Home >Opinion >Columns >Opinion | We need mass mobilization so that 2020 won’t be 1918 redux
Vulnerable groups with co-morbidities must be under proactive observation
Vulnerable groups with co-morbidities must be under proactive observation

Opinion | We need mass mobilization so that 2020 won’t be 1918 redux

Let’s mobilize communities on the scale of the 1942 Quit India Movement to fight the covid pandemic

Year 2020 will be 1918 redux for India. This cold dread grows in me each day that I spend on the frontline, observing how we are tackling the covid-19 pandemic across the country. Tearing through the world from 1918 to 1920 in waves, the Spanish Flu hit India the hardest. Killing 12-18 million, about 4-7% of the country’s population. The 1921 decadal census recorded a decline in population, the only such instance in the history of modern India. 1918 also had the worst economy in 120 years. It shrank by 10.5% and had high inflation, amplifying the misery caused by the pandemic.

The frontline of the battle with covid-19 is not in intensive care units and tertiary care hospitals. Those are sites for compassionate and heroic rear-guard actions to save the lives of those who are seriously wounded by the virus. The frontline is in our communities. From swank high-rises to slums, and from sparsely populated mountains, deserts and jungles to teeming villages on the country’s river plains. It is only there that the spread of the virus can be contained, minimized and tackled.

All feasible precautionary measures must be taken, enabled by continuous community engagement. Physical distancing, wearing masks, not having large gatherings, meeting only in the open, and more. All, accounting for the realities of local geography, our social fabric and life rhythms, including the economic activities that must continue. Labourers breaking stones in the afternoon cannot wear masks. Many don’t have water to wash hands. Panchayats must be conducted. And physical distancing in urban slums is impossible. These illustrate the constraints, some of which will be truly limiting, while some could be addressed through extra resources or support.

Despite all precautions, the virus will spread and infect people. The infected must be identified soonest and put in isolation. Their contacts must be traced rapidly and quarantined till they test negative. Vulnerable groups with co-morbidities must be under proactive observation. Robust ground level surveillance and monitoring systems supported by relevant infrastructure, including testing capacity, are required. Quarantine and isolation facilities are needed. These could be home based, community based, or institutional, but must have adequate capacity and be of good quality. Sufficient number of trained healthcare workers must be deployed to make all this happen.

That is the frontline in the battle against the pandemic. We are failing on this frontline across vast swathes of the country. In a few parts, it is working patchily. This I say from what I or my colleagues have seen, not from hearsay.

People are fleeing from poor-quality quarantine and isolation facilities, avoiding them by any means, including literally running away from monitoring visits by frontline healthcare workers, the ASHAs (Accredited Social Health Activists). Inadequate testing capacities often force samples to be sent 200-300km away, with the earliest results reported in 3-4 days because of backlogs. Given these limitations, surveillance protocols that use widespread testing cannot be even imagined. ASHAs are paid about 4,000 a month. Polio vaccination, enabling institutional childbirth, and the like, was their role; they didn’t sign up to be on the front-line of a battle with a deadly pandemic, nor are they prepared for it. Officials are struggling for resources and effective clinical protocols. We could go on and on. But the starkest marker of our failure is the conflagration of infections that has raced through the country.

Over the past 10 weeks, I have met hundreds of people working on the frontline. From district collectors, tehsildars, and health officers, to ANMs (auxiliary nurse midwives) and ASHAs. Almost everyone is trying their best. It is not for want of their trying that we are where we are. To them we can only express our gratitude.

We are where we are because of decades of underinvestment in our public health system. Exacerbated by our “command and control" culture of governance, which has hollowed out our grassroots institutions, disempowered the frontline, and diminished the value of expertise. Even this crisis has been treated as a “law and order’"problem, with communities and individuals seen as objects to be tamed. Poor situational leadership and flawed decision-making have also marred the past few months, like the misguided advisories on testing, which were quietly reversed last week.

History will take care of apportioning blame; this is not the time for that. If the inferno of infections wakes us up from our torpor and we act, perhaps there wont be much blame to be apportioned.

I don’t know what all exactly must be done. Experts would tell us that. But there is one thing that I know. Our administration and health system must mobilize our communities, with the help of civil society organizations, to play roles as equal partners in the efforts to tackle the covid-19 pandemic. Instead of treating them as the problem.

The scale of such a mobilization must be like the 1942 Quit India movement. No other parallel comes to mind, in the face of the crisis we confront. We have only a few weeks or perhaps months to do this, so that 2020 does not turn out to be 1918 redux.

Anurag Behar is CEO of Azim Premji Foundation and also leads sustainability initiatives for Wipro Ltd.

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