India is leaving it to karma to deal with Covid-19. Three months after we decided to give battle to the virus, Covid-fatigue has set in, both in government and in our people.

Consider just one day’s headlines. Delhi’s Deputy Chief Minister glumly told us yesterday (9 June) that his city-state will have 550,000 virus-infected people by end-July, given the current doubling rate. That’s twice the total current Covid-19 cases in the country (276,583).

Delhi would need 80,000 beds, as against the 8,575 available now. No doubt innovative methods will be found to house those needing institutional healthcare, but this is not the same as flattening the curve or even about winning the battle against Covid-19. It is about Covid working its way through the population and us getting ready to take it on the chin and move on.

Karnataka has gotten off its high horse, too. With cases piling up (5,921 as at the end of 9 June), and with the state’s last Covid-free district (Chamarajanagar) now reporting its first case, the state has now decided against testing those who may have died before being diagnosed. And Health Minister B Sriramulu has said that institutional quarantine is only for the poor, those who can’t afford it. The rest can stay in hotels at their own cost, or quarantine themselves at home.

This is a sharp turnaround from just over 10 days ago, when the state wanted anyone arriving from high-Covid zones to be subjected to seven days of institutional quarantine.

Also, this comes when the state’s war-room has noted over 13,000 breaches of home quarantine rules by those who entered the state after the lockdown was eased. Clearly, it is impossible to police such large numbers.

Mumbai, we are told, is “winning” the battle against Covid, with the doubling rate now at 23 days compared to 11 days two weeks ago. Don’t be too sure. This only implies that the state is hoping god or some sense of self-preservation among the people themselves will help them win the war that the state botched up so completely.

If Delhi is expecting 550,000 infections by July-end (against 31,309 now), to expect more congested Mumbai, whose Covid score has crossed 50,000, to do much better by then is a tough ask. Unless the karmic cycle turns in its favour.

The Supreme Court has bunged another spanner in the works by ordering the return of all migrants in 15 days – just when builders and services companies are seeing a spurt in demand for workers at the end of the lockdown in many states. The migrants returning home will surely spread the infections, and currently low Covid states will become the new standard-bearers of the infection.

Those are just some of the main headlines from today’s newspapers, and if you look hard enough, there will be many more indications that India – even though it manfully struggles to up its medical infrastructure for the challenges ahead – is essentially picking livelihoods over lives.

All over, whether you are in government or in the business sector or just part of the millions who go under the label aam aadmi, Covid fatigue has set in. India is ready to live with it, just as it has learned to live with tuberculosis, diabetes, heart disease, and many other diseases that come and go with metronomic regularity depending on the season.

It was always an impossible task for a country with 1.38 billion people, most of them young, restless and with a limited income earning potential, to lock them down and impose discipline from above.

Also, most of the precautionary advice is relevant only for the middle classes and above. This means, more than one billion people cannot follow basic precautions like wearing masks in public all the time, washing their hands frequently, or maintain social distance in cities.

Just think: how likely is it that outside middle class and rich homes that the poor will wash hands regularly in a water-scarce country? Or will they even wear masks when doing manual work, which is what the millions of migrants come to cities for? It is nearly impossible to do prolonged manual work wearing a mask. As for social distancing, it is a joke.

In crowded Mumbai, even the middle classes cannot maintain social distance in their own homes. And we want over a billion people to maintain this kind of tough discipline for months on end, including during commutes to work.

It is best to now throw the challenge back to the people. Three things can be done.

One, the Prime Minister and all chief ministers must dehype Covid. They should tell the public, and commercial establishments, that the job of policing reasonable compliance with safety regulations is now theirs. Communities must do the enforcement themselves. At best, the state will be ready to help when asked.

Two, once infections run into millions rather than mere thousands and lakhs, we need to use the existing healthcare resources only to focus on the most needy; soon we will also have to deal with a moral dilemma, on whether to use the limited number of beds to help the young survive or to make beds available to older people who have already enjoyed a reasonable span of life. It may also be cheaper to help the young than the old with co-morbidities.

Clearly, we must have clear protocols on the choices to be made when hospitals face this dilemma.

Three, since most Covid patients will be treated in makeshift hospitals (including football stadiums and empty flats or buildings taken on lease), a robust tele-medicine infrastructure must be put up by all states, so that the limited number of healthcare workers – doctors, nurses and other support staff – can advise and oversee patients through video and tele-medicine apps.

India’s fight against Covid is now largely dependent on how responsible people choose to be, and how effectively governments manage those needing institutionalised medical care with the limited resources available.

Karmically speaking, it’s all upto our own karma and god to deal with Covid-19. For the atheist and agnostic, the best hope is the early achievement of herd immunity or an effective vaccine. Neither will happen this year.

Leaving it to karma after doing all that we can possibly do is not such a bad thing. At the very least, it allows us to get on with the rest of our lives. For most people, what may matter is not the length of their lives, but its quality. Lockdowns and draconian measures do not help here.

Institutional Healthcare

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