Wealth in the time of COVID-19

The progress of COVID-19 across India shows a marked difference between its states. While Kerala has received attention for ‘flattening the curve’ there are other states in India that have shown significantly lower cases of infection. The larger among these are Odisha and Assam. Goa recorded infections but has had an impressive recovery rate and zero deaths. At the other end of the spectrum, Maharasthra and Gujarat show a disturbing rise in deaths at the time of writing. Delhi has a large number of cases but a relatively low death rate. What is noticeable in all of this is that the virus is most active in the wealthiest parts of the country. It is clear from this that for a society as a whole wealth is not heath. The relation between wealth and health is mediated by something else. This is the availability of public goods.

A public good does not exclude, and is therefore accessible by all. It need not have physical presence; it could even be a social arrangement for providing universal services. In this sense, the public health infrastructure of a society is a public good. It is accessible to all its members. Clean and sanitised social spaces, made possible by deploying a society’s public health infrastructure, is a good example of a public good. The isolation and quarantining of infected persons implemented by a public health system would be another. In both these cases members of a society benefit from the existence of a public good, which secures their health, without having to pay for it, at least not directly. However, this most agreeable characteristic has implications for public-goods provision. The feature that it does not exclude makes it unlikely that private producers motivated by profit will choose to supply it. Public goods would have to be publicly provided.

Two states in India where the existence of a relatively superior public health infrastructure has made a difference to the containment of Covid-19 are Goa and Kerala. It is notable that while Goa did have infections it did not record a single death. Kerala recorded more deaths, but may have faced a greater challenge as very early on it had travelers returning from the hotspots of the world, namely Wuhan, Italy and the UAE. The public health infrastructure of a society comprises the hospitals and personnel. In a crisis the role of the latter is perhaps more important. ‘Personnel’ stands for more than the doctors. It includes nurses, health assistants, technicians and the sanitation staff. The outcome in Kerala is related to the quality and commitment of its health personnel in the public sector. Experience gained during the Nipah-crisis of 2018, which killed 17 persons, seems to have made a difference too. The system was prepared with its SOPs. Actually, institutional memory is itself a public good.

The response of the public authority to news of the virus was swift in Kerala. It has involved screening, testing, isolation of the infected and contact tracing and quarantining of the latter once tracked down. The role of the police has been significant in contact tracing. The health department is not equipped to do this. Overall the conduct of the police has been exemplary; heavy-handedness evident elsewhere in the country has been avoided with commitment to containing the virus having trumped the temptation to display power. The outcome in Kerala is clearly related to the human development orientation of its public policy, in place for several decades by now. The public health infrastructure is spread widely and is of reasonable quality for primary and secondary care. The state government has been sternly uncompromising in its implementation of restrictions and the lockdown, though it has been dictated by the centre. However, its efforts have borne fruit mainly because of a willingness of the population to self-regulate, noticeable in the voluntary practice of reverse quarantining. The success of a government in overcoming a medical emergency of the kind we are facing in India today requires that the population trusts the government. While difficult to establish, I would contend that the government in Kerala has succeeded in mobilizing trust to a considerable degree. To earn the trust of a people a state must been seen as being efficient and even-handed. Arranging for buses to take home middle-class students but not poor migrant workers from the same state is not a good way to try and build trust. 

States of India harbouring great wealth, such as Maharashtra and Gujarat, continue to record an alarming number of deaths from COVID-19 even after others with less may have succeeded in capping them. In a way the former face challenges that the latter do not, such as the crowded urban spaces where social distancing is not possible. However, a functioning public health infrastructure would still make a difference. On May 2 a 55-year-old man died due to lack of medical care after having been turned away from five hospitals in Mumbai. It has been alleged that this arose from fear that he may be carrying the virus. Most of the hospitals named in this episode are private.