May 06, 2020
NEW DELHI — Like most healthcare workers, my profession puts me at a higher risk of contracting COVID-19. Statistically, however, my risk of acquiring a serious infection is reasonably modest and the probability of dying from it quite low. After all, I practice medicine at a premier hospital in the wealthiest nation on this planet and have access to cutting-edge medical care, was I to develop this infection. It also gives me some comfort to realize that my family has the cushions to ward off any financial hardships, if I were to succumb to this ailment.
I recently came across the news of a man in West Bengal, who allegedly died at the hands of the police when he went to procure milk for his children during the lockdown. He perished, I imagine, uncelebrated for this seemingly selfless act. Being a father myself, I wonder what happened to his children. Countless such tragedies are likely unfolding across the globe, hidden in the available statistics. While it appears that the virus is socially blind, affecting the rich and poor alike, the reality is that the burden of the pandemic and measures to mitigate its effects have fallen heavily on the world's poor.
Although much has been written about differences in individual susceptibility to this infection – age, pre-existing health conditions – relatively little attention has been focused on the economic and societal attributes of a population, which carry major implications on the risk of contracting the infection and or dying during the pandemic.
Emerging data indicates that the disease is disproportionately affecting the disadvantaged and the marginalized. In the US, the working class, Black, Hispanic and immigrant communities have been hit the hardest. Similar patterns have been observed in China and Europe. And there are concerns that the situation will be even more dire in India with its gnawing economic and societal disparities.
Estimates from United Nations reveal that over a billion people worldwide live in the slums, a third of them in India. Almost half of them cohabit with five or more people in a room. It is easy to see how a virulent contagion like COVID-19 will spread in this milieu. The bigger question, really, is what will be the scale of this calamity for India as a whole and for its different sections of society? Familiar faces of people come to my mind when I think of these questions. I think about Renu, who cooks for my 90-year old father back in Delhi, Kasturi, who cleans his apartment, the 14-year old who delivers milk packets in the morning. I worry, "What if?"
Have the Indian policymakers given serious thought to millions of Renus and Kasturis of India? Ignoring their realities and the deep social divisions of India can jeopardize plans and execution for an effective, coordinated response to an outbreak on this scale. Contagion, especially from a virulent respiratory infection, will likely spread easily in these settlements and can seed the rest of the city and beyond.
In a food scarce nation, will it disproportionately affect children, especially of the poor?
In my quest for some answers I came across the works of Doctors Achla and Madhav Marathe (a husband and wife team) and their colleagues at Network Systems Science and Advanced Computing Division at the Biocomplexity Institute at the University of Virginia. Over the past 20 years, they have done stellar work modeling the scale and trajectory of epidemics, including H5N1, H1N1, MERS, Ebola, Zika as well as more recently on the spread of influenza in slums of Delhi.
So, I reached out to Achla Marathe for a phone chat. I peppered her with questions, trying to understand their methodology and gauge the robustness of their projections. She emphasizes that ignoring the attributes of people dwelling in these overcrowded communities and the dynamics of spread of the infection within it significantly underestimates the rapidity and extent of spread of the contagion in the entire population.
I ask, do the current models include "accelerators' of pandemic spread like urban slums? What about the projections for spread in rural India especially in light of the mass migration of workers? It turns out that a major void in available information and data makes reasonable predictions difficult. In other modeling efforts, the plight of the marginalized and their specific attributes have not been taken into consideration. I am unsure if this stems from methodological constraints, paucity of resources to gather essential data elements or a lack of intellectual curiosity.
Regrettably, the world is playing catch-up to the pandemic. In India, the virus was making inroads while its leaders and its administrative machinery were caught up serenading the visiting US president. Physical distancing seems to be the only viable option at this stage in the absence of an effective vaccine or pharmaceutical prophylaxis. Others have rightly pointed out that the concept of social distancing is an anomaly for large sections of the Indian population. And while people of means are able to practice physical distancing, paradoxically large sections of the society are now being hemmed in together.
I brought this up in my conversation with Dr Marathe and ask her how her previous work can inform a more rational response in these circumstances. She agrees that close confinement of large section of the population can be counterproductive and believes that immediate identification, contact tracing and prompt relocation of infected individuals from these settlements make more intuitive sense.
A nationwide lockdown will be a very bitter pill to swallow for many. It is being claimed that the current lockdown will decrease the infection rate by 70 to 80%. It needs to be emphasized that these numbers refer to decreasing risk of COVID-19 infections only. What will be its effect on mortality during these times including death from starvation? How will those with other chronic ailments and non-COVID-19 illness fare during the lockdown? In a food scarce nation, will it disproportionately affect children, especially of the poor? In other words, the net effects of an abrupt countrywide lockdown remain unchartered at this time.
The risk of this pandemic is likely to linger on.
Quarantine and lockdowns are necessary firefighting measures during extreme times. But it may also have catastrophic effects for India's poor majority. The COVID-19 pandemic and the response to it threaten to exacerbate entrenched economic and social disparities.
Keeping India's downtrodden central in policy should be an integral part of a coherent response to the pandemic. Policymakers must devise interventions keeping in mind two important considerations: the susceptibility to infection spread and pre-existing societal and economic vulnerabilities.
While we all hope that immediate threat from this outbreak slows down and the lockdowns are lifted soon, it appears that the risk of this pandemic is likely to linger on. Current projections indicate that it may show multiple peaks like the influenza pandemic of 1918-20, which killed an estimated 12-17 million people in India, the most in the world.
It is likely that COVID-19 will largely be an affliction of lower classes. Or will it be? An insightful study of the 1918 influenza pandemic by Svenn-Erik Mamelund at the Metropolitan University in Oslo points otherwise. The virus of 1918, after all, did not spare the higher-class natives of Europe and North America. While the first wave largely affected the poor and the marginalised, the second wave that followed soon, in historical irony, disproportionately affected the more affluent.
We risk making the same mistakes by ignoring the lessons of the past. I hope this cautionary tale from history will awaken a more compassionate view of the crisis.
Sandeep Kumar is Associate Professor of Neurology at Harvard Medical School.
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Local villagers in western India have been forced to live with a mining waste site on the edge of town. What happens when you wake up one day and the giant mound of industrial waste has imploded?
October 16, 2021
BADI — Last week, when the men and women from the Bharwad community in this small village in western India stepped out for their daily work to herd livestock, they were greeted with a strange sight.
The 20-meter-high small hill that had formed at the open-cast mining dumpsite had suddenly sunk. Unsure of the reason behind the sudden caving-in, they immediately informed other villagers. In no time, word had traveled far, even drawing the attention of environment specialists and activists from outside town.
This mining dumpsite situated less than 500 meters outside of the Badi village in the coastal state of Gujarat has been a matter of serious concern ever since the Gujarat Power Corporation Limited began lignite mining work here in early 2017. The power plant is run by the Power Gujarat State Electricity Corporation Limited, which was previously known as the Bhavnagar Energy Company Ltd.
Vasudev Gohil, a 43-year-old resident of Badi village says that though the dumping site is technically situated outside the village, locals must pass the area on a daily basis.
"We are constantly on tenterhooks and looking for danger signs," he says. Indeed, their state of alert is how the sudden change in the shape of the dumpsite was noticed in the first place.
Can you trust environmental officials?
For someone visiting the place for the first time, the changes may not stand out. "But we have lived all our lives here, we know every little detail of this village. And when a 150-meter-long stretch cave-in by over 25-30 feet, the change can't be overlooked," Gohil adds.
This is not the first time that the dumpsite has worried local residents. Last November, a large part of the flattened part of the dumpsite had developed deep cracks and several flat areas had suddenly got elevated. While the officials had attributed this significant elevation to the high pressure of water in the upper strata of soil in the region, environment experts had pointed to seismic activities. The change is evident even today, nearly a year since it happened.
It could have sunk because of the rain.
After the recent incident, when the villagers raised an alarm and sent a written complaint to the regional Gujarat Pollution Control Board, an official visit to the site was arranged, along with the district administration and the mining department.
The regional pollution board officer Bhavnagar, A.G. Oza, insists the changes "aren't worrisome" and attributes it to the weather.
"The area received heavy rain this time. It is possible that the soil could have sunk in because of the rain," he tells The Wire. The Board, he says, along with the mining department, is now trying to assess if the caving-in had any impact on the ground surface.
"We visited the site as soon as a complaint was made. Samples have already been sent to the laboratory and we will have a clear idea only once the reports are made available," Oza adds.
Women from the Surkha village have to travel several kilometers to find potable water
A questionable claim
That the dumpsite had sunk in was noticeable for at least three days between October 1 and 3, but Rohit Prajapati of an environmental watchdog group Paryavaran Suraksha Samiti, noted that it was not the first time.
"This is the third time in four years that something so strange is happening. It is a disaster in the making and the authorities ought to examine the root cause of the problem," Prajapati says, adding that the department has repeatedly failed to properly address the issue.
He also contests the GPCB's claim that excess rain could lead to something so drastic. "Then why was similar impact not seen on other dumping sites in the region? One cannot arrive at conclusions for geological changes without a deeper study of them," he says. "It can have deadly implications."
Living in pollution
The villagers have also accused the GPCB of overlooking their complaint of water pollution which has rendered a large part of the land, most importantly, the gauchar or grazing land, useless.
"In the absence of a wall or a barrier, the pollutant has freely mixed with the water bodies here and has slowly started polluting both our soil and water," complains 23- year-old Nikul Kantharia.
He says ever since the mining project took off in the region, he, like most other villagers has been forced to take his livestock farther away to graze. "Nothing grows on the grazing land anymore and the grass closer to the dumpsite makes our cattle ill," Kantharia claims.
The mining work should have been stopped long ago
Prajapati and Bharat Jambucha, a well-known environmental activist and proponent of organic farming from the region, both point to blatant violations of environmental laws in the execution of mining work, with at least 12 violations cited by local officials. "But nothing happened after that. Mining work has continued without any hassles," Jambucha says. Among some glaring violations include the absence of a boundary wall around the dumping site and proper disposal of mining effluents.
The mining work has also continued without a most basic requirement – effluent treatment plant and sewage treatment plant at the mining site, Prajapati points out. "The mining work should have been stopped long ago. And the company should have been levied a heavy fine. But no such thing happened," he adds.
In some villages, the groundwater level has depleted over the past few years and villagers attribute it to the mining project. Women from Surkha village travel several kilometers outside for potable water. "This is new. Until five years ago, we had some water in the village and did not have to lug water every day," says Shilaben Kantharia.
The mine has affected the landscape around the villages
Resisting lignite mining
The lignite mining project has a long history of resistance. Agricultural land, along with grazing land were acquired from the cluster of 12 adjoining villages in the coastal Ghogha taluka between 1994 and 1997. The locals estimate that villagers here lost anything between 40-100% of their land to the project. "We were paid a standard Rs 40,000 per bigha," Narendra, a local photographer, says.
The money, Narendra says, felt decent in 1994 but for those who had been dependent on this land, the years to come proved very challenging. "Several villagers have now taken a small patch of land in the neighboring villages on lease and are cultivating cotton and groundnut there," Narendra says.
They were dependent on others' land for work.
Bharat Jambucha says things get further complicated for the communities which were historically landless. "Most families belonging to the Dalit or other marginalized populations in the region never owned any land. They were dependent on others' land for work. Once villagers lost their land to the project, the landless were pushed out of the village," he adds. His organization, Prakrutik Kheti Juth, has been at the forefront, fighting for the rights of the villages affected in the lignite mining project.
In 2017, when the mining project finally took off, villagers from across 12 villages protested. The demonstration was disrupted after police used force and beat many protesters. More than 350 of them were booked for rioting.
The villagers, however, did not give up. Protests and hunger strikes have continued from time to time. A few villagers even sent a letter to the President of India threatening that they would commit suicide if the government did not return their land.
"We let them have our land for over 20 years," says Gohil.
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