Dr Jas Simran Singh Kehal
‘Epidemiology is like a bikini; what is revealed is interesting; what is concealed is critical’. This statement by Peter Duesberg, a cancer epidemiologist, at the time of corona virus disease (COVID-19) pandemic carries significance if we take into account gender, social, economic and demographic inequities in India.
With about 500,000 confirmed cases worldwide and approximately 22000 deaths till date, in spite of the fact that it is still in stage II/III in most parts of the globe, COVID-19 seems to be catching up with Spanish flu which struck exactly a century ago and is estimated to have infected 500 million people (one fourth of the world’s population at that time) with estimated deaths around 50 million. India is foreseeing a minimum of one million confirmed cases and 30,000 deaths by this May end.
Regardless of the etiology of corona virus, its transmission and propagation is purely class based. The so called elite, higher and upper middle class of the globe, are the real culprits of escalating COVID-19 from an epidemic to a pandemic. Leisure trips of the super rich and international freebies bestowed on the middle class at achieving professional targets has catapulted the virus to all corners of the globe. It is this affluent class which by its negligent global hip-hopping and ignorant attitude that has brought the world to the brink of demographic and economic collapse.
Prevention and diagnosis have been limited to public and nations who can afford it. Till mid-March, as compared to European countries like Iceland, Norway, Italy etc. who performed around 2000 COVID-19 tests per million, India could manage only 7 tests per million people. It is anybody’s guess that who would have been these seven privileged people out of one million. India’s current testing rates of 5000 tests/week are far behind countries like Italy and South Korea at 52000 and 26000 tests per week.
This disease seems to easily transgress the class and caste barrier in terms of its spread from rich to poor, urban to rural and upper to lower strata of society via contact to community spread in Phase II & III. Subsequently, its treatment and management in India is expected to be along rigid social, economic, religious, class, regional, political, caste lines especially when the disease reaches deadly phase IV.
As per National Health Profile 2019 data our country has a meager facility of 0.55 beds per 1000 population. With healthcare expenditure hovering around 1% of its GDP, India has only 40,000 ventilators for a 1.3bn population against expected requirement of 200,000 ventilators when corona epidemic reaches its peak. Punjab, as stated by its CM this week, has only 28 ventilators in public setup to cope with the crisis. Who would be left out of the treatment at that crucial stage? Obviously, only the affluent and elite will be the beneficiaries and the rest will be left at their own mercy.
Now, who will be the people who would be systematically excluded from medical care and which part of the civilization is liable to disappear from earth because of this pandemic? These would be those who had not played even a minor role in transmitting or propagating COVID-19. Socially, economically & sexually disadvantaged groups would be left impuissant. Caste and class bias is bound to hamper uniform distribution of the scant health resources.
Tedros Adhanom, Director General of WHO, stated that “The greatest enemy we feel is not the corona virus itself. It’s the stigma that turns us against each other.” In the times of Spanish flu, people starved to death as no one would deliver them food as people lost trust in each other. Intimacy got destroyed and society began fraying. The situation in today’s volatile times, further exacerbated by India’s ‘graded inequality’ as termed by Dr Ambedkar, is bound to be far worse than one can anticipate. Already reeling under social stigma since centuries, lower castes are bound to be left out of the cover of health facilities as a state policy and would have no choice except for turning to miracle cures.
The government being a mute spectator to claims of miracle cures like cow urine in spite of relevant laws to curb such malpractices and misinformation in place and befooling the public with taali, thaali and ghanti as well as plans to re-telecast Mahabharata & Ramayana in lockdown period smacks of a conspiracy to keep these castes and classes indolent while it therapeutically serves a selective few.
Territorial segregation has already commenced and percolated from the state to village level across India. States have closed their boundaries to outsiders and regional discrimination is evident from instances of racial slurs on people from north east. The concept of “Cordon Sanitaire” or medical isolation which was to be implemented from a curative aspect is mischievously being reintroduced as social isolation on basis of caste and class. As the disease spreads from the privileged to downtrodden, social exclusion will be perpetuated primarily due to inaccessible medicare and secondarily, by deep-rooted social and caste biases.
The economic impact of corona virus is such that IMF has proposed to deploy all of its $1 trillion lending capacity. As compared to the United States grant of $2 trillion stimulus, which will ensure direct benefits to its citizens in the form of direct payments, India with a $2.7 trillion total GDP figure is expected to be selective and choosy in its approach. As COVID-19 travels from richer to poorer nations as well as people, the latter, not able to cope with its virulence, penurious by pocket and ostracized by society on the basis of caste, would be made to suffer till death.
Besides the physical and economic impact of the virus on the lower castes, the psychological impact due to insecure income, inaccessible healthcare and differential treatment by the state will have catastrophic effects on their mental health.
Corona virus disease is being disseminated worldwide by the wealthy but the indigent are going to bear the brunt by risking not only their existence but also leaving a permanent void between castes and classes even if they survive. Unless the critical facts are revealed and we become aware beforehand of the impending natural disaster and the intentional state policy to eliminate us, there seems to be no way out of this pandemic.
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Dr Jas Simran Singh Kehal, MS (ORTHO), is an Orthopaedics Surgeon. He also has a Masters degree in Journalism and Mass Communication from Punjabi University, Patiala. He can be contacted at Kehal Trauma Centre, Nangal Dam, Punjab.
