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India’s worst affected: the socio-economic parallels between influenza (1918-19) and Covid-19 in Mumbai

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The experiences of the city of Bombay (present day Mumbai) in dealing with the 20th century influenza pandemic and the novel coronavirus share a remarkable continuity in the socio-economic spheres. Writing on the influenza pandemic, historian David Arnold notes that “In one day alone, 6 October 1918, there were 768 registered deaths from influenza in Bombay city, more deaths than at the height of the plague epidemic in the 1890s and 1900s”. Mumbai is on a similar trajectory, ranking first among the worst affected Indian cities. Between the two episodes lies a striking similarity in how the geographical and socio-economic conditions of the city’s residents have altered the course of the pandemics. Of course, there are pathological differences between the two viruses. For instance, the victims of the Influenza pandemic were predominantly infants, youth and women whereas the coronavirus has killed more people from the older generation, despite its non-discriminatory proliferation. Yet, it is noteworthy that the city’s innate socio-economic characteristics have distinctively manipulated the effects of the virus.

Revisiting the 1918-19 influenza pandemic, the mortality figures for Bombay reflect that the caste status of the patient was fundamental to chances of recovery from influenza. While the mortality rate amongst the upper caste Hindu population was 18.9%, it was as high as 61.6% for the lower caste Hindus in the city. As scholars Radhika Ramasubban, Nigel Crook and others have argued, class and caste were important determinants of spatial segregation and access to civic amenities in colonial Bombay. Since the rising property prices in the southern part of the city were unaffordable, areas like Parel, Sewri, Sion, Mahim and Worli, were predominantly occupied by the industrial working population. In addition to economic distress, these areas were also marked by social divisions on caste lines. For instance, the areas of Kamathipura, Kumbharwada, Umarkhadi, Tarwadi, Mazagaon, and Agripada were predominantly inhabited by the lower caste communities. Unsurprisingly, The Times of India had reported that the worst affected regions of the city were the ones mentioned above. In addition to poverty, high population density and insanitary living conditions, lack of adequate medical relief infrastructure was one of the prominent reasons for the high mortality rates recorded.

There was a clear caste-based discrimination in the response mechanisms mounted by the city’s diverse populace. A spatial analysis of the medical relief infrastructure, set up by the Bombay Municipality, the voluntary and community-based organizations indicates that the table dispensaries and temporary hospitals were concentrated in places like Chaupatty, Malabar Hill, Bhuleshwar, and Tardeo, which were predominantly upper class and caste localities. The temporary hospitals, for example, were mostly set up by communities such as Dawoodi Bohras, Jains, Bhatias, Gaud Saraswat Brahmins and others, where admission was exclusively reserved for their community brethren or members of other elite castes. Consequently, the lower caste communities had to overwhelmingly rely on government hospitals and public health infrastructure, which were distinguished by significant inadequacies. Bombay had an embarrassing ratio of 0.5 beds per 1000 people in comparison with ratios over twice as high in other big cities like Lahore, Madras and Calcutta.

A century later, the city is confronted with the same reality of 1918-19. While the social prejudices in the delivery of healthcare have been largely overcome, the geographic and economic dimensions share a noticeable continuity. Today, in India, the ratio of hospital beds still remains at 0.5 per 1000 people. Even today, the geographical spread of the virus is largely concentrated in areas such as Worli, Byculla, Mazagaon, and Agripada, which were also affected during the Influenza pandemic. As a result, poverty, high population density and the degree of access to basic necessities have re-emerged as the key determinants of both the spread of the disease and recovery from it. The virtual inapplicability of the policy of physical distancing in these regions stands as a case in point. The slums and working-class localities in Mumbai house in some cases hundreds and in other cases thousands of people in highly congested spaces and insanitary conditions, which do not lend themselves to effective application of physical distancing and self-quarantine strategies. Reflecting on this aspect, historian Ramachandra Guha remarked that the urban upper and middle class “have their own safety net, independent of the state which includes a wide range of investments and savings”; therefore, making it easier to practice physical distancing.

At the macrolevel, however, the experiences of Bombay with Influenza and Mumbai with Covid-19, are an expression of the perils of inadequate state investment in health policies. Back in the day, the gaps in healthcare left by the colonial state were filled by the societal elites and the middle classes of the city. Drawing parallels between the past and the present, it is arguable that an increased political will and public-private coordination in improving public health infrastructure is extremely crucial. Piecemeal improvements and ad hoc responses have proven insufficient in 1918-19 as well as 2019-20. Therefore, the experiences of the financial capital of India in tackling the Influenza and Covid-19 pandemics drives home the critical point that socio-economic characteristics of the city have hugely affected the impact of the virus.

Please note: Views expressed are those of the author.

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