The current lockdown and social distancing measures brought about by the coronavirus crisis, coupled with the direct effects of the virus on workers and firms, are having a huge impact on economies in the UK and around the world. Existing literature on the health impacts of business-cycle fluctuations and recessions shows that the resulting economic downturn will have significant consequences on peoples health outcomes in the short and longer term. A debate has started on whether the adverse health effects of a recession may be greater than the increased morbidity and mortality within the pandemic itself. This briefing note discusses some of the mechanisms through which shocks to macroeconomic conditions may affect health.

An economic downturn has a number of effects on peoples lives through increased unemployment, decreased employment, reductions in income and wealth, and increased uncertainty about future jobs and income. The health effects caused by these adverse macroeconomic conditions will be complex, and will differ across generations, regions and socio-economic groups. Groups that are vulnerable to poor health are likely to be hit hardest even if the crisis hit all individuals equally, but evidence is already emerging that the economic repercussions of the crisis are falling disproportionately on young workers, low-income families and women (Joyce and Xu, 2020) so this will also need to be taken into account. Policies that the government has put in place, as well as the subsequent policies that will be implemented both for the exit strategy and for post-pandemic economic recovery, will play an important role in determining the eventual health consequences.

This briefing note discusses what we know about the health effects of business-cycle fluctuations and recessions, but there are additional aspects of the coronavirus crisis that are unique to the current situation that stem from this being a pandemic. Most obviously, the crisis has an impact on the availability of healthcare. At the moment, all non-urgent elective surgeries have been postponed, and there are fears of lack of sufficient intensive care units at later stages of the pandemic. The aftermaths of this additional strain on the NHS on future healthcare are addressed in an IFS briefing note published alongside this one (Propper, Stoye and Zaranko, 2020).

Recessions have been shown to have large and persistent negative effects on health and mortality at the population level. This is particularly true when long-run dynamics, spillovers and spatial effects are taken into account. Janke et al. (2020) estimate a model of the impact of economic shocks on morbidity for Britain that allows for different responses by local area, for persistence in the effect of past shocks and for feedback from national changes in levels of morbidity to the local level. They find that employment changes during and after the 2008 financial crisis had a strong adverse effect on chronic health for five broad types of health conditions, with the strongest effects being for mental health conditions.

Quantitatively, Janke et al. estimate that a 1% fall in employment leads to a 2% increase in the prevalence of chronic illness. To put this in context, if employment were to fall by the same amount as it fell in the 12 months after the 2008 crisis, around 900,000 more people of working age would be predicted to suffer from a chronic health condition. Only about half this effect will be immediate: the full effect will not be felt for two years. The shock to employment from the coronavirus pandemic is likely to be much larger than this and so we may expect a larger rise in poor health. The Janke et al. analysis looks at the prevalence of long-standing health conditions but does not examine the intensity or the duration of the condition within an individuals life course. It is quite possible that health status, outcomes and levels of functioning may well continue to deteriorate over the longer run even once the prevalence of chronic long-standing conditions has plateaued.

The Janke et al. estimate is of an average effect, across all ages, areas and income groups. In any recession, many groups will experience worse-than-average changes in economic fortunes. It is likely that the groups that suffer the biggest economic losses from this crisis are also those who were more vulnerable to begin with for example, people with lower incomes are less likely to be able to work from home or have accumulated liquid savings to tide them over. In addition, even the same change in economic fortunes may have different health consequences for different groups. Research from many fields has shown that certain individuals are more resilient to shocks than others and that there are particular periods in life where shocks are most critical for long-term outcomes. Groups of particular concern are families with young children or where mothers are pregnant, and low-income or low-socio-economic-status individuals of all ages where health vulnerabilities and mental health problems are already prevalent.

Economic shocks and downturns have been shown to be important during pregnancy and early childhood. At this point of the life cycle, physical health and cognitive trajectories are being set and this has long-reaching consequences for later-life economic outcomes and later life health. Poverty rates increase in a recession. This may feed through to negative in-utero and early-childhood risk factors. Van den Berg et al. (2006) examine the Dutch population born between 1812 and 1912 and find that the state of the business cycle at birth affects mortality: being born in a recession reduces lifespan by about 5%. This illustrates the stark and lifelong effects that early childhood conditions have on health, not just because of the biological pathways, but also as a result of the effects of in-utero and early-childhood health conditions on other economic outcomes and family behaviours.

Currie (2009) documents the extensive evidence on the links between parental circumstances and child health, as well as the subsequent link between a childs early-life health and their eventual educational and labour market outcomes. It is well documented that poor nutrition in early childhood, as well as in utero, will have a long-lasting impact on individuals, and there are many other examples where vulnerabilities and shocks in early life have long-term consequences. Hence the interaction of childrens age and their family's vulnerability will be a key point when thinking about policies to mitigate the long-run health and economic effects of the crisis.

Those with pre-existing poor mental health will also be particularly vulnerable. The adverse impact of recessions on mental health and mortality from suicide is clearly documented across a number of studies (World Health Organisation, 2011). Prevalence of mental health conditions in the UK has been rising even before the coronavirus crisis, making this a particularly important outcome to consider. Estimates drawn from Janke et al. (2020) suggest that if the economic downturn were similar to that after the 2008 financial crisis, the number of people of working age suffering from poor mental health would rise by half a million. Poor mental health and depression are also a risk factor for a number of physical health conditions (Kivimaki et al., 2018) and interventions targeting improved mental health can reduce future hospitalisation (Gruber et al., 2019). Thus the impact of the economic downturn on mental health will also affect overall long-run health and mortality through this channel. To add to this, social distancing in itself is likely to have complex and nuanced effects on individuals social isolation and mental health, which will then in turn feed through to physical health and mortality (see, for example, Shankar et al. (2011) or Steptoe et al. (2013)). These social distancing effects of the coronavirus crisis will be additional to any mental health effects that might be predicted when extrapolating from analysis of previous downturns and they are hard to predict.

Reduced economic activity as a result of a recession and the lockdown may also have some positive health impacts. Some unhealthy behaviours such as drinking, smoking and unhealthy eating have been shown to fall, on average, when there are negative income shocks (Ruhm, 2000; Adda et al., 2009; Griffith et al., 2016). Reports already show reduced levels of air pollution in the industrial areas of China and Italy as well as London, and there is a clear link between mortality from certain cardiovascular and respiratory causes and air pollution (see, for example, Janke et al. (2009)). Moreover, the rate of accidents in traffic or at work will be lower given fewer cars on the roads and reduced industrial activity. And in addition to the short-term effects of the social isolation in slowing down the spread of the coronavirus, Adda (2016) finds that economic downturns slow down the spread of viral disease as inter-regional travel and trade are reduced. Thus even after the social distancing measures have been lifted, we can expect the rate of viral transmission to be lower in an economic downturn than it would have been otherwise.

In the long run, the current economic downturn and the social distancing measures that accompany it will hit some industries more than others, and consequently some regions more than others. Janke et al. (2020) find heterogeneous morbidity responses to economic shocks across local areas. Those areas that are hit hardest are those that are the most deprived and have older populations and older industrial structures, which are precisely the kind of areas least able to withstand negative shocks.

The coronavirus crisis has the potential to create long-lasting structural changes in the UK economy. In terms of industries, travel and tourism, as well as hospitality and any non-essential retail trade, have come to a complete halt over the last couple of weeks. Areas of the UK that are disproportionately reliant on one of these sectors may see a severe collapse of activity in the local economy if recovery after the crisis is not fast enough. US studies of areas that were most exposed to structural shocks and industrial decline due to the rise of trade between the US and China have shown long-lasting and severe effects, particularly for males (Autor et al., 2016 and 2019). These shocks have fed through to mortality outcomes (Pierce and Schott, 2020). This is a specific example of how changes in economic fortunes can lead to deaths of despair, the term coined by Case and Deaton (2015 and 2017) who documented strikingly large rises in mortality associated with suicide, alcohol and drug abuse amongst low-educated white American males. The health effects of wholesale structural change, where industries are eradicated in a local area, are severe and persistent as the economic opportunities of people in these areas disappear either permanently or at least for decades.

In facing this economic downturn, government intervention will play a key role in determining the eventual health effects of the resulting recession. The government will need to decide where resources are best used. Importantly, in recent years, the UK welfare system has evolved to protect incomes through the extensive use of in-work benefits. Whilst this proved to be a positive during the 2008 financial crisis when incomes and wages fell but employment held up (see Cribb et al. (2017)), continued erosion of the value of out-of-work benefits relative to average wages leaves the system far less capable to deal with mass unemployment shocks than it was.

The Coronavirus Job Retention Scheme (JRS) has a specific purpose of preserving jobs as well as incomes and is desirable in this respect (see Costa-Dias et al. (2020) for further commentary on the JRS). Obviously, within the lockdown period, most of those who do lose their jobs will find it very difficult to find new work, but the JRS should help to ensure that once the social distancing measures are lifted, more have retained their jobs and can return to work. In the absence of measures that protect employment, job separation and long spells of unemployment can lead to a loss of human capital either through depreciation in skills or a loss of firm-specific human capital that has accumulated through matching in the labour market (Fujita et al. (2020) further discuss the importance of preserving workers attachment to their current employer in the context of the coronavirus crisis). This will have long-run consequences for individuals lifetime earnings as well as affecting their financial security, sense of purpose and mental health. Thus we would also expect knock-on adverse effects on morbidity and mortality. Therefore protecting human capital and minimising unemployment consequences beyond the duration of the social distancing measures is particularly important for both the economic and health consequences of the recovery. Rebuilding lost human capital may well be much more complex than replacing the physical or financial capital that has been wiped out in the large recessions experienced recently.

The example of JRS shows that even the policies that are not directly aimed at improving health outcomes can help alleviate the eventual health consequences of the economic downturn. Thus it is important that any government action is taken with consideration for the long-term health outcomes it may affect. Different policies will help certain groups more than others, and affect their long-term health in differing ways. For example, it is clear that the long-run returns from supporting vulnerable mothers and children through this crisis will have far-reaching consequences for the outcomes of the children. But the current policies aimed at supporting furloughed workers may not do enough to reach these families. Thus any policy should come with an assessment of who it will benefit most and how the health effects may differ by cohort, prior socio-economic status and region. This will be particularly important when the government designs its policies for the removal of the social distancing measures and any subsequent reimposition of them, and then again as additional government economic support measures are phased out.

See more here:

Recessions and health: the long-term health consequences of responses to the coronavirus - - ifs.org.uk

By BITANGE NDEMOMore by this Author

We watched as China confronted the coronavirus and as it threw everything it had at the virus.

We watched as the virus escaped to Korea, then to Europe and now in the US, and as the number of infections and deaths skyrocketed in Europe.

Then we started to see African countries confirm cases. If the trend is anything to go by, then in the next two to three weeks will be our turn to suffer.

Like in the US, we thought the threat was minimal and this affected our decisiveness on response. Now, the number of infections is increasing.

It is as though this Covid-19 sends warning shots and then after 19 days, it comes with vengeance.

This, in my view, is a window that we must exploit by planning for: our homeless, food supply chains, our medical staffs protective gear, new sites for expanding hospital beds, medicines, emergency vehicles, people who rely on daily income.

Above all, we must candidly address our cultural practices on death and burial in light of this pandemic.

Cabinet Secretary Mutahi Kagwe said that Kenya has entered what is known as community infection stage, perhaps the worst stage along the continuum of infections considering that the virus can rapidly spread across the country if we fail in social distancing.

Lessons from Italy and Spain show that the only way of stopping the virus from spreading is through strict adherence to social distancing. Many countries have had to lockdown their countries as a strategy to distance themselves from mingling.

The chairman of the Council of Governors says that a total lockdown will bring misery to citizens. Others say the Governors are using the crisis as a bargaining chip to get more resources.

Either way, we are losing the valuable time to mitigate against the crisis. The more time we take to take action, the more we endanger the lives of people.

SOCIAL DISTANCINGOur context is more complicated than that of developed countries. We have more people crammed up in shanties. A quick decision to give incentives for those who can move to rural areas to do so is urgent. The more people we move from slums areas to rural areas, the better social distancing we create.

We also move the homeless to less densely populated areas, protect food supply chain companies from harassment by the police, establish a local industry to produce some hospital supplies and develop a public private partnership on emergency vehicles.

In as much as we are in a health crisis, some people must focus on the economy to fight off a possibility of economic collapse and further suffering.

Last week, McKinsey & Company published a report, Tackling Covid-19 in Africa: An unfolding health and economic crisis that demands bold action, highlighting their initial analysis of the pandemics economic impact.

Their findings show that Africas GDP growth in 2020 could reduce by 38 percentage points. The report says that in the absence of a major fiscal stimulus, the pandemic and the oil-price shock are likely to tip Africa into an economic contraction in 2020.

The report anticipates four likely scenarios for Africa. These include a scenario where the pandemic: is controlled in the near term, intensifies throughout the world, Asia, Europe and the US takes long to contain the epidemic and a significant outbreak in Africa with repercussion on the economy and lastly continued recovery in Asia, Europe and the US with significant outbreak in Africa.

GRIM PICTUREIn three of the scenarios with the exception of containment of the virus in the near term, the economies of Africa will record negative growth. Various organisations trying to model the infection trajectory paint a grim picture, with some opining that dealing with Covid-19 may take as long as 18 months.

On Kenya, the report says:

In two out of four scenarios, Kenya is facing a likely economic contraction. Under the contained outbreak scenario, GDP growth could decline from 5.2 per cent (after accounting for the 2020 locust invasion) to 1.9 percentrepresenting a reduction in GDP of $3 billion (Sh300 billion).

The biggest impacts in terms of loss to GDP are reductions in household and business spending (about 50 per cent), disruption to supply chain for key inputs in machinery and chemicals (about 30 per cent) and tourism (about 20 per cent). In scenarios in which the outbreak is not contained, Kenyas GDP growth rate could fall to -5 per cent, representing a loss to GDP of $10 billion (Sh1 trillion). As in Nigeria, disruption of consumer spend would be the biggest driver of this loss.

On the continental level, the picture isnt rosy either. Most African countries, including Kenya, are dependent on imports from, and exports to, China. Although China is back to business, the supply chains are already constrained.

To add salt to injury, oil prices have collapsed, with negative consequences on Africas oil rich countries.

Further, African oil producers largely export to China meaning that any disruption to Chinese trade will devastate countries like Nigeria, Angola, South Sudan and Eritrea.

In spite of the locust invasion and now Covid-19, Kenya must sustain its food production and horticultural exports to Europe.

Food production is the most important industry today that can provide jobs as well as income in a very difficult period.

With a projected economic downturn, a significant number of people losing jobs and others needing healthcare, it is surely our turn to suffer.

Within the small window of opportunity that we have, we must fight the pandemic by all means but also find means of tapering down our politics and dealing with our anticipated socio-economic crisis by taking bold actions.

The writer is a professor of entrepreneurship at University of Nairobis School of business.

Original post:

This virus is a robber of health and wealth - Daily Nation

By Heribert Dieter

The Covid-19 virus has hit Germany as unexpectedly as other European countries. For a few weeks, Germans thought the pandemic was an issue for Asian countries and not their own. Today, although Germany is severely affected, the situation is not nearly as dire as in Italy and Spain. Germany, with its enormous financial resources and a well-equipped medical sector, appears to be better placed than other economies to weather this storm.

One of the most striking effects of the crisis is that Chancellor Angela Merkel is experiencing a revival. The debate over her succession and the next chairman of the Christian Democratic Party have become irrelevant. Merkel is firmly in power, and her popularity is quite high. Ironically, the current crisis has been falsifying the claim she made in 2015 that the German borders cannot be protected. On 7 October 2015,she had arguedin a rare television interview that borders cannot be closed. Since 16 March 2020, the German government has implemented policies that were previously considered impossible or inappropriate.

Today, the German authorities are desperately trying to regain control over the coronavirus. These blunt measures are a reflection of the previous complacency. If the German government would have acted earlier, say in mid-February, the restrictions could have probably been less severe. The mistakes Germany made and continues to make become evident when setting Germanys experience against that of Hong Kong. Based on my own calculations, while one in 1,070 citizens in Germany is infected with the coronavirus, the number in Hong Kong is only one in 9,934 inhabitants. Why is a densely populated city-state like Hong Kong apparently more successful in addressing the coronavirus than Germany?

There are some surprising similarities between Germany and Hong Kong in the current crisis. Both are very open economies with substantial fiscal resources, which are proving quite useful today. Both are very dependent on China, if in different ways. And both economies have seen their business models weakened by the crisis. Their response to the pandemic, however, has been extremely different.

The authorities in Hong Kong have been trying to control and monitor the outbreak of the crisis. Fuelled by the experience from the SARS epidemic in 2003, the Hong Kong government quickly implemented measures to control the virus. Schools and universities were closed and now use the online teaching method, and the health authorities continue to document each individual case on several websites. Citizens can identify which train, plane or taxi an infected person has used. The government is using a supercomputer of the Hong Kong Police Force to monitor outbreaks and react against them.

While the Hong Kong government has implemented many measures to curb the spread of the virus, there has been no curfew like the kind implemented in Italy, France, Spain or Germany. From day one, many citizens of Hong Kong have been wearing face masks, which may not be very effective in preventing the user from catching the virus but is useful to curb its spread. Wearing a mask has thus become a symbol of care for others in Hong Kong, where respect for others has been an established social norm. The city has just under 1000 confirmed coronavirus cases, four of whom have died. Considering Hong Kong is a part of China and there has always been an intensive movement of people between the city and the mainland, these relatively low numbers are remarkable.

The measures taken against the coronavirus may have reduced total mortality in the city. Simply put, in 2020, ordinary influenza claimed significantly fewer lives in Hong Kong than the year before, thanks to social distancing and other measures. In 2019, the influenza season lasted 14 weeks and claimed 356 lives. In 2020, the influenza season ended after a mere five weeks, and 113 Hong Kong citizens died from influenza, about two thirds less than the year before. A positive side effect has been the reduction of admissions to intensive care units due to influenza, which dropped from 601 in 2019 to 182 in 2020. Thus, the healthcare systems capacity to handle Covid-19 cases was higher than it would have been in a regular influenza season. Dr. Joseph Tsang, an expert for infectious diseases,called the reduced influenza cases a collateral benefitfrom the coronavirus outbreak.

The contrast between Germany and Hong Kong is stark. Germans very reluctantly embraced the precautionary measures. Despite the virus wreaking havoc across the world, including in Italy, many Germans thought that Covid-19 would not severely affect them. The German government was equally reluctant in implementing comprehensive measures to stop the spread of the virus. Instead, the federal and state governments implemented what an ex-post approach, waiting until the crisis hit and infection rates skyrocketed to implement harsh measures.

To be fair, that may have been the only avenue available in a democracy in general and in Germany in particular. Policies that severely curtail the freedom of individuals are always contested, and without evidence, it is incredibly complicated to convince citizens that they should alter their behaviour. In Germany, the use of emergency acts is currently accepted by a vast majority of citizens but perhaps would not have been tolerated at the end of February. As we know from other policy domains, democracies are not very good at implementing precautionary policies.

German policymakers have continued to emphasise that the country is well-prepared for a health emergency. But this is true only on two fronts: have a good number of hospital beds and laboratory capacity. Germany currently has 28,000 intensive care beds, out of which 25,000 are equipped with ventilators. Germany has more hospital beds than most other European countries.According to World Bank data, Germany has 8.3 beds per 1000 people, while France 6.5 beds, Italy has 3.4 beds and the UK 2.8 beds. Even in the US, which has one of the most expensive health care sectors in the world, there are only 2.9 beds available per 1000 people.

The German approach can partly be explained by the confidence in the existing medical resources. But despite having many hospitals, there is a lack of necessary medical equipment such as masks.

Like most other European governments, Germany has implemented unprecedented measures to stimulate the economy and to keep businesses afloat. What sets the country apart is its fiscal muscle. After years of economic boom, high levels of taxation and restricted government expenditure, Germany can use its vast financial resources to avoid an economic collapse. In 2019, gross public debt was reduced to 59.2 percent of GDP. Somecommentators have suggestedthat saving has paid off. The debate on a possible exit from the measures adopted to curb the spread of the Covid-19 virus has continued. While it appears that the strict rules will remain in place at least until mid-April, Germany might consider a model adopted by many other countries some restrictions on public life, but a return to the workplace for a significant number of the workforce.

Indeed, estimations by some virologists appear bizarre. Lothar Wieler, head of the Robert-Koch-Institute, which advises the German government,had suggestedin mid-March that in an extreme scenario, Germany may have to remain in lockdown-mode for up to two years. Of course, the implementation of the current measures beyond April would risk the stability of many German companies and could lead to massive unemployment, widespread bankruptcies and severe political instability.

Some commentators have already criticised the harsh measures. Hans-Juergen Papier, former president of the German Constitutional Court, has warned that emergency measures do not justify the suspension of civil liberties in favour of a state of authority and surveillance. He said a curfew that has no limitation in space and time most probably represents aviolation of the German constitution. Policymakers in Germany and elsewhere must find a balance between protecting their societies as well as protecting the economy. To place the safeguard of citizens health above all other considerations is a risky strategy. Without a return to economic activity in the foreseeable future, Germany and other European countries may rapidly be exposed to severe socio-economic problems.

If Covid-19 is a severe health crisis, but not an unprecedented one, the question arises why governments all over the world, including the German one, are outbidding each other to curb the freedoms of their citizens. One reason might be the rivalry with China. The Chinese Communist Party has been trying to recover from the mistakes made in Wuhan in the early phase of the outbreak by implementing a draconian lockdown.

Today, the Chinese government is portraying itself as one of the few governments able to protect its population from the virus. Explicitly, the Chinese Communist Party has been suggesting that democratic governments are not well placed to combat a serious threat to their citizens. At the same time, policymakers in those societies want to demonstrate their ability to act forcefully, and they have used the Covid-19 crisis to do so. They have simply copied the Chinese blueprint, perhaps prematurely. The precedent set by China may have hurt the ability of politicians in Europe and North America to develop their strategies to combat the virus.

There are, however, some very optimistic observers in Germany that neither expect a lasting lockdown nor a severe effect on the economy. The Council of Economic Advisors to the government has suggested that Germany may suffer quite limited economic damage from the crisis. In a best-case scenario, they expect a drop five percent drop in GDP in 2020, which would be less severe than the contraction of the economy in 2009. Even if Germany were to stay in lockdown for seven weeks, thereduction in GDPwould be limited to six percent.

What will change is Germanys fiscal position. At the start of the current crisis, the countrys coffers have been well filled. Federal, state and social security funds aresaid to haveliquid reserves of 200 billion euros. In times of crisis, this comes in handy. The federal government has adopted a far-reaching package of measures to mitigate the consequences of the spread of the coronavirus. The cabinet initiated emergency aid for micro-enterprises and self-employed persons. Clinics and practices will be strengthened, and access to short-time work benefits simplified. And the government is helping large companies with an economic stabilisation fund.

Thatfund has three elements:

Given the uncertainty about the duration of the crisis and the severity of the economic decline, the German government has had one primary objective: to stabilise the expectation of its citizens. This goal may have been achieved for now, but any significant deterioration of the situation will alter the equation quickly.

In 2020, Europe is experiencing a problem of historic dimensions. Although there is some solidarity between member states, by and large, each country is fighting the crisis on its own. It is unrealistic to expect Europe to emerge strengthened from the Covid-19 crisis. The nation-state has been the primary source of protection and help, and the citizens of each country will remember that supranationalism, let alone multilateralism, did not provide convincing answers in the crisis.

Of course, there have been nasty episodes during the crisis, and it would be easy to point fingers at the mistakes of others. In an existential crisis, perhaps it is unavoidable for policymakers to act in the national interest. Germany is no exception. The much-criticised ban on exports of medical equipment was implemented after the German government realised that the country did not have sufficient basic equipment (sanitiser, masks) for its own medical personal.

Nevertheless, Germany is contributing significantly to the stabilisation of the European economies. The countrys solid fiscal position, a result of policies that were criticised in the past, today enables Europes largest economy to act as a significant provider of demand. Put differently, if Germany were not able to stabilise the purchasing power of its citizens and the capacity of its companies to survive the crisis, Europes prospects in a post-Covid-19 world would be much bleaker.

Surprisingly, the crisis may have some positive effects on the Germans perceptions of the existing economic and political structures. In the current crisis, the German government is mobilising resources for its citizens, who for years have been funding the state and the social security system with high taxes and high social security contributions. Today, Germans see the benefit of previous frugality. And so, while the Covid-19 crisis will take its toll, the long-term effects may not as bleak for Germany as elsewhere.

Please Donate Today Did you enjoy this article? Then please consider donating today to ensure that Eurasia Review can continue to be able to provide similar content.

Read more from the original source:

Can Germany Weather The COVID-19 Storm More Robustly Than Other European Countries? Analysis - Eurasia Review

In the past ten days, Prime Minister Narendra Modi has addressed the nation an unprecedented four times, all about how his administration is responding to the coronavirus pandemic. In each of these addresses, the public at large has been told what they should do for the country, and not what the country will do for them.

When on March 19, Modi went live on TV at 8 pm, he asked people to observe Janata Curfew the following Sunday (March 22) and demonstrate the national zeal to defeat the pandemic through a 5 pm thali-bajao exercise. On 24 March when Modi came live, again at 8 pm, he announced a much-feared three-week nationwide lockdown, and from that very midnight. This gave a mere four hour warning, resulting in a late-night panic buying spree. Thousands caught off-guard by the lockdown, who unsurprisingly were daily wage labourers and poor working classes, were forced to pick up their kids and meagre belongings and start walking to their homes in faraway villages. Scores were subjected to exhaustion and hunger. However, in his Mann ki Baat that came a few days later, Modi merely extended an apology for the suffering heaped on the poor and the migrant workers due to the lockdown. Nothing more.

Modi came out once more to speak to the nation on April 3 and thankfully in the morning. Given the widespread criticism of what has come to be known as a #lockdownwithoutplan, the expectation this time was that he would delve into the details of preparedness essential in dealing with this difficult period. This is what leaders of other pandemic affected countries have been doing, spelling out the details and with great sensitivity too. Modis speech once again was without any details; as before he asked people to perform yet another public demonstration of their support for ongoing efforts to tackle the pandemic shine a diya, or candle, or a torchlight from their darkened homes and balconies. There appears to have been very little thought paid to the fact that this nation-wide darkening of homes could result in a grid collapse, and a possible blackout, and that this could potentially jeopardise lives of thousands relying on continuous electricity supply, especially those in critical care.

Pandemic, not politics

But such complexities have hardly been of concern to Modi. His way is to be sparing with the truth but high on hyperbole. His solutions for resolving complex problems are simple and sometimes even simplistic. But his ability to communicate in ways that is accessible to a majority of the population, relying on entreaties of sacrifice for the greater common good proclaimed as fundamentally transformative, is what Modi has done in all his speeches. He did this with demonetisation and in introducing GST, both reforms undertaken without any planning or preparation. Expectedly they have had devastating consequences on the Indian economy and on millions of lives and livelihoods.

To his advantage has been the weak and fragmented Opposition, a largely compromised media and uncritical corporates -- factors that have enabled him to carry on with a form of governance that is didactic and unapologetically explicit in promotion of majoritarian politics based on divisiveness. Such political methods have worked wonders in normative politics, indicated by the thumping majority he gained in the last general elections. Employing which he abrogated Article 370 and then enacted the highly divisive and sectarian Citizenship (Amendment) Act 2019 disregarding nation-wide protests.

The question is, can such methods work in tackling the pandemic? For dealing with a virus demands a rational approach, which is at once nuanced and scalable. With the exception of Kerala, which prepared well in advance and graded its lockdown, thus arresting the spread of the disease, the rest of the country has been caught rather unprepared. Reliance was heavy on guidance from the Centre, which has largely been reactive, down to writing manuals on how to make masks well after the lockdown was in place. A number of circulars issued by the Ministry of Health and Home Affairs, clarifying various normative aspects of lockdowns on public health grounds, is most revealing of the utter state of disaster unpreparedness.

Swallowing pride and comfort at the sudden erosion of fundamental freedoms and dignity, and dealing with a variety of police excesses, even brutality, people are still faithfully following Modis ways in dealing with the pandemic. While one hopes steps taken thus far will pay off, and that the lockdown will end as scheduled, given the woefully underprepared state of Indias health sector and extension of relief measures, the next two weeks are promising to be exceedingly long and excruciating. Every State would do their people a lot of good if they would develop a range of scenarios and be prepared in every manner necessary to deal with the worst-case scenario, i.e., massive spread in infection, high rates of morbidity and also high death rates. It is of utmost necessity that preventive, curative and relief operations are organised ground up so none is left to suffer without care, and due to lack of food, shelter and security.

This situation, in many ways, is the direct outcome of Modis style of functioning -- centralised, didactic and disempowering. While such methods may have been useful in dealing with the usual adversarial political situations, it is highly unlikely to be of any use in dealing with a viral pandemic. There is no Opposition to bait here, no legacy to attack. If mishandled, people will suffer, and millions will die. The political comfort one can draw from the fact that this is a global pandemic and so one must grin and bear, or that it has not impacted India as much as it has the rest of the world, are positions unlikely to weigh in Modis favour.

Already, news of frontline sanitary, health and police personnel getting infected due to inadequate provisioning of Personal Protective Equipment is filtering in. This is a very disturbing indicator, and does not help build public confidence in the response strategy. Instead of focusing on such crises, the narrative appears to have been deliberately shifted to communalising and criminalising victims of a disease outbreak. Such methods will only spread more fear of the disease and force massive suppression of infections, a nightmarish situation that must be avoided in dealing with a pandemic.

It is high time, therefore, that those in the Centre and state governments who really care about getting India on the right track in dealing with the pandemic, immediately focus attention on drawing from deep and extensive experiences of public health and environmental health experts in the country, and step up efforts to win the trust and build public confidence in the governments efforts. It is that collective spirit that can and will help India survive this pandemic, in bringing down the extent of suffering and much-feared socio-economic collapse.

(Leo F Saldanha works on environmental and social justice, and governance concerns through the non-profit, Environment Support Group)

The views expressed above are the authors own. They do not necessarily reflect the views of DH.

Read the original post:

Has Narendra Modi lost the plot in tackling the coronavirus pandemic? - Deccan Herald

People, mostly apparel workers, headed for Dhaka crowd at a place at Uthali in Manikganj on Saturday amidst a public holiday aimed at staving off the novel coronavirus threat. New Age

I feel compelled, I feel obliged to share the insufferable experience of two friends from the past weeks the lived experience of fear of the novel coronavirus that changed their lives. One of them is an organiser of womens movement and the other is an organiser of workers movement in the apparel industrial sector. One of them is in hospital with COVID-19-like symptoms and the other is homebound with critical heart disease. Both are my dear ones. Their experiences are haunting me like trauma. However, it is important to share a few words about the current situation of apparel workers and the COVID-19 outbreak in Bangladesh before I move on to their stories.

I

LOCALLY and globally, the COVID-19 pandemic is taking a new turn every day, alongside escalating fear and uncertainty. It is signalling an economic recession and severe health insecurity. The total death toll of the pandemic has crossed over 64 thousand. On International Womens Day 2020 (March 8), the first case of COVID-19 was confirmed in Bangladesh. Since then, as of April 4, 70 are infected and eight people are dead. Developed countries in Europe and America are struggling to contain the spread of the virus.

Bangladesh, from the very beginning, has been rather laid back in responding to the crisis. From government announcements, it appeared as if nothing serious would happen. The national plan to prevent the spread of the virus including the declaration of a general holiday was rather sudden. Then began the panic buying middle-high income groups begun stockpiling three to six months worth of food supply. All educational institutions closed, government and non-government offices suspended their business activities. Ever crowded Dhaka slowly became deserted, rural areas also became desolate. The military took to the street along with the police. New forms of societal and state harassment begun. People with COVID-19-like symptoms and their families are harassed by neighbours, burials of COVID-19 victims are obstructed, workers are beaten by the police in the name of teaching social distancing and government officials are humiliating people by making them do sit-ups holding their ears for violating government directives on coronavirus prevention.

The national economy is also affected. The president of Bangladesh Garment Manufacturers and Exporters Association in a video message called the European and American retailers to reconsider the large number of orders they cancelled and suspended so far. Labour organisations demanded that industrial owners, the government and global buyers take the responsibility of the 41 lakhs workers health safety and announce paid leave during the outbreak. Still, in the prime ministers national address on March 25, no declaration came on the question of shutting down the production line. But, an announcement came of a stimulus package of Tk 5,000 crore for export oriented industries. The following day, the president of BGMEA, instead of announcing the factories closed, personally requested owners to consider temporary factory closure. The president of Bangladesh Knitwear Manufacturers and Exporters Association also made similar requests. This is how began the phase of killing time. Workers feared the contagion. They became anxious about losing jobs and their struggle for economic survival. Some factories were closed at owners will. In some places, when workers refused to work, factories were closed. This is how the ploy of keeping the factories close and open continued. And the work order cancellation by international retailers may cost the apparel sector about $3 billion.

A research of the Workers Rights Consortium shows that 10 lakh worker may lose job in the near future. Many workers are already losing job. Meanwhile, the government has extended the public holiday from April 4 to April 11. The president of the BGMEA, referring to the government, has said that factories can be opened on the conditions that the health rules are followed. In fear of losing jobs, on April 4, thousands of workers began walking to their workplaces from distant districts. On the way to work, two apparel workers were killed in a road accident in Mymensingh. This inhuman scenario shocked the nation. In the face of fierce criticism, later at night on April 4, leaders of the BGMEA and the BKMEA requested to keep the factory closed, but it was already too late.

Questions arise, who benefited from this ploy of killing time? Isnt it absolutely irresponsible that the government and the factory owners brought the workers back to factories disregarding their health safety concerns? What is the real reason behind the supposed disunity between industrial owners? Why has the prime minister remained silent on workers health issue? Why has the attention been diverted to the prime ministers address or to the BGMEAs announcement? Is it to complete pending orders, to keep the production line open? Why havent they thought of making personal protection equipment before? Why have the local and international media including the New York Times and the BGMEA been lamenting the loss that Primark, Zara and H&M incurred or may incur during this pandemic? Workers sweat and hard work brought fortune for the global buyers and local owners, and helped the country to earn 84 per cent of its export earnings. These workers are the primary capital of our national economy, of buyers and industry owners. Why such negligence towards their lives? If their health and livelihood are not protected, can the industry survive?

We could have made a historically unprecedented example by ensuring workers health security through creating an emergency fund from a share of the profit from global buyers and local industry owners, financial assistance from the government and other sources. If necessary, the government could have taken the lead in this regard. Not just because of humanity and ethics, but in the interest of industry and national economy, all three parties benefitting from this sector could have taken up a special plan to protect these workers. In this way, despite the predicted economic recession, the industry could have better managed its finances in the long run. Sadly, in our socio-economic system, it is normal that such possibilities are not considered. Instead, we are witnessing a decline in social empathy and solidarity. Society is teaching us, in this time of crisis, to selfishly stay safe, alone.

II

LETS return to the stories of my friends. I will begin with labour organiser Aminul Islam Shamas (36) story. He is a known face in industrial areas as the organising secretary of Garments Workers Solidarity. Nine years ago, because of his illness he had to leave the factories. In a complicated surgery, two of his heart-valves were replaced. Many physicians refused to do the surgery, but in 2011, Dr Prashanta Kumar Chanda of National Heart Foundation Hospital had agreed to do the surgery. Now, his valves are not functioning properly leading to breathing difficulty, cough and accumulation of water in the lungs.

Every day of the past two weeks was passed by worrying about Shamas future. On March 15, around midnight, Julhas Nayeen and I took him to the NHFH as he was having serious breathing difficulty. Physicians there told us that he has congestive heart failure. He needs immediate replacement of heart-valves. There is not enough time in hand, but there is no seat available to admit him. We need to take him somewhere there is an Intensive Care Unit or to the heart institute. By then the fear of the coronavirus has gripped the city.

After visiting another private hospital, at last, around 2:30am, we were able to admit him to the National Heart Institute. The institute had no seat in their PCCU. Shama was accommodated on a mattress laid on the floor by the bathroom. Shamas breathing difficulty intensified, he begun to vomit. The ward was already overcrowded. We started to worry. What if he catches the virus in this unsafe hospital environment? We waited until 2:00pm the next day to get him a seat. But then, to avoid the crowd, we took him to Dhaka Community Hospital at our own risk. Physicians there tried to improve his heart condition and address his breathing difficulty.

Fear has heightened at hospitals. Some hospital authorities were making announcement on PA system urging attendants to leave. A day later, they arranged for hand washing and sanitising dispenser at the entrance of the DCH. Because of Shamas condition, he needed to be in the hospital, and he urgently needed a second surgery. On the other hand, there is the risk of being infected. At DCH, number of patients begun to decline. Our fear of the virus intensified. Amid confusion and fear, instead of taking Shama to the NHFH, he was sent back to his rented home in Ashulia on March 20. We thought, in the current situation, home is the relatively safer option for him.

A few days later, Shama came to see cardiac medicine specialist, Mir Ishrakuzzaman at the NHFH. That is when we realised that the entire health system is on the verge of collapse. Security guards prevented us from entering the premise. No physician would see outdoor patients. With the help of a friend, Dr Anika Nawar, we finally managed to find the doctor. He tried to comfort Shama, gave him courage. We felt really lucky. There were not that many outdoor patients. Patients were not attended to outside of the emergency. Security guards were extra alert. The hospital authority couldnt even think of admitting new patients, let alone doing surgery. The situation appeared as if the ICU and the emergency ward may also face lockdown and the majority of the doctors will go on leave. Later, we heard, except for the emergency unit, the NHFH is under lockdown.

In this trying time, Dr Prashanta Kumar Chanda, Dr Mir Ishrakuzzaman, Dr Anika Nawar of the NHFH, Dr. Haun-ur-Rashid of Dhaka Community Hospital, Dr. Sayema Sadia in Chattogram helped in so many ways. We are immensely grateful to them. Shama and I spoke to Dr Prashanta this week. He gave us courage. We talked about the preparation for an impending surgery. But, waiting is all we could do now. Some physicians gave us hope, but some didnt want to see him again. It is because the majority of physicians are left unprotected in this time of a pandemic. There is fear, and it is justified. It is not easy to fight an invisible virus. Without access to PPE, any physician could get infected. They could spread the infection to others. Dr Abdul Wadud Chowdhury is an example. After treating a patient in Tolarbagh, he had to stay in self-isolation for 14 days with COVID-19-like symptoms.

III

NOW, the story of Mina (45), an organiser of womens movement. She is also a patient suspected of being infected with COVID-19. Since March 26, she has been admitted in a hospital designated for coronavirus treatment in Dhaka. The report of her COVID-19 test has not arrived yet, so she has been treated for pneumonia. Mina works for a private organisation with a meagre salary. Her husband is a small entrepreneur. With two of their incomes they barely manage their household. Their two daughters are students. I am left with no choice but to introduce her with a pseudonym Mina. I did so to prevent any further harassment and humiliation of her family.

On March 25, her husband Apu (pseudonym) left home with a critically ill Mina to see if he could get her admitted to a hospital. The harrowing experience of the next 13 hours, visiting from one hospital to another, 11 to be exact, is something he will never forget. We must know the backstory of Mina and Apu, or else we will not know the grave crisis that is awaiting us.

Mina has preexisting chronic condition of high blood pressure, diabetes and asthma. In past weeks, she has also developed cough, breathing difficulty and fever. In a CNG, Apu took the critically ill Mina to a nearby clinic. There they told him to take her to BIRDEM since she has high diabetics (sugar level 31). In BIRDEM, they saw it was rather deserted. Instead of treating the patient, they sent her to Dhaka Medical College Hospital.

Once arrived at DMCH, a chill went down Apus spine. As if they had arrived at a haunted place, there was no sign of the familiar hustle and bustle. In my 52 years, never have I witnessed such silence in DMCH. After buying a ticket from the emergency, they went to the ward number 512 on the 5th floor. There was not even a single patient. Just one physician and a few nurses. They provided Mina with oxygen support and nebulised her before doing an X-ray and ECG. After viewing the test reports, the physician said, Mina has excess fluid in her lung, and she is a suspected COVID-19 patient. As the DMCH does not have treatment for her, they must go to a designated hospital for treatment.

Apu took her to another hospital near their house before going to the designated hospital. There, he learnt, it will take 45 days to start treatment. Helpless, as it is, he took her to the hospital where she is now admitted. This time they were able to manage an ambulance. In the first attempt, the hospital authority said, Minas condition require ICU treatment, she should be transferred to a hospital with ICU facility. By then, the family has already visited five hospitals. The run from hospital to hospital begun, again. Mina was in an ambulance with oxygen support. They went to a hospital in Sayedabad, but they did not take her. The ambulance driver recommended a hospital in Shanir Akhra. After two hours and an X-ray, they said, For the sake of other patient, they cannot keep her there, Mina is a suspected [of corona] patient, and she needs to be taken elsewhere.

It was past midnight by then. Apu desperately took her to the IEDCR. They told him that tests are done only between 10:00am and 5:00pm. For the second time, they went to the designated hospital, and this time around, they said, Mina is a cardiac patient. They should go to the heart foundation hospital. So, they went to the NHFH. At the heart foundation emergency unit, after an ECG, they said, Heart is fine and wrote, suspected corona, immediate admission. Then, for the third time, they went back to the designated hospital. It is only after doing 11 rounds in different hospitals they were able to earn the sympathy of the physicians there. They finally admitted Mina. Apu asked, If they were going to admit her in the end, why refuse her so many times? Why such harassments? No response.

Momentarily, her family was relieved. Finally, they were able to get her admitted to a hospital. The elder daughter is staying with her mother as attendant. Physician comes once a day. But they do so from a distance, hesitate to come close. Nurses leave medicine and food by the door. Apu visits every day. From a three 9 feet distance, leaves food for their daughter, even managed a PPE for her. Minas family is still grateful to the physicians and nurses.

A day after the admission of Mina to the hospital, her family was socially harassed. The Facebook posts of Minas concerned friends come to the notice of her neighbours. By the next morning, 8am to be precise, they received eviction notice. Apu and Minas daughters got anxious. Where are they going to go? What will they manage, hospital or the landlord? A few friends spoke to the landlord and managed to stop the eviction notice. They were allowed to stay on the condition that they will follow the rules. When all these were going on, one of the nights, the designated hospital was out of syringe for insulin. They couldnt get it to Mina, even after trying for hours. This is how it is. Eight days have passed but the result of the COVID-19 test still has not arrived.

The insufferable experiences of Mina and Shama tell us that the country is awaiting a serious crisis. I know of many physicians who will work tirelessly to help patients like Mina and Shama. Until and unless, physicians and hospitals are supported with proper protection from the contagion individual commitment will not do much. Many will discourage patients needing urgent care. Stating different flimsy excuses such as, seats are there, cant admit patients, physicians are on leave, or patient will not suffer much in this condition, they will signal us their limitations. Perhaps, Shama will be able to gain some access using her organisational contacts. But, as we wait for his operation, will he be able to survive only on medication? Will he get a chance to do the second surgery? Shama or his physician, will they be able to get out of their home to reach hospital? If Mina is tested positive, what will happen to her nurse and physician? Will they go even further away? What will her neighbours do? We are all walking towards an extremely uncertain future.

A deafening siren is ringing. It is reminding us, no matter how many times we say the words like health security, nutrition, warning home quarantine, hygiene, these words only make meaning for the ruling elite. For the working class, public and private sphere are equally unsafe. Still they try their best to stay home for safety. To protect the country, its people and its economy, the government must put in its highest effort. The government must protect people from corona. It must ensure that patients with diseases other than corona are not left to die and more importantly, people are not left to starve. A united effort to tackle this emerging crisis is the demand of the time.

Taslima Akhter is the president of the Garments Workers Solidarity and photographer.

Read more:

Risk of social isolation and greater health crisis - newagebd.net