<![CDATA[In India, doctors evicted over infection fears amid expected flood of coronavirus cases]>

It was the day of India's janata (people's) curfew that foreshadowed a more sweeping nationwide lockdown, and at the request of Prime Minister Narendra Modi, Indians across the country took to their doorways and balconies to applaud and bang kitchenware in a show of solidarity with the nation's health care workers fighting the novel coronavirus pandemic.

But in the northern state of Rajasthan, a senior resident doctor at Jodhpur's Ummaid hospital had just been evicted from her home over fears she might spread the virus.

"First, [the landlord] asked me not to use the toilet. Then he said he would disconnect the water supply and electricity connection because he wanted to renovate the house," Ankita Mathur said.

"When I informed him that it would be impossible to find another house at such short notice, he clearly said that he wanted me to leave because he feared that I would put everyone at high risk of contracting the coronavirus infection."

People gather on a balcony of a residential building to clap and make noise with kitchenware to thank essential service providers on March 22. Photo: AFP alt=People gather on a balcony of a residential building to clap and make noise with kitchenware to thank essential service providers on March 22. Photo: AFP

Cases of Covid-19 infection in India have ticked rapidly higher the past week, raising alarm over the ability of the world's second-most populous country, with its fragile health care system and battered economy, to handle a future surge in cases.

While the country has officially seen 27 deaths and more than 1,000 cases so far, experts fear the real tally could be much higher and say the disease is already spreading in the community, a charge authorities have denied.

Yet even as the looming crisis unfolds, health care workers on the front lines of the fight against the virus are now being made homeless, thanks to what Mathur, the doctor in Jodhpur, blamed on "herd mentality".

"If one person is throwing doctors out of his house, others will do it as well," she said. "Indians love to follow others, they never question if it is wrong."

So many frontline health care workers across the country have been evicted that the All India Institutes of Medical Sciences' resident doctors' association has written to Home Minister Amit Shah urging him to intervene.

"Many doctors are now stranded on the roads with all their luggage [and] nowhere to go," the association wrote.

Some health care workers have been called "dirty" by their former landlords, while in the central state of Telangana, 22-year-old Nihal Mallela, a junior resident doctor at Mahatma Gandhi Memorial Hospital, said he hides the identifying markers of his profession such as a stethoscope and white coat out of fear people will look at him "with suspicion".

"Doctors in other countries are fighting the virus but doctors in India are fighting the stigma," said a senior resident doctor at the same hospital, who only gave his initials M. P.

India's health minister Harsh Vardhan has moved to assure the public that all precautions are being taken by both "doctors and staff" treating coronavirus patients to ensure that they do not become disease carriers, and the authorities have warned of legal action against any landlords evicting tenants on such grounds.

But a general lack of personal protective equipment is leaving the country's health care workers vulnerable to infection. There have been numerous complaints of staff having to work without face masks, sanitiser and various other basic pieces of kit, with one nurse at a hospital in Kolkata saying they had been told to wear raincoats in lieu of hospital gowns.

Indian nurses wearing masks walk outside a special ward set aside for possible Covid-19 patients in Mumbai. Photo: AP alt=Indian nurses wearing masks walk outside a special ward set aside for possible Covid-19 patients in Mumbai. Photo: AP

This is what is making landlords nervous, according to 33-year-old pathologist Anirban Dutta of West Bengal's Murshidabad Medical College and Hospital, who was also evicted recently.

"I told the owner of the house that the infection is mainly transmitted through droplets that come out when an infected person coughs or sneezes, and I was not infected," he said.

"Plus, we stayed on separate floors, we didn't use common spaces or utensils, she could not have contracted the infection from me. But she was not convinced."

Kolkata-based psychiatrist Jai Ranjan Ram said the "hypocritical" behaviour of landlords who applaud health care workers one day and evict them the next could be explained by "poor health awareness" in the country, as well as a cultural tendency for Indians to mistrust one another which "manifests in the form of stigmatisation".

A worker arranges beds at an indoor sports centre that has been converted into a quarantine centre in Guwahati, Assam. Photo: AFP alt=A worker arranges beds at an indoor sports centre that has been converted into a quarantine centre in Guwahati, Assam. Photo: AFP

Leprosy, tuberculosis and HIV-Aids patients had all been similarly stigmatised in the past, he said, adding that this time the panic was particularly acute as many were "worried about how a resource-poor India will be able to survive this pandemic".

Modi's government has announced it will provide medical insurance cover of 5 million rupees (US$66,500) per person for all frontline health care workers fighting the virus, and on March 24 initiated the world's largest quarantine by ordering the country's population of 1.3 billion people not to leave their homes for three weeks.

But there is concern it still might not be enough, and such a large-scale lockdown will be difficult to implement, particularly in a place where the poor live in close quarters and the social distancing measures being advocated in the West are almost impossible.

Along with the lockdown, India has also acted to curb inbound travellers from overseas. Should these measures fail to halt the virus' spread, though, epidemiologists say the numbers could be staggering. A University of Michigan-run study predicts the country could have 915,000 coronavirus infections by mid-May, more than the caseload for the whole world right now.

Last week, leading public health expert Dr Ramanan Laxminarayan, director of the US-based Centre for Disease Dynamics, Economics and Policy, told This Week In Asia that as many as 300 million people in India, or about 20 per cent of the population, will catch coronavirus in the worst-case scenario. He maintained, however, that the overwhelming majority of these infections would be "extremely mild".

In viral hotspots like China's Hubei province, Italy, Spain and now New York, a rapid surge of infections brought a wave of patients to hospitals that exceeded their capacity for critical care. Doctors have been forced to effectively choose who lived and who died through the deployment of scarce resources like ventilators.

In India, that tipping point " if it comes " will arrive sooner.

The country spent just 3.7 per cent of gross domestic product on health care in 2016, putting it in the bottom 25 of nations globally, according to the most recent World Bank data. On numbers of doctors, nurses and hospital beds, it ranked similarly near the bottom. While there is a growing private hospital sector, nearly 65 per cent of the population has no health insurance, putting significant pressure on the overcrowded, understaffed and sometimes rundown public hospitals.

Additional reporting by Bloomberg

This article originally appeared on the South China Morning Post (SCMP).

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