Life or livelihood? This is the question we debated during the first India-wide lockdown or Lockdown-1. The answer was obvious: life came before livelihood. The nation supported Prime Minister Narendra Modi.
The question has changed now with an extension of the nation-wide lockdown till 3 May or Lockdown-2. While the guidelines issued by the government provide for graded relaxation, there is still no sign or even promise of any expansion in social security for those affected by the lockdown. Now, the debate is about lives versus lives. Or rather, the balance is between visible loss of some lives versus the invisible loss of many more lives. Now the balance of argument has tilted decisively against continued lockdown.
I am not saying that Lockdown-1 was a bad idea. I had argued that given the range of expert knowledge and choices available three weeks ago, we cannot fault PM Narendra Modi for taking the call. It was badly executed, though: poor communication, absence of planning and high-handed implementation of the original decision had reduced it to a one-dimensional draconian response. The continuation of public health emergency does require pro-active and tough measures. But Lockdown-2 is clearly a medicine worse than the disease itself.
A quick summing up of both sides of the balance sheet reveals why benefits of the kind of lockdown extension PM Modi has announced clearly outweigh the costs.
Benefits of lockdown
On the positive side, we now know that the lockdown has helped us to reduce, at least for some time, the rate of spread of the coronavirus in India. In the three weeks between 24 March and 14 April, the total number of cases went up from 536 to 10,815.
If we compare it with where other countries had reached three weeks from the day they crossed 500 cases, it is clear that India has done better than others: in this comparable period (three weeks from the day a country crossed 500 identified cases), the number of cases crossed 38,000 in the UK, 41,000 in Italy, 50,000 in Germany, 73,000 in Spain and over 1 lakh in France and the US . We can compare the numbers of deaths, which are not likely to be massively under-reported. We have had around 350 deaths during these three weeks, compared to over 2,400 in the three weeks after the US crossed 500 cases.
It is fair to conclude that the lockdown has helped, even if our numbers for positive cases seem to be under-reported due to severe under-testing.
It is hard to say just how many lives may have been saved because this success is temporary. We are nowhere close to flattening the curve, nor are we likely to be there at the end of Lockdown-2. We have only succeeded in delaying the almost inevitable spread of the virus through much of our population. This delay is useful, for a sudden exponential growth could have resulted in a run on our fragile public health infrastructure. We can also assume that the psychological impact of the lockdown, the nation-wide awareness of “social distancing”, would help us reduce the total number of cases as well.
Based on this preliminary information, let us hazard a guess. Let us assume that India would have touched about a million cases (the number expected in the US) by the end of May. Let us assume that we maintain the current rate and contain the numbers to under 50,000 by the end of Lockdown-2 and under 2 lakh by the end of May this year. Since we may not have eliminated the virus, let us allow for another 2 lakh cases over the rest of the year. So, on this generous reading, if we are able to limit the total number of cases to 4 lakh instead of 10 lakh, we may have prevented 6 lakh new cases. Calculating at 4 per cent fatality among positive identified cases, this would mean 24,000 lives saved (16,000 deaths instead of 40,000 if we had 10 lakh cases). Say 50,000, if you wish to be very safe with this wild guess. That looks like very good news.
Cost of Lockdown
Let us now turn to the costs of the kind of lockdown imposed and now extended by the Modi government. The most visible faces of this lockdown without any notice or compensation are the 6.3 lakh migrant workers living in relief camps in or around the metropolitan centres. That number would go up if you include the lakhs of workers stranded at construction sites or too far away from any urban centre to be visible. Add to it the workers who are stranded in their own rented accommodation without income or food, unable to go back home. And then think of those who are very much inside their homes, but without income and possibly food. Nearly 12 crore persons had lost their livelihood in the first two weeks of Lockdown-1. On a conservative reading, this would affect one-third of the 25 crore households in India.
Turning to the less visible crisis in rural areas, there is a small proportion of poor who do not have a ration card for no fault of theirs: the official cap on the number of ration cards has not been revised for 10 years, new names have not been added, wrong deletions have taken place or it’s a nomadic or migratory family. Many reports suggest that lockdown has pushed many of these families to the verge of starvation. There have been many reports of looting of food trucks, situations resembling a food riot, besides migrants’ protest in Bandra and Surat. Not to put too fine a point on it, years of gains of people moving out of poverty could be wiped out in a few weeks. The longer the lockdown, the larger this number.
It is not just livelihood. It is about lives. Put any number on the households that would have suddenly sunk into poverty and would be forced to spend less on nutrition and medical care. Let us be most conservative and put this figure at 1 crore households — comprising 5 crore persons. If this economic shock leads to additional mortality of 0.1 per cent, that would be 50,000 deaths, as much as the most generous estimate of lives saved due to lockdown.
Health experts call these ‘preventable’ deaths, which take place just because the family could not access or afford quality health care. Every year about 24 lakh deaths in India could be attributed to this. Even a 1 per cent increase in the proportion of those who cannot now afford quality healthcare due to effects of lockdown would mean additional 24,000 deaths; 2 per cent increase will push the figure to 48,000.
Look at this differently. According to the latest estimate of ‘Burden of Disease’ in India, every year we have 73,000 deaths directly due to malnutrition. Then there are the number of diseases closely related to poverty: Diarrhoea (believe it or not, 5.2 lakh deaths per year), tuberculosis (3.75 lakh), infant mortality (4.45 lakh), malaria (1.85 lakh). A sudden push to poverty is bound to accentuate malnutrition. Assuming that it leads to an increase in malnutrition deaths by 10 per cent and other directly poverty-related deaths by as little as 1 per cent, over the next two years, we are looking at 50,000 additional deaths induced by lockdown.
No matter which way you look at it, the lockdown might end up costing us as many, if not more, lives as it might save. The lives saved might be more visible, better off and elderly. The lives lost are bound to be poorer, younger and invisible. Once you add the impact on livelihoods, economy and society to this balance sheet, this kind of lockdown is increasingly indefensible.
A disaster waiting
The guidelines for Lockdown-2 provide for graded relaxation for some categories of economic activity. Opening of construction work and MNREGA after 20 April are welcome steps, as is the relaxation for all farming operations. But all this can come to a naught unless backed by a series of emergency relief measures.
The Modi government must immediately address the food crisis by universalising the Public Distribution Scheme and use the school Mid Day Meal infrastructure to arrange cooked food for the most needy families. The stranded migrant labourers must be provided special point-to-point trains or given food and cash to survive. This must be followed by MSP guarantee or compensation for the farmers, reverse GST for small business, waiver of interest on loans under moratorium and a grand nation-wide employment mission. Otherwise, we are looking at one of the biggest man-made disasters in our history.
The author is the national president of Swaraj India. Views are personal.