India Shrugs at the Swine Flu Outbreak

When swine flu first hit Mexico City, the Mexican government shut the city down for three full days. But when the flu struck Mumbai last week, the Indian government shut down only movie theaters and schools and then, while the flu spread unchecked, opened them again a few days later. By Aug. 17, the countrywide death toll had reached 28, and Pune, two hours' drive southwest of Mumbai, was being considered an H1N1 cluster. There, infections were spreading faster than doctors could track them, and health authorities counted 14 deaths from swine flu. Nearly 1,700 more Indians had tested positive for the flu, which spreads rapidly from human contact, kills a little less than 1% of its victims, and is considered one of the fastest-spreading pandemics in recent history.

In Mumbai, malls nevertheless stayed open through the weekend, with a few people spotted wearing face masks. But most visitors seeming unconcerned. On Friday, the city celebrated the birth of Krishna, with entire neighborhoods swarming with events called dahi-handi (buckets of yogurt): Young men and children climb over each to reach earthen pots of yogurt dangling from strings above streets. "Swine flu?" asked Rajeshri Murthy, 14, as she joked with her friends in a crowded north Mumbai neighborhood. "Why worry about it? It's a holiday!"

She could have been taking a cue from the government's handbook. Prime Minister Manmohan Singh told Indians on Aug. 15 in his annual Independence Day speech not to be too worried. "I want to assure you that the situation does not warrant a disruption in our daily lives because of fear and anxiety," he said.

Creaky Medical Infrastructure Why the relative lack of official alarm in India about a disease that has consumed the World Health Organization's resources since it was first detected in April and led to quarantines all around the world? After all, a full-blown pandemic in India would overwhelm the country's creaky medical infrastructure. Economists are already taking note, with Macquarie researcher Rajeev Malik factoring the possibility of a big outbreak into forecasts of gross domestic product. "The H1N1 scare is a potential risk, especially on consumer sentiment," says Malik, who decided it was too early to decide how widespread the impact would be on the Indian economy.

From a political standpoint, the government's muted reaction is understandable. Just three months after a resounding victory at the polls, the Congress Party has found itself in a difficult situation. The monsoon rains, vital for the country's agriculture, have failed, leading to drought in one out of every five Indian districts. As a result, food prices are inching upward. And newspapers every day criticize the government for not bringing the perpetrators of the November Mumbai terror attacks to justice. "The government's record has generated a good deal of skepticism. And with good reason too," wrote The Times of India, the world's largest English-language newspaper, on Aug. 15.

At the same time, shutting down Mumbai, India's teeming financial capital, with 18 million residents, is close to impossible. As many as 6 million people ride in Mumbai's commuter trains every day, its airport handles one-third of India's air traffic, and by some estimates the city makes up more than 52% of India's service industry, with the main Indian stock exchange and most of the major corporations headquartered there. Even a one-day shutdown could send tremors through the Indian economy, which is still rebounding from the global economic crisis. Now that the initial media and public panic has died down and 24-hour television coverage of the outbreak has given way to other news, movie theaters and other public places have reopened in Mumbai. On Aug. 17, residents lined up to buy tickets for the latest release, Kaminey, which the rest of India got to watch a few days earlier. "I will probably die from this cigarette that I am smoking before I die from swine flu," joked Riteish Chowdhury, 28, who had brought his wife and 10-month-old child to the theater.

Other Scourges Far Worse Health officials point to one possible explanation for the apparent lack of concern among many in Mumbai: Indians have lived with far worse diseases for decades. Malaria, tuberculosis, and even diarrhea kill more Indians each day than the swine flu has claimed nationwide. The other is simply a question of numbers: Twenty-eight dead in a country of 1.2 billion people is easily ignored. After all, about 15 people died every day in 2008 as they took Mumbai's infamously overcrowded and doorless trains to work.

Even AIDS is mostly ignored in government and Indian private philanthropic spending, even though as many as 2.5 million Indians are estimated to be HIV positive. "It's all a question of what you choose to care about," says Kiran Nayyar, a psychologist in Mumbai, pointing to an Aug. 16 WHO report which found that 300 Indians die each day just from road accidents, the highest number in the world. "If it didn't have such a bombastic name, I don't think people would even talk about swine flu."

In spite of its public posture, the Indian government does say it is taking concrete measures. In a visit to a Mumbai hospital on Monday, it appeared that a central government directive to quarantine suspected swine flu victims was being followed. The government has already distributed 100,000 Tamiflu tablets nationwide, with a further 10,000 on the way, said a Health Ministry spokesman. Testing centers were being set up at government-run hospitals, and private hospitals were being asked to pitch in. And according to The Hindu, an Indian newspaper, even the Prime Minister, having told people not to panic, has been calling up the Health Minister to push for more action.

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