After a brief period of some kind of an ‘unlock’, the dreaded lockdown is making a comeback in the Indian Covid-19 response vocabulary. The city of Chennai and the state of West Bengal, among other locations, are implementing lockdowns, and it’s likely other areas might follow suit. It’s time to reflect on the experiences of communities under the initial phases of the lockdown and look at lessons that we can draw from this on how to structure public health responses to a spread of infection.
The urge for enforcement during the lockdown and the fact that decisions were taken often arbitrarily without public health advice being integral to them meant that the response was often a law-and-order one, enabled by the exercise of state might, rather than a supportive, evidence-based public health one. Only the latter would enhance the possibility of communities following public health norms like physical distancing, avoiding social interactions, etc.
Let’s take the story of a small and remote region in Uttarakhand, Mori Tehsil, where one author works. It is a geographically hard-to-access part of India, which at the time of writing this article, has not reported a single case of Covid-19. The people of the region should rightly be relieved, looking forward to whatever normal life is possible. But as the author found out during the last trip up, the region and its people have been scarred even before the dreaded virus reached them.
The populace is fearful of not the virus, but the containment measures that come with it. For almost 45 days of the lockdown, before things eased up a bit, there were multiple accounts of people being randomly caned by police and authorities or vehicles being impounded when people were just going about their normal essential lives. People tending to their fields, going to check on their orchards, walking their cows, attending to emergent community issues, or just sitting outside their own house in one case, you name it, all have been roughed up at some point or another—because the area had to be ‘locked down, those were the orders’. We have seen stories of excessive use of force from across the country, but we want to just pause and reflect on the case of this one region.
Why was there a need or justification for any form of force in a sparsely populated area, which had not seen a single case of Covid-19? How would this in any way help in building community support for public health measures, rather than creating fear about the disease and the state response to it? The region faced heart-rending scenes. Like many other parts of Uttarakhand, hundreds of youth and men returned to their villages due to economic collapse across the country. Many of them struggled for days to find transport to get them to their home state and then onwards to their respective villages. After enduring untold hardship, a kick in the gut awaited them at their doorsteps.
Many villages didn’t want anyone to enter them anymore. They were and still are fearful of the virus reaching them—and worse, the containment measures that come with it. The returnees were told to head back, as far away from the villages as possible. A couple of families one of the authors spoke to revealed that it is community pressure that is forcing them to turn back their loved ones, while this is glossed over as ‘voluntary’ in public. Thankfully, due to the government stepping up with clear quarantine protocols and most of the migrants having returned, the situation has stabilised for now. But it is now unclear how villagers will learn to ‘live with the virus’, as normal economic activity, i.e. people visiting from outside, will have to resume sooner than any solution is found for Covid-19.
If you thought rumours and fake news spread only on WhatsApp, the bush telegraph appears to be equally good. Many villages have forbidden villagers from going to the nearby market to buy any vegetables as rumours have spread that vegetables spread the virus. Thus, pregnant women and children who desperately need the nutrients are denied access to them. Many villages have decided that any packaged products have to be quarantined for 14 days. None of this is of course scientific, but there is no active government outreach to counter this misinformation.
The situation of the local community health workers (CHWs) is the direst. They had to manage quarantined individuals in village centres and monitor the community. There is evidence of open hostility to routine door-to-door questioning for ILI (influenza like illness) symptoms, which is being perceived as hostile by the local community (why repeatedly question people who have not come in contact with the virus?). The time is not far, when if there is a Covid-19 case within the CHWs, they themselves will be ostracised. Imagine the ripple effect this would have on our public health programs like pregnancy care, immunisation or monitoring tuberculosis.
As Covid-19 spreads through the country, it will reach remote parts eventually. We can help communities and local governance systems prepare for this, so that when cases do occur, the response is sensitive and evidence-based. But rather, the experience of Mori Tehsil and many more such regions in the country show that our missteps during the lockdown might have alienated the local populace and contributed to a loss of trust in the government.
This could mean that when cases pop up, or individuals have symptoms, they would hesitate to report to government facilities, scarred as they were by the heavy-handed policing-led response during the early lockdown. We must introspect about how we can fundamentally amend our response to situations like pandemics to not be adversarial towards communities, but rather be focused on partnerships. Only then, perhaps, we will be successful in our Covid-19 strategies in most parts of this country, especially the rural and remote ones.
Anand Sankar
Founder of Kalap Trust, an NGO working on public health in Uttarakhand
DR Anant Bhan
Researcher, global health, bioethics and health policy
(Tweets @kalapian, @AnantBhan)