While modelling exercises such as these will be evolving and ongoing, and every scientific exercise has levels of uncertainty and bias embedded in the design, there is a concern regarding the overwhelming importance of numbers in this discourse. History has taught us, that the value society places on a life lost to disease, depends on the value society placed on that life when alive. We are concerned about whom, in this pandemic, society has chosen to protect, and who it has decided to lose in the process.
Politically Mathematics is a collective of committed individuals associated with mathematics out of interest, occupation, and study. We are oriented towards understanding and communicating the perspective of the working people in the world. We aim to engage with mathematics as a practice and profession, in its relationship to the state, industry, finance, education and the nature of work in society, to recover the political character of mathematics.
The outbreak of COVID-19 has brought mathematical modelling into the public focus. We would like to highlight three concepts that have become important in modelling the spread of COVID-19 and then express our concerns.
The Susceptible-Exposed-Infected-Recovered model:
It sees the population as having four types of people:
- Susceptible : Who have not had any contact with the disease but could get the disease potentially
- Exposed : Who are infectious but are asymptomatic
- Infected : Who are infectious and are symptomatic
- Recovered : Who have developed immunity to the disease
The R0, or the basic reproduction number:
It is the average number of people, who will receive the infection from one infected person.
They are used to map the spread of illness from one country to another. This approach sees populations as connected through travel points. How disease spreads from one region to another is modelled and estimated based on the prevalence of the disease in one population and the volume of migration to the other.
Together, these models have come to underlie the predictions and estimations of the spread of COVID-19 in India. Though different research groups have used variations of these tools to make claims about data, the tools come together in different ways to form an approach. We will call the research approach that is based on these three mathematical tools as the National Epidemiological Mathematical Approach, or the approach for short.
Building from work by epidemiologists abroad, recently the approach stated above has been used to estimate the rising demand of our healthcare system in the wake of the impending COVID 19 pandemic against the capacity of the healthcare system and gives prescriptions to public policy.
The approach is predisposed to recommend quarantining of the infected population and restricting travel, but these numbers bypass important parts of disease prevention and recovery, namely the care of those who are ill and the care of society at large.
When the approach uses network theory, where diseases are shown to jump from one country to another, it assumes a prescriptive orientation for the nation-state, which becomes the default site of response to a global epidemic. This makes the premise of response a matter of borders, infiltrators and defenders of the nation. This makes for a national story in a context where the problems are very local. In India, the number of hospitals available differs strongly from urban to rural. They differ strongly from state to state. Access to healthcare is decided by social identities, such as caste, gender, class, and other social identities.
To centre the discourse to some modelling artefacts, like the R0, it might have some value in conveying the concerns of public policy, but it also confuses many key problems. The network approach has worked to reproduce the language of the nation-state as the unit of public health. While modelling exercises such as these will be evolving and ongoing, and every scientific exercise has levels of uncertainty and bias embedded in the design, there is a concern regarding the overwhelming importance of numbers in this discourse. History has taught us, that the value society places on a life lost to disease, depends on the value society placed on that life when alive. We are concerned about whom, in this pandemic, society has chosen to protect, and who it has decided to lose in the process.
The working poor of India has been on the receiving end of the war on its existence for a long time. Since liberalization, many key sectors of society, responsible for producing food, provisioning healthcare, maintaining sanitation, and performing many other forms of labour required for the basic functioning of our society have felt greater levels of precarity, owing to a combination of the contract employment system, breaking down of labour organizations or communities, and policies that have led to the greatest levels of wealth inequality in independent India.
India has never had an effective and comprehensive healthcare system, and most healthcare expenses are handled privately. At a time when demand for proper health care has been higher than ever before, effective awareness, provisioning and care has been dropping. Care of society will fall onto the most vulnerable members of society. Home care of the sick and elderly will fall to the women of society. Care of the street to marginalized communities, who are dalit and migrant communities. Without proper awareness campaigns for the protection of the caretakers and provisioning of proper safety equipment, they are put at unfairly high risk. This has hit hard in times of pandemics.
Those working in sanitation, healthcare and other forms of domestic and social care-labour are left out of policy and any protections it may give. The essential sanitation work, both for the public spaces and in medical spaces, are disproportionately done by Dalits. They have been stigmatized for the labour they have done which the caste-society has benefited from. Access to sanitation and healthcare has been disproportionately denied to them. This continues even during times of epidemic when they continue to work for this society as it turns away from their utterly unsafe conditions of work on the streets and in medical institutions. The rural population, who never was able to fully realize the promise of assured healthcare, have been left at risk. This is even truer for the Adivasi communities who have been pushed to remote areas, and have been denied any reasonable access to healthcare.
A response from the government requires the political will of the state, not just to protect the powerful, but to protect the vulnerable members of society, who have held it up.
Such responses need to be in concert with the labouring population that have been instrumental in keeping the health of society and have to work as part of a broader policy of the state regarding health. The hollowed out and unaccountable healthcare system cannot suddenly function to combat a pandemic, so ideally policies should have been in force for a long time.
Our provisioning of care, at this time, requires that the state and society affirm a commitment of a comprehensive and democratic healthcare system, both in the short term and the long term, which is both accountable to the people it cares for and is transparent.
Our collective is concerned, both by what numbers reveal and by what they hide. Our reading of the models used to determine policies and the subsequent policies hide many important needs of our society. We would urge the state to look to the needs of the working population, consider the regional aspects of healthcare, in implementing welfare, directing policy, and accommodate the needs of the different sections of society that allow the society to function.