Pandemic unmasked the real disease: governance failure
On 24 March 2020, the Narendra Modi government in India imposed the first lockdown with just four hours of warning. WHO praised this ‘timely and tough action’ to stop Covid, and the University of Oxford at the time called it the strictest lockdown in the world. With China’s zero-Covid policy that is probably not true anymore.
Still, India’s sudden lockdown unleashed the greatest movement of people in the Subcontinent after the 1947 Partition, which had a cascading effect on Nepal.
‘For a country with zero social security, which did not even have an authentic count of the number of people left without an income due to the lockdown, and where fractiousness and social fault lines make the poor and the backward easy preys of the systematic corruption, a measure like this would need weeks of planning. Even then it could still go wrong. So the repercussions of such a move without any preparation were unimaginable.’
In her book Billions Under LockdownIndian journalist Abantika Ghosh chronicles the impact of lockdowns on her country. In a smaller scale, the upheavals caused by the lockdowns impacted Nepali migrant workers in India and Indians in Nepal who had to undertake arduous treks home.
In her book, Ghosh tells the story of 38-year-old Ranveer trying to make the 400km journey on foot from Delhi to his village in Madhya Pradesh. He died along the way, 100m short of reaching his destination. Nepali migrant workers, prevented from entering their own country at the border, swam across the Mahakali River in Darchula. Some drowned.
Once quarantined, often without proper testing and contact tracing, Covid refugees were housed in crowded shelters which themselves became super-spreaders for the virus. The outbreak snowballed as migrants took the virus home to families, leading to community transmission.
As hospitals were overwhelmed with cases, several treatment therapies were introduced. From a combination of HIV drugs and convalescent plasma therapy to malaria drug hydroxychloroquine, a typhoid antibiotic Azithromycin and Remdesivir, all of which were later proven to be ineffective, and sometimes even harmful. What saved lives was the timely supply of oxygen, and the cheap steroid Dexamethasone.
Ghosh writes about India: ‘The biggest lesson of all was how politics became the most insurmountable impediment in the control of the disease.’ Ditto for Nepal.
The pandemic unmasked the real disease: state neglect, corruption, governance failure leading to ad-hoc restrictions, lack of testing and surveillance, an overwhelmed health system that left hundreds of millions of hapless citizens to fend for themselves.
It also showed what worked: empowered local health institutions which responded quickly with testing, tracing and quarantining. No surprise that the Indian state with the lowest Covid fatality rate despite high exposure was Kerala.
Abantika Ghosh’s lessons learnt could just as well be written for Nepal: ‘A matured health system is also decentralized, transparent, and, on occasion, self-sustaining … If you don’t treat diseases early, you only treat them when they are complex, and because complex interventions are more expensive, you do not have the resources left to bolster primary care. The more hospitals you build without investments in primary care, the more hospitals you will need to build.’