“He feels uneasy but does not realize the gravity of the situation. Within a short while, he grasps what is at stake and warns the authorities that unless steps are taken immediately, the epidemic could kill off half the town’s population of two hundred thousand within a couple of months.” (‘The Plague’, 1948).
From ancient times till now there were several infectious diseases, epidemics, and pandemic, affected humankind all over the world. Around 5000 years ago, the prehistoric epidemic: Circa 3000 B.C. has found in the village of China. The spread of that disease was rapid, and there was no option for the cremation process of the bodies. The Athenian Plague of 430 B.C. wiped out the people of Athens and endured for five years. The Antonine Plague occurred between A.D. 165 to A.D.180 and killed around 5 people during the Roman empire. Around half of Europe’s population was affected by the Black death of 1346 to 1353. The main source of a place was in Asia, and it traveled in Europe. The Cocoliztli epidemics of 1545 to 1548 occurred in Mexico and Central America.
This disease killed around 15 million inhabitants of these places. American Plague of 16th century, Great Plague of London in mid 17th century, Great Plague of Marseille in the first stage of 18th century, Russian Plague of 1770 to 1772, Philadelphia yellow fever epidemic of the last phase of 18th century were the period of Plagues. During the time of the modern industrial age, Flu Pandemic killed around 1 million people. The spread of Spanish flu considered the deadliest pandemic of history. The spread of this pandemic was very vast that it infected approximately 5 billion people worldwide from the northern hemisphere to the southern hemisphere. In India, alone, the death toll was around 12 to 17 million people. The main source of Asian Flue was in china and killed above 10 lakh people between the years of 1957 to 1958. The source of the Human Immunodeficiency Virus (HIV) was in the Chimpanzee virus, found mainly in West Africa for the first time in the year of 1920. HIV causes AIDS diseases worldwide, particularly in Africa, and affects nearly about 40 million people.
From 2009 to now, a total of 5 including the COVID-19 epidemic has been identified one after another. The origin of the H1N1 Swine Flu pandemic from 2009 to 2010 was in Mexico. It infected a large number of lives worldwide, i.e. over 1 billion. The emergence of the West African Ebola epidemic killed more than 11,000 populations and infected above 25,000 populations in between the 2014-2016 year. The Zika virus epidemic in 2015 was originated mainly from mosquitoes. The main affected areas were Southern America, Central America, and the Southern province of the United States.
After that, the recent Nipah virus outbreak in 2018 reported from Kozhikode district of Kerala in southern India and the first confirmed case of COVID in Kerala, which killed around 17 persons and more than 9,500 people (numbers are likely to increase in future) In India, respectively. One possible assumption of the southern region being the source of transmission of such diseases could be a tourist hotspot, immigration-emigration to Middle East countries, and other parts of the world. With the advent of globalization and neoliberal policies, there has been an immense pressure of regular trade and commerce in the southern coastal regions.
The first case of COVID -19 was reported from Thrissur district of Kerala on January 30, 2020. Now the world wide confirmed cases of this novel virus are 7.69 million people followed by more than 4 lakh death toll (numbers are likely to increase in future). No prediction is there, that how far the pandemic will go, and how many will be infected? Still, the spread is very fast with no break, and efforts to develop a vaccine are ongoing worldwide.
The spread of Coronavirus across the Globe
According to history, the source of all of the above diseases is mainly found in Asia, Europe, Africa, or America (South and Central America). The source of one disease is in one country, but through migration of people, it transferred one human infected to another country or province. The human transmission was repeated again during COVID-19 pandemic, which has been ravaging the humankind in all over the world in recent times. In the year 2003, the outbreak of SARS in China has some similar characteristics with Coronavirus diseases. For that, the official name of the Coronavirus is SARS-COV-2 given by the International Committee on Taxonomy of Viruses (ICTV).
The emergence of this disease was first observed in Wuhan province of China in late December i.e.31st December of 2019. On January 13, 2020, Thailand recorded the official COVID-19 case, which was the first country affected by this disease after China. Between January 27 to February 2 the outbreak of this disease spread in other countries and the confirmed cases were reported in India, Philippines, Russia, Sweden UK, Spain, UAE, Canada, Australia, Germany, Japan. U.S., Vietnam, and Singapore. On 14th February Egypt record the first case of COVID -19 in the continent of Africa. Then it spreads one by one of all the countries. Iran reported the first death on February 19 and South Korea on February 20 respectively.
Between February 24 to March 1 the confirmed cases again started to increase and spread in other countries of Brazil, Pakistan, Kuwait, Norway, Qatar, Greece, Romania, Denmark, Netherlands, Northern Ireland, Bahrain, Afghanistan, etc. On March 11 WHO declared Coronavirus a Pandemic. On March 21 the epicenter of Coronavirus shifted to Europe. The recorded case of Coronavirus affected people in the USA has crossed China in late March. On April 28, the USA surpassed 1 million total cases of COVID -19. The total confirmed case of the USA is around 2.14 million people so far (numbers are likely to increase in the future). The death toll started to increases in Europe also with the top two countries of Russia and the U.K. in terms of total corona confirmed cases and total death respectively.
According to UNO prediction this year the world economy will decline to 3.2 percent, which is in the worst condition since 1930 depression in the past time leading to poverty and other critical condition all over the world, affecting Africa severely.
COVID-19 in India: Effects and Challenges
In India, the first, second, and third cases of Coronavirus has reported in the state of Kerala on January 30, February 2, and February 3, 2020, respectively. The travel history of all the affected persons was from Wuhan, China and all of them were students. In the rest of February month, there were no new cases has reported.
The first week of the 2nd March total case was six, and only after two days it sharply increased and reached a total of twenty-nine cases. On March 12, 76-year-old person in Kalaburgi, Karnataka returned from Saudi Arabia reported first death. After that, the virus spread all over India one by one from Punjab to Delhi, Maharashtra, Gujarat, Tamilnadu, Karnataka, Uttar Pradesh, West Bengal, Orissa and so on.
In late March it increased and surpassed 1000 cases on infected people, and the increasing process is ongoing up to date. In late April, it was 34,863, and in May 3rd week it was above 95,000. On June 15 the total confirmed case is around 3 lakh 32 thousand with 9,520 death toll (numbers are likely to increase in future). The hotspot of the COVID-19 case in India are Maharashtra, Tamilnadu, Delhi, Gujarat, Uttar Pradesh, and Rajasthan respectively (position are likely to change in future). Among all the states, the state of Kerala performed well in all terms from early preparedness to providing testing kit to doctors, screening, tracing, community awareness, etc. That is why the recovery rate is maximum in Kerala among all the states in India.
Health Care System in the World and India
There are the top five countries in the world in terms of health care access and quality index of 2016. The high score countries are Iceland with 97.1, Norway with 96.6, Netherlands 96.1, Luxembourg 96, Finland and Australia each with 95.9 scores; while India scored only 41 and ranked 145 out of all 195 countries in the world. The other Asian countries of China, Bangladesh, Srilanka, Bhutan, are in a better position than India as reported by The Lancet. USA, U.K., Italy, France, Germany are those countries that are economically developed and spend a good amount of GDP in the health care system. The developed countries have nearly failed to battle against COVID-19 with they improve the health system, causing uncountable deaths, and leaving a puzzling situation for the rest of the third world countries.
Challenges faced by Health Workers in India
The Doctor-patient ratio of India is 1: 1445, which is lower than the norms prescribed by WHO, i.e. 1:1000. In terms of overall health care facilities, the condition of India is not satisfactory. Other than the doctor-patient ratio, lack of availability of nurses and medical staff has also shown a critical in this pandemic situation. The availability of PPE kits, testing kits, ventilation, isolation ward, number of COVID testing labs is a shortage in almost every state in India. The global average of GDP is nearly six percentages, where India spends only 1.3 percentage of GDP on public health care.
A report was given by NITI Ayog shown that Kerala rank first in all the index of health sector among all the states in India. Kerala spends around 3 percent to 5 percent of GDP for the public health sector, especially on the Primary health care system. There are a total of six states having more doctor-patient ratio than the WHO norms. These states are Delhi, Karnataka. Kerala, Tamilnadu, Punjab, and Goa, reported by TOI.
Doctors and medical staff are not only facing infrastructural shortages during treatment time but also fighting with social myths and evils. It has been reported in many localities, how civil workers and health staffs have been harassed and attacked by neighbors and landlords as they direct contact of COVID patients. Infection among doctors, nurses, medical staff, workers, technicians, ambulance drivers, are rising due to lack of PPE kits, ineffective rotational duties, and work overload.
The Plight of Migrant Workers
“India is two countries in one: an India of Light and an India of Darkness.” (The White Tiger, Aravind Adiga, 2008).
Leaving the mere decisive effect of COVID-19 on the environment and boosting individual social action towards the impoverished, the article would be focusing on the catastrophic side, also supported by the International Labour Organization (ILO) that has tagged this pandemic as the “worst global crisis since world war II.” Globally, around 200 million people are working in the informal sector, mostly in developing countries. Accordingly, these casual sector laborers were left in a destitute state who fundamentally contributes to constructing roads, dams, and other essential maintenance to develop a region. This auxiliary assistance provided by them to the large business houses, local and regional authorities faced severe hardships and crises during the COVID-19 in the country.
The incompetent bureaucracy failed labor laws, and governmental policies made them prone to a vulnerability that caused death out of hunger and starvation and not specifically due to COVID. Moreover, in several countries, one specific challenge was to battle COVID and focus on enhancing their health arrangements, but India was overburdened by poverty, lack of health structure, dire economic condition, and socio-economic hindrances.
This triggered the sense of insecurity among the migrant workers during the lockdown with unfulfilled basic needs compelling them to go back to their native places. One major drawback was the failure of the government to provide proper transport facilities that urged them to walk fearlessly, 100 miles on the road, railway tracks and highways. Without proper testing and screening, it has increased the number of confirmed and unconfirmed cases across the country.
The idea behind the Shramik express was to support the destitute migrants and stuck students, which was disorderedly implemented. The sudden and unplanned decision of the government resulted in affecting many lives, families, and communities all around.
Between a short span from May 9 to May 27, around eighty migrant laborers have died due to a ceaseless journey with the half-filled stomach, de-hydration, and despair state of consciousness, as reported by Railway Protection Force in Shramik express operational trains. Nearly one hundred and seventy migrants have died due to uncertain railway administration’s negligence, overloaded passengers in trucks, and road accidents.
The most dreadful was the death of sixteen people resting on the railway tracks run over by a goods train in the Aurangabad region of Madhya Pradesh. Several have been mistreated, abused, and lathi-charged by the police administration that created an unrest situation in many states and districts. This critical situation might have been handled with empathy and rapport between multiple groups of people.
The other tragic incident reported by NDTV that killed twenty passengers packed in a tempo en-routing Mumbai to Lucknow. Another road accident reported by The Hindu on May 16 that lost twenty-five workers’ lives when a trailer truck overloaded by people collided with DCM vehicle near Auraiya in Uttar Pradesh.
The most hysterical event was when a toddler tried to wake up her dead mother in Muzaffarpur, in the states of Bihar retrieved numerous sympathetic tweets on social media. This imposes a serious question of accountability and responsibility on both the central and state government rather than a meager announcement of compensation.
The only organized pattern of proper communication, trust-building to provide food and housing, and actually following the physical distancing norms to fight COVID-19 was a praise-worthy attempt of the Kerala government.
Prospects and Success Stories: Highlighting Effective Models
The notion – ‘Prevention is better than cure’ is suitably followed by the Kerala government.
Emphasizing the flattened curve in battling the virus, Kerala has projected an example of speedy recovery and tested plasma therapy as a trial. The early preparedness, testing, and isolation, contact tracing, quarantining the people, community support, were some of the straightforward and simple strides to win over this infectious disease revolutionized a ‘Kerala Model’ that brought them international acclamation. This was later adopted by the state of Madhya Pradesh as reported by The Economic Times. The state already had a previously planned strategic action, policies, and measures to cope up with the Nipah virus outbreak that helps to fight against Coronavirus in recent times.
• The Kerala government addressed the doctors and medical staff to be cautious and prepared for the challenges of COVID-19. Additional DMO of Ernakulam district Dr. S Sreedevi told PTI, “Persons having travel history from China and coming back to India after January 15 will be screened by the surveillance team in each District.”
• A You Tube video session organized by British Asian Trust in conversation with Health Minister of Kerala, Dr. K.K.Shailaja, and British MP. Lord Gadhia along with Shashi Tharoor expressed their views and opinions on the pressing need of separate isolation ward in hospitals. A quarantine guideline of twenty-eight days was advised to strictly follow instead of fourteen days recommended by the World Health Organization.
• At the beginning on January 24, they opened the control room formed 18 expert groups, organize meetings constitute a special team, and prepared guidelines followed by each district’s administration for fighting with corona.
• After 2016 the new government on power modified the initial policy, having single doctors in a health center was increased up to three, converting it into people-friendly hospitals. This empowered the marginalized to afford better health facilities which cost them zero or free services.
• The previous governmental policies focused on poverty alleviation programs, free health check-ups, low infant mortality rates, and a people-centric approach to accelerating the overall socio-economic growth. Decentralization and immense power given to the local and regional bodies have boosted their motivation and satisfaction for social development.
• The essential medical equipment and PPE kits to health workers, appointed psychologists, and psychiatrists to lower depression and distressing state of mind for quarantined people. Much attention was given on sample tracing, sufficient testing kits, and ventilators, timely availability of ambulance.
• Media and Journalism did play a crucial role in forwarding authenticated and informative guidelines through social media and regional channels. They considered control on fake news and draw awareness among the masses and people reciprocated as a civilized citizen following the prescribed guidelines.
• The free flow of communication and efficient local administrative staff and field workers responded to the problems of the people through an emergency toll-free number. Hence, a positive recovery rate is regularly recorded and reported by many authentic sources.
Soni Mishra in one of her articles in The Week shared another success story of Bhilwara district of Rajasthan state, on early tackling of COVID. Decentralization where ground-level staffs connected to the local people helped in having a favorable impact. The doctors and other staff of a private hospital were found positive on March 19, which demanded an immediate probe of rigorous investigation. These doctors and people were isolated, shifted, and the district was immediately sealed after cases reported. A similar stringent pattern of sealing tracing, reporting, testing, proper quarantining, and post-observation of asymptomatic people have been found as a successful strategic action.
The North-eastern states previously with zero or none cases of COVID affected people was mainly due to proactive action and lockdown measures effectively followed by these regions. Sikkim reported sixty-eight cases, Arunachal Pradesh, Meghalaya, Manipur, Nagaland, and Mizoram, with approximately a hundred or more than a hundred confirmed cases but death toll to zero except in Meghalaya reported only one death. The changed in the scenario was witnessed after the unprecedented migration of people from cities to their native places. The worst among these are Assam and Tripura. The confirmed cases in Assam are four thousand with eight deaths, reported and in Tripura, it is more than one thousand and one death respectively.
An elementary suggestion of promoting a proposal of ‘smart city’ in 2015, launched by the Government of India needs to rethink about the ‘smart village,’ which will discontinue the problem of population explosion in the metropolitan cities and stimulate Gandhian dream of self- sustaining or self-reliant villages across India.
Though the government has lifted the lockdown from June 1, it has bought extensive pressure on individual self-reflection and social responsibility as a global citizen. In order to sustain the economic condition of the country, the government might have to face an increasing number of cases in the near future, as physical distancing norms and health consciousness is found limited among the general public. The upper-middle-class in fast-moving cities seems satisfied to get back to their normal state, but the other side of the coin reflects how sensible and cautious the humans are in dealing with the ongoing pandemic. The significant aspect of focusing on the solution comes from childhood learning- ‘Health is Wealth’. The people should develop a habit of eating organic/nutritious food intake, boosting their immune system, avoid unnecessary outing, wear a mask, and maintain personal hygiene.
India needs to increase its GDP spending in the health sector. The central and state government should make obligatory arrangements for restructuring the health infrastructure and public health care administration. This pandemic should be treated as a dreadful lesson so as to let the world prepare for potential threats and epidemics.
The views and opinions expressed in this opinion article are those of the author(s) and do not necessarily reflect the official policy or position of The Eastern Herald.