RAMESH THAKUR. Lives vs lives: Corona without karuna

Coronavirus threatens to overwhelm the health and economies of many developing countries where a billion people subsist in a Hobbesian state of nature and life is ‘nasty, brutish and short’.

In response to my original article on 30 March, some people inquired about my interest in the subject and point of departure. First, my major niche interest in pandemics comes through global governance. With Thomas G. Weiss, I co-authored Global Governance and the UN: An Unfinished Journey (Indiana University Press, 2010), chapter 9 of which is ‘Protecting against Pandemics’. Thus in addition to my article and the postscript here, I’ve written an article for The Lowy Interpreter on the Sino-American geopolitical contest in the age of corona, and another for The Strategist on the need to balance national resilience measures with more but better global governance.

A Hobbesian world

Second, as someone who has seen poverty up close in many different countries, I believe the choice is not between ‘lives vs money’, but ‘lives vs lives’. We cannot have a first-world health care system and facilities if our economy tanks to third-world poverty. And in the third world, in a very real sense poverty is the biggest killer of all. In Western societies, the major causes of death are non-communicable diseases like heart problems. In poor countries, the biggest numbers of deaths are caused by water-borne infectious diseases, nutritional deficiencies and neonatal and maternal complications. Coronavirus threatens to overwhelm the health and economies of many developing countries where a billion people subsist in a Hobbesian state of nature and life is ‘nasty, brutish and short’.

The Hindi word for the Hindu-Buddhist concept of compassion, but with the added connotation of taking action to alleviate suffering, is ‘karuna’. It seems to be in scarce supply in India these days, either amongst the people or in government policy. Launching the world’s most brutal lockdown in the war against coronavirus, PM Narendra Modi imposed a 21-day clampdown from 25 March: a de facto legalised house-arrest of the 1.3bn population.

As a big emerging market, India has some unusual strengths among developing countries, including good private hospitals and a sophisticated pharmaceutical sector. Yet India’s hospital bed capacity is only 20%-25% of Western countries. Worse, India has neglected human resource development at the primary care frontline: primary health centres in villages and local urban wards, staff trained for early detection, investigation, counselling, basic tests, triage and referral, in addition to clinical care. There is also a national scarcity of epidemiologists, microbiologists, statistical modellers and research institutes staffed by experts to trace the origins, spread, projected course, and capacity gaps in the public health system.

Consequently the human and social costs will be far more devastating with primitive health systems, teeming slums, unclean water and sanitation systems, congested mass transit, no safety nets and widespread ignorance-induced prejudice. Thus it is that in the UK, a tired nurse comes home after a hard day’s work in the age of corona to a hero’s welcome from her family. But in India, people spit at and abuse health workers because they are feared as carriers of the virus. And I will attract online abuse from Indians for my lack of patriotism in mentioning this.

Lives vs lives

New York’s Gov. Andrew Cuomo has become the latest hero in the Democratic pantheon for insisting that his sweeping, expensive measures to stem the coronavirus would be worth it even if they saved one life: ‘we’re not going to put a dollar figure on human life’. This is stirring but sheer idiocy: a soundbite, not sound policy. Every single budget of every central and state government in every country of the world juggles with competing public policy priorities and, in that sense, puts a dollar figure on human life. Otherwise, if we took Cuomo’s statement literally, the health budget should cannibalise all other sectors of government expenditure. And we should abolish all museums and galleries and redirect all public subsidy into health coffers etc.

Health costs are incurred from increased loneliness and mental anxiety and social costs from emotional distress at job losses, financial stress and forced family separations. A 2014 study in Social Science and Medicine by Timothy J. Halliday showed that a 1% rise in the unemployment rate raises the risk of dying next year by 6%. US unemployment during the Great Depression was around 25%. According to the Federal Reserve’s James Bullard, who supports the Covid-19 shutdown measures as an investment in public health and survival, unemployment could climb to 30%. A report in The Wall Street Journal notes that amid the pandemic, ‘many hospitals and doctors are grappling with an unexpected side effect: a financial squeeze that could deplete the health-care resources needed to meet local surges in cases and threatens the operations of some financially struggling hospitals’.

Of course Cuomo is not stupid, any more than other politicians who feel compelled to say silly things. It’s not that they cannot think clearly. Rather, they are trapped in a ‘gotcha’ political hothouse in which they cannot be seen to be thinking logically, based on facts, and speaking and acting accordingly. In the risk-reward calculus, political leaders have less to lose from an excessive response based on preventing the worst imaginable outcome, and more to lose from a reasonable response based on the most likely trajectory. On the same political calculation, they will be too risk-averse to stop and reverse course early in case something goes wrong, compared to keeping everyone at home because they can still point to fresh cases of infection. Governments may not back off the sequester orders until citizens rebel against the de facto police state regulations and mentality as the new normal.

The coronavirus impact on India

The lockdown has produced its own version of Thucydides’ dictum that the strong do what they can, the weak suffer as they must. Under Indian conditions, saving livelihoods is no less important than saving lives. The privileged jet-setters who imported the virus can utilise the private hospitals but the poor they infect have little access to decent healthcare and will be disproportionately devastated. The rich carry the virus, the poor bear the burden since staying at home means foregoing daily income. Millions ‘fear hunger may kill us before coronavirus’.

Like other strongmen with authoritarian instincts, Modi has prioritised the expansion and consolidation of state power over the development of state capacity. Democratic India is using brutal tactics to enforce the world’s harshest lockdown, for example by spraying desperate migrant workers with chemical disinfectant. On the one hand, Modi’s exceptionally high level of trust in the Indian public gives him room for tough and decisive action. On the other hand, weak capacity in turn means that authorities will have correspondingly greater difficulty in contact-tracing, for example the people, including many foreigners from Southeast Asia, who have attended the sweet spot of a religious event spread over many days at a mosque in New Delhi that may have contravened social-distancing orders already in place and set off six separate clusters in several regions. But stupidity does not discriminate by religious belief. On 2 April cabinet minister Shripad Naik boasted that India’s ancient herbal medicines-based Ayurveda had helped cure Prince Charles of Covid-19. The next day the prince’s spokesperson said he had ‘followed the medical advice of the NHS in the UK and nothing more’.

India has the world’s biggest pool of poor, illiterate, sick, hungry, underweight and stunted children, and sexual assault victims (think also domestic violence during prolonged confinement in homes). Widespread poverty diminishes the state’s capacity to provide adequate nutrition needs of its people and being malnourished makes people more vulnerable to coronavirus. The lockdown could cripple India’s already struggling economy, ballooning the unemployment crisis, destroying the livelihoods of daily wage workers, forcing thousands of inter-state migrant workers to return home under highly stressful conditions, distressing the agricultural sector and causing massive food wastage with broken supply lines.

According to Deepak Nayyar, a one-time chief economic adviser to the government and former Vice Chancellor of Delhi University, under 10% of India’s workforce is in regular, salaried employment. In the 90% at-risk categories, 52% are self-employed, 25% are casually employed on daily wages and 13% work in the informal economy with no social protection. Construction, transport, and hospitality workers are the most vulnerable to big economic shocks.

How exactly does a rickshawallah survive in a 21-day lockdown? How do you implement physical distancing in slums where multi-member families sleep in one room, eat together in an adjacent room and share communal water and sanitation facilities in crowded conditions in the congested population clusters?

The most expeditious spread of the virus occurs when it finds a sweet spot: a cruise ship in Sydney, a football stadium in Italy, a church in South Korea, a mosque in India. India’s geographical size, physical distances and antiquated transportation networks mean broken supply lines for food and other essentials. For the almost totally corrupt police force at the coalface of interaction with ordinary (that is, non-VIP) people, every draconian regulation is an opportunity for fresh extortion. Stories abound of people being harassed and beaten up and trucks stopped to check if their goods include non-essentials.

Exit strategy

It’s possible the worst fears of the coronavirus pandemic will prove wildly exaggerated. In the panicky predictions of a runaway swine flu pandemic in 2009, instead of the feared 1.3% fatality rate, the actual rate was 0.02%. In the UK it was 0.026%. The total worldwide deaths was about 280,000 (range 151,700-575,400), and in the US about 12,500. According to a September 2010 study from Wisconsin’s Marshfield Clinic, the swine flu was no more severe and posed no greater risk of serious disease than the 2007–09 seasonal flus. The World Health Organisation came under severe criticism for having served the interests of Big Pharma in selling unnecessary vaccines. Governments were left with costly surplus stocks for disposal. Peoples in the poorer Southeast Asian and African countries were killed in disproportionate numbers, reflecting the sad reality of inferior access to prevention and treatment resources.

Alternatively, Covid-19 may end up with a fatality rate of 1%, ten times the seasonal flu, or worse. Even then, an exit strategy might still require a managed process of herd immunity in the population at large. If we are lucky, this will come through the development of a vaccine shortly. More likely, it will require a progressive but targeted lifting of the very tight restrictions currently in place that are unsustainable over any length of time. This is the recommendation from Professor Graham Medley in the UK, an expert in the spread of infectious diseases who is a key adviser to PM Boris Johnson. He is worried that the government may have ‘painted itself into a corner’ with the imposition of widespread restrictions with the potential to cause more damage than the disease itself.

In the US too, Dr Alex Berezow, a microbiologist who is vice president at the American Council on Science and Health, cautions against a panic-driven policy. ‘The consequences of … draconian measures are potentially devastating and irreversible …. a total economic collapse would tear at the fabric of society and also pose a threat to public health’. He also points out that in general, the relationship between the infectiousness and lethality of a disease is inverse.

As more data come in, Covid-19 might reveal itself to be either highly infectious with a low case-fatality rate or poorly infectious with a high case-fatality rate. The nightmare scenario of a highly infectious, highly lethal coronavirus is the least likely outcome

The equation has clear if uncomfortable implications for all countries with poor public health infrastructure. The government has a critical and indispensable role to play in public health during pandemics: prompt, accessible and affordable universal testing, ramped up hospitals to cope with a surge in demand, accelerated supplies of protective, preventive and therapeutic medicines and equipment, etc. But poverty hollows out state capacity to do all this. They might do better to focus on managing herd immunity in the society at large rather than killing millions through economic lockdowns.

A final sobering thought. It is highly unlikely that India would have locked down had the Western countries not led the way. If the most advanced economies and the world’s leading exemplars of liberal democracy had not taken to extreme policies of quarantines and social distancing in order to slow the spread of the virus and keep the patient loads manageable, India almost certainly would not have caught the panic virus either.

Ramesh Thakur, a former United Nations Assistant Secretary-General, is emeritus professor in the Crawford School of Public Policy, Australian National University

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Ramesh Thakur is a professor emeritus at the Crawford School of Public Policy, the Australian National University.

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6 Responses to RAMESH THAKUR. Lives vs lives: Corona without karuna

  1. Geoff Fitzgerald says:

    Personally I think Mr Thakur and Mr Manne are getting bogged down in some side issues today, albeit important ones.

    Surely Mr Thukur’s central point over the last few articles is this:

    That the response by authorities to this pandemic has been grossly disproportional- grossly disproportional to other comparable pandemics we have had recently, and grossly disproportional to the actual threat that this current pandemic presents.

    I am not trying to support or refute his argument but I think we have to recognise the crux if what he is saying.

    I disagree with Mr Manne in that I think Mr Thakur actually has provided strong evidence to support his argument. Neither I not Mr Manne are qualified to refute or verify his evidence for this central issue.

    However I thank Mr Thakur for making his case. I think it is an important one.

    I suspect that the Australian authorities are actually sympathetic to this argument. But they also have to manage the pandemic pendulum (I forget whose term this is) and have to juggle the Hobbesian problem with the current tide of public demand for shut downs.

    I personally don’t know who is right or wrong but I believe it is an important.public discussion for us to have.

  2. Richard Barnes says:

    Robert Manne has accurately attacked the three most contentious sentences in a piece which I thought nonetheless raised some very important issues.

    No, Australia’s economy will not ‘tank’ to third world poverty. Nonetheless, we are paying a huge economic price – and I mean economics in the broad, social science sense – which as others are pointing out is disproportionately borne by those who are disadvantaged. Think about a Mum with 3 screaming kids at home; lives in a flat, so no yard; no Internet (yep, readers of P&I, that’s not so rare); husband was just laid off; and throw in some domestic violence, exacerbated by anger and frustration.

    Will we surrender to police state despotism? No. But my old Dad, who lives alone in a unit in a retirement village, has been asked my both management and neighbours to now not even have a weakly visit from one of his kids. Or how about a couple walking along a quiet street with their intellectually disabled adult son, sent home by police? It should not surprise us to see arbitrary powers used arbitrarily.
    Every government is facing the unenviable task of balancing harm from lockdown against harm from COVID – the ‘lives versus lives’ overarching theme of Professor Thakur’s piece.

    Is Modi imposing a brutal shutdown because most Western countries have done so? Probably not. But I valued very much the confronting description of what COVID means for India. As Duncan Graham has indicated elsewhere in P&I, more or less the same applies to Indonesia. And undoubtedly Brazil.
    We are so fortunate in this country that despite our fears we really can make the necessary choices to both minimise the COVID carnage and minimise the collateral carnage. I thank Professor Thakur for reminding us of that.

  3. Kien Choong says:

    Is the author recommending not taking any action beyond simply encouraging social distancing (without legal enforcement)? While this seems to be working in Sweden, the experience of many countries (Italy, Spain) is that it eventually overwhelms the capacity of the public health system to treat every patient, and so morally confronting choices need to be made about who to treat and who not to.

    Most responsible governments (whether democratic or not) understandably prefer to prevent their health systems from being overwhelmed. I would argue that Hong Kong, Singapore, S Korea and (yes) China show that governments with strong institutions do have the capacity to control Covid-19 infections without causing permanent economic harm.^*

    Admittedly, many countries do not have this institutional capacity – e.g., India, Pakistan, Indonesia. And perhaps the reality is that even in normal times, many people die every day from treatable infections because public health systems are limited. So it may be that in these countries, letting people die (which in practice means the poor, not the rich) is unavoidable.

    ——
    ^ Recovery may be prolonged, but with appropriate policies, I feel sure lasting economic harm can be avoided. These policies ought to include social support to minimise the harm to health from (for example) the stress of unemployment.
    * There is a separate policy question of whether to go for complete suppression (i.e., stop infections) or aim to achieve “herd immunity” through controlled infections.

  4. Mark Freeman says:

    Thank you Professor Manne for this concise summary of my own concerns about this piece. I’m a fan and regular reader of Professor Thakur here but I’m afraid he’s way out of his depth on this one.

  5. Robert Manne says:

    I am rather astonished at the intellectual confusion in an article–the running together at the time of the Corona virus pandemic of the problems of severe poverty faced by India and the problems faced by wealthy Western countries–by someone with previous interest and experience of pandemics.

    Professor Thakur writes: “We cannot have a first-world health-care system and facilities if our economy tanks to third-world poverty”. Does Professor Thakur genuinely believe that short term radical shutdowns among Western societies threaten them with a collapse into extreme third world-like poverty?

    Professor Thakur writes: “Governments may not back off the sequester orders until citizens rebel against the de facto police state regulations and mentality as the new normal.” Does he truly believe that general compliance with short-term radical shutdowns threatens these societies with a surrender to a police state despotism?

    Professor Thakur writes: “It is highly unlikely that India would have locked down had the Western countries not led the way.” Does he truly believe that Modi’s shutdown can be explained by an imitation of Western governments’ decisions. Anyone following the pandemic knows that the radical shutdowns originated in Asia–in different models by China, South Korea, Singapore etc.

    Thus far the evidence suggests that those Western governments that accepted the idea of short-term radical shutdown–Germany, Finland, Norway, Denmark, New Zealand and, yes, Australia–have avoided the thousands of unnecessary Corona deaths experienced by those countries that imposed the short-term shutdown too late–Italy, Spain, France, the United Kingdom and the United States.

    Of course the exit from the shut down will pose questions of great difficulty for all Western governments. They will not be helped by wild exaggeration and false equivalence between the problems they will face and the problems faced by Modi’s India.

  6. stuart lawrence says:

    Yes this virus will pass and yet more australians will die of smoking related causes etc

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