Why social distancing is not helping stop coronavirus in India
By Mohd Imran Khan and Anu Abraham*
A few simple preventive steps help sharply reduce the spread of the coronavirus and the chances of infection from it. Wash hands frequently with soap and water and practice social distancing, that is keep at least six feet away from another person in public spaces, according to guidelines from the World Health Organization (WHO)
If you have come in contact with someone who has been exposed to the virus or have visited an area where people were infected, WHO advises quarantine or home stay for at least 14 days.
Severe shortage of testing for the virus
The safety measures recommended by WHO have worked to reduce the spread of the virus in China, though implemented forcefully by a dictatorship, and in South Korea, Taiwan and Singapore. Initially, soon after the first cases emerged, the precautions were not widely adopted in the U.S., Spain, Italy and the UK, leading to exponentially rising cases of infections and deaths in those wealthy countries.
As of today, India has 3,100 cases of infections and 86 deaths, according to the John Hopkins University’s Coronavirus Resource Center. Both these numbers will likely rise sharply with increased testing. As of March 31, the number of tests conducted in India was just 42,788, less than two percent of the pace in the top testing countries like South Korea, according to Bloomberg. India is at the back of the line, behind the U.S., U.K. and other wealthy countries, for securing test kits from foreign sources. Locally developed tests are either crippled by regulations or do not have the necessary materials.
India is currently under a lock down with people being asked to stay indoors. The lock down, which expires on April 14, is likely to be extended. Millions of migrant labor though have ignored the lock down, walking hundreds of miles back to their villages. They lost their jobs and, with no savings and facing starvation, they hope to find food in their villages. Very likely some of them are spreading the virus to new areas.
Using soap is not a habit
India, as well as Pakistan, Bangladesh, Indonesia and Nigeria, have huge populations with densely inhabited regions which make them very vulnerable to infections. They, and most other developing countries, have very inadequate public health systems, which are also not equipped to deal with a rapidly spreading disease that might infect hundreds of thousands, if not millions. It is hence critical that India, as well as other developing countries, strictly implement the preventive measures recommended by WHO to contain the spread of the virus.
While the WHO safety measures will help, there are major sanitation and housing obstacles that is greatly reducing their effectiveness in India. Three quarters of Indians wash their hands with soap after defecation. The rest use only water or try to clean their hands by rubbing against grass, shrubs or waste paper.
About two thirds do not use soap to wash their hands before meals, even if they have come home after a day of manual labor. These habits show that the key method to curtail coronavirus infections, namely washing hands with soap several times a day, needs to be cultivated by most Indians. There is an economic reason as well since many of the poor cannot afford to buy a bar of soap, which costs as much as half a day’s wage for a laborer.
Communal water sources & toilets are spreading the virus
Easy access to water within a home helps promote the habit of washing hands frequently. But about 40% of urban homes and three quarters of rural homes in India do not have tap water. This means that members of these households, mainly women, have to fetch water from public taps, wells, tanks, rivers or other communal sources. Also, each day, on average it requires about an hour of walking to fetch water from community sources. So, when they go outside their homes to fetch water, even if they maintain a social distance, the women face a high risk of being exposed to the virus, especially while touching taps and pots at the communal water sources. If they have an infection, they are spreading the virus to others.
Among rural households, nearly half have no access to private washrooms and 39% have no access to their own toilets. The situation is better in urban areas, with only a tenth of homes having no access to private washrooms and 4% with no toilets. Yet, in urban areas about a tenth of households use common public washrooms and toilets, double the number of those in rural areas. Using such public sanitation facilities, which are also used by other residents of a village or a building, increases the chances of being infected by the virus.
No room to quarantine
About a third of India’s rural population and half its urban population live in homes where a room is shared by two or more people. This effectively means that in such homes isolating a person within a room is nearly impossible. So, home quarantine and self-isolation, for those with an infection or risk of having the infection, will be difficult to implement for about two thirds of India’s 1.3 billion people. Quarantining them in a public space, such as a social service center or a public park, will require funding which has so far not been granted by the central or most state governments.
In addition, a quarter of Indians have no proper homes and little or no access to sanitary facilities. They are mostly the poor, including those who live on the streets and in slums in urban areas. They defecate in the open and wash themselves at communal wells or tanks. They are most at risk of being infected and also very likely to spread the virus.
In India’s case, even if the WHO safe practices are widely circulated, and even if an infected person wants to self-isolate, the habits, cramped living conditions and lack of water and sanitation resources as well as funding, all work against containing the spread of the virus, especially among the poor.
(The figures in the article have been calculated by the authors using data from the NSSO 76th round (2018): Drinking Water, Sanitation, Hygiene and Housing Condition.)
*Mohd Imran Khan teaches economics at NMIMS, Mumbai. He got his Ph.D. from the Centre for Development Studies, Trivandrum. He can be reached at: mohdimran.khan@nmims.edu.
Anu Abraham teaches economics at NMIMS. She is working on her Ph.D. at the Indian Institute of Technology, Madras. She can be reached at anu.abraham@nmims.edu
