Covid-19: How can it benefit India?

Can the pandemic catalyze transformation ? An objective and logical evaluation shows that change is possible.

Also published at HCITExpert.com one of the top 50 healthcare blogs globally. https://hcitexpert.com/2020/05/covid-19-how-can-it-benefit-india-by-saif-razvi-sai-praveen-haranath-vikram-ramakrishnan.html/

Saif Razvi, Sai Praveen Haranath, Vikram Ramakrishnan

The costs of the Covid-19 pandemic are well documented. The costs of the responses to the pandemic are yet to fully play out and could be equally devastating.

Lockdowns have varied nation to nation in intensity depending on the breadth of economy that was shut down. There have been millions more job losses than deaths to date. School and university disruptions, restriction of travel, unsettling of migrant labour, interrupted food and transport chains have all added to the burden. People have suffered other physical ill-health due to healthcare systems being focused solely on Covid-19. For example, delays in cancer diagnosis and heart disease may have led to otherwise preventable deaths.[1]

As nations emerge from lockdowns with different restrictions still in place, bruised by the battering their people and economies have endured, it is perhaps difficult to shrug off the cloak of trepidation. However, nothing is as good or bad as it first seems, and this holds true for our post-lockdown future.

First, the bigger picture. After every natural or man-made disaster, growth is inevitable. In fact, growth rates may speed up to compensate for periods of lower or disrupted activity. Within India, nothing has changed structurally. The populace, their skills, natural resources, the internal market, manufacturing capacity, road and transport networks remain unchanged. With appropriate well-thought stratagems and policies, India can bounce back.

However, even before the likely resurrection, a positive transformation has already taken place. The Covid-19 pandemic has provided an impetus to a sweeping range of advances in an incredibly short span of time. Ideas and innovations that have waited years to be adopted, delayed due to personal and societal inertia, have become an accepted part of daily lives. India will never be the same again, and thank goodness (or Covid-19) for that.

Let us look at some of what has improved and hopefully is here to stay.

Working from home

The lockdown shifted the workforce to a new office space — their home. Fast internet has allowed work, communication, planning and organisation to continue through the lockdown. Officegoers have found that they can be just as productive from home as from their places of work. This is no surprise, as previous studies have demonstrated that productivity can increase by over 20%, when working from home.[2]

Zoom, Microsoft Teams (users more than doubled in 4 months) and many other software solutions have sounded the death knell to unnecessary round the table meetings. The time, energy and money saved via virtual meetings, is unlikely to be ever squandered again.

In India, especially in metropolitan cities, office workers often lose two hours daily commuting. 150,000 Indians die each year in road traffic accidents, and many more are seriously injured. Commutes add to stress levels even before reaching one’s desk in the morning. Post-lockdown, with increased working from home, diminished numbers of commuters may help ease traffic and pollution, besides reducing human resource lost due to injuries and deaths.

Companies may benefit too from reduction of formal office space footage, with decreased rentals and running costs, as well as increased employee satisfaction and productivity.[3]

A more inclusive workforce

Indian female workforce participation is amongst the lowest in the world, with only some parts of the Arab world lower.[4] Only 5% of the female workforce is in the formal sector. There has been a significant decline in female labour workforce participation from 36.7% in 2005 to 26% in 2018, primarily due to socio-economic reasons, as the average Indian woman spends over 5 hours daily in household tasks.[4, 5] Even during India’s growth years, it has been estimated that only 19% of new employment opportunities in India’s top ten occupations were taken by women.[6] Increased acceptance of working from home may hence permit many otherwise hesitant women to join the workforce. This could be made possible due to shorter working days (no commutes) with more flexibility.

Wider inclusiveness would facilitate a more diverse workforce, further representative of society, in turn more dynamic and innovative, helping companies become additionally competitive and successful. Understandably, these benefits would accrue disproportionately to the educated, whose work is conducive to remote access as opposed to manual labour.

Environmental benefits

21 of the 30 world’s most polluted cities are in India.[7] Air pollution decreases life expectancy in India on average by 1.7 years.[8] Over 140 million Indians live in areas where air pollution is 10 times higher than WHO recommended safe limits.[9] However, during the lockdown, the smog has lifted from urban India.[10] The positive effects translate into fewer upper respiratory symptoms, fewer exacerbations of asthma and chronic lung disease. A sustained decline in air pollution could lead to lower incidence of cancer and chronic obstructive pulmonary disease (estimated to affect 55 million Indians) in the long term.[11] Young Indians who have never known better, may now have lasting impressions of what could be. A change in attitudes and behaviour towards the environment is likely. The gains in environmental awareness could be sustained through public education and enforcing long ignored sustainability rules.

The healthcare industry

The pandemic has led to a significant shift in healthcare provision. Private and public sector systems have worked in tandem amalgamating their resources. In particular, intensive care capacity, which is typically higher quality in the private sector, has been pooled.

This relationship forged between the government and private health sector could continue when better times return, aided by increased public spending on healthcare from the current 1.4% share of GDP. The private sector has much to offer. For example, well maintained non-Covid facilities could be offered for specialist services with limited availability such as cancer treatments, heart surgery and neurosurgery.

Enhancement in critical care infrastructure during the pandemic could also help reduce deaths in the future from common diseases that affect all of us such as pneumonia, sepsis, heart failure, stroke and encephalitis. The government could expand public sector intensive care units, firstly in the short term, by installing more ventilators. The key long-term issue of skilled intensivists and intensive care nurses could be addressed by introducing a national intensive care training and mentorship programme.

Tele-critical care, the use of specialist centralised monitoring and advising critical care clinicians, could help manage a nation-wide network of intensive care units safely. There are functional examples of these systems in India and significant force multiplication could occur with simple solutions.

Telemedicine consultations, once reserved for only remote parts of India, have become sine qua non during the lockdown. Patients as well as clinicians have found the method effective, using either conventional apps such as Facetime or WhatsApp, or bespoke software. A large part of medical diagnosis is in the history, and with the right experience, training and mentorship, backed by government policy, telemedicine could spread through the length and breadth of India. Government guidelines published in March 2020 have already provided reassurance on the legal status of the practice of telemedicine.

There is further advantage. There is only 1 medical (allopathic) doctor for every 1,467 Indians, well below the WHO recommended minimum standard of 1:1,000.[12] This shortage is further compounded by uneven geographical distribution, urban versus rural divides, as well as significant inter-state variation. Specialists tend to conglomerate in larger cities such as state capitals. Telemedicine annuls the geographical as well as specialist divide and could bring specialist advice and treatments to one’s doorstep or bedside. The government and private sector could also provide dedicated telemedicine consulting rooms with requisite connectivity, technical support and nurses to aid consultations, to assist individuals without the necessary skills or access to broadband and smart devices. Towards this objective, the government has already launched an app and a voice response system to be used for telemedicine.

Improvements in personal and public hygiene

Covid-19 has heightened awareness of the importance of personal and public hygiene. This is especially relevant in India, where a deadlier, locally endemic infection, tuberculosis kills 440,000 Indians each year.[13] The emphasis on washing hands to prevent infections could also reduce diarrheal illnesses, a huge source of distress and death especially in children (a major contributor to India’s infant mortality rate of 37 per 1,000 births). Better public sanitation could help tackle mosquito borne illnesses such as malaria and dengue that kill thousands each year.

The abandonment of meaningless jobs and espousal of useful ones

In 1930, Keynes predicted that by the 21st century, people would work 15-hour weeks due to machines doing their jobs. Despite technological advances, people have continued to work in many meaningless jobs, especially clerical ones. Such “BS jobs” (David Graeber, London School of Economics), lost during the pandemic, may never be regained. Financial compulsions will ensure only jobs that add value to an organisation will be reinstated. Artificial intelligence will also take the role of many a person.

However, the initial cull of jobs will be balanced by an increased value of jobs that really count. More emphasis on training doctors, nurses, physiotherapists and pharmacists will provide new job opportunities and additionally improve India’s health. As India’s middle-class ages, new opportunities for care and support of the elderly could also appear in the social services sector. Covid-19 has disproportionately killed people with obesity, smoking-damaged lungs and diseases related to lifestyle. Increased awareness of the protective effects of a healthier lifestyle will open up business opportunities in health, wellness and fitness.

Tradesmen, such as plumbers and electricians, who everyone relies on, remained immune to lockdowns. Only 5% of India’s workforce have formally acquired vocational skills (compared to 75% in Germany).[14] The pandemic could provide a further push to train job-seekers in such vocations.

New opportunities in virtual learning and education

No other group has been as widely disrupted by Covid-19 as the school going population. Over 1.5 billion children globally have sat at home waiting for their schools to reopen. Many have attended virtual classes through various video conferencing applications. Learning Management Systems (LMS) have provided virtual capability for remote course delivery, testing and assignments. Adoption of technology has been rapid and feedback affirmative.

Whilst physical schools will undoubtedly continue to exist in the future, the experiences from using technology will improve quality and access. Students will have greater flexibility when it comes to subject choices enabled with access to high quality remote teachers. Students in smaller towns could access specialist teachers in cities. Recorded video lectures could enable students with special needs, to continue uninterrupted education. For example, students training for professional sport during typical school hours could access virtual classes at a time and place of their choosing, thus continuing vital education. Additionally, home schooling, done successfully for decades in some parts of India, could be boosted by technology.

The opportunities for continuous professional development are even greater. With many jobs destroyed because of the downturn, the onus is on society to help skill the unemployed. Virtual training will provide a variety of options to train and upskill people, from simple tasks such as gardening to complicated ones like operating an MRI machine. For workers in specialised fields, such as health and safety, or in factory roles, training and certification could be made mandatory and delivered virtually at a large scale.

Make in India innovation

Innovation in healthcare has become mainstream during the pandemic. Teams of engineers, scientists and university students have been building ventilator prototypes as well as 3D printing personal protective masks. This new momentum could be disruptive, lessening reliance on foreign technology and therefore helping lower cost of local healthcare in the future.

The decline of “brain drain”

Many economists have predicted an era of deglobalisation. As economies contract, job opportunities for Indian emigrants will reduce. This could result in a decline or reversal of current trends of capable people leaving India, which could be to India’s advantage, provided opportunities for such individuals are fostered. In this regard, the pandemic has proven to the world the pre-eminence of science over every other stream. Media coverage, public consciousness and respect of scientific voices of reason as compared to some politicians and celebrities, has been obvious. Such discourse will increase the scientific temper of the nation, attracting youngsters to science and all the wonders and opportunities it has to offer. Additionally, fiscal stimulus packages as those announced by the Government of India and cutting of red tape, may allow entrepreneurs the ideal new environment to ride a crest of transformation.[15] In fact, with a young demographic, Indians would be uniquely placed to change the face of the planet by pioneering applications that could guide every sphere of industry in the future.

A new outlook

The history of humankind is rife with epidemics. Each epidemic has been faced by societies in different phases of their development, with culprit microbes exploiting specific vulnerabilities in each society. Epidemics have made humans reflect on their mortality, in turn shaping subsequent moral, religious and philosophical thought. Hierarchies and power structures have collapsed and new ones established, sometimes better and sometimes worse.[16]

India is at a turning point. As it prepares to take centre stage in the world, there is a risk that long-standing baggage of the past may hinder it. The Covid-19 coronavirus is a big leveller though. Like God, it sees no race, gender or creed. The pandemic could therefore help unify and galvanise all Indians against a common enemy and focus minds once again on cooperation and collaboration towards an enriched society, healthier in every respect for all. Similarly, a post-pandemic awareness of the ephemeral nature of life could promote generosity and compassion in society, with increased philanthropy and public participation in community improvement.

In summary, Covid-19 has upturned lives across the world sparing none. Societies that take the positives from the disruption and institutionalise such changes will emerge stronger than before. With opportunities to improve in every field, India can be foremost amongst them.

Saif Razvi, MD, FRCP, is a neurologist in the United Kingdom with interests in telemedicine, neuropsychology and human behaviour.

Sai Praveen Haranath, AB, MPH, FCCP, is a pulmonologist and critical care physician in India and the USA with interests in telemedicine, tele-critical care and public health.

Vikram Ramakrishnan, FRCS, MBA, is a qualified surgeon, management consultant and entrepreneur with interests in virtual learning and school education.

21st May, 2020.

Disclaimer: The views and opinions expressed in this article are the personal opinions of the authors. They do not reflect the official positions or opinions of the organisations that the authors work for.

References:

  1. https://www.theguardian.com/society/2020/apr/29/extra-18000-cancer-patients-in-england-could-die-in-next-year-study
  2. https://nbloom.people.stanford.edu/sites/g/files/sbiybj4746/f/wfh.pdf
  3. https://www.bbc.co.uk/news/business-52467965
  4. https://blogs.lse.ac.uk/southasia/2019/10/22/where-are-indias-working-women-the-fall-and-fall-of-indias-female-labour-participation-rate/
  5. https://www.thehindu.com/business/female-labour-force-participation-in-india-fell-to-26-in-2018-report/article26467857.ece
  6. http://ilo.ch/wcmsp5/groups/public/---dgreports/---inst/documents/publication/wcms_250977.pdf
  7. https://edition.cnn.com/2020/02/25/health/most-polluted-cities-india-pakistan-intl-hnk/index.html
  8. https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30261-4/fulltext
  9. https://ig.ft.com/india-pollution/
  10. https://www.theguardian.com/environment/2020/apr/11/positively-alpine-disbelief-air-pollution-falls-lockdown-coronavirus
  11. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30409-1/fulltext
  12. https://www.business-standard.com/article/pti-stories/india-has-one-doctor-for-every-1-457-citizens-govt-119070401127_1.html
  13. https://tbfacts.org/tb-statistics-india/
  14. https://timesofindia.indiatimes.com/business/india-business/are-plumbers-carpenters-the-answer-to-indias-unemployment-problem/articleshow/65528837.cms
  15. https://uk.reuters.com/article/us-health-coronavirus-india-economy/indias-modi-announces-266-billion-economic-package-after-coronavirus-hit-idUKKBN22O2BM
  16. https://www.newyorker.com/news/q-and-a/how-pandemics-change-history

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COVID19 : The India Story

This publication is a chronicle of three authors who have tried to simplify the COVID19 story . There has been a flood of material and information overload. This is the place to understand the science and the scope of the crisis.

Sai Praveen Haranath

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Global Physician. Pulmonary and Critical Care Medicine. Remote Intensive Care. Committed to excellence in the ethical practice of medicine.

COVID19 : The India Story

This publication is a chronicle of three authors who have tried to simplify the COVID19 story . There has been a flood of material and information overload. This is the place to understand the science and the scope of the crisis.

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