This is the second piece in a series titled “The Rural Front Line,” by Yogesh Jain and Naman Shah, about the COVID-19 pandemic. Jain and Shah are both doctors working with Jan Swasthya Sahyog, a public-health initiative based in rural Chhattisgarh. Over the course of the series, they will address the issues they witness on the ground while dealing with the virus and discuss how policy decisions affect the lives of India’s rural residents.
Even until the seventh day of the countrywide lockdown to contain COVID-19, chaos reigned at the Jan Swasthya Sahyog’s hospital in Ganiyari village of Chhattisgarh’s Bilaspur district. Due to the lockdown, the number of patients coming to the hospital every day has fallen by ninety percent. We discharged 28 patients on 25 March, from neighbouring Madhya Pradesh, but they remain trapped in the hospital as they could not travel back. One tuberculosis patient, from rural Bilaspur district, unexpectedly died on 27 March. The police had prevented him from travelling to the hospital a day earlier, according to his family. A woman, pregnant with twins, laboured in the forest throughout the day on 28 March as she was unable to find transportation. She arrived at night, bleeding profusely, and thankfully, delivered two preterm but vigorous girls weighing 1.3 kilogrammes each.
The overall vision to combat the pandemic remains a mystery—the government seems to be making it up as they go. We were and still are, entirely unprepared. While poorly planned, the lockdown allowed a semblance of action. Follow-up steps are now trickling in to correct the mistakes made while enacting it. Our state of Chhattisgarh, among others, expanded the eligibility criteria of the public-distribution system and has given additional rations. States seemed to wake up to the horrific plight of migrants only after being prodded by public outcries and civil society. It was only on the third day of the lockdown that the government exempted categories required for agricultural work—essential for survival in rural India—from the lockdown guidelines.
Epidemics bring a need to move fast, compounding the usual difficulties associated with policy making. At times, public policy requires making decisions even if there is a dearth of information. Examples abound to show that such decisions were taken with respect to COVID-19 as well. What was the decision-making process for the restrictive testing policy for the coronavirus? Why did we start using the anti-malarial drugs chloroquine and hydroxychloroquine for preventing COVID-19 infections in health workers?
Sometimes a lack of information leads to paralysis in policy formation, due to a fear of mistakes. Other times, this results in knee-jerk reactions—often, too little too late. Principles offered by three economists provide insight for navigating the challenge posed by uncertainties.