Ideas of India is a podcast in which Mercatus Senior Research Fellow Shruti Rajagopalan examines the academic ideas that can propel India forward. You can subscribe to the podcast on Apple, Spotify, Google, Overcast, Stitcher or the podcast app of your choice.
In this episode, Shruti and Chinmay Tumbe discuss the history of pandemics in India and throughout the world, including cholera, influenza, plague and now COVID-19. They also discuss how issues of caste, migration and scientific progress have influenced these pandemics. Tumbe is an assistant professor of economics at the Indian Institute of Management Ahmedabad. His research interests include urban and labor economics, business and economic history, and migration studies. His most recent book is “The Age of Pandemics (1817-1920): How They Shaped India and the World.” He is also the author of “India Moving: A History of Migration.”
SHRUTI RAJAGOPALAN: Welcome to Ideas of India, a podcast where we examine academic ideas that can propel India forward. My name is Shruti Rajagopalan, and today my guest is Dr. Chinmay Tumbe, an assistant professor of economics at the Indian Institute of Management Ahmedabad and the author of “India Moving: A History of Migration.”
We spoke about Chinmay’s most recent book, “The Age of Pandemics (1817-1920): How They Shaped India and the World.” We talked about how pandemics are remembered or forgotten in collective memory, the relationship between religion and pandemics and caste and pandemics, how to think about Western versus Asian medicine, how to estimate deaths in a world where recordkeeping is poor, Chinmay’s intellectual influences and much more.
For a full transcript of this conversation, including helpful links of all the references mentioned, click the link in the show notes or visit Discourse Magazine DOT COM.
Chinmay, welcome to the show.
CHINMAY TUMBE: Thanks for having me over.
Pandemics and Collective Memory
RAJAGOPALAN: One of the first things I realized when I read your wonderful book is that we have really forgotten that there was something called the Age of Pandemics, even though this is not that far back in history. Of the 72 million that died globally, you estimate that 40 million people died in the Indian subcontinent, so this was not a small loss. This is the sort of loss that you should hear about in every song, that should have its own memorial days, that should have special temples or sites that commemorate a particular event or tragedy, and we just don’t seem to have that in India.
Why do you think that is? Is it because it’s morbid and unpleasant? Is it because in India we have an oral tradition in the Indian regional languages, which is quite different from the Western way of recording these things? Is it because we cremate, so we don’t have cemeteries where we can walk through and easily do a count 200 years later? What is the reason for this loss of collective memory or consciousness over pandemics?
TUMBE: It’s a great question, and I think there are various ways to look at it. One is, of course, that the bacteria or the virus is not a clearly defined enemy like, say, for many Indians, the British Empire or something like that. The lack of a clearly identifiable enemy means you’re less likely to have commemorations.
We have, for example, the Jallianwala Bagh tragedy of April 1919, which killed a few hundred people. Every Indian knows about this, but just a few months earlier, 20 million Indians died during the influenza pandemic. Twenty million versus a few hundred: you would think that the 20 million tragedy would register, but I never learned about the influenza pandemic in my school, but I definitely learned about the Jallianwala Bagh tragedy. That’s one way to look at it. That is, pandemics, viruses, bacteria don’t—I mean, people see it as an act of God, or they don’t see it really as a calamity which is enforced by somebody else. That’s probably one reason.
The other is that pandemics—compared to wars, even natural calamities like earthquakes, floods—don’t leave behind a visual memory. In the sense like an earthquake destroys a city, so buildings are broken, so you can see the effects of that. Wars, the bombs, even the terrorist strikes in Bombay a few years back, the bullet marks in the building walls and so on. Pandemics kill labor. From an economics perspective, it kills labor but not capital stock. That’s, I think, another reason why pandemics have slipped out of memory across the world, not just in India.
They have been memorialized a little bit when they have been there for many, many years. For example, plague—there’s a plague temple in Bangalore—or of cholera temples and so on. But broadly, I would say, compared to how the Black Death of the 14th century has registered in the European consciousness—kids learn about it because one-third of Europe was knocked out. I think that’s another reason why we’ve kind of completely forgotten about this.
So, lack of clearly identifiable enemy. The fact that they don’t leave visual markers. The fact that our history textbooks obsess about political history rather than, say, economic, demographic or any other kind of history. It means, again, we know more about World War I than influenza, and World War I killed fewer people than influenza globally. In fact, the global death count of World War I is lower than just how many people died in India during the influenza. So many, many reasons, but I think this is one, definitely.
Of course, like you rightly said, it’s tragic and we want to forget it. If there’s no clear enemy, then we tend to forget it.
What I found when writing this book is when you scratch the surface, you do find memories. I found this old history from Central India, and this person told this doctor—just last year. This doctor had gone for COVID-19, Dr. Yogesh Kalkonde. He asked villagers, “Has any of you had these experiences before?” An old person stepped up and said, “You know, my grandfather told me this story that in their time, about 100 years back, it was so bad that they dumped all the corpses in the bullock cart, and they gave the driver a pint of alcohol to drink to forget all the stench and told him to go and dump the bodies in the jungle.”
That’s a very powerful memory lingering around. It’s there 100 years later. That memory of presumably the flu pandemic of 1919 was definitely there, but it was not registered in the national-consciousness level.
Treatment of Pandemics in History
RAJAGOPALAN: I think it may also have something to do with who writes history. As you mentioned, certainly I was a keen reader of history in my school years, so I remember my childhood history textbooks quite well, and Jallianwala Bagh was, of course, a big one. When we talk about 1918-1919, I’ve learned about the Russian Revolution more than about any tragedy that happened in India.
Or even something banal, like I think I recall Indian National Congress: Motilal Nehru was the president when it happened in Amritsar. The way we needed to learn where each National Congress was conducted, the annual meeting and things like that. Those things we remember.
Does this have something to do also with the fact that the way history was written in India post-independence is because of a particular dispensation, who also happened to be the major party in the Indian nationalist movement, and that’s why those are the events that seem to loom big?
We do hear about the plague in Bombay, right? We hear about how it became a huge municipal election issue; we hear about [Gopal Krishna] Gokhale winning the election, or we hear about [Bal Gangadhar] Tilak. Any part of the epidemic or the pandemic which has to do with the nationalist movement slowly trickles in and makes its way into the history books, and everything else seems to be forgotten.
TUMBE: Absolutely. You’re bang on that the people who wrote the history textbooks, especially . . .
It was, of course, an epochal moment, throwing out the British in 1947. Clearly, then, the emphasis was, well, how did we do this? That was a lot of pride-giving, saying that “Look, we could do this. Now we can do anything.” It’s a lot of inspiration-building; it’s a lot of heroes—construction of national heroes and so on. That was the emphasis. In that, of course, I think that emphasis from freedom fighters and so on, it basically became our political history.
What strikes me after writing this book is that if the Indian National Congress was instrumental in writing our history textbooks after 1947, they should have at least—the historians should have seen how critical epidemics and pandemics were in shaping the Indian National Congress itself. Like you mentioned, how important plague is for not only Gokhale and Tilak, but also Sardar Patel. His first job in life was in Ahmedabad as a municipal committee member handling plague.
I mentioned other leaders in the book. Savitribai Phule is another person that comes to mind. Now, after writing this book, I thought I’ll see our freedom movement through pandemics, in the three pandemics: cholera, plague and influenza. If you see 1857, the mutiny in India—the uprisal and, by some terminology, the first war of independence—that came on the back of a massive cholera epidemic.
So 1857: cholera. Then if you look at 1896 to 1918, the real foundation of the Congress Party, the split of the Congress, extremists versus moderates: It’s all happening in the backdrop of plague. The year in which they split is the year of massive plague mortality—1 million deaths thanks to plague. Then, of course, after 1918, Gandhi comes to fore. Gandhi’s real emergence in the Indian national scene is in 1918-1919.
In a way, looking at our own freedom movements through pandemics, I would say 1857 and cholera, the rise of the Congress and plague, and the rise of Gandhi and flu pandemic. The pandemics actually bookend the freedom movement itself. I think that’s something which I kept stumbling upon while doing this.
You’re absolutely right. Your specific question that the historians who wrote this—I’ve gone back to the history textbooks. There is no mention of the flu pandemic.
I think the fact that 20 million people—even if you don’t accept my figures of the pandemic, the estimate is now between 10 million and 20 million; it’s higher than the famines. There’s no famine also which people are saying—I mean, the Great Famine was supposed to be 6 million to 7 million and it’s, what, 1876? This is the worst disaster. It’s not just a disaster. It’s the worst disaster in Indian history, which we’ve completely forgotten.
That’s one of the reasons why I wrote the book. I said, “There is no book on this.” I said, “This is an opportunity to write something.”
RAJAGOPALAN: One fascinating thing about what you just said is how there are moments in the Indian nationalist history and the political movements which bookend these pandemics. I wonder how much of that has to do with existing disapproval of the administration or a lot of disgruntled people—because when there is a death and a funeral in every home, this is not a happy group of citizens.
How much of that automatically fuels any movement that is against a particular kind of administration? It could be at the municipal level, it could be East India Company, it could be at the national level. The way they come out is through some other event, which is political or social or in elections or something like that.
It would be the equivalent of historians presently and people in the future reading about 2020 and 2021 as the year Donald Trump lost and had a coup in Washington, DC. I live in the area, and it’s a really remarkable moment in my own memory, but 2020 and 2021 means something completely different to those of us who have lived through it. I wonder if historians in the future will remember it like that.
TUMBE: That’s true. The pandemics get political. Everyone’s trying to prove a point that . . .
As I point out, there’s a lot about the pandemic that we simply don’t know while we’re living through it. To say that somebody has performed better or not; there’s just so many reasons that go into pandemic management. You’re right. I like the way you framed it. If you see this as a year of Donald Trump rather than the pandemic, the pandemic is the override. The pandemic is used then, of course—underlying anxieties are played on in various ways.
Now, in India, if you ask me, I think it was a mistake to have all large gatherings, but people who are anti-Modi will point out about the elections and the Kumbh [Mela], but people—the pro-Modi will point out the farmers’ protests. This is a classic way of . . .
The BJP side today is basically saying the farmers’ protest started the pandemic. The other guys are saying the election rallies and the Kumbh Mela started and fanned the pandemic. Of course, scientifically all we can say is that all of them were misguided in the sense that all large gatherings, whether it’s even a large religious gathering in your small town, was also not advisable.
Clearly, it’s a very partisan topic now. It’s playing into existing polarization, existing divides. Now here’s an opportunity to take your strong position. The reasoned debate definitely dies out along with so many other things in the pandemic. That’s one casualty.
The Black Death Versus Other Pandemics
RAJAGOPALAN: Absolutely. I learned more about cholera during my time walking through European cities and cemeteries. The first thing that strikes me is how far we have come, sort of “The Great Escape,” as Angus Deaton calls it. The number of kids who are dead, the number of young women—and you can quite clearly see that this is a family area. There are four tombstones for little children or infants, and the mother’s clearly died in childbirth. You can very quickly put the story together in your head.
Similarly, even if you go hundreds of years back, the Black Death seems to be a collective memory that is very well preserved, right?
Not only is this well preserved in terms of historians having written about it, there are modern-day economic historians who continue to write about Black Death and the various consequences that may have come of it, and some of them are quite counterintuitive.
Children in school in various parts of Europe still study the Black Death and know a lot about the plague. Anything to do with rats and rodents and public sanitation is incredibly high in the European consciousness, in a way that it’s not even true for the United States. You don’t see a similar public memory of an event like that.
What is it about that particular event which doesn’t quite copy for the other plagues? Whether this is—and it can’t just be the number of people who died, because cholera wipes out 10% of Egypt, and you don’t see this sort of emotional or public memory in Egypt relating to cholera or even other pandemics.
TUMBE: It’s a good question. I’ve thought a lot about it.
One is, of course, the regional spread was very wide, and much of Europe collectively saw this, so if you traveled within Europe from one place you could talk about it. Now, the cholera—that happens only in the late 19th century, but otherwise it was more endemic in India. Even when it broke out in New York and so on, at the same time it was not affecting many other parts. It happened in different points of time in different places. Whereas the Black Death, the whole part of it hit so strongly between 1348 to 1352. Pretty much all of Europe in that time collectively experienced that pandemic.
I do think it is a bit about numbers as well because we’re talking of, by most estimates, one-third of the population. In a relative sense, the numbers must have been small because overall population had been smaller, but one-third is huge. Because we’re saying the flu pandemic of 1918 hit 6% of India, which is huge—20 million—but it’s 6%. One-third, if these estimates are right, is much more. It’s virtually like completely families destroyed.
I think it’s a combination of these two things: that Europe collectively saw it because it spread so fast across the region at that time, and then the fact that so many people were affected.
We think Black Death was four or five years, but plague actually hits Europe again and again until about 1720. Black Death has one event, of a particular time, but plague comes again and again. Some places hardly ever, but it’s last registered in Europe in a big way in Marseille in 1720, so between 1350 and 1720.
That is why when it hit India in—it hit Bombay in—Hong Kong in 1894 and Bombay in 1896—the British went nuts, because they remembered London in the 1660s, which fell to the plague. They remembered Black Death. When I was going through these reports, you could see the collective memory. These were officials, doctors invoking the Black Death, invoking the 1660s London outbreak.
You could see it’s not that they forgot; it’s clearly there. That’s why they went into overdrive, saying, “At whatever cost, we’re not going to allow plague to reach Europe.” Of course, that was the operating stance. They didn’t say, “At whatever cost, we will not allow plague to reach Punjab from Bombay,” but Punjab was eventually battered from plague.
In their collective memory, they had registered it very well. There’s no doubt that they clearly saw plague as the—in a hierarchy of diseases, as the worst disease possible.
RAJAGOPALAN: Some of it might be endemic, and some of it might also be just how visual it is, right? Plague and smallpox leave a lot of visual evidence behind, for those who are suffering from it or have it. Whereas things like influenza and cholera, they kill so swiftly without that kind of major physical evidence left behind, that it might just be harder to record or remember. Same with malaria. You don’t have spots on your face or huge, bulbous armpits and things like that.
It might just be some of it, I think: the way we record things is also how it looks visually and how people describe it.
TUMBE: Yes, that’s a fair point. The earliest instances, for example, I think plague and smallpox and all go back to these mummies that they’ve uncovered—again, of these physical markers, and so that’s why . . .
If you look at the society-level response, very stark when it comes to plague, precisely because of the visual markers. You couldn’t go out because you have these marks on your body, especially with smallpox and so on.
In that sense, you are absolutely right. The malaria, influenza, even the coronavirus, you get a high fever. You don’t get these big boils or big stuff growing on your body, so that’s a big difference. Cholera is somewhere in between, I would say, because you did have to go to the toilet. When you see the descriptions, it’s quite painful for a lot of people because they would have to—a lot of stool passing and so on. I would rank cholera in between plague and smallpox on one end and similarly malaria on the other side.
Pandemics, Caste and Segregation
RAJAGOPALAN: What was the impact of the pandemic on social segregation and caste? Obviously caste segregation precedes any pandemic in India; it’s not the cause or the consequence of it. But does this change things in any particular way? I know there was—the way you have witch burnings in Europe, you had literally Dalit women being burned at the stake, saying that they are the cause for cholera and things like that.
What does it do to urban scapes? What does it do to the way people live with each other, the way they treat each other or the way they interact with another subgroup from another caste, and so on?
TUMBE: I think in the 19th-century world in particular, whether it was London or cities in India, interesting: the rich often survive these pandemics much better than the poor, and the poor saw this often as a way of the rich to eliminate them. There are a lot of these complaints saying that “Look, this is a disease brought to eliminate us. They don’t like us; they don’t like us as human beings, and hence these diseases have been artificially brought to wipe us out.” That was one interesting class divide, and so you had some riots and so on as part of that.
For example, when plague happened, a lot of the poor who were displaced in the evacuation or when they were pressed for segregation to hospitals and so on, they said, “This is all a ploy.” They started spreading rumors that the British are taking people to hospitals to extract fluids from their bodies and so on.
There could be a lot of class conflict the pandemics added to that—and in the Indian context, definitely caste. I would say the death rates were so staggeringly different. The lowest-ranking castes in the traditional hierarchy were basically just smashed out by the pandemics, basically because of nourishment. Infectious diseases, obviously, are going to be much more deadly if you’re not eating food.
In the 19th-century world with famine, with droughts, all those kind of situations, these infectious diseases—when I looked at the numbers in death rates in general, something like 10 or 20 times higher than, say, the Brahmins or the Parsis or even the British by the late 19th century, who had nourishment—or even soldiers. Soldiers had good nourishment. Compared to them, different classes almost 20 times death rate. That’s another way in which caste obviously factors in a pandemic: that is, people.
I’ll tell you the story of cholera. I have a map in this book of the caste of—a village map. It’s interesting case of how caste itself was used to unearth the science in a pandemic. This is a case where—John Snow in London had shown in 1854 about the waterborne theory of cholera. Incredibly, for 40 years after that, the British officials in India did not accept John Snow’s theory.
RAJAGOPALAN: This is the famous hand pump at Broad Street that he tracks.
TUMBE: And every GIS [geographic information system] class in the world starts with this famous thing: how you can use maps to solve epidemic puzzles.
John Snow had done this in the 1850s, and the European cities had started investing in water purification systems. For 40 years, these very stubborn British officers, Indian medical service officers, insisted that cholera was airborne and not waterborne.
One officer in Madras Presidency in South India wrote a book called “Cholera and Water in India.” He draws this map of—a village-level map—and he shows a street. One side he calls, I think, “high-ranking castes”; other side, he calls it “lower castes.” He says in that particular village, interestingly, it was the higher castes who got cholera and not the lower castes.
He draws these wells on the map. The two wells were contaminated with cholera, and because these guys from the other side of the street would not drink this water, they kind of escape that contamination. The only person who got cholera from this side was a washerwoman. Again, he went on this—very beautifully kind of explained why cholera is waterborne. Unfortunately, he was not taken seriously in his time. It was only about 10 or 20 years later, after him. By the 1900s, the medical establishment accepts, finally, that cholera is waterborne.
Interesting ways in which caste has entered the equation of pandemics, especially in the 19th century.
RAJAGOPALAN: I think one huge casualty of some of these pandemics has been the Adivasis and the whole wiping out of the Bhil population in parts of Gujarat. These are large communities that have lived—and Adivasis always lived in a particular kind of seclusion because they were forest dwellers or mountain dwellers. They didn’t have immunity for some of these diseases.
It’s very similar to, say, the natives in Australia or the Americas being completely wiped out by smallpox, and you have something similar going on in Adivasi populations.
TUMBE: Yes, there’s a paper of the 1918 flu pandemic by David Hardiman, and he looks at the Adivasi tribes in the border of present-day Maharashtra Gujarat, in which he points out one district was badly affected, one district was not. In search of the histories, he taps it from, again, typically doctors, missionaries and so on.
A side angle to this whole story of Adivasis and epidemics is, of course, the epidemics were used to convert, of course, a lot of people, especially into Christianity. That’s also a side story. A large part of this conversion story in India also happens on the backdrop of epidemics.
Yes, I think David Hardiman’s work on western India is one of the good works on Adivasis and epidemics. I think there must be good work, I’m pretty sure, on both cholera and plague. Plague, especially outside Bombay—Thane and so on, which has a lot of tribal populations out there. They were also badly affected.
As I mentioned, this oral history quote from Dr. Yogesh Kalkonde of these bodies being dumped in the jungle, that comes from the Gond tribe in Central India. Again, these oral histories. Somebody can do a nice project on this, to go and capture memories of the 1918 flu pandemic because they must—because Central India was completely knocked out ,and a huge part of Central India is Adivasi population. It must be preserved in local methods.
Accurately Recording Deaths in India
RAJAGOPALAN: About the preservation of memory, one reason for it, of course, is that we are terrible at counting deaths in India, in the subcontinent. The first official death registry system comes with the British, which is also a consequence of the pandemic, as you point out in the book.
Even today—I mean, we’re talking 2021 pandemic: Other than very big cities, where the municipalities are functional and the crematoria and cemeteries are supposed to get a death certificate, record a cause of death and then follow a protocol—in most parts of India, we simply don’t record deaths, no matter what the cause.
What is going on with death registration in India? Is this state capacity, is it cultural, is it some interaction of the two? Is it the fact that a majority of Indians cremate as opposed to bury?
TUMBE: Yes—I think, of course, there’s huge variation across India. I live in Gujarat, and Gujarat has close to complete registration and also (I would say) massive underreporting right now during COVID. If you look at UP, Bihar, it’s definitely linked with state capacity. The weaker the state, the weaker the funding, the weaker the public health system, the weaker your death registration system is going to be.
It’s clearly related to per capita income. You can measure this. How do you measure this? You have the death registrations, and then you do what we have in India, SRS (Sample Registration System), where you do these sample surveys to estimate death rates. You can compare how many death certificates should have been issued in that year vis-a-vis how much were issued. That’s called a completeness coverage. Completeness coverage is very poor in UP and Bihar.
Having said that, we do have the census. The census, from 1881, at least, has been happening every 10 years, except maybe this year. I used, example, the census of 1911 and 1921 to estimate how many people must have died during the influenza of 1918. It’s a guess, of course, but the point is the census is nice because think about all these people dying or their bodies being dumped in the Ganga, just like in 1918—and unfortunately, it’s happening today.
TUMBE: Now, people say there’s no way we will know the numbers, which is absolutely true because they are not being registered. There’s no death certificates for them. But the fact is that if they were enumerated in the census of 2011 in some village of India, that village is going to see a gap when we see the next census. This is not real-time data—you have to wait a few years—but the fact is, it is still possible to estimate deaths because we know it’s not the kids; it’s people in 40-plus age groups generally affected. You can do cohort matching between 2011 and 2021-22 and find out the gaps.
When I was doing research on the flu, the first numbers on the influenza pandemic were actually 6 million in November 1918. That also, of course, caught the headlines. The difference is today we have a national scorecard on deaths. Back then, you had city-level scorecards. People knew—in Bombay, people knew how many people were dying every day. People in Delhi knew. This was published daily, but nobody aggregated. They didn’t have the technology to aggregate.
That came out in February 1919, when Norman White, the sanitary commissioner of India, published 6 million deaths. That became the rallying-point number. The next visitation to that number came from the census official of 1921, in 1923. He basically notched up that number to 11 million. If you read the census of 1921, all the provincial reports, it’s amazing because they all are literally struck by how many villages are depopulated. It did leave its trace in the census.
We’ll also find out, I think—especially UP, I think, is substantially depopulated in certain cohorts because of the pandemic. I don’t want to be reckless, but I do think it’s a substantial toll that’s been taken in UP. In terms of how can we improve this death reporting? Or how do we understand the scale of the tragedy today? As I said, the underreporting factor back then I estimated was three. That is, 6 million reported deaths, and my estimate is 20 million. I always thought that three is like the upper bound. That is, you can’t really have plausible underreporting factors more than three. My look at the Gujarat data now is saying that—
RAJAGOPALAN: It’s in double-digits now, the underreporting of deaths, from what I understand.
TUMBE: Since I worked on this last time on 1918, I thought I should work on it this year as well, for the current—the number for Ahmedabad I can tell you is four, which is the lowest in Gujarat—
RAJAGOPALAN: It’s one of the most functional municipalities, Ahmedabad, right?
RAJAGOPALAN: You’re already at a huge advantage, yes.
TUMBE: Yes, and that’s underreporting of four. Of course, this will vary from state to state. Of course, there is genuine underreporting; there is underreporting at the hospital level. Hospitals—this is about incentives. Hospitals don’t have an incentive to report deaths, so they’re going to fudge data. Fudge in the sense—it’s not even fudging. It’s just saying, “This person tested negative but died, so this is not COVID.”
This book I have written is dedicated to a friend of mine, our institute’s librarian, who passed away in the first wave last year. He tested negative and then passed away a day or two later. He sent us an email that he’s tested negative and we were so happy, and just a day or two later, he passed away. Now, his death is most likely not recorded as a COVID death. The obvious case is that if he had not got COVID, he would be with us today. It is, in a way, a COVID-related death. That’s going to be huge in India.
Even without any deliberate government cover-up—though that is also possible—even without that, we are going to get an underreporting factor of more than three. Which to me is amazing because 1918 was horrific and you got an underreporting factor of three. If you get more than three, say, on average in India, then obviously we are looking at more than a million deaths, by any way you look at these numbers, unfortunately. It is quite a horrific second wave that we are living through in these times.
For me, it’s amazing because last year—and not just last year, even the year before that—I’ve gone through so many old reports, especially newspaper headlines of these pandemics, that a lot of stuff which happened in the last one month, I say, “I’ve seen this headline before.” The bodies in Ganga: I say, “I’ve seen this before.”
Virtually everything that’s happened in the past month, it’s almost like a deja vu moment for me as a researcher because I have spent times in these archives, these old newspaper headlines and so on, reading death scorecards.
RAJAGOPALAN: A couple of thoughts on that. One: when you talk about using the census and you see villages are depopulated, now, of course, we know that it’s influenza-related because that’s what’s going on. How easy or difficult is it to parse out that X number of people died from influenza, the disease; Y number of people died because there was a famine right before or a drought right after and they were already hit by influenza and they were malnourished, or the other way around?
Or, the third category, which is the able-bodied members of the family are dead and now children are orphaned or elderly are left to fend for themselves, and then they died because there is no systematic support structure that we have socially for these people. And so you get maybe an entire family that is wiped out. Whereas only 2 members out of 10 or 3 members out of 10 may have actually died of influenza.
How do you resolve these kinds of problems? Are there ways to estimate, or is it one of those “This is influenza-related, so we just put it under one bucket”?
TUMBE: It’s a great question. Very challenging, very tough, but it can be done to a certain extent. Let me just—a point about the drought that you mentioned, because we’ve not talked about that yet—1918, as I have argued in the book, was unusual not only because of influenza but because India registered its third-worst drought in recorded history. As a result of which, massive food price inflation happened, especially in western and northern India, and case mortality rates were unusually high.
I’m arguing that it’s not the temperature, but really the drought and food crises which killed more people than in eastern and southern India. I’m arguing that about 40% to 60% of India got influenza, but the people who died as a proportion of it was much higher in western and northern India because the drought and so on.
The valid question to ask was, Is this because they didn’t have food or is it because of influenza? The way to decide this thing is to look at when they died. If it was just about food, you can look at the past famines. The past famines always happened in the year after the drought rather than in the drought. Arguably, in 1918, if influenza had not come, we would have still got a few hundred thousand deaths because of the famine the next year.
Because what had happened typically, if you look at the previous famines—that is, 1876, 1899—the drought would come, the food production would fall, people would have some buffer stocks, but those buffer stocks would last them for a few more months and by the time the next year came, things would get really bleak and then they would start dying off in large numbers. Because the human body can resist for a few months. This is a classic anatomy of India if you look at when the drought happens and when people start dying.
Now, if this was not influenza, people should not have died so much in October and November 1918. Why is it that only in October and November, when people around the world are dying, they’re dying also in India? You can look at the weekly data, you can look at the monthly spikes, all of it is pointing . . .
It was recorded as fevers because fever was a symptom. Because they did provide for whatever limited registration they had. They had six categories of deaths. You’ll see that the other numbers are not going up. It’s basically fevers which is spiking.
You’re absolutely right that I cannot say with precision that 20 million people died. It’s a guess.
RAJAGOPALAN: What can we learn from the way you’ve estimated in the past with how we estimate in the present? Because we’re having the exact same problems a hundred years apart.
TUMBE: I think we need to classify deaths very honestly.
TUMBE: As simple as that.
Which means if a person goes to the hospital and dies even after testing negative, we should say it is COVID-related in the sense that that person had COVID a few days or a week before. What is happening now is, often by the time of the first test, when it’s positive, and then the person, unfortunately, dies after 10 or 15 days, by the time the test is taken then, it’s negative—but the person, unfortunately, dies.
There’s a large—even with honest governments, there’s a large part of deaths being wrongly classified as being not COVID-related. Hospitals have all the incentive to classify them as not COVID because the minute you say COVID, on the government’s dashboard right now, they are not tracking non-COVID deaths. So if the hospital is reporting more COVID deaths, more attention is going to be focused there.
This is a classic incentive problem. That’s why the central government already has to say—I think they’re doing it now—saying, “Just because there are more deaths, we are not going to penalize you.”
I can tell you, just my gut feeling is that more people have died in Gujarat in the second wave than in Maharashtra. That’s my gut feeling in terms of COVID-related deaths.
RAJAGOPALAN: That’s because of obituaries, right? In the regional papers, you see 12 pages, 15 pages of obituaries. You are not seeing that in Maharashtrian regional papers. To me, that is a smell test for what is going on.
TUMBE: Yes, and also journalists have not been taking on the mantle to report well. That’s my gut. If you look at the reported numbers, Maharashtra is way ahead of Gujarat. There is a political . . .
I mean, you are an expert of this. How should politicians be responding? In my book, the last chapter starts with this quote from the Arthashastra. Remarkably, the Arthashastra has a quote saying, basically, have good data reporting systems at the ground level—which I think has huge relevance today. It’s a classic problem.
But there is no doubt that one or two years down the line, we will get to know a picture of some estimate—this current death distribution of COVID-19 is going to change so drastically in one or two years’ time when we get more data.
RAJAGOPALAN: I agree with you that it’s not some huge conspiracy, because you can’t conspire like this at the national level, right? Some of it is just bad incentives for the hospital. The second is the way ICMR [the Indian Council of Medical Research] tells Indian hospitals to categorize deaths. One is, of course, if you’re COVID-positive and you die, even with comorbidities, it’s a COVID death. The second is a COVID-probable death for those who had a negative test or did not test at all but died of the same symptoms.
Now, that needs to be done through an audit committee, and there has to be a committee of doctors who actually evaluate all the deaths. Now, the problem is, in a pandemic with already weak healthcare capacity, that simply can’t be done. Right? Your morgues are overflowing. You have no time to do autopsies. Literally, hospitals and morgues are begging family members to take those who have deceased away as quickly as possible because they just can’t handle the burden.
Now you have a situation where before you know it, someone has come in, they’ve died in a matter of days, the body is gone—it’s been cremated anonymously by someone because COVID protocol doesn’t allow family members to enter. Now all record of what may have happened is just completely wiped. So that’s one.
Let’s say someone 100 years from today is looking at the current pandemic. They say, “Look, let’s just look at excess deaths in Delhi. Anyone who died in this three-week period, there’s a very high chance that it is COVID.” Now, I think that’s a very reasonable assumption.
Having said that, one of the first things that’s happened in the pandemic in Delhi is that hospital capacity has just been completely overwhelmed, which means that people who are non-COVID are also not being treated. This is people who are cancer patients and dialysis patients or someone who came in because of a heart attack or a motorcycle accident, so on and so forth.
Now, all that stuff is going to get lumped together with COVID deaths, which may still give you a decent estimate of COVID deaths—“We triangulate. We look at the time, the weekly spike and so on.” I don’t think there is a very good substitute we have come up with so far for recording cause of death accurately at the local level. The only thing we have in India—and this is true for tuberculosis, true for malaria—we just do this through verbal autopsies ex post, a health survey that is run every few years. Then you realize that, oh, the number of people that died from tuberculosis.
I’m just concerned about that sort of thing when it comes to COVID because I don’t know if we’re going to get good fatality rates and infection fatality rates for the second wave. It’s crucial for long-term development, whether it’s vaccination, whether it’s treatment protocols. This is a really critical thing, and we just don’t seem to have a handle on it.
TUMBE: Yes. If you look at case numbers, so often after looking at these numbers, the only metric that makes sense to me now is the test positivity rate. Within the cases, cases are a huge undercount, but within those cases, how many are testing positive? That’s giving you some sense of how infectious it is.
RAJAGOPALAN: Yes, exactly.
TUMBE: If that’s going up and that’s falling down, that’s maybe saying that . . .
Again, that’s also, to some extent, a function of testing capacity and so on. We probably need better metrics, definitely, to understand. I think one basic metric which by these journalists in Gujarat I’m told is the death certificate data. The only thing is, people should not be punished for reporting honestly and not have a political sling match. But that could be a terrific data point to have, just the number of death certificates issued every day.
Of course, last year there was a problem. In lockdown there were fewer deaths because of fewer accidents in many places and so on.
The Gujarat thing is interesting because these journalists compared 2021 to 2020, and the Gujarat government is not disputing the 2021 numbers. They’re disputing the 2020 numbers, saying it’s artificially too low and hence excess deaths are too high. I’m doing some work on this. Of course, the Gujarat government does have a point that you can’t compare to 2020, but however you look at it, it’s an underreporting factor of an order of magnitude.
Flattening the Curve
RAJAGOPALAN: When did flattening the curve become a thing in pandemics? We don’t hear about this much in past pandemics. That could partially be because we don’t have good healthcare systems, and most people are poor and they can’t quite afford it (this was before “The Great Escape.”)
The entire focus has been on, let’s make sure the health system does not get overwhelmed. We don’t have a cure, but we can manage the symptoms and we can deal with this, right? So to keep the death count low. When did this become a part of pandemic management strategy in India, and how closely is it linked to state getting involved?
Because for a very long time, poverty and people’s individual circumstances were responsible for pandemic.
TUMBE: The plague in 1897 is the single most important juncture. I would say plague was probably—I mean, the most important incursion that the British Empire made into Indian people’s lives. They started a quarantining system in a big way and so on. It came from this idea. They didn’t use the phrase “breaking the curve” or “flattening the curve,” but the idea was to contain plague in Bombay city.
The idea was to do that. They said that we’ll take what it takes, all the restrictions possible to do that. They didn’t shut down the railways. In fact, they had special trains to ferry out migrant workers back home. I think that’s where it really came about. Between August 1896 and February 1897, so much of activities came from Bombay. Finally, they came up with that law, which we are still using today, the Epidemic Diseases Act of 1897. That’s the strongest legacy. I would pinpoint that law, February 1897, as the first real epidemic management policy that India started off with.
Of course, it hugely clamped down on civil authorities and so on, and of course even last year there were some concerns over it. There’s no doubt that you have to do a bit. If people are going to roam around as they want, things would get out of hand. Obviously something has to be done. It’s more striking that balance. I would say that’s really the starting point of this idea of restrictions in India, of breaking down the transmission.
But in that plague nobody knew how it is being transmitted, and so that’s the really funny part of the plague on hindsight because they thought by doing these measures, they would—none of it actually mattered. India is finding about the coronavirus, we’re finding with each passing day many of the things we took for granted last year—surface transmission, people are saying, is not very important now. We learn along the course of the pandemic. We overreact and then can find out what is really important and then start scaling down.
Flattening the curve is a concept to buy time to ramp up medical infrastructure and not put too much caseload. I think that whole concept is very much new now, in the sense it’s really coming of age globally with COVID. I’m not an expert on SARS or MERS and so on, but I don’t think those guys use this terminology. They just shut down because it went haywire in China and so on.
This is very new, and it would be interesting to find who are the ideological creators of this particular phrase. I remember there was an article on Medium.com, which went completely viral across the world, saying what’s happening in Italy last year in February and why one needs to flatten the curve. I think whoever wrote that is probably the person who’s really popularized this phrase.
Of course, the joke, as we know, in India now is that in the second wave, we flattened the curve on the wrong axis, on the y-axis rather than the x-axis, and the cases have just shot up through the roof. That’s the other flattening of the curve.
RAJAGOPALAN: But I think it has something to do with universal healthcare in European countries. We’re very Eurocentric even today in the way we report on these things, the way we think about these problems. Europe did not—I mean, initially, it had the big spike, but it’s nowhere close to the highest death count or anything like that. I think public healthcare and universal healthcare have a lot to do with it.
The idea that this can be scaled up very quickly, so now what we need to do is we’ve got to make sure that infrastructure doesn’t collapse so that more people don’t die. I think that might have something to do with where the terminology is coming from because it assumes a certain inelastic supply of healthcare.
We know that certain healthcare, of course—certain aspects are relatively inelastic in the short run. Doctors can’t be magically increased in number or nurses or technicians, but you can increase the number of beds and the number of testing centers. Those sorts of things are extremely elastic, especially in the middle of a pandemic. Unless you throw people in jail for gouging on oxygen concentrators or something like that, these things tend to be elastic.
I think it might be coming somewhere from there, but I haven’t quite figured it out, but this seems very new.
TUMBE: It’s a good perspective. I’ll just build onto that. We’re talking of “flattening the curve” as a phrase. What’s interesting is even the phrase “public health,” when it emerged—especially in India, and I kind of argue in the book that it happened after the flu pandemic. Interestingly, the word before that was “sanitation.” The leading health official in India was called the sanitary commissioner of India. By 1920 or 1921, this designation is now the public health commissioner of India.
I think that gives you a clue of the world before 1920 and after. Sanitation was the obsession, and that moves to a more holistic idea of public health. I think that is an interesting breakpoint that happens out there.
From Culture to Science and the Enlightenment
RAJAGOPALAN: I want to go back 100 years again and talk to you a little bit about the science. Now, sanitation is always the obsession, because we partially are constantly blaming—in these narratives, we’re constantly blaming the poor and the fact that they live in filth or the urban areas which are full of rodents. We don’t have very good control studies. As you said, even after John Snow’s revelation with the Broad Street hand pump, it doesn’t penetrate public consciousness and manuals for the next 40, 50 years almost, right? There’s that going on.
Then at some point, it shifts to this idea of Western science. Now we have these studies. Now we know what is the cause. This is a viral infection. This a bacterial infection. This is spread by rat flea and this is spread—which is airborne. And so on and so forth. Or with cholera, it’s waterborne. Now, where do you think that switch happens, from saying that all of this is because of witches and superstition and culture and people living in filth, to some systematic Western science or the tradition as we know of it today?
TUMBE: There is really no survival advantage that Western medical science gives, especially living in India, vis-a-vis Ayurvedic practices or Unani practices or Siddha practices and so on, but by 1905 it was a huge difference. I would say that difference is also not there in 1850s. It starts from the 1860s and it builds up.
You can actually see this in the numbers, and you can see it in the data on the mortality rate of Britishers in India. That’s a nice metric to look at because Britishers were dying at about the same mortality rates as Indians in the early 19th century and even up to the 1870s. The decline starts happening in the 1890s. They start doing this—Sumit Guha has some excellent work on this; it’s that the death rate—especially infant mortality rates—among the Britishers in India. It starts declining because of not just medicines but practices.
The idea of living in clean environments, the idea of washing your hands, and there’s a massive propaganda about cleanliness and so on. That’s the context in which medical improvements lead to reductions in mortality among the British in India. Among the general Indian population, that is to wait till only after 1920, when death rates start coming down meaningfully. This is the critical period: 1860 to 1910.
I think the way Western medical science demonstrates its utility is really in curbing cholera, because cholera does not really devastate Europe anymore after 1870 or so—1866 is the last, pretty much. Similarly in the U.S. In Latin America, cholera still devastates in the late 19th century, early 20th century. That’s why Marquez has his book “Love in the Time of Cholera.”
RAJAGOPALAN: Yes. It’s a beautiful book.
TUMBE: Yes, but North America and Western Europe have escaped cholera because they understand the value of prevention—that is thanks to John Snow—and cure, which is coming out slowly from vaccines developed by people like [Waldemar] Haffkine and so on by the 1880s and 1890s.
This is a paradigm shift which happens in medical traditions, which for centuries across the world thought that all diseases were because of impure air—the miasma school of thought. This is a big shift which happens. Of course, the field of bacteriology emerges thanks to Louis Pasteur, Robert Koch, people like that. Vaccines emerged. Vaccine was there before, but they emerge for this new class of diseases.
This is definitely a foundational shift. It’s only by the 1900s where you can clearly say that Western medical science had a clear superiority in handling many diseases, over Ayurveda, Unani and so on, but it takes time to filter through.
Then you have Indian scientists. One of the things I mentioned in the book is also the role of Indian scientists in ending some of these pandemics. Like cholera, there’s a guy called S. N. De in Calcutta in the 1950s, very late in the day, of course, [who] finds what exactly is cholera. People say he should have won the Nobel for getting that. Who are these scientists? They were trained, again, in the same schools which are training the British guys.
That change had happened, that thing had happened by the 1900s. Nineteen hundred, I think, is the critical decade, because people could demonstrate that if you use certain methods, you could actually end these pandemics.
Having said that, the 1918 flu pandemic was a complete mystery. Nobody really understood what hit them.
RAJAGOPALAN: It still is.
TUMBE: It still is, and people thought it was a bacteria. They thought influenza was a bacteria in 1900. The takeaway from that particular history is that every generation thinks they’re at the cutting edge, which they probably—we probably are, but there’s still many things we have no clue about. Think about yourself in 1917: We have 40 years of research showing you how to end cholera, plague, and we’re very prideful, saying, “Nothing can happen now.” We understood what these things look like.
Then comes influenza which—people think it’s a bacteria, and it takes another 100 years to find out actually what happens in 1918; they reconstructed that virus 20 years back and so on.
What is the coronavirus? A hundred years later, maybe somebody will write a book saying a lot of the things we’re doing this year are completely useless; what we should have been doing is X, Y, Z.
RAJAGOPALAN: Absolutely. That was actually going to be my next question.
Your son asked you to explain what is a pandemic, and my sense is his grandkids, when they read their great-grandfather’s book, are going to be like, “Oh my god, I can’t believe they were using steroids or they were using plasma.” I think 100 years from now there’s also going to be some hilarious things.
Of course, every generation thinks differently, but what changed in Western medicine in those two decades is one of the things that is mysterious to me because, as you say, before that, between South Asian, East Asian medicine and Western medicine, there isn’t really that much difference in outcomes.
In fact, not medicine, but some of the subcontinent’s practices—like vacating the entire village when the rats start fleeing or dying. This is not a medical practice, but it is some oral tradition which has been passed on, which seems to work in containing the plague. Some of it might even work, right, when it comes to these methods—but what is it?
Is it that the West got rich? Is it better money spent on R&D? Is it trial and error and experiments? Is it that they started writing these things down in a way that Asian cultures are all about the oral tradition and not really writing down manuals?
What is it about those two decades that just completely changes the trajectory of how we think about medicine?
TUMBE: That’s a good and very tough question to answer simply because, say in economic history, a lot of the stuff that we do is about divergence and the “when” and the “why.”
TUMBE: There’s so many ways to look at this. One starting point would be the Enlightenment, so the Enlightenment as a starting point: You can’t get guys like Louis Pasteur, Robert Koch without the Enlightenment—as simple as that—and so you’re much more likely to have a person like Louis Pasteur and Robert Koch in Germany and France than in India, where Enlightenment ideas were there but not as well entrenched as they were in the west. That’s definitely the foundation on which—by Enlightenment, for the listeners, you’re looking at mainly 17th- and 18th-century diffusion of a particular method of doing science and so on. So that’s definitely there.
I think this thing about capacity or public money—I’ve not seen the numbers. I don’t know how much the governments were investing. On cholera I know they invested hugely in water purification systems, so that’s an improvement. But in the medicine side, on scientific—were there prizes that incentivized them? Maybe not so much in biology—the Nobel Prize starts much later as a big draw. I think the pandemics themselves—if you ask me why is it that it happens in the 1890s and not 1790s is because cholera, plague were huge problems of the day to be solved.
That is the burning concern, public policy concern, which draws—if you ask why did Waldemar Haffkine come to India, he had absolutely no reason to come here, but he came with this idea of also helping people and saving lives in a great pandemic. I think the pandemic context itself was very important. Why so many discoveries and so much investment was taking place in not only, like, public health systems, but also in science. If you see people like Louis Pasteur—they set up these Pasteur Institutes around the world; they’re a diffusion of this model around the world—[and] Robert Koch—and they are all competing with each other.
We might also get competition into this: That is, who will be the first to decipher the plague bacteria? Like there were teams which ran to Hong Kong saying, “Can I be the first person?” They came to Bombay. Bombay had all these people from around different countries of Europe coming to test samples and so on. That competition also might have helped these guys trying to get to the heart of medicine.
One of the things I note in this book: In 1883-4 is around the time when the Berlin Conference happens, when the road to Africa’s colonization really starts, and that’s the year in which Robert Koch goes to Egypt and then later on Calcutta to test his findings. So there is this backdrop of imperial rivalry also which is driving, and if you can show that you’re a powerhouse which can curb pandemics or curb epidemics . . .
One actually interesting way to look at this period, then, is to look at why did the Americans send a person to the moon in the 1960s? I think you have to take into account the U.S. and Russia space rivalry, and the whole impact is then to do it, and that’s why it happened in 1960 and not in the 1920s. I think that’s very similar to what happens out here. It’s a combination of the pandemic context and the imperial competition of those times.
RAJAGOPALAN: I think you’re absolutely right on one aspect, which is, that is also when you see a huge elevation in the status of scientists. They become people who now appear in front pages of newspapers; it’s not just politicians and it’s not just the monarchs. Now you have scientists who have become part of popular culture and people can say their names. The same thing that happened with the people who went on the space missions. I knew the first dog that went to space.
TUMBE: “Sputnik” is now the name of the vaccine.
Migration and Pandemics
RAJAGOPALAN: I want to talk to you about something that is linking your previous book and your current book. Your previous book [“India Moving: A History of Migration”] is a sort of history of India told through mobility and movement—that’s the way I think about your book. The way epidemics which are endemic to a particular region become pandemics is obviously through mobility, so this we understand.
And as we go further back in history and modes of transport are slower and trade routes are very specific, you see pandemics spreading in a very particular way; you don’t see them spread that quickly—and as more recent parts of history, you just see the spread of these things happening very, very rapidly.
As you said, there’s no surprise that Bombay is this hot spot or Hong Kong is this hot spot, because they’re also huge ports. Egypt, because it’s such an important spot in the trading route because of the Suez, getting badly infected—and now we’re in the modern world of air travel where now things happen to spread in a matter of hours and days as opposed to years or weeks, as may be the case.
How should one think about this? Because you get the same arguments over and over again; you get the same arguments about quarantining and lockdown and keeping people out and travel bans and so on and so forth.
There’s a recent paper by Michael Clemens and Thomas Ginn on how travel bans don’t work; even with the influenza pandemic it delays maybe at best by a few weeks, not even by months, and the economic loss—and that’s the way, of course, all economists think about this: the economic loss because of quarantines and because of travel bans is just massive.
TUMBE: Firstly, the link between the two books—I get this question often: “You work on migration. How do you get a pandemic?” The fact that you can’t have a pandemic without some migration; that, as you’ve said, it goes from one region to another through some movement. It could be systematic migration corridors or travelers or however, but mobility is at the heart of the pandemic, which also means dealing with mobility is important but not the only—but it’s an important ingredient of curtailing the pandemic, so obviously some curbs on mobility are important, otherwise they’ll rip through like wildfire.
It’s boiling down, then, to intelligent design of restrictions on mobilities. Here I make a differentiation between international and internal migration, and I think I’m one of the few researchers maybe in the world who’s working on both, because these are two classics: people who work on only international or internal migration.
I think it’s still possible. It’s also feasible and enforceable to shut down airports. It’s easier to curb international mobility vis-a-vis internal mobility, and we saw this classically in India last year, and we shut down airports . . .
RAJAGOPALAN: Yes, with the lockdown.
TUMBE: Nobody tried to swim from the UK to India, but if you shut down the trains, people will just walk back home. So this idea that you can always walk back home means that that option to migrate internally is always there. So that’s my first point. It is almost impossible to place curbs on internal mobility. I think one of the things I appreciate about this year’s approach to our risk containment strategy is that we have not shut down the railways, for instance. I think that caused more problems last year because . . .
I mean, the idea is noble: If you shut down the railways, there’ll be less spread of the virus and so on. What we got then is these massive migrant refugee camps. Then more people huddled up in dense clusters, making the virus spread even more, so it’s all sorts of unseen consequences.
Now on international migration, it’s a really tricky issue, because there are, of course, geopolitical stakes, so if a country says no to another country’s travel—so all sorts of permutations and combinations. Look at what Australia and New Zealand have done. They are of course island countries. They’ve been very stingy, right? They’ve managed—compared to the West, they’re way ahead. Despite the similar age profile, they’re doing well on the death count and so on, and they basically shut themselves in the world.
I was reading an article saying Australia is planning to shut itself for another two years. So those are—they are kind of valuing the possibility of the pandemic—they’re putting much more weight on that and saying, basically, nothing doing internationally.
There’s another view on quarantines that Singapore has, saying you can come, but you have to go through a rigorous process, but we will pay for it. I think that’s classic.
So, I think that’s a possible model that, if not the government, but there’s a split: a public-private partnership where you pay for some of the services, the government would chip in. I think that’s the real—if you ask me, “What is a way forward? Should we just be shutting down airports and starving them off?” I think that’s suboptimum. I don’t think we should be shutting down completely. Of course, it might happen that others shut down to us if they see the threat perception as such, but I don’t think it’s a wise idea.
So definitely don’t shut down internal mobility by shutting down trains and so on. On the international front, if you want to shut down, I think sensible quarantine systems with—this is a medical call: how many days or weeks that a person has to go through. The critical component is, Who is going to pay? So that is basically a solution. That is, you don’t want it to be so prohibitive that nobody comes in. That is, suppose I want to go to the U.S. but they say that you have to go through this quarantine system which is extremely painful, and that’s a disincentive for me.
How do I make it? It’s a win-win for both these countries if their software worker goes there for a project for three months and then comes back. So I think there has to be a mechanism which seamlessly does this as well as protects the citizens of America and India, when the person comes back, from catching some new variant and so on.
So that’s my sense. A lot of interesting work is happening on migration, optimal lockdowns in terms of internal migrations, optimal quarantines. You’re absolutely right about the debates on this because it’s a tradeoff between lives and livelihoods. One has to have a sense of balance.
There’s no doubt that if pandemic is completely raging, the airports will shut down. It’s raging across the world, the airports will have to shut down and so on. In that sense, this year’s call on restrictions I think was much more sensible than last year’s, which I thought was completely drastic. But having said that, even this year, I have been tracking these mobility numbers. I think a lot of state governments were very slow to start imposing restrictions.
If you see what happened this year, Maharashtra went into this lockdown mode. Tamil Nadu went into it last week, I think. Of course, some states had elections and so on, but I think UP, if you look at UP, they have reduced their mobility so slowly over the course of the last 40-50 days.
RAJAGOPALAN: They’ve had a Kumbh Mela. I mean, for heaven’s sake, not only have they—is it a question of not reducing mobilities swiftly enough? You are increasing mobility and inviting next year’s problems to the current year, right?
TUMBE: Yes. So it was very unfortunate that happened.
I think internally you can actually track this using Google mobility data, which I’m finding quite useful nowadays.
RAJAGOPALAN: I have a paper on this, actually, using some Google mobility data. What we found, interestingly—we did some very rough estimates. Last year I had recommended lockdowns because we didn’t know the extent of the devastation and, whatever basic capacity count I did for healthcare capacity in India, it seemed like it was very fragile. Then of course the lockdown happened, and I thought it would be good social science to just go back and see if the lockdown made sense.
One of the things we did was, because it was a nationwide lockdown and de jure you have the same rule, but de facto, the rule is obviously implemented differently. Now, how do we get a good metric of whether the lockdown really happened and if people were moving around? And we thought Google mobility data is probably the best metric of that, so that’s how we came to it—me and my coauthors, Abishek Choutagunta and G. P. Manish.
What we really did was we said—we were looking at two things. We said, does the lockdown reduce mobility? And does a reduction in mobility also track with reduction in number of cases?
It’s a two-step thing that we’re really checking. We saw that in some places—these are typically states like Maharashtra, Delhi, Tamil Nadu—you see that the lockdown really helps because there’s a drastic drop in mobility, and with the drop in mobility you see a decrease in number of COVID cases. As mobility goes back to trend line, you see an increase in number of cases. You can clearly see that the lockdown worked.
But there are a bunch of states where there’s a drop in mobility even though there is no significant change in number of cases. Some of the extreme examples of this is places like Sikkim, where there were zero cases to begin with and there are zero cases throughout the lockdown and hardly any increase post the lockdown.
Then there are some fascinating instances like Bihar, for instance, where you see a huge drop in mobility initially, but as mobility picks up with the migrant workers coming back and so on, there is no increase in the number of known cases per 100,000 (that is, per capita). What we found was very mixed results, that lockdowns at best were a partial success.
We concluded that lockdowns should be at the state or local level: Don’t have a centralized lockdown, because it just doesn’t make sense. These hot spots are not developing everywhere simultaneously. Having said that, the problem with that is exactly what you pointed out—which is you are now going to leave it to the state government. Some state governments are going to be quite proactive; Maharashtra is relatively more proactive. Some state governments for political incentives, like the elections, are not going to be proactive, and some are just asleep at the wheel, like Uttar Pradesh and Bihar, and you know that nothing’s going on there.
There is this problem: This is a part of the dysfunction of Indian federalism, which is you don’t want these things to be too centralized, but do decentralized governments at the state and local level actually have the capacity to make sensible decisions? That, of course, is not the case.
TUMBE: Yes, true. It’s a big tradeoff—lives versus livelihoods—it’s a very tough one. If you’re a policymaker, literally you’re damned if you do and you’re damned if you don’t. It’s coming down to that.
RAJAGOPALAN: I’m curious why the focus is not more on testing. We’ve figured out fairly high-sensitivity, very, very good tests for COVID. Somehow the focus has never been on testing, other than in places like South Korea initially, which really ramped up their testing and did a fantastic job of how they were tracking the spread of infection. I don’t know why that is still not—even now there are countries that don’t require a test before you enter the country, and those things seem very bizarre to me.
TUMBE: That’s true. I think testing is hugely important. I was just listening to an interesting observation today on testing: That is, policymakers are afraid of random testing, in particular in times when the curve is going down, for example in December, January. A particular doctor mentioned this today, saying, “We approached them saying we need to ramp up testing now when there’s actually not too many cases, just to get a sense of what’s happening.” The government said if we go for testing now, people will think that something is in the air and lead to a panic situation. Right?
It’s interesting that the case against testing also exists from the perspective of that, which I thought didn’t make any sense. But this is apparently how, in a sense, some people think about it.
There’s no doubt we’ve lagged behind in testing, and even worse is the complacency that struck us after the peak in September.
RAJAGOPALAN: Yes, absolutely.
TUMBE: Meant that testing is wound down; forget ramping up—it’s wound down substantially. So this idea that testing data is an important weapon in this fight is completely thrown out the window.
RAJAGOPALAN: I think this goes back to what you said about Enlightenment values: understanding that more information, even if it comes from trial and error and not all of it is good, and better data and better tracking is a good thing is, once again, a very Enlightenment sort of value, right?
TUMBE: Better science.
Pilgrims and Pandemics
RAJAGOPALAN: One of the things that struck me in the book is, again, how quickly religious super-spreader events keep coming up, right? The Kumbh Mela makes an appearance many times in your book, as does the Haj pilgrims going to Mecca, right? There’s also local-level things like the Puri temple. This keeps coming up over and over again, how religious events are partly also on a spike in years of pandemics because people feel like they need to pray; they think it’s an act of God and they want the pandemic to go away and they think religious ceremonies will help with that, but they end up becoming super-spreader events very quickly.
TUMBE: Yes, the pandemic creates anxiety—and religion is, of course, as somebody has famously said, an opium of the masses. But in a pandemic it really becomes even much more than that. In that sense, it’s historically been used for scapegoating, right? The first question that all of us ask is “Who started this,” right? There’s still a lot of theories as to where does this virus come from, because your life is completely overturned. They have restrictions; you see people around you dying. You’re looking for a cause for it; you need to attribute it to something.
So you can either, like our finance minister, say “act of God,” which is the classic way to look at it. Or you can find someone to blame, which is the classic outsider. If you see the Black Death, Jews were blamed back then in Europe. Jews are being blamed for many other epidemics in European history. Some of those tropes in India—in plague in European history, this is this idea that Jews are poisoning the wells. And in India, in Punjab, there was this rumor that the British are poisoning the wells. That’s like a big trope, but religion definitely there is scapegoating.
I think the British did a lot of this in India: blaming pilgrims. The Indians, they really said, “Look, if you provide better facilities at the pilgrimage sites, this should not be happening.” It was very classic. During cholera in particular, because it was waterborne, it was a fact that these pilgrimage sites were problem sites, but the fact is that Indians have been doing these pilgrimages for centuries, for millennia. From the Indian perspective, it’s like, “What are you saying? This is our tradition. How can you stop this?”
The British, on their part, did not do enough to invest in good facilities at the pilgrimage sites, which could have curbed the epidemic outbreaks from those places. In the 19th century, religion, in India in particular, really got into the way of pandemic management at many crucial levels. The British also, after 1857 and the plague, backed off.
TUMBE: Earlier, people would just pray. Today we pray and do other things like go to a doctor and so on. In that sense, the value of religion has definitely gone down, in a relative sense—that is, where it was the No. 1 recourse, today there are also other recourses available and so on. Pandemics and religion also means that there will be religious—let’s call these spiritual gurus or religious gurus—who will also gain more popularity and also lose popularity.
If you go to your local spiritual guru and say “Save me,” and if the person can’t save you, then that person has no value. No healing power. Let’s call it the healing market. They derive their powers in the ability to say we can heal, and if that doesn’t work, people . . .
In the book, I mentioned this particular thing about different temples that are competing for people and so on. That’s one thing that definitely is related to pandemics. Also the fact that new people come up. Just today I was reading newspaper headlines that women in Uttar Pradesh are lining up to a temple called Corona Mai [Mother Corona]—
RAJAGOPALAN: Yes, I saw that too.
TUMBE: —out of nowhere. That’s another way in which religion and pandemics intertwine. That is, new deities emerge and new kind of things.
There is a waxing and waning. There’s a shift happening in that. I discussed earlier, in the 19th century it was also used to justify conversion by the British, especially Christian missionaries saying that “Look, we’re offering a more superior civilization,” and so on. “We can cut down your mortality rates only if you convert.” That’s the other 19th-century—not just 19th, 20th-century—episode of how religion and pandemics are intertwined. Scapegoating, conversion, new deities: I think these are the ways in which they’re often connected.
RAJAGOPALAN: Some of it is also coincidence, right? Like there are these temples, they’re the cholera temples and things like that in southern India, and some of it is, the deity might have saved you just because you went to a different water source. You go to something on top of a hill, and that becomes the plague temple because the rats are not there at the top of the hill. Those sorts of bizarre things.
TUMBE: Coronavirus is very simple. Think about it: case fatality rate of 1% means 99% are going to survive it. If I was in the spiritual market, I would just cleverly place myself because I know whatever I say, 99% of the people are going to survive it. So there’s a very good chance—unlike plague, unlike cholera, which were less virulent but they had case mortality rates of 80%. Plague was 80%.
RAJAGOPALAN: Yes, they’re incredibly high.
TUMBE: If you got plague, you were going to die: as good as that. There the value of the spiritual guru really mattered, because if that person would say that you would not die, it’s an 80% chance—the probability is very low. Today with coronavirus and 1%, you can say anything. I have seen a tweet—somebody said eat popcorn three times a day and you will survive coronavirus. Statistically, yes.
RAJAGOPALAN: Chances are you will! The only thing I so far agree on with our health minister is eating dark chocolate three times a day. I must say I have been following this advice for a very long time and I attribute all my good health to consuming dark chocolate in copious quantities.
Pandemics and Labor Shocks
RAJAGOPALAN: The thing you said about—statistically, when it came to the plague, 80% of the people died. Again, economic historians have done a lot of work on this.
There are two aspects. One is the Malthusian worldview, which is, these plagues are coming because the world has become unsustainable and the human population has grown out of control. “Look at this: this is a natural redistribution, and as soon as it happens, the people who are left behind and who are alive are better off.” That’s one view.
The non-Malthusian economic view, of course, thinks of this slightly differently. This is work, for instance, by [Lynne] Kiesling and [David] Haddock, how they show with the Black Death—because you heard about a third of the labor pool dying, it fundamentally changed the relationship between human capital and physical capital, and therefore the evolution of property rights. They even attribute this eventually to the breaking down of serfdom in Western Europe, for instance.
You have both these views; I believe even Ram Mohun Roy said something along these lines. I don’t know if he was coming from a Malthusian point of view or the other point of view, but very similar—that yes, there has been this great devastation, but the people who are left behind are more productive, particularly given physical stock of capital.
TUMBE: There was an undercurrent of thought in some quarters where you say, “Oh, famines or epidemics—of course, this is nature’s way of checking the population,” so the Malthusian argument. The cholera, the numbers were still relatively smaller. They were localized in particular places and so on.
I think it’s really the plague where the numbers really start increasing for Bombay Presidency. But really the big shock is the flu pandemic. I do think—in the book I argue that the starting point of India’s labor movement is really the flu pandemic because the bargaining power of labor really tremendously increases after that.
The Royal Commission on Labor in 1929-30 also pointed out that the inflection point in India’s labor history was the flu epidemic. The balance of power within capital and labor shifts substantially towards labor in this argument that the surviving labor benefits because there are so many people out there. I think you really see that only in the flu, and you’ll see it again only in western and northern India where more people died—not so much in southern and eastern India.
One argument of why militant trade unions emerged first in Bombay, rather than in Calcutta, in the early 20th century could also be attributed to plague and influenza hitting much more in Bombay than in Calcutta.
RAJAGOPALAN: That’s interesting.
TUMBE: Definitely, this idea of surviving labor—you need to have a substantial labor supply shock in order for these capital-labor relations to change. Now, even if it happens in one small city, like cholera or plague, there’s all this migration. You lose, say, 10% of your labor, but people can come in from somewhere else and replace it. You need to have a shock which is substantially (unfortunately) huge across the board, in which even migration can’t replace it, such that the people who own the enterprise have to give higher wages or more benefits in order to induce people to come and work.
Then that really started with plague in Bombay with the cotton mills. They said, “OK, we need this labor force. They’re just going back whenever plague comes to their villages.” Very similar to now, actually, where this return migration has become a big issue. So, OK, how do we give benefits?
Today, if you see—to take the parallel to today, last year, a lot of these workers went back. This year, of course, the trains are not shut down, but fewer workers have gone back. That’s partly because, especially in construction work sites, employers have made conditions for them better—arrangements—with the learning from loss. It’s, again, a case of a shock kind of leading to a changed contractual relationship between the worker and the employer.
RAJAGOPALAN: I want to talk to you a little bit about your intellectual influences. What got you interested in economic history? And of course then eventually in migration and, since then, in pandemics?
TUMBE: On migration, I was in London in 2006 or 2007, I think: There’s an essay-writing competition on “Development, where next?” I was a young student. Then I said, “OK, development, where next? I have no idea about this topic, so let me read a bit about it.”
There was a time when international migrant remittances suddenly came out on the international limelight, saying that, actually, many countries receive more migrant remittances than foreign aid or foreign direct investment and so on. So what can we do to ease the flow of migrant remittances?
I wrote this essay, which won that prize, by the way, on migration as the next big thing in development and how we facilitate safer migrations. That’s really the spark of migration. If there was no essay-writing competition, I would not have ever thought about migration. That’s the serendipity element out there.
But then I wanted to do my Ph.D. in Bangalore, at IIM [Indian Institute of Management] Bangalore, under this professor who worked on international migration—Rupa Chanda—who herself was a previous student of Jagdish Bhagwati. I did my Ph.D. eventually under her, but then during my Ph.D. out there, I saw that international migration remittances—some people had done work, but nobody had already done work on domestic migration and domestic remittances. My Ph.D. supervisor, who was really an expert in international economics, said, “OK, go ahead.” She was fantastic. She gave me full freedom. Then I started working more on internal migration.
Then, again, a chance encounter in the library in Kerala, where I found the back series of the post office annual reports. The post office used to have these money orders. This was the classic source of domestic money orders. And this library in Kerala had them backed up. I was looking for a time series of postal money orders. I was trying to find each and every postal annual report, and this shelf in this CDS (Centre for Development Studies) in Trivandrum had it going back to 1880. Not 1980: 1880. They had every annual report of the post office.
I saw those numbers, and even in 1880, Bihar was a remittance-dependent economy. You could see how much money was going into Bihar in 1880. That’s when really the light bulbs went in my head saying, “Look, what I’m looking at is not some sort of a new thing.” Migration has a really long history in India, and without understanding the history I’m not going to get anywhere.
I had audited courses on economic history when I was at the LSE [London School of Economics] in London—Professor Tirthankar Roy, who’s out there. He’s been a huge influence on the way I think on economic history and so on. I came to IIM Ahmedabad actually as a visiting faculty to teach a course in business history.
IIM Ahmedabad, interestingly, was the pioneer of business history in India with Professor Dwijendra Tripathi. That’s the connection of how I came here to IIM Ahmedabad. In a way, I’m trying to revive his legacy, because he was a faculty for 25 years, from 1964 to 1990. He really pioneered this field of business history.
I want to try and bring back that element of business and economic history. I’m happy to see more and more institutes in India pointing people to do both a bit of contemporary stuff as well as historical approaches. There’re more and more faculty being appointed across India. I think when I came to IIMA, I was probably the only faculty in India working on business or economic history. I think now it’s still in single digits, but at least it’s a small but growing tribe.
I like to look at the big questions. I think you had Alice [Evans] on your program. Alice is also fond of these big questions of divergence.
RAJAGOPALAN: Oh, yes. Yes—the great divergence between men and women.
TUMBE: That’s exactly the kind of research questions I love.
RAJAGOPALAN: What are you currently reading, and what is the big project you’re working on now?
TUMBE: I’m continuing my work on migration—moving more from migration to cities. Cities is really the big thing I’ve been working on for the last five years. I did have a working paper in 2016 called “The Growth of Cities in India, 1870-2020.” The rise and fall of cities in India is something that fascinates me. I’m reading a lot on urban history, urban issues and so on. Regional development in India, that’s another big passion of mine.
The courses I teach at IIMA are actually more global in nature. While I’m still working—I think the next year’s projects are India-based; I think in a few years I definitely want to start writing on countries outside India as well, and so I’m reading a lot on global economic history, global business history, and so on. I’m particularly fascinated by Italy. Partly because I lived there: I lived in Florence for a year.
In fact, I’ve lived in London, Florence and Bombay, all three plague-hit places, at some point. That’s another connection to pandemics. Florence was spectacular, and I really got interested in Italian culture and history when I was out there. Who knows, maybe someday I’ll write something on Italy.
RAJAGOPALAN: Florence is also great for things like studying business history and remittances, right? Because you’ve got the Medicis and their accounts of these single families going back generations. I read a fascinating paper on how the most influential families in the 15th century in Italy, especially in Florence, continue to be the most influential families today in terms of concentration of wealth.
What’s your writing process? I find it astounding that you started and finished a book during the lockdown. [laughs]
TUMBE: My first book took 10 years to write, I would like to say now, and my second book took 10 months—so some sort of learning must have happened between these two. But no, obviously the pandemic—I really wanted the book to be published in 2020, in the year of the pandemic. So that’s really what pushed me forward, I think.
Obviously, a project of this kind needs ideally at least two years or three years and so on. In normal time, if there was no pandemic in the world right now and I was interested in pandemics, I would have taken my time and taken two years or three years. It would have been even more researched and so on. We were in a pandemic, and I was writing this book during the lockdown. Definitely, I wanted it to be published in 2020.
Obviously, it was a tradeoff, again, between how much research I could do versus getting it out in 2020. Having said that, of course, it was a very strenuous process in the sense of—I love writing now, it’s become an addiction, and so even long essay formats I have been writing a lot. I wrote one on the founder of IIM, Dr. Kamla Chowdhry, some months ago.
I think in the last two years—I certainly love to write, which is again—an important part of writing a book is to really enjoy the process, because that’s half the battle won. If you’re going to get up and say, “Oh no, I have to write 1,000 words today,” it’s not going to get to that. If you can write 1,000 words and if you’re going to write an 80,000-word book, you are going to need about 80 days. That’s the magic of writing a book, if you’re disciplined enough. I just say that I was very disciplined because I was working on very strict deadlines, self-imposed.
I have a wife and son—obviously, this would not have happened if the family did not support me. And we were in a lockdown. Full appreciation for both my wife and son for dealing with long absences in the office. I would literally get into my office at 10 in the night and come back at 6 or 7 in the morning and then sleep during the day—a completely inverted schedule for months on end. I work best during the night when it’s completely silent.
So the fallout of that was that my family said, “You’re not going to do anything now”—not writing any book now for a long, long, long time. This—right now I’m in my so-called vacation, summer vacation, and I’m doing absolutely nothing. Just following the pandemic. It’s hard, but it’s not like I have got any projects on hand and so on. This is my break here, completely, now from writing.
RAJAGOPALAN: What is that process like once you’re in your office?
TUMBE: It’s important to have notes on a blackboard or somewhere that I can see from time to time. It’s very important to get the slope, to have this some sort of broad structure. Writing a book—this is not an academic book; this is a book for a wide audience, which also gives you leeway.
I’ll tell you, when I write academic papers now—I just got a paper returned to me on the revision. The last line of this paper was a cheesy line which would work in a book. But this reviewer said, “Please take the sentence out,” and I said, “Oh my God, this person doesn’t have a sense of humor,” but that’s the amount of experimentation leeway you can have in writing a book for a wide audience. It’s a fun process.
I listen to music during the breaks where I just—obviously, you can’t write eight hours on a stretch, but this particular project was literally written in not, like, fits and spurts. It was written just continuously over many months. In fact, I was just beating myself up for this deadline. The first book was very much more—missed many, many, many deadlines. I really don’t know how it came about it in the end. Probably every first book is like that. It just takes years and years, finally comes out and so on.
I will say that the happiness of seeing the first book finally in the stands definitely was very inspiring to write the second book. I think one thing which I did, at least for writing this book, is that when the publisher and I were discussing the cover of the book, “The Age of Pandemics” and so on, we kind of finalized the cover by August something.
TUMBE: Yes, exactly. We kind of finalized this cover by, I think, August. I printed that cover, stuck it on the bulletin board in front of me, and said, “Look. This is what it’s going to come out to be.” [laughs] “So you better write today because that’s how it’s going to look in the end.” If you like the final product of how it’s going to look, at least that will you force you to . . .
RAJAGOPALAN: Well, the bad news is I think you’re going to have to do more editions of the book, because COVID is not in the rearview mirror as you had originally anticipated. Now we’re going through a second wave. People say a third wave might be coming, so I look forward to future editions of the book, or a different book specifically on the COVID pandemic.
One last question which I ask everyone, which I think is the most important during this pandemic: What are you binge-watching?
TUMBE: Binge-watching. Yes, it’s binge-reading, along with my son. That’s definitely there. He’s going through all these comics and so on, so I’m doing that.
RAJAGOPALAN: I love that he loves Tintin. That makes me happy.
TUMBE: Yes, and we’re doing these jigsaw puzzles, which is great. Last year we did the Tintin jigsaw puzzle, 1,000-piece. Then we did a new one. We just finished one and we’ve just started Van Gogh’s “Starry Night,” which is impossible. You can’t do it. Almost given up. It’s all the same colors on every piece, practically, so it’s a very tough puzzle.
Binge-watching, I’m trying to think of the last series which I watched. I’ve seen some good movies. Trying to catch up with some Hindi movies which I missed both last year (or two years) and so on, but I’m seeing more stuff with my son now. We end up watching kids’ movies. I saw a lovely movie which is very relevant in the time of mass mortality. It’s a movie called “Soul.” It’s an animation movie and Pixar . . .
RAJAGOPALAN: Yes, it’s beautiful.
TUMBE: It’s a very—in a time that so many people are unfortunately dying, I saw this movie recently and it really touched my heart.
Then there is Ghibli Studio animation movies for kids, which are also fantastic. Lots of kiddie stuff, but amazing stuff. I mean I would rate these movies very, very high.
RAJAGOPALAN: Thank you so much for doing this, Chinmay. This was a pleasure.
TUMBE: Thanks so much. Yes, absolute pleasure.
RAJAGOPALAN: Thanks for listening to Ideas of India. If you enjoy this podcast, please help us grow by sharing with like-minded friends. You can connect with me on Twitter @srajagopalan. In the next episode of Ideas of India, I speak with Keshav Desiraju on his new biography of MS Subbalakshmi.