India had one of the strictest quarantines in the world. Why are cases still growing?

The response to the spread of coronavirus that most Indians are talking about this week is not an innovation in contact tracing or a big increase in hospital beds, it’s the death of a father and son in judicial custody in the southern state of Tamil Nadu. It happened after the local police picked them up for complaining about having to close their small store early to comply with lockdown rules. In some ways, the case exemplifies India’s struggle with its coronavirus response: if you can’t beat it with a stick, what do you do?

India now has nearly twice as many cases as the UK, and will surpass Russia to become the world’s third worst-affected country after the US and Brazil within days. India’s prime minister, Narendra Modi, is no Jair Bolsonaro; since his 24 March address to the country announcing a national lockdown, Modi has been relentlessly on message, and wears a mask and practises physical distancing.

Why then was India not able to translate an early, strict and long lockdown – characterised by the University of Oxford’s Blavatnik School of Government as among the most stringent on its stringency index – into a flattened curve? It isn’t the case that the Modi administration did not try. Police officials, healthcare workers and other government employees have been dispatched across every Indian city and village to look for people with symptoms, and either quarantine them or get them to hospitals. This work has come at great risk: more than 1,000 police officials in the state of Maharashtra, and more than 1,200 doctors and nurses in Delhi have tested positive.

But the lack of state capacity in India remains so acute that it simply cannot pull off the big moves it truly needed to make, no matter what Modi’s administration or its friendly media might claim about how he has reformed governance.

“We’ve seen this now in multiple disasters, that south Asia pulls together quite well actually in a crisis,” Jishnu Das, professor of economics at Georgetown University, and an expert on healthcare delivery, told me in a recent interview. “It’s the sustained institution-building between crises that’s the problem.”

India could not expand testing to the extent needed in the breathing space that the lockdown gave it, especially to historically poorly served and underdeveloped regions; in the eastern part of Uttar Pradesh, the most populous Indian state, one testing lab serves 30 million people. It could not bolster its contact-tracing ground force, and in the worst affected cities, contact tracing has now fallen too far behind to resuscitate.

It could not improve hospital capacity in any meaningful way; Indian Twitter is awash with desperate pleas from the family members of seriously ill Covid-19-positive people, begging for help securing a hospital bed after being turned away by everyone. Anyone with some money has long seceded from the public healthcare system in most Indian states, but with state-run hospitals the designated treatment centres in many smaller towns, dystopian horror stories of the decay in these hospitals have now surfaced; a woman in Jalgaon, a small town in the western state of Maharashtra, died after waiting six hours for a bed in the local government hospital’s intensive care unit. Eight days later, the body of her mother-in-law was discovered in the same hospital. Positive for Covid-19, she had been made to use the bathroom unassisted, and had died in there, her body unnoticed for eight days.

Now the Indian state has turned either to bluster or to brute force, both of which have worked for it in past crises, but which simply cannot defeat a pandemic. When cases spiral even after a strict lockdown, some administration officials are deployed to provide statistically impossible, optimistic charts to the media. Migrants are instructed not to return to their home states, but no state aid arrives for weeks, and when they are left with no choice but to walk home they face hostile police. People are sealed into “containment zones” but the state capacity to take care of their needs doesn’t exist in many places, so the police are deployed to wield their sticks at people attempting to escape to work.

These failings are not of Modi’s creation, but a year into his second term, they are still a long way from going away. Modi’s key offering on health was an expanded insurance scheme, but one year in, it remained heavily stacked against the poor. For emergency welfare, including on food delivery and income transfers, he has only built on programmes introduced by the centre-left Congress party-led coalition that preceded his first term. With India’s first recession in 40 years around the corner, the appetite for large expansions of the welfare state might recede further. Modi has certainly talked more about a responsive and accountable state than any Indian prime minister before him. If his administration could admit it, they would recognise that India’s pandemic response demonstrates that the change hasn’t yet happened – certainly not enough of it.

But all indications are that Modi’s and his party’s popularity remain unscathed; it’s unlikely that their reckoning will come.