Over the past two weeks, state governments across the country have scrambled to curb the spread of coronavirus. Several states have ordered the closure of public spaces such as malls, schools, colleges, cinema halls.

Some like Karnataka and Delhi have banned gatherings of over 50 people. Section 144 that bans the gathering of five or more people in an area was imposed in parts of Maharashtra including Nashik and Nagpur, and in Kargil in the Union Territory of Ladakh on Tuesday.

The number of cases of Covid-19, the disease caused by the coronavirus, in India stands at 137. On Tuesday, the country reported its third death. The highest number of cases was reported from Maharashtra and Kerala. While these are the official numbers, many fear that the number of those affected in India could be much higher because of concerns that the country is not conducting enough tests to check the spread of the virus.

Instead of testing more widely, some states resorted to extreme measures to contain the spread. On Monday, the Maharashtra government started using indelible ink to stamp the hands all those who were asked to isolate themselves with the words “home quarantined”. Chief Minister Uddhav Thackeray stated that this was done to instil a “sense of responsibility”. The Brihanmumbai Municipal Corporation described the stamp as a “badge of honour”.

However, public health experts say such measures are inhumane. “Such coercive measures are self-defeating,” said Sunita Sheel, secretary of Forum for Medical Ethics Society. “It only adds to stigma and leads to loss of public trust in the government.”

Public health crisis

In Uttar Pradesh, the district magistrate in Agra directed the chief medical officer to file a First Information Report against a woman for allegedly fleeing and endangering lives after her husband tested positive for the virus in Karnataka. On March 15, the woman’s father-in-law was booked by the Uttar Pradesh police under the Epidemic Act and could be jailed for up to two years.

The couple had returned from a visit to Switzerland and Greece to Mumbai on March 6. From there, they went to Bengaluru on a flight that landed around 10 pm on March 8. The woman travelled to Delhi by the 1.40 am flight on March 9 and then reached her parents’ home in Agra.

The Karnataka government dismissed allegations that the woman fled as her husband’s test results came out on March 12 as she travelled before that. A person who identified himself as someone who knew the couple claimed on Facebook that the woman was quarantined in Agra but the family sought permission to leave because the hospital was not clean. “The sight of the unhygienic condition of the toilets made her retch,” the woman’s brother-in-law told the Times of India.

Public health experts said that a human rights approach was needed in such situations. “Issues of privacy and stigmatisation need to be taken into account,” said Sulakshana Nandi, Joint National Convener of the Jan Swasthya Abhiyan. “The first thing to do is to take stock of facilities that can be provided.”

The scene outside a movie theatre in Jammu on March 11. Credit: PTI

Other experts said that the fear was palpable among common citizens and that shaming those who were affected was not a solution. “This happened with leprosy and HIV [Human immunodeficiency virus] patients and it impacts the basic principle of respect for human dignity,” said Sheel. “We have to go to the root cause of why such instances occur.”

India’s dismal public health infrastructure has come under the spotlight as several instances were reported where suspected cases fled isolation wards in government hospitals and preferred to seek private treatment. Activists said that this eroded public trust in government facilities during a public health crisis.

The panic of the virus spread has permeated within communities and has led to ostracisation in some cases.

On March 15, a couple that returned to Thrissur in Kerala from a trip to Saudi Arabia found that the door to their apartment was sealed with tape by neighbours who wanted to monitor their movements. This occurred after the couple stated to the flat owners’ association that they had been screened at the Kochi airport and that they would remain quarantined in their flat for 14 days, The News Minute reported on March 16.

Police officials filed a case against four persons for wrongful confinement, wrongful restraint and offences committed with common intention. “They were arrested as part of public awareness so that such acts of ostracisation do not happen anywhere,” a police official was quoted in the report.

Government messaging

As the situation escalates around the globe, the Central government put several restrictions in place. On Monday evening, it released a circular stating that travel of passengers to India was barred from member countries of European Union, European Free Trade Association and the United Kingdom from March 18. This created panic among Indians abroad as the circular was not clear on whether or not they would be able to return.

On Tuesday, India also barred the entry of passengers from Afghanistan, Malaysia and Philippines.

Public health experts said that governments at the state and Centre had to focus on their communication related to coronavirus.

Viruses bring about uncertainty and community messaging was key to making people aware, Sheel said. “People are under anxiety and fear,” she said. “There should be brief, simple and plain messaging in regional languages about the virus. The aspect of communication is crucial.”

Nandi concurred and said that the government advertisements on coronavirus focused only on social distancing. “This is a very individualistic approach,” she said. “The priority should be for the government to improve facilities.”

Moreover, she added that there was a need for a more centralised form of leadership to fight the virus even though health is a state subject. “States are on their own and there is not much national leadership from testing to treatment.”