IDSK Special Series on COVID-19 2 Vulnerability of Major Indian States Due to COVID-19 Spread and Lockdown Subrata Mukherjee Priyanka Dasgupta Monalisha Chakraborty Gopal Biswas Soumi Mukherjee June 2020 INSTITUTE OF DEVELOPMENT STUDIES KOLKATA DD 27/D, Sector I, Salt Lake, Kolkata 700 064 Phone : +91 33 2321-3120/21 Fax : +91 33 2321-3119 E-mail : [email protected], Website: www.idsk.edu.in Vulnerability of Major Indian States Due to COVID 19-Spread and Lockdown Subrata Mukherjee1 Priyanka Dasgupta2 Monalisha Chakraborty3 Gopal Biswas4 Soumi Mukherjee5 Abstract Both the spread of COVID-19 and lockdown announced by the governments to contain the spread have put an immense challenge to India’s economy, society and health care system. However, the situation is not uniform across the states of India as they vary enormously from one another in terms of risk of the disease spread, size of the population vulnerable to COVID-19, capacity to deal with medical emergency, size of the population economically vulnerable to lockdown and financial capacity of the state governments to take care of the vulnerable population in the absence of adequate assistance from the central government. This study, first attempts to assess the vulnerability of the population due to the possible disease spread; and then tries to assess four different dimensions of vulnerability caused by nation-wide lockdown. The four dimensions that have been considered are (i) poverty, (ii) possible disruption of access to health care for chronic ailments (iii) possible disruption in students’ access to school education and mid-day meals; and (iv) ills caused by alcoholism and domestic violence. The major Indian states found to be with higher volume of risky population are Kerala, Andhra Pradesh, Tamil Nadu, West Bengal, Telangana, Odisha and Punjab. The states which would probably face relatively greater challenges in dealing with large hospitalisation cases if the disease is spread to its risky population are Odisha and Madhya Pradesh if their current institutional medical capacity is not improved significantly. When we consider all four dimensions of vulnerability, the major states which seem to be more vulnerable due to lockdown are Bihar, Jharkhand, Odisha, West Bengal and Chhattisgarh as they show higher index values of three or more dimensions of vulnerability out of the total four dimensions. These five major states may require concerted efforts by central as well as state governments to address their problems. The study makes a number of suggestions to deal with the current crisis and similar crisis in future. ---------------------------------------------------------------------------------------------------------------- 1 Associate Professor, Institute of Development Studies Kolkata, Email: [email protected]; 2 PhD Student, Institute of Development Studies Kolkata, Email: [email protected]; 3 PhD Student, Institute of Development Studies Kolkata, Email: [email protected]; 4 PhD Student, Institute of Development Studies Kolkata, Email: [email protected]; 5 PhD Student, Institute of Development Studies Kolkata, Email: [email protected] The authors are grateful to Professor Achin Chakraborty for his detailed comments on an earlier draft of the report. 1 Introduction The emergence of COVID-19 caused due to novel corona virus, known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has created an unprecedented challenge for all countries across the world. The first case of COVID-19 was reported in November last year in Wuhan city of Hubei province in China (Wang et al, 2020; Wu and McGoogan, 2020). Since then, within a short span of just over 6-7 months, the infection has spread to over 213 countries across the world, with 4,837,361 confirmed cases and 317304 deaths (as on May 18, 2020).1 In India the first case was reported on January 30, 2020 in the south Indian state of Kerala and first confirmed death due to COVID-19 was reported around second week of March in another south Indian state, Karnataka.2 Since then infections started growing in India at an exponential rate like in any other affected countries. The fatality due to COVID-19 also multiplied but at a much slower speed than many other countries which reported higher disease spread earlier than India did. Individual state governments started responding to the situation of disease spread in their respective states and initiated measures like closing down of educational institutions, advising citizens to practice measures like washing hands frequently with soaps and wearing masks in case of sickness. After calling for a nationwide voluntary stay at home advice on March 22, the prime minister of India announced a total lockdown of the country for three weeks starting from March 25, 2020. By the time of announcing total lockdown, the number of known COVID-19 cases increased to 564 with 10 reported deaths. At the end of initially announced three-week period, lockdown was further extended first till May 3, then till May 17 and May 31 on suggestions from different state governments which were struggling to contain the cases of new infections from COVID-19. The nation-wide lockdown, though inevitable from a public health point of view and supported by experts across disciplines, was a sudden shock to a large section of vulnerable population which was not much affected by the disease spread and its fatality at the time of lockdown. On the one hand, the lockdown has imposed multiple challenges on India’s poor, migrants and socially marginalized groups, chronically ill population, poor students depending only on school for their education and mid-day meal for their regular nutrition. It has also worsened the lives of those who regularly face violence at home by their family members. On the other hand, the actual spread as well as the fear of spread of the disease has brought an immense pressure on country’s health care system which is grossly inadequate due to poor infrastructure, inadequate human resources and low overall funding. However, the situation is not uniform across the states of India. Whereas some of the states are better positioned in terms of lower burden of affected population and better health infrastructure, conditions 1 https://www.worldometers.info/coronavirus/countries-where-coronavirus-has-spread/ 2 There is still controversy over the first death due to COVID-19 in India. See https://www.bbc.com/news/world- asia-india-52343241 2 of some states, especially the most populous states are very challenging. The inequality in the burden and coping up capacities of the states are compounded by varying risks of disease spread. At this juncture, it may be a useful exercise to assess the vulnerability of major Indian states arising from the spread of COVID-19 and lockdown to contain the possible spread by using available information on various aspects of the economy, society and health sector. The objective of the study, therefore, is twofold. In the first stage, it attempts to assess the vulnerability of the population because of the possible disease spread by considering information on current known level of spread, population density and population-subgroups which might be more vulnerable to the disease. In the second stage, the study tries to assess the vulnerability of the population with regard to livelihood and income, access to essential health care services, access to education and school/ICDS- based nutritional programme and social bad due to alcoholism and domestic violence which are all compounded by lockdown. Both types of vulnerability can then be compared and contrasted with medical as well as financial capacities of the states to understand their possible resilience power to face the vulnerability. The report is organised into the following sections: A section on data and methods briefly describes the data sources used for the study as well as methods applied. The first empirical section presents and analyse the risk prospects due to the spread of COVID-19, risky population, and coping capacity of the states. The next four sections deal with possible effects of lockdown on the population in terms of (i) livelihood and income; (ii) possible disruption of chronic health care need; (iii) possible disruption in school education and nutritional programme; and (iv) social bad due to alcoholism and domestic violence. The last section summarises the discussion and highlights a few policy lessons. Data Sources and Methods This study uses multiple data sources for assessing different dimensions of vulnerability caused both by the spread of COVID-19 and lockdown imposed by various state governments as well as the central government in India to contain the disease spread. The data sources used for the analysis are the following: Ministry of Health and Family Welfare, a non-government COVID-19 tracking site, Census 2011, National Family Health Survey (NFHS) 4 (2015-16) unit record data, National Sample Survey (NSS) 75th round unit record data (2017-18) for Education and Health, NSSO’s Periodic Labour Force Survey (2017-18) unit-record data, Reserve Bank of India, Central Bureau of Health Intelligence, CSO database and IndiaStat.com. In addition, we have used information from numerous articles appeared in online news portals and newspapers. 3 Data on COVID 19 There are two main sources of information on state and national level COVID-19 cases. They are Ministry of Health and Family Welfare (https://mohfw.gov.in/) and COVID19INDIA (https://covid19india.org).3 We have