India and Nepal in Covid-19 crisis together

On 5 September, India tallied a record 90,600 new cases of the novel coronavirus in a single day – more than any other country since the pandemic began. India will soon overtake Brazil to have the second-highest caseload after the United States.

India’s National Statistical Office revealed last week that the country’s output between April and June 2020 was 24% lower than in the same period the previous year. This was the first time India had recorded a quarter of negative growth since it began issuing such data publicly in 1996.

No other big economy has by shrunk so much during the pandemic. In the same period, the GDP of the United States fell by just over 9%. What had seemed a dismal economic performance by India in 2019, has been overshadowed by what the pandemic has done. And there is little sign of recovery, both in terms of the economy and a slowdown of the Covid-19 spread.

India’s lockdown in late March at only four hours’ notice was arguably too soon (although some would regard it as prescient) and too unselective. The ban on commercial activity and movement outside the home was nearly total for two months.

India was even less prepared than many. It had fewer than 1 hospital bed per 1,000 people when the epidemic started -- South Korea had more than 16 times as many. Around 140 million people were thrown out of work, and millions of urban workers felt obliged to return home, usually on foot, to their villages where often they were unwelcome.

The only silver lining is that the number of recorded deaths in India due to SARS-CoV-2 infections is lower than expected – the country’s 3.8 million detected cases have given rise to ‘only’ 70,679 as of 5 September. This is low rate by global standards. It is possible that many deaths have gone unreported, but the results of blood serum surveys suggest that, in India’s crowded cities at least, a relatively high proportion of people may have now been infected, survived and have immunity. Antibodies were found in 41% of samples collected in Mumbai in July, and nearly 57% in slum areas. They were also found in 23% of tests in Delhi in June and more than 28% in August.

All this has direct bearing on Nepal, as this paper reported recently. The virus is now spreading in the community in Nepal, and closing the border will not stop transmission. 

The rapid spread of the virus in India and the lockdown had a big impact on millions of Nepalis living and working in India. When they lost their jobs, they felt impelled, like so many of their Indian fellow workers, to return to their villages in April-May.

Nepal imported the virus willy-nilly as the migrants crossed the border and fanned out across the country. As most Nepalis returnees travelled by road or rail, rather than by air, stopping international air travel was largely irrelevant as regards this particular influx.

Attempts to control the border, and quarantine the returnees have proven largely unsuccessful. This is in part because of the lack of resources and/or incompetence of the local authorities (given the very limited federalisation of funds and powers allocated to the new states) and in part because the border between India and Nepal is porous.

The virus therefore was carried to many different parts of the country,  evading effective control at an early stage and ‘seeding’ a number of local outbreaks. The limited capacity of public facilities at the local level to respond effectively to such outbreaks, except by lockdown, has delayed or even prevented proper treatment of those infected and becoming seriously ill. It has also adversely affected local economies, and thus the national economy.

Nepal’s economy has, in any case, but hard hit by the restrictions on international and domestic travel and transport, and by relatively unselective and arguably draconian lockdown measures. These have together devastated certain sectors – notably tourism, transport and the hospitality and entertainment business, and led to a serious increase in unemployment.

Many returning migrant workers will have brought money back with them, which will have helped those families and local communities to which they have returned. Many who came back from India are now going back there because they have run out of savings, and have no jobs in Nepal.

Nearly 80,000 Nepali workers have flown back from the Gulf, Malaysia and other countries. And as those destination countries also try to control the epidemic, the flow of remittances is bound to diminish in the coming months.

After the lifting of the lockdown led to a surge of Covid-19 nationwide, and now Kathmandu Valley, the government re-imposed restrictions in 48 districts out of 77 districts.

The total 45,277 cases remains relatively low in comparison with many other countries of the same size of population. The number of deaths at 280 is also comparatively small. The UK, which has more than double of Nepal’s population, for example, the total number of cases is now roughly 340,000 and the number of recorded deaths at 46,000.

Nepal’s early peak (in April in Nepal) has been followed, first by a decline to a level comparable to the early days of the outbreak (in July in Nepal), and then by a resurgence following a lifting of the lockdown to a point where now the average daily figure for the number of cases tops 1,000.

The omens are not good. The epidemic is clearly not under control, and it is not evident that a total or widespread lockdown is likely to provide anything more than another temporary respite.

The only strategy that is likely to succeed in the medium term is one in which both the basics of maintaining physical distance, wearing masks and washing hands thoroughly are emphasised in all advice and are duly followed by all the population.

A universal test and trace approach also needs to be adopted, combined with a ‘cat and mouse’ (what PM Boris Johnson referred to as ‘whack-a-mole’) strategy of selective lockdown, test and trace in the case of local outbreaks, to ‘hit’ the virus hard when it re-appears.

In the long run, the main hopes are:

Increasing numbers of those infected will recover and gain immunity, creating a sufficient ‘critical mass’ of immune people, to reduce the ‘R’ rate to a minimum

The virus will mutate to become less virulent

Treatments will lead to a significant decline in cases of seriously ill people and numbers dying

A vaccine or vaccines will be available to a majority of the population to raise immunity and reduce the chances of becoming seriously ill.

David Seddon is author of Nepal in Crisis: Growth and Stagnation in the Periphery and The Struggle for Basic Needs in Nepal, Nepal - A State of Poverty, and co-author of The People’s War.