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 Table of Contents  
INVITED PERSPECTIVE
Year : 2020  |  Volume : 36  |  Issue : 5  |  Page : 126-130

Social analysis of the governmental-based health measures: A critique


1 Director-cum CEO, Institute of Mental Health, Pt. BDS University of Health Sciences, Rohtak, Haryana, India
2 State Drug Dependence Treatment Centre, Institute of Mental Health, Pt. BDS University of Health Sciences, Rohtak, Haryana, India

Date of Submission26-May-2020
Date of Acceptance10-Jul-2020
Date of Web Publication02-Oct-2020

Correspondence Address:
Prof. Rajiv Gupta
Institute of Mental Health, Pt. BDS University of Health Sciences, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_197_20

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  Abstract 


Governments across the globe have responded to the COVID-19 pandemic by imposing restrictions of various magnitudes on citizen activities. The Indian government imposed one of the strictest lockdown among all nations. The lockdown initially meant for 3 weeks has been extended thrice for a total duration of about 10 weeks. During this period, there has been closure of nonessential services. While the government did take certain proactive steps, however much remains to be desired at the ground level. This unprecedented move and other precautionary steps to control the pandemic unearthed numerous psychosocial consequences; however, for this particular paper, we will focus on social challenges such as migration, poverty and hunger, social disconnection, homelessness, and increased screen time arising as a result of government-based measures. Government policies for health-care workers have been only partially successful as there had been numerous incidents of struggles expressed from different corners of the country. Further stigma related to pandemic has had a serious impact on control measures. It remains unclear whether the social changes occurring to combat the crisis are transient or will create a totally transformed society. The true extent of the devastation due to the pandemic will only be clear in the near future.

Keywords: COVID-19, health-care workers, lockdown, social distancing, stigma


How to cite this article:
Gupta R, Arya S. Social analysis of the governmental-based health measures: A critique. Indian J Soc Psychiatry 2020;36, Suppl S1:126-30

How to cite this URL:
Gupta R, Arya S. Social analysis of the governmental-based health measures: A critique. Indian J Soc Psychiatry [serial online] 2020 [cited 2020 Oct 31];36, Suppl S1:126-30. Available from: https://www.indjsp.org/text.asp?2020/36/5/126/297134




  Introduction Top


COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Governments around the world are acting to contain and end this pandemic by deploying all available health resources. The disruption of normal services has put an unprecedented strain on health, social, and economic systems in all countries. Further, COVID-19 pandemic is a threat to physical and mental health. This crisis has given rise to fear and anxiety, which maybe spreading faster than the virus itself.

The first case of SARS-CoV-2 in India was reported on January 30, 2020. Thereafter, for the next 6 weeks, the numbers reported remain low but nevertheless kept increasing. Concerned by the imminent pandemic, the Government of India took a number of steps to control the situation. The most important and perhaps difficult one was directing a nationwide lockdown, initially meant till April 14, extended till May 3, and staggered approach since then. This lockdown was considered as one of the strictest lockdown globally.[1] This led to closure of all nonessential services and, in many cases, impacted the health services as well.[2] The people were encouraged to self-quarantine themselves and practice social distancing. In addition, a number of health-related measures were taken by the Ministry of Health and Family Welfare including surveillance and contact tracing, laboratory diagnosis, risk communications and community engagement, hospital preparedness, infection prevention and control, and implementation of containment plan.[3] Further measures were taken by the government to handle the mass migration which ensued in response to closure of factories and work. The nature of the pandemic as well as the government's response to contain it has contributed to a number of social issues which we intend to discuss broadly.


  Analysis of Social Issues Related to the Pandemic Top


Stigma

As the COVID-19 pandemic has spread across the world, so has the stigma associated with it. The fact that it is a new disease about which much less is known has contributed significantly to create panic. In India, measures taken by various agencies have also contributed to it. The exercise of contact tracing and contamination coupled with poor knowledge among the common masses has led to certain incidents where people have misbehaved with health workers tasked with sample collection in community. Further, there have been numerous incidents of people trying to escape the hospitals and run away. Individuals who are COVID positive and under self-quarantine have been ostracized by their neighbors. Even those who have recovered from COVID-19 face discrimination. Certain communities and areas are being labeled purely based on false reports floating in social media and elsewhere. Stigma drives people to engage in counterproductive actions such as hiding the illness, preventing from seeking health care immediately, and discouraging them from adopting healthy behaviors. One of the most prominent causes for such discrimination is heightened fear and misinformation about infection.[4]

Although the government has made attempts to increase awareness about COVID-19 by engaging various telecom operators and media services, the stigma associated with the epidemic has grown stronger. The frequent changes in government policy and unclear instruction in part have contributed to stigma in many segments of society in India.

Response toward health-care workers

Health-care workers across the country have been at the forefront of battling this pandemic. Although undersourced and extremely strained, the Indian health system has responded quite well till this point. However, similar cannot be said about the government's response to taking care those so essential in fighting this pandemic. Despite Government's announcements of mandatory health insurance, advance pay and monetary remunerations for health care professionals, much remains desired at implementation level. A number of health-care professionals have been subjected to issues related to travel and accommodation. Initial stages were marked by extreme anxiety about shortage of protective equipment and lack of clarity in the policy decisions taken by the government.

According to a recently published article,[5] addressing key areas (proper preparation and support, providing adequate protection, showing care by authorities, and being heard) can significantly reduce anxiety and stress in health professionals. However, since health is a subject of matter for state, no uniform policies have been devised to address the concerns of health professionals. Further, very limited steps have been taken by the government to address the mental health of these professionals. It would go a long way if uniform policies and benefits could be announced for health-care workers and their families.


  Analysis of Social Issues Related With Lockdown Policy Top


India was put under a lockdown on March 24 initially till April 14 which was subsequently extended till May 3. This initial lockdown was meant to suspend all nonessential services so as to minimize the contact between individuals, who were asked to practice social distancing and self-quarantine themselves. Since then, further 2-week restrictions have been imposed till May 17 and then further till May 31, allowing for limited number of activities to start their operation.[6] Going by the current situation, there appears to be no clarity on details regarding a clear and clean exit from lockdown. The staggered exit plan shows not only a considerable increase in cases but also a lot of problems in maintaining law and order including maintaining necessary precautions such as social distancing and isolation. A recently conducted review states that negative psychological effects of quarantine include posttraumatic stress symptoms, anger, and confusion, with some evidence for long-lasting effects. Factors such as longer quarantine duration, boredom, infection fears, frustration, inadequate supplies and information, financial loss, and stigma were found to further worsen the outcomes.[7] The study concluded with suggestions that measures such as shortest possible duration, providing clear rationale for quarantine, protocol information, and ensuring sufficient supplies can be useful in allaying the associated anxiety.

In the Indian context, the information regarding the lockdown was provided by the Prime Minister of India on March 22 in his address to the nation. Subsequently, the Prime Minister took the onus of conveying details about further continuation of the lockdown in his address to the nation. This needs to be appreciated as the Prime Minister made attempts to reach out to masses and ensure that correct information reached the citizens. However, despite these and other numerous prospective steps, a significant proportion of the population failed to get the message. This led to panic-stricken groups trying to horde things irrespective of their needs. This also triggered a mass migration in the poorest of laborer groups. Distressed due to loss of work, with no certainty about the future and food supplies, the poorest and the marginalized ones took the road back home. Further, this period was also marked by the use of excessive force by police authorities.

Migration

The impact of lockdown has been seen on all spheres of life. However, the working class has been the most severely affected by it. A complete closure meant that all those working on a daily basis were left to fight for themselves. Loss of daily work meant they had no money to buy food and pay their bills. Although the government tried to provide food to a specific section, millions were missed. Faced with uncertain futures, these migrant laborers decided to head back home traveling hundreds of kilometers hungry. Further fuelled by rumors, a gathering of thousands was observed hopeful of catching a bus or train to home. All these incidents led to a mass migration unheard since partition. It remains to be seen kind of psychological trauma suffered by these laborers and what future consequences will be. However, consequences in the present are very clear. There has been an incidence of numerous people dying of various reasons while migrating back. The most prominent danger of this migration is that now COVID pandemic can find its way to rural and remote areas that remained largely unaffected, thus putting further millions at risk.[8]

Poverty and hunger

Another prominent effect of lockdown has been the loss of job and earnings. This has significantly affected the poorest ones, who are dependent on daily earnings to feed themselves and their families.[6] With no money and work, food has become scarcity for them. These situations would make them more susceptible to COVID-19 and other illnesses. With no access to treatment services, many would suffer and die of non-COVID reasons. The end result of this sudden lockdown is that majority of these people will be pushed to the brink of hunger and poverty and many may find it difficult to survive.

Homelessness

The focus on home isolation and shutdown has had an unexpected effect. India is home to a large number of homeless people, which further increased due to sudden unemployment created by lockdown. Managing these people and providing basic services are proving to be a challenging task. Further, in many ways, they hold the key to successful contamination of community spread as these are the most vulnerable ones.[9] In addition, mental health services across the nation have seen an increased number of homeless being brought into treatment services on the suspicion of a mental illness. While till now administration turned a blind eye to them, now fear of spread of coronavirus through these homeless has driven them to bring forth to treatment services.

Social disconnect

Social distancing or rather physical distancing has been used as one of the most effective general public measures to control the spread of COVID pandemic. The lockdown and restraint at home have provided an unprecedented situation, where people are spending all their time at home. This presents a wonderful opportunity for many to spent time with their loved ones. Families started living as families, and spending time at home gave a lot of boost to healthy lifestyle changes, but the duration is too short to have long-lasting effects. If the changes are carried forward continuously in the postlockdown phase, then it will have a good effect on health and society.

However, spending too much time with family has also brought difficulties for already strained relationships. with incidences of physical emotional and sexual abuse reported.[10] According to a report by the United Nations Population Fund, lockdown across the world will lead to undermining the progress made on reducing gender-based violence.[11] There are reports from various states of India, highlighting the cases of domestic violence.[12]

A practical challenge in following social distancing in a country like India is that there are millions of people who live in urban slums. Multiple people often share a single room, and common toilets cater to many families. Under such circumstances, it becomes impossible to adhere to principles of physical distancing. Hence, despite government pushing for such measures, they may not be actually implementable at many places.

Another consequence of social distancing has been the failure to attend the funerals of loved ones. Although the death toll in India till now is quite low, in the coming times, it is expected to rise to exponential proportions. That will present a situation where people would have to forego funerals of their dear ones. Such incidents can lead to complicated grief reactions and psychological distress.

Increased use of onscreen time

Self-quarantine has provided people with ample time. While some of it has been utilized to spend quality time with family, for most, it has resulted in spending excess time over the Internet. The fact that whole work and teaching have shifted to online mode has tended to normalize the excessive screen time. According to certain reports, there has been an exponential rise in online gaming and gambling.[10] Such transitions are going to be problematic in the future as these may pave the way for Internet and gaming disorders.

Further, a major section of media and social media has contributed toward spreading “infodemic.”[13] Through conflicting messages and continuous misleading information, the news channels in India keep working toward a propaganda which serves to generate fear among the viewers. This, in turn, contributes toward creating a pan-anxiety among the viewers, painting a much grimmer picture of the situation than the reality.


  Critical Appraisal of the Situation and Measures Taken Top


Lockdown is an unprecedented move, especially in India, and initially, it was welcomed by majority. In the first two phases, people observed compliance as reflected through the social group messages and interactions, but as we enter the fourth phase of the lockdown (extended till May 31), the restlessness, anger, and frustration among masses are becoming clear as it becomes difficult to maintain lockdown regulations.

Lockdown has definitely served to control the spread of the infection, preventing the situation from completely spiraling out of control. According to various estimates, lockdown in India has been successful in averting an average of 20 lakh new COVID infections and 54,000 COVID-related deaths.[14] Further, this lockdown lasting around 6 weeks has reduced the initial doubling period from 5 days to 13 days currently.[15] To put in context, 50 days after the 500th case, India had 10 times less cases than the USA. Although the good intentions of the governmental health measure to contain and slow down the infection by imposing a stringent nationwide lockdown cannot be questioned, in hindsight, this pivotal move by the government appears excessive and perhaps poorly planned. Some experts argue that the government failed to take geographical and cultural context into account and blindly followed an untested Western model.[8] While the lockdown has definitely slowed down the spread of the virus, it has failed to halt the infection numbers and currently is yet to flatten the curve. Contrary to this, unintended consequences of lockdown have caused much human suffering and loss of lives.[3] Perhaps, a model which emphasized local lockdown depending on the presence of cases could have partially averted consequences related to migration, poverty, and homelessness. Further, the government is in a fix to make a clear exit plan. The staggered approach by the government is fraught with its own limitations, and the lockdown and associated exit plan are both acting as a double edge sword. It appears as if like having entered into a “Chakravyuh” with no clear exit in sight.

Governments across the globe have taken a string of steps with somewhat credible scientific evidence so far. The lack of clarity over the origins of coronavirus has given rise to numerous conspiracy theories which are often becoming a part of discourse among common people, further fuelling their anxiety and concerns.[16] Once the pandemic is relatively controlled, then only we would be in a better position to analyze the real positive and negative impact associated with COVID-19.

COVID-19 pandemic is a novel challenge, and newer processes and solutions are required to address it. The Prime Minister's address to the nation on May 12, focusing on self-reliance, was quite motivating. We need to be prepared for COVID and must move forward, taking necessary precautions, much similar to the WHO's apprehensions that “we need to learn to live with the virus.” Thus, in the backdrop that the COVID pandemic will last much longer than expected, society and countries need to move forward to turn the crisis into opportunity and make ourselves self-reliant.

A guarded approach is needed. The solutions recommended to fight the pandemic will have an adverse effect on mental and physical health. Social distancing measures have potential to contribute toward isolation and depression and impair social connectedness which is very important for mental health. We need hugs and kisses for our mental well-being, and if human touch is made the “villain,” then individuals will be deferred of the healing touch. We need to keep the checks and balances and be cautious in taking extreme steps as propagated to control the epidemic. Caution is also needed in interpreting the data and the so-called scientific evidence which is pushed at us by various agencies across the world. There is still a lack of clarity regarding the nature of the origin of the virus and its treatment leading to various myths and propaganda. Various guidelines dominated by the health system response of Western countries appear difficult to implement in countries like India. Our response needs to be modified keeping in view our limited health resources, population variability, and fragile economy. We have to wait and watch how things move on from here and learn from the real aftermath of the pandemic. In addition, whether the social changes occurring to combat the crisis are transient or create a totally transformed society, only time will tell. Let us hope we tide over the crisis safely and successfully and emerge stronger, healthier, and peaceful.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hale T, Angrist N, Kira B, Petherick A, Phillips T, Webster S. Variation in Government Responses to COVID-19. Version 5.0. Blavatnik School of Government Working Paper; 29 April, 2020. Available from: http://www.bsg.ox.ac.uk/covidtracker. [Last accessed on 2020 May 27].  Back to cited text no. 1
    
2.
Arya S, Gupta R. COVID-19 outbreak: Challenges for Addiction services in India. Asian J Psychiatr 2020;51:102086.  Back to cited text no. 2
    
3.
Ministry of Health and Family Welfare, Government of India. Available from: https://www.mohfw.gov.in/pdf/MeasuresUndertakenToEnsureSafetyOfHealthWorkers DraftedForCOVID19Services.pdf. [Last accessed on 2020 May 27].  Back to cited text no. 3
    
4.
Bagcchi S. Stigma during the COVID-19 pandemic. The Lancet. Infectious Diseases 2020;20:782.  Back to cited text no. 4
    
5.
Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020;323(21):2133–2134. doi:10.1001/jama.2020.5893.  Back to cited text no. 5
    
6.
Dahdah MA, Ferry M, Guérin I, Venkatasubramanian G. The COVID-19 Crisis in India-A Nascent Humanitarian Tragedy. Books and Ideas; 2020. Available from: https://booksandideas.net/The-Covid-19-Crisis-in-India.html. [Last accessed on 2020 May 27].  Back to cited text no. 6
    
7.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.  Back to cited text no. 7
    
8.
Cash R, Patel V. Has COVID-19 subverted global health? Lancet 2020;395:1687-8.  Back to cited text no. 8
    
9.
Banerjee D, Bhattacharya P. The hidden vulnerability of homelessness in the COVID-19 pandemic: Perspectives from India. Int J Soc Psychiatry 2020.  Back to cited text no. 9
    
10.
Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, et al. The socio-economic implications of the coronavirus pandemic (COVID-19): A review. Int J Surg 2020;78:185-93.  Back to cited text no. 10
    
11.
United Nations Population Fund (UNPFA). Available from: https://www.unfpa.org/resources/impact-covid-19-pandemic-family-planning-and-ending-gender-based-violence-female-genital. [Last accessed on 2020 May 27].  Back to cited text no. 11
    
12.
Most Domestic Violence Cases in Lockdown from Uttarakhand, Haryana: NALSA India News, The Indian Express; 2020. Available from: https://indianexpress.com/article/india/most-domestic-violence-cases-in-lockdown-from-uttarakhand-haryana-nalsa-6412084/. [Last accessed on 2020 May 27; Last retrieved on 2020 May 16].  Back to cited text no. 12
    
13.
Zarocostas J. How to fight an infodemic. Lancet 2020;395:676.  Back to cited text no. 13
    
14.
Dey S. COVID-19: Lockdown Prevented 37,000-78,000 Deaths, Government. Says. Times of India; 2020. Available from: https://timesofindia.indiatimes.com/india/lockdown-prevented-37000-78000-deaths/articleshow/75907344.cms. [Last accessed on 2020 May 27; Last accessed on 2020 May 27].  Back to cited text no. 14
    
15.
Krishnan S, Deo S, Manurkar S. 50 Days of Lockdown: Measuring India's Success in Arresting COVID-19,” ORF Special Report No. 107, May 2020, Observer Research Foundation. Available from: https://www.orfonline.org/research/50-days-of-lockdown-measuring-indias-success-in-arresting-covid-19-66336/. [Last accessed on 2020 May 27].  Back to cited text no. 15
    
16.
Lynas M. COVID: Top 10 Conspiracy Theories. Cornell Alliance for Science; 2020. Available from: https://allianceforscience.cornell.edu/blog/2020/04/covid-top-10-current-conspiracy-theories/. [Last accessed on 2020 May 27].  Back to cited text no. 16
    




 

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