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Devastating scenes show how Covid-19 is ravaging rural India
03:12 - Source: CNN
New Delhi CNN  — 

Millions of Indians are living under a mix of locally-imposed coronavirus restrictions, as the central government resists calls from leading medical experts for a nationwide lockdown.

The Indian Medical Association earlier this month said a “complete, well-planned, pre-announced national lockdown” for 10 to 15 days would give the country’s overstretched health system time to “recoup and replenish both the material and manpower” it needs.

And top US coronavirus advisor, Dr. Anthony Fauci on May 9 said of India: “You’ve got to shut down … you need to break the chain of transmission.”

However, Prime Minister Narendra Modi’s government has done that before, and learned a very painful lesson. Experts say shutting down the nation again is not realistic.

When the first wave of the virus hit India in March 2020, Modi announced a sweeping national lockdown hours before it went into effect, shutting state borders, suspending inter-state travel, halting businesses and requiring people to stay at home.

Indian Prime Minister Narendra Modi at a rally during the pandemic in West Bengal on April 10.

That lockdown, which ultimately lasted almost four months, helped India to control the spread of coronavirus, but it came at a high cost, leaving the country’s poorest and most vulnerable without income or food, and often stranded far from home.

This time around, Modi says a national lockdown would be a “last option.”

“We have to save the country from lockdown,” Modi said in an address to the nation on April 20. “We have to try hard to avoid lockdowns.”

Since then, the leaders of 35 of 36 of India’s states and union territories have imposed their own restrictions, including night curfews, partial closures and week-long lockdowns. These kind of short-term, localized measures are drastically different from the approach taken the last time India faced a coronavirus wave.

Some experts say this makes total sense, as it gives regional leaders the freedom to tailor restrictions to the size of the local outbreak, and the needs of their residents.

A one-size-fits-all lockdown for a country of 1.3 billion people doesn’t work, they argue.

India’s poor were hit hardest

Since the start of the pandemic, India has recorded more than 24 million cases, second only to the United States. More than 270,000 people have died.

According to a projection model from the Indian Institute of Science, at the current rate of spread, India’s case numbers could rise to 50 million by June 11, with 400,000 deaths.

The model says a national 15-day lockdown could save approximately 100,000 lives, and prevent some 20 million people from catching the virus. The longer the lockdown, the more case numbers are projected to fall, according to the model.

But a nationwide lockdown has its own health risks, particularly for India’s poor.

About 100 million Indians are migrant workers, mostly from rural areas who moved to cities for work. During the first lockdown, many were stranded without jobs or food, prompting a mass exodus from cities.

With the national railway system suspended and domestic borders closed, hundreds tried to make the journey home on foot over many weeks and thousands of miles. Many didn’t make it, dying from exhaustion, dehydration, hunger or roadside accidents

People walk through a deserted alley during a lockdown imposed by the government amid rising Covid-19 cases, in New Delhi on May 16, 2021.

“The experience of the past year has shown us that economic closures are most disruptive to the poorest sections of society,” said an April report from the Lancet’s Covid-19 Commission India Task Force. “In urban areas, daily wage earners, informal sector workers, and low-skill workers are the most likely to be impoverished from disruptions in economic activities.”

Ajnesh Prasad, a professor and Canada Research Chair in the School of Business at Royal Roads University, said only a “certain class of individuals” had the luxury to stay at home and maintain social distance.

“If we talk about the urban poor, it’s impossible for them to observe these directives,” Prasad said. “They will tell you that observing these directives would be tantamount to starving themselves to death.”

Population density complicates matters further – about 35% of India’s urban population lives in slums, where households lack sufficient living space and adequate sanitation facilities, according to the World Bank.

In densely populated slum areas an entire family often lives in one small room and shares a bathroom with other families. It’s impossible to distance from others – and unrealistic to expect movement without the risk of virus transmission.

The things that make a lockdown both feasible and effective – staying indoors, working and attending school remotely, social distancing – require access to a stable internet connection, and to resources like a laptop and electricity. These luxuries simply aren’t available to the vast majority of Indians, most of whom don’t even have access to doctors or oxygen as the second wave overwhelms major cities.

Millions thrown into poverty

India’s struggling economy also makes it much harder for the government to impose a second national lockdown.

The first lockdown sent much of the country spiraling into poverty – the number of people earning $2 a day or less in India is estimated to have risen by 75 million due to the Covid recession, according to the Pew Research Center.

“The lockdown came at a huge economic and social cost,” said Chandrika Bahadur, chair of the Lancet Covid-19 Commission India Task Force. “The suddenness of the announcement meant … the vast majority of the country was unprepared in terms of the implications on income, food, security of tenure, and safety. And in turn, both the central and state governments were unprepared for the migrant crisis.”

The economic disruption of the first lockdown has also left India’s government with “less policy room to maneuver,” Bahadur added.

Underprivileged people wait to receive free food in Kolkata, India, on August 27, 2020.

India has a weaker financial system than countries the United States or the United Kingdom, for instance. There’s less money and fewer systems to send it to those who need it most.

Some parts of the country did see ration kits distributed to the poor during the first lockdown, but that wasn’t enough to keep people at home. They still needed to earn a wage to feed their families.

“Without a government establishing a robust system of social support through public policy, which would appear in the form of social assistance programs like stipend or subsidies, a lockdown isn’t feasible,” said Prasad, from Royal Roads University.

A localized approach

In early April, as cases began surging in the capital, New Delhi, many migrant workers returned to their home villages even before any restrictions were imposed. Many were afraid that a surprise lockdown could leave them stranded once again.

India’s varied topography means its population density is concentrated in specific hubs – and while the virus can spread everywhere, its effects are felt more acutely in cities like Delhi, Mumbai and Bangalore. Each state also has a different level of resource availability, including health care capacity.

A nationwide lockdown would leave little space for state and local governments to respond to the pandemic in a way fitting to their local circumstances. Right now, some states have nightly curfews, restrictions on public transport and localized measures in certain districts

Indian police stand at a checkpoint after West Bengal announced a 15-day lockdown to curb the spread of coronavirus, in Kolkata on May 16, 2021.

In its April report, the Lancet’s Covid-19 Commission India Task Force recommended against a “blanket national or state lockdown.”

Instead, it backed measures such as closing venues for large gatherings and encouraging white-collar workers to operate from home – but urged the government to minimize restrictions for the rural and urban poor.

Bahadur said the Task Force is now calling for localized but synchronized closures based on two variables – the spread of the disease and medical preparedness.

Modi echoed those recommendations in his April address, asking state leaders to focus on “micro-containment zones” instead of full lockdowns.

States and union territories are now adopting this approach – for instance, Delhi has imposed several consecutive lockdowns for short periods of time such as seven or 10 days, with exceptions for many categories of essential workers – unlike the first lockdown last year.

“The basic point is that there are no simple yes or no answers to a very complicated set of questions,” Bahadur said.

“In a country with such diversity, localized decisions, driven by a common science and evidence based approach, with a strong coordinated response is our best bet for success.”