BY REENA SHAH
Volunteers across India, many of whom have lost multiple loved ones during a COVID crisis that had officially taken over 287,000 lives in the country as of mid-May and unofficially many more, are getting little sleep. Day and night, they are responding to desperate pleas for help, calling and visiting hospitals to find beds, arranging for oxygen cylinders and food deliveries, tracking down medicines, and in some cases organizing cremations and collecting ashes when family members are too grief-stricken, or too sick, to do so.
Yet even as they’re praised for their work, many face government backlash for drawing attention to the country’s fractured health care system and lack of preparation. Shruti Chaturvedi, a 28-year-old entrepreneur in Goa, began volunteering in mid-April through her vast social media network. For weeks, she and others appealed to officials for COVID-related information. There was no help line set up, scant communication on government websites, and no way to offer support for the relief effort. In early May, Chaturvedi, along with activist Armando Gonsalves, successfully petitioned the state’s high courts to demand that the Goa government, led by the right-wing BJP party of Prime Minister Narendra Modi, provide transparency on bed availability, impose a statewide lockdown, and require a negative RT-PCR test to enter Goa.
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Of the dozens of volunteers in Chaturvedi’s group, she was the only one who felt comfortable formally bringing the petition to the courts. “People were afraid to put their names on something like that. I had to convince the group that I put together that I’m going as a private citizen and that this wouldn’t affect them,” says Chaturvedi.
Chaturvedi made sure to praise Chief Minister Pramod Sawant on Twitter for following through on the PCR test requirement. But she says that the state has mismanaged its COVID response. Goa experienced a massive tourism boom earlier this year, with lax health precautions. Test positivity went from 5 percent in March to nearly 50 percent in May, one of the highest in the country.
On the night of May 12, Chaturvedi got a text about an oxygen shortage at Goa’s largest COVID hospital. Patients were dying between the hours of 2 and 6 a.m. as supplies fluctuated. As of May 16, dozens of patients have died overnight, allegedly due to lack of oxygen related to a central pipeline issue. Government and hospital officials have been reluctant to attribute deaths to oxygen shortages, as a committee has been set up to investigate the problem.
“Suppressing criticism, long a BJP tactic, has intensified during the COVID crisis.”
Meanwhile, Chaturvedi and others are securing oxygen cylinders and continuing to push for government accountability. “I am sleeping three to four hours a night. We are figuring out simple solutions and wondering why the government could not do this. I wish I didn’t have to do this. Some days I was getting 150 to 200 calls a day asking for help.”
Government supporters are now targeting Chaturvedi, with websites and social media accounts dedicated to attacking her. Chaturvedi, who says she is careful not to leave her address on any website, describes the intent as to scare her and others in her volunteer group from speaking out. “I can afford to speak out. I have supportive friends and family, but not everyone has that. In India it’s become criminal to say that the government is doing something wrong or to suggest the right way to do it.”
Such tactics appear to be working. In Lucknow, a sprawling city in Uttar Pradesh (UP), India’s most populous state, volunteers asked to remain anonymous for fear of government reprisal. “We have heard of a person being arrested from our network for posting about oxygen online,” said one. Other volunteer networks across the country have scaled back outreach and taken down resource databases they’ve compiled over the last month. At least one, Citizens’ Aid Collective, has shut down all of their WhatsApp groups. A farewell statement read, “On one hand we are facing major roadblocks in helping people due to scarcity & even non-availability of resources, and on the other there are indications that such groups can be targeted. Your safety is our utmost concern.”
“More Positivity, Less Criticism”
Suppressing criticism, long a BJP tactic, has intensified during the COVID crisis. On April 25, UP’s Chief Minister Yogi Adityanath, a staunch member of the BJP, called for sedition charges to address “rumors” about oxygen shortages posted on social media. In April, Twitter and Facebook temporarily took down posts criticizing the prime minister’s handling of the pandemic at the request of the government. On May 15, at least a dozen people were arrested in Delhi for putting up opposition party posters that asked, “Modiji, why did you send our children’s vaccines abroad?”
Government supporters say these moves are intended to crack down on a growing and dangerous black market peddling oxygen cylinders and the antiviral drug remdesivir. But alongside arrests for fraudulent supplies, cases are being filed against people who scrutinize the government, especially those who do so in the press or on social media.
“The intense focus on narrative is hamstringing the country’s COVID response.”
Narendra Modi and the BJP have won numerous electoral victories using savvy social media and advertising strategies that influence, if not demand, favorable coverage. Now, facing broad criticisms of mismanagement and complacency, the ruling party has doubled down on image management. On April 30, during a virtual meeting with Indian diplomats around the world to talk about mobilizing aid, the country’s external affairs minister spent much of the meeting focusing on quelling “negative” international media coverage. On May 5, the administration held a workshop for hundreds of central-government employees about how to push positive images about the government’s response.
The intense focus on narrative is hamstringing the country’s COVID response. Meenakshi Ganguly, South Asia director of Human Rights Watch, stated in an email, “The crisis is massive now, with scores of unclaimed bodies turning up in rural India. This is not the time for blind loyalty. This is the time to act in an informed manner, which means recognizing that denying or hiding the truth will only cause suffering to millions.”
Scientists are deeply concerned about underreporting of cases and deaths in areas where testing and awareness about the virus are low. Journalists and medical experts have documented widespread inconsistencies in labeling deaths as COVID, as well as discrepancies between official and reported death counts.
Yet, despite the surge and limited testing infrastructure, the WHO’s latest weekly situation report shows that India continues to labels itself as a country with “clusters of cases,” as opposed to the more serious designation of “community transmission.” The less urgent classification is in line with the government’s triumphalist tone toward the pandemic earlier this year. In a Davos summit speech in January, Modi declared, “India has been successful in saving so many lives, we saved the entire humanity from a big tragedy,” a statement that has become a scathing meme for critics both within India and abroad.
In May, the BJP tweeted a response to mounting criticism, including a list of 12 points labeled “Narrative,” with corresponding statements labeled as “Truth.” For example: “On March 17 2021, at a COVID review meeting with CMs [state chief ministers], PM Modi alerted states about a second wave coming and asked them to take quick steps before it gets too late. This was when India still only had 30,000 cases per day!”
But Modi’s statements during the meeting seemed to contradict his actions. While he warned states about “overconfidence,” he and other BJP officials were holding numerous political rallies ahead of state elections in West Bengal and Assam. On April 17, at a largely unmasked rally, Modi declared, “Wherever I see, I just see people.” By then, the country was recording over 250,000 cases a day. A rally scheduled for April 23 was canceled on the 22nd.
Some defenders of the government say that the international media is obsessed with portraying negative news and that what is needed is “more positivity.” Shakti Singh, a volunteer working to spread vaccination registration and awareness in his village in rural Uttar Pradesh, says that too many people, particularly in the opposition, are blaming the government instead of helping. “The problem here is it is easier to blame the government for anything than take responsibility themselves. No one saw this COVID wave coming. Any government would have struggled with such a population.”
Early Warning Signs, Long-Term Consequences
Reports suggest that the Indian government failed to respond to troubling data earlier in the year. As cases inched upward in February and March in the state of Maharashtra, India’s COVID task force didn’t meet, despite concerns among several members. Around the same time, Rukmini S, a data journalist in Chennai, pointed out that results from national sero surveys conducted in the fall suggested high rates of antibodies in densely populated cities hit hard in the first wave, like Pune and Mumbai. Yet cases there were still rising dramatically.
In addition, India’s genomic sequencing to detect the prevalence of new variants, including B.1.167 that is now threatening to become the dominant variant in the U.K., was far behind other countries with large case numbers. “There hasn’t been a culture of transparency here now for a while,” says Rukmini. “Any data that sets up the government for criticism is often suppressed. And there’s not enough pushback to change this.”
The health ministry’s updated COVID treatment guidelines still include ivermectin, a broad-spectrum anti-parasitic, to treat mild COVID cases, despite the WHO advising against it except in clinical trials. Several states are actively pushing the drug as a prophylactic, with Goa’s health minister announcing that all adults ages 18 and over will be given the drug as a preventative measure. And a new drug, 2-deoxy-d-glucose, has just been approved for emergency use despite scant evidence of efficacy.
In August 2020, Rukmini noticed alarming trends in India’s public-health database, the National Health Mission’s Health Management Information System. During the most stringent period of India’s countrywide COVID lockdown from April to June, the rates of maternal-health screenings, immunizations, and outpatient treatment for serious diseases were all frighteningly low. Rukmini reported that these trends could set back public health in India for years, if not decades. “After I wrote about it, the database went offline,” Rukmini says. “And it still hasn’t returned. It’s such a routine system of public-health data.”
Public-health experts warn that the confusing, irrational, and often contradictory guidance during the pandemic will have long-term effects on India’s overall health. “We have the ability to do good science and good public health, and we need to stick to that,” says Sonali Vaid, a public-health expert and physician based in Delhi who has been volunteering throughout the pandemic, with a focus on supporting health care workers. “There’s no prevention for COVID apart from vaccines and public-health measures.”
Fatal Political Fallout?
Anger toward Modi and the BJP is at an unprecedented high, with rebukes coming even from within the party and its urban, middle-class base. Milan Vaishnav, director of the South Asia program at the Carnegie Endowment for International Peace, notes that while past policies faced pushback, this time, “the level of outrage we are hearing and feeling and seeing is unlike anything we have seen in seven years.”
Yet, the five-state election results from May 1 display the complexity of Indian politics. Modi and the BJP campaigned heavily in West Bengal only to lose significantly there. But in the northeastern state of Assam, the BJP expanded control. And in Kerala, the Left Democratic Front (LDF) routed Congress, the national opposition party. The elections happened just as COVID cases began to surge, making it difficult to ascertain how the pandemic affected voters. Instead, regional issues and identities gained strength at the ballot box.
“There are many micro factors at play,” says Vaishnav. “You can go to one region of a state and then get a completely different narrative just a couple kilometers away.”
National elections will not be held until 2024, but upcoming assembly elections in UP, a BJP stronghold, may act as a bellwether. In April, village council elections, known as panchayats, were allowed to take place, a massive undertaking that involved over a million candidates for about 800,000 posts. According to the state’s teachers union, more than 1,000 teachers who had to serve at polling stations have died due to COVID, a claim that the UP government has dismissed. Initial results show signs of wavering support for the BJP as independent candidates, some dying before being able to take office, saw the biggest victories.
Anger toward Modi and the BJP is at an unprecedented high, with rebukes coming even from within the party.
But Modi and the BJP have time on their side. “Three years in politics is an eternity and if we know anything, it’s that Modi is good at shifting narratives,” says Vaishnav. There’s also division among Modi’s opposition, Vaishnav explains. “There’s just no one on the horizon that you can point to and say that people are going to coalesce around.”
Could health care infrastructure become a unifying issue the way religious ideology did in 2014? India’s health care spending is woefully low, hovering at between 1 and 3 percent since independence. Kafeel Khan, a pediatrician and health care activist, says that it’s wrong to say that India’s health care system collapsed during the pandemic: “COVID-19 has exposed our collapsed health care system.” In 2017, Khan was a junior doctor at a public hospital in Gorakhpur, UP, when oxygen supplies were suddenly cut, allegedly because the state government had failed to pay mounting bills, a charge the government denies. While Khan frantically tried to obtain cylinders, 70 children died, and he was held responsible for negligence. Jailed for over a year, Khan was released on bail in April 2019. No proof of negligence was ever found.
Since then, Khan has been outspoken about the dismal state of India’s health care infrastructure, as well as government policies like the Citizen Amendment Act and National Register of Citizens that critics say unfairly target Muslim minorities. In the last three years, he’s been jailed three times for a total of 500 days, though courts have cleared him of charges each time.
Watching India’s acute shortage of oxygen supply in early May, Khan says, “It’s like déjà vu for me.” Since 2018, he has set up medical camps in disaster-stricken areas across India and is now providing COVID education, masks, pulse oximeters, and food rations in areas with little to no health care infrastructure, in collaboration with Progressive Medicos and Scientists Forum.
Many of the people Khan encounters at medical camps want basic services from the government, like education, decent jobs, and health care. Still, Khan is skeptical about real political change. “I won’t blame it on one party. They all play with religion, region, caste, social status, the same as in the United States. Elections, unfortunately, are fought on the basis of these issues. And in the process the common person suffers.”
This story was first appeared on prospect.org