covid-19 outbreak, has been dealt a double whammy and may not see a revival anytime soon. 

The knock-on effects of this rapid deceleration of demand on consumer companies and, therefore, employment, will compound the existing slowdown and can be potentially catastrophic. Expanding the food distribution system is likely to address the problem of starvation only partially, since the reach and efficacy of the ration shops in rural India is patchy. In other words, India faces the real threat of widespread destitution if the unintended side effects of the Covid-19 shutdown are left unmanaged. A partial lifting of the lockdown may address some of the issues but it is unclear how far and how quickly a country hit by anaemic growth ahead of the pandemic can recover unless governments remain proactive in the long run.   

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