Three world famous economists — Amartya Sen, Raghuram Rajan, and Abhijit Banerjee — recently took to The Indian Express to push for aggressive government spending to curb the loss of lives and livelihoods to COVID-19. While their argument is certainly applicable in every country caught in the throes of this pandemic, their focus on India’s susceptibility to COVID-19 is particularly notable. India’s vulnerability to widespread infection, likelihood of experiencing severe cases of COVID-19, and economic instability have led experts to predict that COVID-19 may take an unprecedented toll on the country.

First, the juxtaposition of population density and poverty means that India is ripe for the rapid spread and ravages of COVID-19. Those elements — extreme population density and extreme poverty — routinely converge to produce extreme environments that serve as the breeding grounds for infectious diseases. This is nowhere more apparent today than in the many districts like Mumbai’s Dharavi. This district houses roughly a million people within an area less than a square mile. There are no multistory buildings in Dharavi — just a million people squeezed shoulder to shoulder.

In such circumstances, strategies like social distancing — which are already showing signs of flattening the proverbial curve in countries across the globe — are nearly impossible. To make matters worse, unsanitary living conditions make it almost impossible to enforce frequent handwashing and general hygiene strategies geared to slow the pace of COVID-19. This pandemic could spread across India, especially its slums, with unprecedented ferocity. According to the Ministry of Health and Family Welfare, there have been 18,381 documented cases in India to date. This relatively low figure could reflect the desired impact of the national lockdown or may represent a dramatic underestimate due to current testing limitations.  

Second, India suffers from high rates of several underlying health conditions that experts associate with poor health outcomes when infected. Many of these conditions — including chronic obstructive pulmonary disease (COPD), lung cancer, and tuberculosis — affect the lungs. While these diseases are driven by multiple factors, ranging from genetic predisposition to air pollution, there is no denying that smoking, in a country with over a quarter of a billion tobacco users, is an important risk factor. India has some of the highest rates of tobacco and smokeless tobacco use in the world. The World Health Organization estimates that tobacco contributed to 9.5% of all deaths in India (roughly one million people) last year. This toll will almost certainly increase during the pandemic. 

Third, even for those whose lives are spared by the pandemic, their livelihoods may not be. The national lockdown — an aggressive, prudent, and necessary measure taken by the government — has significantly disrupted the economy. Those already on the margins of Indian society, such as daily-wage and migrant workers, are especially vulnerable. Approximately 12.5 million bidi workers and tendu leaf pickers are likely living under limited rations and with virtually no savings. This, after all, was the animating impulse for the op-ed by Sen, Rajan, and Banerjee. As they note, “the biggest worry right now, by far, is that a huge number of people will be pushed into dire poverty or even starvation.”

Finding ways to address that worry is of the utmost importance. The Indian government has already implemented measures to curb the spread the disease. As the economists argue, it must now take equally strong measures to stem the looming economic fallout from the pandemic. After that, it must address deeper structural challenges like poverty and a high burden of diseases, driven in part by high rates of smoking.