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Image copyright GETTY IMAGESImage caption Within a week of reopening, India has seen a sharp spike in cases
India is roaring – rather than inching – back to life amid a record spike in Covid-19 infections. The BBC’s Aparna Alluri finds out why.
On Saturday, India’s government announced plans to end a national lockdown that began on 25 March.
This was expected – the roads, and even the skies, have been busy for the last 10 days since restrictions started to ease for the first time in two months. Many businesses and workplaces are already open, construction has re-started, markets are crowded and parks are filling up. Soon, hotels, restaurants, malls, places of worship, schools and colleges will also reopen.
But the pandemic continues to rage. When India went into lockdown, it had reported 519 confirmed cases and 10 deaths. Now, its case tally has crossed 173,000, with 4,971 deaths. It added nearly 8,000 new cases on Saturday alone – the latest in a slew of record single-day spikes.
Image copyright GETTY IMAGESImage caption Fast food chains like McDonald’s have begun reopening outlets in parts of India.
So, why the rush to reopen?
The lockdown is simply unaffordable
“It’s certainly time to lift the lockdown,” says Gautam Menon, a professor and researcher on models of infectious diseases.
“Beyond a point, it’s hard to sustain a lockdown that has gone on for so long – economically, socially and psychologically.”
From day one, India’s lockdown came at a huge cost, especially since so many of its people live on a daily wage or close to it. It put food supply chains at risk, cost millions their livelihood, and throttled every kind of business – from car manufacturers to high-end fashion to the corner shop selling tobacco. As the economy sputtered and unemployment rose, India’s growth forecast tumbled to a 30-year-low.
Raghuram Rajan, an economist and former central bank governor, said at the end of April that the country needed to open up quickly, and any further lockdowns would be “devastating”.
The opinion is shared by global consultant Mckinsey, whose report from earlier this month said India’s economy must be “managed alongside persistent infection risks”.
Image copyright GETTY IMAGESImage caption As restrictions ease, Indians are slowly getting used to the new normal
“The original purpose of the lockdowns was to delay the spike so we can put health services and systems in place, so we are able handle the spike [when it comes],” says Dr N Devadasan, a public health expert. “That objective, to a large extent, has been met.”
In the last two months, India has turned stadia, schools and even train coaches into quarantine centres, added and expanded Covid-19 wards in hospitals, and ramped up testing as well as production of protective gear. While grave challenges remain and shortages persist, the consensus seems to be that the government has bought as much time as possible.
“We have used the lockdown period to prepare ourselves… Now is the time to revive the economy,” Delhi Chief Minister Arvind Kejriwal said last week.
The silver lining
For weeks, India’s relatively low Covid-19 numbers baffled experts everywhere. Despite the dense population, disease burden and underfunded public hospitals, there was no deluge of infections or fatalities. Low testing rates explain the former, but not the latter.
In fact, India made global headlines not for its caseload but for its botched handling of the lockdown – millions of informal workers, largely migrants, were left jobless overnight. Scared and unsure, many tried to return home, often desperate enough to walk, cycle or hitchhike across hundreds of kilometres.
Perhaps the choice – between a virus that didn’t appear to be wreaking havoc yet, and a lockdown that certainly was – seemed obvious to the government.
But that is changing quickly as cases shoot up. “I suspect we will keep finding more and more cases, but they will mostly be asymptomatic or will have mild symptoms,” Dr Devadasan says.
The hope – which is also encouraging the government to reopen – is that most of India’s undetected infections are not severe enough to require hospitalisation. And so far, except in Mumbai city, there has been no dearth of hospital beds.
The government, for instance, has been touting India’s mortality rate as a silver lining – at nearly 3%, it’s among the lowest in the world.
But some are unconvinced by that. Dr Jacob John, a prominent virologist, says India has never had, and still doesn’t have, a robust system for recording deaths – in his view, the government is certainly missing Covid-19 deaths because they have no way of knowing of every fatality.
Image copyright GETTY IMAGESImage caption Indians are venturing out again but it’s unclear how many of them are asymptomatic.
And, he says, “what we must aim for is flattening the mortality curve, not necessarily the epidemic curve”.
Dr John, like several other experts, also predicts a peak in July or August, and believes the country is reopening so quickly because the “government realised the futility of such leaky lockdowns”.
A shift in strategy
So is the government gearing up for another lockdown when the peak comes?
While Dr Menon believes the lockdown was well-timed, he says it was too focused on cases coming from abroad.
“There was a hope that by controlling that, we could prevent epidemic spread, but how effective was our screening [at airports]?”
Now, he adds, is the time for “localised lockdowns”.
Media caption Coronavirus: Death and despair for migrants on Indian roads
The federal government has left it to states to decide where, how and to what extent to lift the lockdown as the virus’ progression varies wildly across India.
Maharashtra alone accounts for more than a third of India’s active cases. Add Tamil Nadu, Gujarat and Delhi, and that makes up 67% of the national total.
But other states – such as Bihar – are already seeing a sharp uptick as migrant workers return home.
“Initially, most of your cases were in the cities,” Dr Devadasan says. “But we kept the migrant workers in cities and didn’t allow them to go home. Now, we are sending them back. We have facilitated transporting the virus from urban areas to rural areas.”
While the government has said how many infections have been avoided – up to 300,000 – and lives saved – up to 71,000 – by the lockdown, there is no indication of what lies ahead.
There is only advice: The day the government began to ease restrictions, Mr Kejriwal tweeted, urging people to “follow discipline and control the coronavirus disease” as it was their “responsibility”.
Image copyright GETTY IMAGESImage caption Social distancing will prove to be India’s biggest post-lockdown challenge
Because the alternative – of curfews and constant policing – is unsustainable.
“My worry is more the circumstances of people – it’s not as though they have an option to practise social distancing,” Dr Menon says.
And they don’t – not in joint family homes or one-room hovels packed together in slums, not in crowded markets or busy streets where jostling is second nature, or in temples, mosques, weddings or religious processions where more is always merrier.
The overwhelming message is that the virus is here to stay, and we have to learn to live with it – and the only way to do that, it appears, is to let people live with it.
Image copyright GETTY IMAGESImage caption India has more than 150,000 reported infections
On the face of it, things may not look bad.
Since the first case of coronavirus at the end of January, India has reported more than 150,000 Covid-19 infections. More than 4,000 people have died of the infection.
To put this in some context, as of 22 May, India’s testing positivity rate was around 4%, the death rate from the infection around 3% and the doubling rate of infection – or the amount of time it takes for the number of coronavirus cases to double – was 13 days. The recovery rate of infected patients was around 40%.
All this is markedly lower than in the countries badly hit by the pandemic.
Like elsewhere in the world, there are hotspots and clusters of infection.
More than 80% of the active cases are in five states – Maharashtra, Tamil Nadu, Delhi, Gujarat and Madhya Pradesh – and more than 60% of the cases in five cities, including Mumbai, Delhi and Ahmedabad, according to official data.
More than half of people who have died of the disease have been aged 60 and older and many have underlying conditions, hewing to the international data about elderly people being more vulnerable to the disease.
The more than two-month-long grinding lockdown, official data suggests, has prevented the loss of between 37,000 and 78,000 lives. A paper published in Harvard Data Science Review appears to support that – it shows an eight-week lockdown can prevent about two million cases and, at a 3% fatality rate, prevent some 60,000 deaths.
“Infection has remained limited to certain areas. This also gives us confidence to open up other areas. It is so far an urban disease,” says VK Paul, who heads the medical emergency management plan on Covid-19.
This is where such claims enter uncertain territory.
Image copyright GETTY IMAGESImage caption India has conducted some 180,000 tests so far
Infections are rising sharply, up from 536 cases on 25 March when the first phase of the world’s harshest lockdown was imposed. The growth of infections is outpacing growth in testing – tests have doubled since April but cases have leapt fourfold.
Epidemiologists say the increase in reported infections is possibly because of increased testing. India has been testing up to 100,000 samples a day in the past week. Testing criteria has been expanded to include asymptomatic contacts of positive patients.
Yet, India’s testing remains one of the lowest in the world per head of population – 2,198 tests per million people.
The bungled lockdown at the end of March triggered an exodus of millions of informal workers who lost their jobs in the cities and began returning home in droves, first on foot and then by train. Some four million workers have travelled by rail from cities to their villages in more than half a dozen states in the past three weeks.
There is mounting evidence that this has already led to the spread of infection from the cities to the villages. And with the messy easing of the lockdown earlier this month, there are growing fears of infections spreading further in the cities.
Rising infections and a still-low fatality rate possibly points to milder infection in a younger population and a large number of asymptomatic cases. The focus, says Amitabh Kant, CEO of the government think-tank NITI Aayog, should be “bringing down fatalities and improving the recovery rate”.
But if the infection rate continues to grow, “things are going to get pretty grim in a few weeks time,” a leading virologist told me.
Image copyright GETTY IMAGESImage caption Millions of workers have fled the cities and returned to their villages after the lockdown
Doctors in the capital, Delhi, and the western city of Mumbai tell me they are already seeing a steady surge in Covid-19 admissions and worry about a looming shortage of hospital beds, including in critical care.
When the infection peaks in July, as is expected, a spike in infections could easily lead to many avoidable deaths as hospitals run out of beds for, or delay treatment to, infected patients who need timely oxygen support and clinical care to recover.
“That is the real worry. A critical-care bed needs an oxygen line, a ventilator, doctors, nursing staff. Everything will be under pressure,” Dr Ravi Dosi, who is heading a Covid-19 ward at a hospital in Indore, told me. His 50-bed ICU is already full of patients battling the infection.
With the lockdown easing, doctors are feeling jittery. “It’s a tactical nightmare because some people have begun going to work but there is a lot of fear”, says Dr Dosi.
“One co-worker sneezed in the office and 10-15 of his colleagues panicked and came to the hospital and demanded they get tested. These are the pressures that are building up.”
One reason for the confusion is the lack of – or the opacity of – adequate data on the pandemic to help frame a strategic and granular response.
Most experts say a one-size-fits-all strategy to contain the pandemic and impose and lift lockdowns will not work in India where different states will see infection peaks at different times. The reported infection rate – the number of infections for every 100 tests – in Maharashtra state, for example, is three times the national average.
“The infection is not spreading uniformly. India will see staggered waves,” a leading virologist, who insisted on anonymity, told me.
The lack of data means questions abound.
What about some 3,000 cases, which are not being assigned to any state because these people were found infected in places where they don’t live? (To put this into context, nine states in India have more than 3,000 cases.) How many of these cases have died or recovered?
Also, it is not clear whether the current data – sparse, and sporadic – is sufficient to map the future trajectory of the disease.
There is, for example, no robust estimate of carriers of the virus who have no symptoms – last month a senior government scientist said at least “80 out of every 100 Covid-19 patients may be asymptomatic or could be showing mild symptoms”.
Image copyright GETTY IMAGESImage caption More than 4,000 people have died of Covid-19 in India
If that is indeed true, then India’s fatality rate is bound to be lower. Atanu Biswas, a professor of statistics, says the predicted trajectory could change “with the huge inclusion of asymptomatic cases”. But, in the absence of data, India cannot be sure.
Also, epidemiologists say, measures like the doubling time of the infections and the reproduction number or R0 have their limitations. R0, or simply the R value, is a way of rating a disease’s ability to spread. The new coronavirus, Sars-CoV-2, has a reproduction number of about three, but estimates vary.
“These measures are good when we are in the middle of a pandemic, less robust with fewer cases. You do need forecasting models for at least a month’s projection to anticipate healthcare needs. We should always evaluate an aggregate of evidence, not just one measure, but a cascade of measures,” Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, told me.
Others say even calculating the number of recorded infections every day is “not always a good indicator of how an infection is spreading”.
A better option would be to look at the number of new tests and new cases every day that would provide a “degree of standardisation”, K Srinath Reddy, president of the Public Health Foundation of India, told me.
Likewise, he believes, a measure of how many Covid-19 deaths have occurred compared with the size of a country’s population – the numbers of deaths per million people – is a better indicator of the fatality rate. Reason: the denominator – the country’s population – remains stable.
In the absence of robust and expansive data, India appears to be struggling to predict the future trajectory of the infection.
It is not clear yet how many deaths are not being reported, although there is no evidence of large scale “hidden deaths”.
Image copyright GETTY IMAGESImage caption A Covid-19 isolation ward in India
Epidemiologists say they would like to see clearer data on deaths due to pneumonia and influenza-like illnesses at this time over the past few years to quantify excess deaths and help with accurate reporting of Covid-19 deaths.
They would also like to see what racial disparities in infections and deaths there are to help improve containment in specific community areas. (In Louisiana, for example, African Americans accounted for 70% of Covid-19 deaths, while comprising 33% of the population.)
What is clear, say epidemiologists, is that India is as yet unable to get a grip on the extent of the spread of infection because of the still limited testing.
“We need reliable forecasting models with projection for the next few weeks for the country and the states,” says Dr Mukherjee.
Epidemiologists say India needs more testing and contact-tracing for both asymptomatic and symptomatic infections, as well as isolation and quarantine.
There’s also the need to test based on the “contact network” to stop super-spreader events – frontline workers, delivery workers, essential workers, practically anybody who interacts with a large group of people.
“We have to learn how to manage and minimise risk in our daily lives as the virus is going to be with us,” says Dr Mukherjee.
Without knowing the true number of infected cases India is, in the words of an epidemiologist, “flying blindfolded”.
That can seriously jeopardise India’s fight against the virus and hobble its response in reviving the broken economy.
Image copyright GETTY IMAGESImage caption Millions are workers are defying a curfew and returning home
When I spoke to him on the phone, he had just returned home to his village in the northern state of Rajasthan from neighbouring Gujarat, where he worked as a mason.
In the rising heat, Goutam Lal Meena had walked on macadam in his sandals. He said he had survived on water and biscuits.
In Gujarat, Mr Meena earned up to 400 rupees ($5.34; £4.29) a day and sent most of his earnings home. Work and wages dried up after India declared a 21-day lockdown with four hours notice on the midnight of 24 March to prevent the spread of coronavirus. (India has reported more than 1,000 Covid-19 cases and 27 deaths so far.) The shutting down of all transport meant that he was forced to travel on foot.
“I walked through the day and I walked through the night. What option did I have? I had little money and almost no food,” Mr Meena told me, his voice raspy and strained.
He was not alone. All over India, millions of migrant workers are fleeing its shuttered cities and trekking home to their villages.
These informal workers are the backbone of the big city economy, constructing houses, cooking food, serving in eateries, delivering takeaways, cutting hair in salons, making automobiles, plumbing toilets and delivering newspapers, among other things. Escaping poverty in their villages, most of the estimated 100 million of them live in squalid housing in congested urban ghettos and aspire for upward mobility.
Image copyright GETTY IMAGESImage caption Informal workers are the backbone of India’s big city economies
Last week’s lockdown turned them into refugees overnight. Their workplaces were shut, and most employees and contractors who paid them vanished.
Sprawled together, men, women and children began their journeys at all hours of the day last week. They carried their paltry belongings – usually food, water and clothes – in cheap rexine and cloth bags. The young men carried tatty backpacks. When the children were too tired to walk, their parents carried them on their shoulders.
They walked under the sun and they walked under the stars. Most said they had run out of money and were afraid they would starve. “India is walking home,” headlined The Indian Express newspaper.
The staggering exodus was reminiscent of the flight of refugees during the bloody partition in 1947. Millions of bedraggled refugees had then trekked to east and west Pakistan, in a migration that displaced 15 million people.
Image copyright GETTY IMAGESImage caption Migrant labourers feel they have more social security in their villages
This time, hundreds of thousands of migrant workers are desperately trying to return home in their own country. Battling hunger and fatigue, they are bound by a collective will to somehow get back to where they belong. Home in the village ensures food and the comfort of the family, they say.
Clearly, a lockdown to stave off a pandemic is turning into a humanitarian crisis.
Among the teeming refugees of the lockdown was a 90-year-old woman, whose family sold cheap toys at traffic lights in a suburb outside Delhi.
Kajodi was walking with her family to their native Rajasthan, some 100km (62 miles) away. They were eating biscuits and smoking beedis, – traditional hand-rolled cigarettes – to kill hunger. Leaning on a stick, she had been walking for three hours when journalist Salik Ahmed met her. The humiliating flight from the city had not robbed her off her pride. “She said she would have bought a ticket to go home if transport was available,” Mr Ahmed told me.
Others on the road included a five-year-old boy who was on a 700km (434 miles) journey by foot with his father, a construction worker, from Delhi to their home in Madhya Pradesh state in central India. “When the sun sets we will stop and sleep,” the father told journalist Barkha Dutt. Another woman walked with her husband and two-and-a-half year old daughter, her bag stuffed with food, clothes and water. “We had a place to stay but no money to buy food,” she said.
Then there was Rajneesh, a 26-year-old automobile worker who walking 250km (155 miles) to his village in neighbouring Uttar Pradesh. It would take him four days, he reckoned. “We will die walking before coronavirus hits us,” the man told Ms Dutt.
He was not exaggerating. Last week, a 39-year-old man on a 300km (186 miles) trek from Delhi to Madhya Pradesh complained of chest pain and exhaustion and died; and a 62-year-old man, returning from a hospital by foot in Gujarat, collapsed outside his house and died. Four other migrants, turned away at the borders on their way to Rajasthan from Gujarat, were mowed down by a truck on a dark highway.
As the crisis worsened, state governments scrambled to arrange transport, shelter and food.
Image copyright SALIK AHMED/OUTLOOKImage caption Ninety-year-old Kajodi Devi is walking from Delhi to her village
But trying to transport them to their villages quickly turned into another nightmare. Hundreds of thousands of workers were pressed against each other at a major bus terminal in Delhi as buses rolled in to pick them up.
Delhi chief minister Arvind Kejriwal implored the workers not to leave the capital. He asked them to “stay wherever you are, because in large gatherings, you are also at risk of being infected with the coronavirus.” He said his government would pay their rent, and announced the opening of 568 food distribution centres in the capital. Prime Minister Narendra Modi apologised for the lockdown “which has caused difficulties in your lives, especially the poor people”, adding these “tough measures were needed to win this battle.”
Whatever the reason, Mr Modi and state governments appeared to have bungled in not anticipating this exodus.
Mr Modi has been extremely responsive to the plight of Indian migrant workers stranded abroad: hundreds of them have been brought back home in special flights. But the plight of workers at home struck a jarring note.
“Wanting to go home in a crisis is natural. If Indian students, tourists, pilgrims stranded overseas want to return, so do labourers in big cities. They want to go home to their villages. We can’t be sending planes to bring home one lot, but leave the other to walk back home,” tweeted Shekhar Gupta, founder and editor of The Print.
Image copyright GETTY IMAGESImage caption There is a precedent for this kind of exodus during crisis
The city, says Chinmay Tumbe, author of India Moving: A History of Migration, offers economic security to the poor migrant, but their social security lies in their villages, where they have assured food and accommodation. “With work coming to a halt and jobs gone, they are now looking for social security and trying to return home,” he told me.
Also there’s plenty of precedent for the flight of migrant workers during a crisis – the 2005 floods in Mumbai witnessed many workers fleeing the city. Half of the city’s population, mostly migrants, had also fled the city – then Bombay – in the wake of the 1918 Spanish flu.
When plague broke out in western India in 1994 there was an “almost biblical exodus of hundreds of thousands of people from the industrial city of Surat [in Gujarat]”, recounts historian Frank Snowden in his book Epidemics and Society.
Half of Bombay’s population deserted the city, during a previous plague epidemic in 1896. The draconian anti-plague measures imposed by the British rulers, writes Dr Snowden, turned out to be a “blunt sledgehammer rather than a surgical instrument of precision”. They had helped Bombay to survive the epidemic, but “the fleeing residents carried the disease with them, thereby spreading it.”
More than a century later, that same fear haunts India today. Hundreds of thousands of the migrants will eventually reach home, either by foot, or in packed buses. There they will move into their joint family homes, often with ageing parents. Some 56 districts in nine Indian states account for half of inter-state migration of male workers, according to a government report. These could turn out to be potential hotspots as thousands of migrants return home.
Image copyright GETTY IMAGESImage caption The fleeing migrants could spread the disease all over the country
Partha Mukhopadhyay, a senior fellow at Delhi’s Centre for Policy Research, suggests that 35,000 village councils in these 56 potentially sensitive districts should be involved to test returning workers for the virus, and isolate infected people in local facilities.
In the end, India is facing daunting and predictable challenges in enforcing the lockdown and also making sure the poor and homeless are not fatally hurt. Much of it, Dr Snowden told me, will depend on whether the economic and living consequences of the lockdown strategy are carefully managed, and the consent of the people is won. “If not, there is a potential for very serious hardship, social tension and resistance.” India has already announced a $22bn relief package for those affected by the lockdown.
The next few days will determine whether the states are able to transport the workers home or keep them in the cities and provide them with food and money. “People are forgetting the big stakes amid the drama of the consequences of the lockdown: the risk of millions of people dying,” says Nitin Pai of Takshashila Institution, a prominent think tank.
“There too, likely the worst affected will be the poor.”
Image copyright NATIONAL MUSEUM OF HEALTH AND MEDICINEImage caption The 1918 flu pandemic is believed to have infected a third of the population worldwide
All interest in living has ceased, Mahatma Gandhi, battling a vile flu in 1918, told a confidante at a retreat in the western Indian state of Gujarat.
The highly infectious Spanish flu had swept through the ashram in Gujarat where 48-year-old Gandhi was living, four years after he had returned from South Africa. He rested, stuck to a liquid diet during “this protracted and first long illness” of his life. When news of his illness spread, a local newspaper wrote: “Gandhi’s life does not belong to him – it belongs to India”.
Outside, the deadly flu, which slunk in through a ship of returning soldiers that docked in Bombay (now Mumbai) in June 1918, ravaged India. The disease, according to health inspector JS Turner, came “like a thief in the night, its onset rapid and insidious”. A second wave of the epidemic began in September in southern India and spread along the coastline.
The influenza killed between 17 and 18 million Indians, more than all the casualties in World War One. India bore a considerable burden of death – it lost 6% of its people. More women – relatively undernourished, cooped up in unhygienic and ill-ventilated dwellings, and nursing the sick – died than men. The pandemic is believed to have infected a third of the world’s population and claimed between 50 and 100 million lives.
Gandhi and his febrile associates at the ashram were lucky to recover. In the parched countryside of northern India, the famous Hindi language writer and poet, Suryakant Tripathi, better known as Nirala, lost his wife and several members of his family to the flu. My family, he wrote, “disappeared in the blink of an eye”. He found the Ganges river “swollen with dead bodies”. Bodies piled up, and there wasn’t enough firewood to cremate them. To make matters worse, a failed monsoon led to a drought and famine-like conditions, leaving people underfed and weak, and pushed them into the cities, stoking the rapid spread of the disease.
Image copyright PRINT COLLECTORImage caption Bombay was one of the worst hit cities by the 1918 pandemic
To be sure, the medical realities are vastly different now. Although there’s still no cure, scientists have mapped the genetic material of the coronavirus, and there’s the promise of anti-viral drugs, and a vaccine. The 1918 flu happened in the pre-antibiotic era, and there was simply not enough medical equipment to provide to the critically ill. Also western medicines weren’t widely accepted in India then and most people relied on indigenous medication.
Yet, there appear to be some striking similarities between the two pandemics, separated by a century. And possibly there are some relevant lessons to learn from the flu, and the bungled response to it.
The outbreak in Bombay, an overcrowded city, was the source of the infection’s spread back then – this something that virologists are fearing now. With more than 20 million people, Bombay is India’s most populous city and Maharashtra, the state where it’s located, has reported the highest number of coronivirus cases in the country.
By early July in 1918, 230 people were dying of the disease every day, up nearly three times from the end of June. “The chief symptoms are high temperature and pains in the back and the complaint lasts three days,” The Times of India reported, adding that “nearly every house in Bombay has some of its inmates down with fever”. Workers stayed away from offices and factories. More Indian adults and children were infected than resident Europeans. The newspapers advised people to not spend time outside and stay at home. “The main remedy,” wrote The Times of India, “is to go to bed and not worry”. People were reminded the disease spread “mainly through human contact by means of infected secretions from the nose and mouths”.
“To avoid an attack one should keep away from all places where there is overcrowding and consequent risk of infection such as fairs, festivals, theatres, schools, public lecture halls, cinemas, entertainment parties, crowded railway carriages etc,” wrote the paper. People were advised to sleep in the open rather than in badly ventilated rooms, have nourishing food and get exercise.
“Above all,” The Times of India added, “do not worry too much about the disease”.
Image copyright PRINT COLLECTOR
Colonial authorities differed over the source of infection. Health official Turner believed that the people on the docked ship had brought the fever to Bombay, but the government insisted that the crew had caught the flu in the city itself. “This had been the characteristic response of the authorities, to attribute any epidemic that they could not control to India and what was invariably termed the ‘insanitary condition’ of Indians,” observed medical historian Mridula Ramanna in her magisterial study of how Bombay coped with the pandemic.
Later a government report bemoaned the state of India’s government and the urgent need to expand and reform it. Newspapers complained that officials remained in the hills during the emergency, and that the government had thrown people “on the hands of providence”. Hospital sweepers in Bombay, according to Laura Spinney, author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World, stayed away from British soldiers recovering from the flu. “The sweepers had memories of the British response to the plague outbreak which killed eight million Indians between 1886 and 1914.”
Image copyright PRINT COLLECTORImage caption The hospitals in Bombay were overwhelmed by patients
“The colonial authorities also paid the price for the long indifference to indigenous health, since they were absolutely unequipped to deal with the disaster,” says Ms Spinney. “Also, there was a shortage of doctors as many were away on the war front.”
Eventually NGOs and volunteers joined the response. They set up dispensaries, removed corpses, arranged cremations, opened small hospitals, treated patients, raised money and ran centres to distribute clothes and medicine. Citizens formed anti-influenza committees. “Never before, perhaps, in the history of India, have the educated and more fortunately placed members of the community, come forward in large numbers to help their poorer brethren in time of distress,” a government report said.
Now, as the country battles another deadly infection, the government has responded swiftly. But, like a century ago, civilians will play a key role in limiting the virus’ spread. And as coronavirus cases climb, this is something India should keep in mind.
Image copyright AFPImage caption Delhi remains on edge after three days of rioting
The religious violence which has roiled Delhi since the weekend is the deadliest in decades.
What began as small clashes between supporters and opponents of a controversial citizenship law quickly escalated into full-blown religious riots between Hindus and Muslims, in congested working class neighbourhoods on the fringes of the sprawling capital.
Armed Hindu mobs rioted with impunity as the police appeared to look the other way. Mosques and homes and shops of Muslims were attacked, sometimes allegedly with the police in tow. Journalists covering the violence were stopped by the Hindu rioters and asked about their religion. Videos and pictures emerged of the mob forcing wounded Muslim men to recite the national anthem, and mercilessly beating up a young Muslim man. Panicky Muslims began leaving mixed neighbourhoods.
On the other side, Muslim rioters have also been violent – some of them also armed – and a number of Hindus, including security personnel, are among the dead and injured.
Media caption Delhi religious riots: ‘Mobs set fire to my house and shop’
Three days and 20 deaths later, Prime Minister Narendra Modi tweeted his first appeal for peace. There were no commiserations for the victims. Delhi’s governing Aam Aadmi Party was criticised for not doing much either. Many pointed to the egregious failure of Delhi’s police – the most well-resourced in India – and the inability of opposition parties to rally together, hit the streets and calm tensions. In the end, the rioters operated with impunity, and the victims were left to their fate.
Image copyright AFPImage caption More than 20 people have been killed in the rioting
Not surprisingly, the ethnic violence in Delhi has drawn comparisons with two of India’s worst sectarian riots in living memory. Nearly 3,000 people were killed in anti-Sikh riots in the capital in 1984 after the then prime minister Indira Gandhi was assassinated by her Sikh bodyguards. And in 2002, more than 1,000 people, mostly Muslims, died after a train fire killed 60 Hindu pilgrims in Gujarat – Mr Modi was then the chief minister of the state. The police were accused of complicity in both riots. The Delhi High Court, which is hearing petitions about the current violence, has said it cannot let “another 1984” happen on its “watch”.
Ashutosh Varshney, a professor of political science at Brown University who has extensively researched religious violence in India, believes that the Delhi riots are beginning to “look like a pogrom” – much like the ones in 1984 and 2002.
Pogroms happen, according to Prof Varshney, when the police do not act neutrally to stop riots, look on when mobs go on the rampage and sometimes “explicitly” help the perpetrators. Evidence of police apathy in Delhi has surfaced over the past three days. “Of course, the violence thus far has not reached the scale of Gujarat or Delhi. Our energies should now focus on preventing further escalation,” he says.
Political scientist Bhanu Joshi and a team of researchers visited constituencies in Delhi ahead of February’s state elections. They found the BJP’s “perfectly oiled party machinery constantly giving out the message about suspicion, stereotypes and paranoia”. In one neighbourhood, they found a party councillor telling people: “You and your kids have stable jobs, money. So stop thinking of free, free. [She was alluding to free water and electricity being given to people by the incumbent government.] If this nation doesn’t remain, all the free will also vanish.” Such paranoia about the security of the nation at a time when India has been at its most secure has “widened” existing ethnic divisions and “made people suspicious”, Mr Joshi said.
Image copyright AFPImage caption Mosques have been vandalised in the clashes
In the run-up to the Delhi elections Mr Modi’s party embarked on a polarising campaign around a controversial new citizenship law, the stripping of Kashmir’s autonomy and building a grand new Hindu temple on a disputed holy site. Party leaders freely indulged in hate speech, and were censured by poll authorities. A widely reported protest against the citizenship law by women in Shaheen Bagh, a Muslim-dominated neighbourhood in Delhi, was especially targeted by the BJP’s campaign, which sought to show the protesters as “traitors”.
“The repercussion of this campaign machine is the normalisation of suspicion and hate reflected in WhatsApp groups, Facebook pages, and conversations families have among themselves,” says Mr Joshi.
It was only a matter of time before Delhi’s fragile stability would be shaken. On Sunday a BJP leader issued a threat, telling the Delhi police they had three days to clear the sites where people had been protesting against the citizenship law and warned of consequences if they failed to do so. The first reports of clashes emerged later that day. The ethnic violence that followed was a tragedy foretold.
Image copyright GETTY IMAGESImage caption Mr Trump is making his first official visit to India
US President Donald Trump is expecting a raucous welcome on his first official state visit to India on Monday and Tuesday.
He follows a long line of leaders who have made the journey. Some of his predecessors were greeted enthusiastically; others stumbled through diplomatic gaffes; one even had a village named after him.
Can history be a guide to how this diplomatic tryst might go? Here’s a brief look at past visits, ranked in order of how they went.
The good: President Eisenhower
Let’s begin at the beginning.
Dwight D Eisenhower, the first US president to visit India, was greeted with a 21-gun salute when he landed in the national capital, Delhi, in December 1959. Huge crowds lined the streets to catch a glimpse of the World War Two hero in his open-top car – Mr Trump is expecting a similar reception in Ahmedabad city, where he will be doing a road show.
Image copyright US EMBASSY ARCHIVESImage caption Dwight D Eisenhower, pictured with Prime Minister Jawaharlal Nehru, was the first US president to make the trip
The warmth between President Eisenhower and Indian Prime Minister Jawaharlal Nehru helped during what was a rocky phase in US-India ties. This was early in the Cold war, when the US and Pakistan had become become close allies, and India insisted on staying neutral or “non-aligned”. Like today, relations with China were at the core of the India-US equation, with Washington pressuring Delhi to take an aggressive stance with Beijing on the issue of Tibet.
But, on the whole, Eisenhower’s four-day trip was billed a success. And nearly every US president on a state visit to India has emulated his itinerary: he laid flowers at Mahatma Gandhi’s memorial, took in the splendour of the Taj Mahal, addressed parliament and spoke at Delhi’s iconic Ramlila grounds, which, according to one news report, attracted one million people.
When he left, Nehru said he had taken with him “a piece of our heart”.
Image copyright US EMBASSY ARCHIVESImage caption President Eisenhower was greeted by large crowdsThe game-changer: Bill Clinton
If there was a game-changing visit, it would be Bill Clinton’s in March 2000 with Prime Minister Atal Bihari Vajpayee. Mr Clinton’s arrival came after a two-decade lull – neither Ronald Reagan nor George Bush Snr made the journey East. It came at a tricky time as Washington had imposed sanctions on Delhi following its 1999 test of a nuclear bomb.
But, according to Navtej Sarna, a former Indian Ambassador to the US, the five-day trip was “a joyous visit”. It included stops in Hyderabad, a southern city that was emerging as a tech hub, and Mumbai, India’s financial capital. “He came and saw the economic and cyber potential of India, and democracy in action,” says Mr Sarna.
Image copyright GETTY IMAGESImage caption Bill Clinton’s visit was described as “joyous”Mr Clinton also danced with villagers, took a tiger safari and sampled Delhi’s famously creamy black dal (lentils) at a luxury hotel that has since been associated with the president.
The country’s reaction is perhaps best expressed in this New York Times headline: “Clinton fever – a delighted India has all the symptoms.”
The nuclear deal: George W Bush
George W Bush, as Forbes magazine once put it, was the “best US president India’s ever had”. His three-day visit in March 2006 was a highlight in the two countries’ strategic relationship – especially in matters of trade and nuclear technology, subjects they have long wrangled over. His strong personal dynamic with Prime Minister Manmohan Singh was hard to miss – after he left office, Mr Bush, a keen artist, even painted a portrait of Mr Singh.
The two leaders are credited for a historic but controversial nuclear deal, which was signed during Mr Bush’s visit. It brought India, which had for decades refused to sign the Nuclear Non-Proliferation Treaty (NPT), out of isolation. Energy-hungry India got access to US civil nuclear technology in exchange for opening its nuclear facilities to inspection.
Image copyright US EMBASSY ARCHIVESImage caption George W Bush and Manmohan Singh had a very good relationshipHowever, while the visit was substantive, it was not as spectacular as others – there was no trip to the Taj, nor an address to parliament. But the timing was important. Anti-US sentiment over the invasion of Iraq was running high – left-wing MPs had staged a protest against Mr Bush’s visit, and there were demonstrations in other parts of India.
Double visit: Barack Obama
Barack Obama was the only president to make two official visits. First, in 2010 with Prime Minister Manmohan Singh, and then in 2015 with Prime Minister Narendra Modi.
On his first visit – in a break from the past – he landed in Mumbai, instead of Delhi, with a large trade delegation. This was not just about economic ties but a show of solidarity following the Mumbai terror attacks of 2008, which killed 166 people. Mr and Mrs Obama even stayed at the Taj Mahal hotel, one of the main targets.
It was significant that the US president declared support for India to join a reformed and expanded UN Security Council, says Alyssa Ayres, a former US deputy assistant secretary of state for South Asia. “That all these years later nothing has changed in the UN system is another matter, but that was a major policy shift for the United States.”
Image copyright US EMBASSY ARCHIVESImage caption Barack Obama visited India twiceMr Obama returned in 2015 as chief guest at India’s Republic Day celebrations, at PM Modi’s invitation. Trade, defence and climate change were at the heart of the talks. The trip also emphasised an Indo-Pacific strategy, where both leaders expressed unease over Beijing’s provocations in the South China Sea.
The not-so-good: Jimmy Carter
Although Jimmy Carter’s two-day visit in 1978 was a thaw in India-US relations, it was not free of hiccups.
With some 500 reporters in tow, Carter followed a packed itinerary: he met Prime Minister Morarji Desai, addressed a joint session of parliament, went to the Taj Mahal, and dropped by a village just outside Delhi.
The village, Chuma Kheragaon, had a personal connection: Carter’s mother, Lillian, had visited here when she was in India as a member of the Peace Corps in the late 1960s. So when Carter and his wife, Rosalynn, made the trip, they gave the village money and its first television set. It was even renamed “Carterpuri”, a moniker it still holds.
Image copyright US EMBASSY ARCHIVESImage caption Jimmy Carter being greeted by villagers of ‘Carterpuri’But beyond the photo-ops, India and the US were sparring. India was building its nuclear programme, and had conducted its first test in 1974. The US wanted India to sign the NPF, which sought to stop the spread of nuclear weapons. But India refused, saying the agreement discriminated against developing countries.
In a leaked conversation that made headlines and threatened to derail the visit, Mr Carter promised his Secretary of State, Cyrus Vance, a “very cold and very blunt” letter to Desai. The two leaders signed a declaration, promising greater global co-operation, but Carter left India without the assurances he had hoped for.
The ugly: Richard Nixon
Richard Nixon was no stranger to India when he arrived in August 1969 for a day-long state visit. He had been here as vice-president in 1953, and before that on personal trips. But, by all accounts, he wasn’t a fan.
“Nixon disliked Indians in general and despised [Prime Minister] Indira Gandhi,” according to Gary Bass, author of Blood Telegram: Nixon, Kissinger and a Forgotten Genocide. And, he adds, the feeling was said to be mutual.
This was also at the height of the Cold War, and India’s non-alignment policy “appalled” American presidents. Mr Bass says that under Gandhi, India’s neutrality had turned into a “noticeably pro-Soviet foreign policy”.
Image copyright GETTY IMAGESImage caption Richard Nixon waves to the crowds alongside Mohammad Hidyatullah, India’s acting presidentThe relationship only turned frostier after the trip as India backed Bangladesh (then East Pakistan) in its fight for independence from Pakistan, a close American ally. The differences were laid bare when Gandhi visited the White House in 1971. Declassified state department cables later revealed that Nixon referred to her as an “old witch”.
And the future: Donald Trump
The US and India have certainly had their ups and downs, but during the last official visit in 2015, Mr Obama and Mr Modi signed a declaration of friendship: “Chalein saath saath (Let’s move forward together)…” it began.
President Trump’s visit will take the relationship forward, but it’s unclear how.
Image copyright AFP
His arrival in Ahmedabad, the main city in PM Modi’s home state of Gujarat, followed by a big arena event, is expected to draw a massive crowd. It will echo President Eisenhower’s rally in Delhi years ago, perhaps cementing the personal ties between the two leaders.
But while Mr Trump’s trip will be packed with pageantry, it could be light on policy. Unlike other presidential visits, this one is not expected to yield concrete agreements, with the trade deal Mr Trump so badly wants looking unlikely.
NEW DELHI (Reuters) – U.S. President Donald Trump will meet executives of large Indian companies with interests in the United States as he looks to drum up investments during his visit to New Delhi this month.
Executives of some of the companies expected to attend the meeting include Indian oil & gas company Reliance Industries (RELI.NS), diversified group Tata Sons and auto sector companies such as Bharat Forge (BFRG.NS), Mahindra and Mahindra (MAHM.NS) and Motherson, industry and business sources told Reuters.
Trump is scheduled to make his first visit as president to India on Feb. 24-25 during which he will travel to Prime Minister Narendra Modi’s home state of Gujarat followed by talks in New Delhi. The two countries are trying to sign a trade deal during his visit.
On Feb. 25, a meeting is being planned between Trump and Indian executives, especially those focussing on job creation and manufacturing in the United States, the sources said.
The meeting, which will be held in New Delhi, was unlikely to include executives of U.S. companies, they said.
Creating new jobs and boosting manufacturing is critical for Trump in his re-election bid later this year. U.S. factory activity rebounded in January but only after it contracted for five straight months.
“President (Trump) is keen on acknowledging Indian companies which are focussing on manufacturing in the United States,” said a Washington-based source aware of the plans.
United States is a key market for several Indian firms.
Mahindra last year said it will invest another $1 billion (£767.64 million) in the United States and was committed to creating American jobs, while Bharat Forge has announced plans to invest $56 million to set up a new plant in North Carolina.
The $100-billion Tata Group says it is one of the largest Indian-headquartered multinationals in North America, with 13 companies and more than 35,000 employees.
The Confederation of Indian Industries and U.S.-India trade groups have suggested several Indian executives for the Trump meeting and the U.S. Embassy in New Delhi was reviewing that, one source said, adding the final list was yet to be finalised.
The U.S. Embassy in New Delhi declined to comment.
Other than his meeting with Indian business leaders and Modi, Trump is expected to attend an event at a stadium in Gujarat along the lines of the “Howdy Modi” extravaganza held in Houston last September during which the two leaders made a joint appearance.
Image copyright GETTY IMAGESImage caption Discrimination against women on account of menstruation is widespread in India
India’s uncomfortable relationship with periods is back in the headlines.
College students living in a hostel in the western Indian state of Gujarat have complained that they were made to strip and show their underwear to female teachers to prove that they were not menstruating.
The 68 young women were pulled out of classrooms and taken to the toilet, where they were asked to individually remove their knickers for inspection.
The incident took place in the city of Bhuj on Tuesday. The young women are undergraduate students at Shree Sahajanand Girls Institute (SSGI), which is run by Swaminarayan sect, a wealthy and conservative Hindu religious group.
They said a hostel official had complained to the college principal on Monday that some of the students were breaking rules menstruating women are supposed to follow.
According to these rules, women are barred from entering the temple and the kitchen and are not allowed to touch other students during their periods.
At meal times, they have to sit away from others, they have to clean their own dishes, and in the classroom, they are expected to sit on the last bench.
Image copyright BBC GUJARATIImage caption Female students gather outside the Shree Sahajanand Girls Institute (SSGI)
One of the students told BBC Gujarati’s Prashant Gupta that the hostel maintains a register where they are expected to enter their names when they get their periods, which helps the authorities to identify them.
But for the past two months, not one student had entered her name in the register – perhaps not surprising considering the restrictions they have to put up with if they do.
So on Monday, the hostel official complained to the principal that menstruating students were entering the kitchen, going near the temple, and mingling with other hostellers.
The students allege that, the next day, they were abused by the hostel official and the principal before they were forced to strip.
They described what happened to them as a “very painful experience” that had left them “traumatised” and amounted to “mental torture”.
One student’s father said that when he arrived at the college, his daughter and several other students came to him and started crying. “They are in shock,” he said.
On Thursday, a group of students held a protest on the campus, demanding action against the college officials who had “humiliated” them.
The college trustee Pravin Pindoria said the incident was “unfortunate”, adding that an investigation had been ordered and action would be taken against anyone found guilty of wrongdoing.
But Darshana Dholakia, the vice-chancellor of the university which the college is affiliated with, put the blame on the students. She said that they had broken rules and added that some of them had apologised.
However, some of the students told BBC Gujarati that they are now under pressure from the school authorities to play down the incident and not to speak of their ordeal.
On Friday, the Gujarat State Women’s Commission ordered an investigation into this “shameful exercise” and asked the students to “come forward and speak without fear about their grievances”. The police have lodged a complaint.
Media caption Using comics to combat India’s menstruation taboos
This is not the first time that female students have been humiliated on account of periods.
Discrimination against women on account of menstruation is widespread in India, where periods have long been a taboo and menstruating women are considered impure. They are often excluded from social and religious events, denied entry into temples and shrines and kept out of kitchens.
Increasingly, urban educated women have been challenging these regressive ideas. In the past few years, attempts have been made to see periods for just what they are – a natural biological function.
But success has been patchy.
In 2018, the top court in a landmark order threw open the doors of the Sabarimala shrine to women of all ages, saying that keeping women out of the temple in the southern state of Kerala was discriminatory.
AHMEDABAD, India (Reuters) – U.S. President Donald Trump will be shielded from the sight of slums by a newly built wall when he visits the city of Ahmedabad during a visit to India this month.
A senior government said the wall was being built for security reasons, not to conceal the slum district.
But the contractor building it told Reuters the government “did not want the slum to be seen” when Trump passes by on the ride in from Ahmedabad’s airport.
“I’ve been ordered to build a wall as soon as possible, over 150 masons are working round-the-clock to finish the project,” the contractor said, speaking on condition of anonymity.
The government official conceded that the wall was part of a “beautification and cleanliness” drive.
Whatever the reason, the 400-meter-long and seven-feet-high wall will prevent the U.S. leader from getting a glimpse of a slum district that houses an estimated 800 families.
Trump, who has made his pledge to build a wall along the United States’ border with Mexico a feature of his presidency, will visit India on Feb. 24-25 to reaffirm strategic ties that have been buffeted by trade disputes.
He is expected to attend an event dubbed “Kem Chho Trump” (“How are you, Trump”) at a stadium in Ahmedabad along the lines of the “Howdy Modi” extravaganza he hosted for Indian Prime Minister Narendra Modi in Houston last September.
Speaking at the White House on Tuesday, Trump quoted Modi as saying “millions and millions of people” would attend the rally.
The event provides Trump, who was impeached in December, with the opportunity to woo the support of hundreds of thousands of Indian-American voters ahead of the U.S. presidential election in November.
But some slum dwellers whose homes will be cordoned off by the wall in Ahmedabad – the largest city in Modi’s home state of Gujarat – said the government was wasting tax-payer money to hide the poor.
“Poverty and slums are the reality of our life, but Modi’s government wants to hide the poor,” said Parvatbhai Mafabhai, a day worker who has lived there with his family for more than three decades.
MUMBAI (Reuters) – India’s richest state is set to be ruled by parties opposed to Prime Minister Narendra Modi’s nationalist Bharatiya Janata Party, jeopardising a Japanese-backed bullet-train project opposed by farmers.
The BJP’s inability to pull together voters in the westerly state of Maharashtra, of which Mumbai is capital, has meant that three parties, including a former BJP ally, will form the government. That is a major setback for Modi after his landslide victory in general elections this year.
It could also hinder the bullet train project, a $17 billion investment largely financed by a long-term, low-cost loan from Japan. The BJP was in power in both Maharashtra and Gujarat states when work began on project in 2017.
“We have always opposed the bullet train,” said Manisha Kayande, a spokesperson for the Shiv Sena, a former BJP ally whose leader is now set to head Maharashtra. “Our state is giving a major chunk of money for the project, when most of the track is in another state. This will definitely be re-framed,” .
The train will run from Mumbai to Ahmedabad, the main city in Gujarat state, a distance of 508 kilometres (315 miles). But it has run into obstacles acquiring land amid opposition from fruit farmers.
Any delay of the project is likely to undermine investor confidence, at a time when growth has slowed to its weakest pace in years.
Critics say India does not need the high-speed train and investment should go instead to improve the existing network.
“We are not against development or infrastructure projects, but at the same time farmers’ interests can’t be ignored. We will rethink about projects that farmers are opposing,” said a senior leader of Nationalist Congress Party, which is a part of the coalition government.
National High Speed Rail Corporation (NHSRCL), the government agency overseeing the project, had no immediate comment.
The authorities have acquired 548 hectares land out of the total requirement 1,380 hectares and the project was targeted to be operational by 2023 , the government told parliament in July.
Protests against land acquisitions are common in India, where tens of millions of farmers till small holdings. A planned $44 billion refinery to be run by a consortium including Saudi Aramco, the world’s biggest oil producer, is also struggling to secure land in Maharashtra.
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