Socio-economic Vulnerabilities to COVID-19 in India: Swimming against the Tide

COVID-19 poses an unforeseen challenge to the world. The virus is testing the capacity of public health systems globally and their ability to respond effectively. India is no exception. The country has already witnessed more than 35,000 confirmed positive cases by the end of April 2020, and the number is fast rising despite strict measures by the government. The virus has reached every state and union territory of the country. In the absence of a drug or a vaccine, the only measure available to fight this deadly novel pathogen is to adopt changes in behaviors and lifestyle – physical distancing, frequent hand washing, and proper respiratory etiquette. The government has imposed lockdown to maintain social distance since 24 March 2020, but it cannot continue for long due to the immense loss of economy and livelihood. The country needs to learn to co-exist with the virus and embrace the prescribed measure of physical distancing, and handwashing even after the government lifts the lockdown. The paper uses the data from the most recent Indian version of DHS, known as National Family Health Survey-4, to examine the feasibility of the adoption of these new norms and their impact on a densely populated country like India, where there are nearly half of the households (49%) with three or more people sleeping in a room, 35% going out to fetch water for daily usage, and 38% have no toilet facility within their household premises. The study uses multivariate analysis, Wagstaff’s Concentration Index, and decomposition analysis to find out the extent of vulnerability across different socio-economic strata of the Indian population in adopting these safety measures to fend themselves from the corona infection. GJMR-K Classification: NLMC Code: QW 160 S. K. Singh , Aditi σ & Sudipta Mondal ρ AbstractCOVID-19 poses an unforeseen challenge to the world. The virus is testing the capacity of public health systems globally and their ability to respond effectively. India is no exception. The country has already witnessed more than 35,000 confirmed positive cases by the end of April 2020, and the number is fast rising despite strict measures by the government. The virus has reached every state and union territory of the country. In the absence of a drug or a vaccine, the only measure available to fight this deadly novel pathogen is to adopt changes in behaviors and lifestyle – physical distancing, frequent hand washing, and proper respiratory etiquette. The government has imposed lockdown to maintain social distance since 24 March 2020, but it cannot continue for long due to the immense loss of economy and livelihood. The country needs to learn to co-exist with the virus and embrace the prescribed measure of physical distancing, and handwashing even after the government lifts the lockdown. The paper uses the data from the most recent Indian version of DHS, known as National Family Health Survey-4, to examine the feasibility of the adoption of these new norms and their impact on a densely populated country like India, where there are nearly half of the households (49%) with three or more people sleeping in a room, 35% going out to fetch water for daily usage, and 38% have no toilet facility within their household premises. The study uses multivariate analysis, Wagstaff’s Concentration Index, and decomposition analysis to find out the extent of vulnerability across different socioeconomic strata of the Indian population in adopting these safety measures to fend themselves from the corona infection. The paper acknowledges that widespread inequalities in protective behaviour from COVID -19 and the invisible virus will coexist till the development of a vaccine. The study, in its closing, recommends adopting focussed interventions with the most vulnerable groups, not only for changing their behavior but also improving their access to essential services on a war footing with a particular focus at people from low-income communities, who are socially deprived, and economically marginalized and living in resource-poor settings in 53 millionplus urban agglomerations of India. COVID-19 poses an unforeseen challenge to the world. The virus is testing the capacity of public health systems globally and their ability to respond effectively. India is no exception. The country has already witnessed more than 35,000 confirmed positive cases by the end of April 2020, and the number is fast rising despite strict measures by the government. The virus has reached every state and union territory of the country. In the absence of a drug or a vaccine, the only measure available to fight this deadly novel pathogen is to adopt changes in behaviors and lifestyle – physical distancing, frequent hand washing, and proper respiratory etiquette. The government has imposed lockdown to maintain social distance since 24 March 2020, but it cannot continue for long due to the immense loss of economy and livelihood. The country needs to learn to co-exist with the virus and embrace the prescribed measure of physical distancing, and handwashing even after the government lifts the lockdown. The paper uses the data from the most recent Indian version of DHS, known as National Family Health Survey-4, to examine the feasibility of the adoption of these new norms and their impact on a densely populated country like India, where there are nearly half of the households (49%) with three or more people sleeping in a room, 35% going out to fetch water for daily usage, and 38% have no toilet facility within their household premises. The study uses multivariate analysis, Wagstaff’s Concentration Index, and decomposition analysis to find out the extent of vulnerability across different socioeconomic strata of the Indian population in adopting these safety measures to fend themselves from the corona infection. The paper acknowledges that widespread inequalities in protective behaviour from COVID -19 and the invisible virus will coexist till the development of a vaccine. The study, in its closing, recommends adopting focussed interventions with the most vulnerable groups, not only for changing their behavior but also improving their access to essential services on a war footing with a particular focus at people from low-income communities, who are socially deprived, and economically marginalized and living in resource-poor settings in 53 millionplus urban agglomerations of India. I. Background and Rationale he rapidly spreading severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which originated from Wuhan city in China, was declared as a pandemic by the World Health Organisation (WHO) in early March 2020. Initially, not much could be said about the virus except for the fact that it was highly infectious. The disease spread fast and engulfed about Author α: e-mail: sksingh31962@gmail.com 185 countries in a short period, with nations reporting human-to-human transmission (Cohen and Kupferschmidt, 2020). The entire human population generally lacks immunity to SARS-CoV-2 and hence is susceptible to the novel virus. Even after months, there has been no substantial containment in geographical spread, mortality, and economic losses caused due to the pandemic. Worldwide, it has engulfed 3,269,667 people, and there have been 233,704 reported deaths as on 30 April 2020 (JHU CCSE, 2020). China is the epicenter of the pandemic and witnessed the havoc first with a massive number of patients and deaths, later the disease spread to the entire world encasing almost all the major countries of the world including US, Italy, Spain, Iran, UK France, India and many more (Khan & Fahad, 2020). Currently, the case-fatality ratio of the current pandemic in the world is 7.1 percent. The United States has the maximum number of confirmed cases and deceased people due to the virus (JHU CCSE, 2020). The Indian sub-continent is not aloof to the disease. In India, as of 30 April 2020, a total of 35,043 confirmed cases and 1,154 deaths had taken place with the current case-fatality ratio of 3.3 percent (JHU CCSE, 2020). The reproduction number defines the transmissibility of a virus, and represents the average number of new patients rising due to an infectious person in a naïve population. SARS-CoV-2 is much more contagious than any known virus that affects human race. On an average one infected person passes the disease to 3.2 people (Liu et al., 2020; Ryu et al., 2020). The older adults with comorbidities and pregnant women are more prone to acquiring SARS-CoV-2 (Yi et al., 2020). The COVID-19 is contagious during the latency period and is highly transmissible in humans, especially in the elderly and people with underlying diseases. People who have a weak immune system and who are exposed to the virus directly or indirectly are more likely to catch the infection. The symptoms of the disease are similar to that of pneumonia, common flu such as fever, malaise, and cough (Guo et al., 2020; Singhal, 2020; Yi et al., 2020). Yet, it is a more severe illness with a substantial risk of death, particularly among the elderly and especially among those with other chronic underlying conditions (Zhou et al., 2020). The disease has an incubation period of 1-14 days, and the advanced stage of the disease has people exhibiting symptoms like acute respiratory distress syndrome, T 7 Y e a r 20 20 G lo ba l Jo ur na l of M ed ic al R es ea rc h V ol um e X X I ss ue I V V er sio n I