A chronicle of crises foretold: We must brace for likely covid waves

Over the last 10 weeks, as the second wave of covid engulfed India, I travelled across eight states, spending only a few days at home in Bangalore. I visited villages and towns across 29 districts, meeting local community members, healthcare workers in the public system and private hospitals, other frontline workers combating the pandemic and officials across the hierarchy—from panchayats to the state capital. Despite lockdowns, I travelled to these places and was allowed because we work there. My colleagues—from the Foundation and members of our partner civil society organizations—work on the ground with the state governments to help tackle the pandemic and its effects. Here follow some of my observations from these travels, validated by colleagues who live there.

First, the phrase ‘second wave’ is misleading. For Delhi, Mumbai, Pune and a few other places, this was the third or fourth wave. For Bangalore, Chennai and other cities, it was the second wave. But for vast swathes of the country, including large parts of rural India that were affected, this was the first wave. And there are large pockets within these areas, as also other large geographical tracts, that have remained unaffected so far. These areas have not experienced their first wave yet. An accurate country-wide understanding can only emerge from a comprehensive and quick serological survey. But the implication is simple: the country is sitting on ticking time-bombs of the next set of waves. Most public health experts have repeatedly and rightly reminded us that another set of waves is not inevitable—it depends on our actions. But what I saw on the ground gives me little confidence that we have done enough, or will do so, to avoid future waves aggregating into a massive country-level ‘third wave’.

Second, both mortality and caseloads are greatly under-reported. This matter is being widely discussed. In the places I have been to, deaths are indeed underreported (usually not deliberately), with actual mortality as much as 4-10 times the reported count. And I have not even travelled to states that are notorious for deliberate efforts at downplaying numbers. Expectedly, the most under-reporting is from the rural areas. The implication is that when the next set of waves happen, which are likely to be a lot more rural, the factor of underestimation will be at the higher end of the range. In all likelihood, this will mean a slower and an even more inadequate response than during the ‘second wave’.

Third, without doubt, the ‘second wave’ is receding. The numbers are coming down everywhere, including the remotest of rural areas. This is a result of lockdowns, and therefore the situation is untenable. One of the core problems in our approach to this pandemic has been that we have handled its prevention as a ‘law and order’ issue, and not as an exercise in community mobilization and education, as it should have been. So, there is little or no real behavioural change in the vast majority of the population, only forced curtailment. As lockdowns are eased, even if gradually, the pathways for the virus to spread will open up again, with people returning to their old patterns.

Fourth, hunger and economic deprivation have been devastating. For many, these come on top of personal tragedies of having lost loved ones. The headline numbers and economic indicators do not reflect these realities sufficiently because such a large share of our economy is informal. And the vulnerable who are the large majority—dependent on the informal economy—have been most hurt. Every community that I met has survived the past year of tumult by borrowing money, raising their indebtedness manifold. This heavy burden will be borne for years to come. The ‘second wave’ has also hampered the only lifeline that was available in rural areas, the Mahatma Gandhi National Rural Employment Guarantee Scheme. MNREGA has slowed down sharply, as states have put a hold on large public works projects to prevent them from becoming sites of infection. Moreover, people have been fearful of going out. And the scheme has not received extra funds from the Centre, unlike last year.

The situation in urban India is equally grim. All those outside the upper middle class and the salaried class of large private-sector organizations and public institutions are in various degrees of distress. One implication of this is that it is impossible to continue with harsh lockdowns—our only method of controlling the pandemic till now.

Fifth, the response of states has varied across the spectrum of effectiveness. It ranges from thoughtful planning and reasonably rigorous execution to what can only be called shocking incompetence and egregious neglect. But on one crucial dimension, all states are in the same place: too small a proportion of their population has been vaccinated, and that too, with glaring inequities.

I fear that we have not learnt our lessons—even from the near apocalypse of the ‘second wave’. We fail to recognize that the current respite—if we can call it that—is likely to be fleeting. We lack control over the pandemic, and we fail to see the looming crisis ahead. We have already used the Brahmastra (ultimate weapon) of lockdown, and, most of the country’s population still remains unvaccinated.

I hope my chronicle of crises foretold is wrong. I fear it might not be.

Anurag Behar is CEO of Azim Premji Foundation