MUMBAI, India—As the world practices social distancing to keep the novel coronavirus at bay, 40-year-old Lata Jadhav still spends 13 hours a day in eight different homes in suburban Mumbai. Working as domestic help, she cooks, cleans, and picks up waste. She has heard of the COVID-19 pandemic from her employers, most of whom are now working from home. Already apprehensive, her fears escalated when another domestic worker in Mumbai tested positive for the virus after contracting it from her U.S.-returned employers. Jadhav quickly bought a mask, but social distancing—a choice between life and livelihood—is unthinkable to her.

“If I sit at home, I will lose pay for the days off. I have two daughters to marry, and loans to pay off,” says Jadhav. “I earn 14,000 rupees (U.S.$183) a month and 8,000 goes as monthly installment on my loans. My husband runs a food stall but is now out of work as the government has cleared all vendors from streets. Illness or its anticipation cannot be excuses to miss wages. Every day of work counts.”

In a public address to the country on Tuesday, Prime Minister Narendra Modi announced a 21-day lockdown, calling on Indians to stay indoors, asserting that social distancing is the only way to stop the coronavirus. “India will have to pay a very high price if social distancing is not adhered to,” said Modi.

But although limiting human-to-human interactions is the only way to control the spread of the coronavirus, public health experts say social distancing is not an option for the hundreds of millions in India’s unorganized sector. Tactics being employed in other countries are just aren’t possible here.

"Sanitation workers are required to work under subhuman conditions without any medical protection." — Milind Ranade

“These are workers who need their daily wages to sustain their families and to afford food and nutrition. They work in crowded markets and travel by public transport. It is extremely difficult for them to adopt the social distancing approach,” says K. Srinath Reddy, president of the Public Health Foundation of India, a not-for-profit public-private health initiative.

India’s informal sector is the backbone of its economy. According to the Economic Survey of 2018–19, almost 93 percent of the country’s total workforce—an estimated 437 million people—is informal. This includes agricultural, construction, manufacturing, sanitation, and domestic workers. Although this sector contributes to nearly half of the country’s GDP, such workers enjoy virtually no legal safeguards, working in poor conditions and living off paltry wages. India has two of the largest social security schemes in the world, and yet a majority of the workers live without basic protections like proper safety gear and medical facilities, says C.K. Saji Narayanan, president of the Bharatiya Mazdoor Sangh, a New Delhi–based trade union in India.

“Workers in the informal sector have indefinite working hours, no paid sick leaves, and no social security benefits. Laws and schemes exist, but they have failed to reach over 90 percent of the beneficiaries,” says Narayanan. “As there are no safeguards to their livelihoods, they cannot afford missing work. Staying home could mean no food on the table for days.”

One area of the unorganized sector, which has always been worrying for human rights groups, is the sanitation chain, where workers handle fecal sludge and human waste, cleaning manholes, public toilets, sewers, and septic tanks. About 5 million people work in sanitation in India, and according to a study, one of them died every five days in 2017 and 2018. Milind Ranade, the founder of Kachra Vahatuk Shramik Sangh, a Mumbai-based organization focused on labor issues, says that despite the fear and panic over the COVID-19 outbreak, about 6,500 contractual laborers in the Mumbai civic authority’s sanitation department have not been provided with proper masks, hand gloves, shoes, or uniforms. For wages as low as Rs 250 (U.S.$3.27) a day, these workers continue to collect, segregate, and dispose waste.

“Although the government is advising people not to venture out, sanitation workers are required to work under subhuman conditions without any medical protection,” says Ranade. “The COVID-19 epidemic can be fatal for them.”

Sachin Randive, a 30-year-old sewer cleaner in Mumbai, says that despite being aware of the coronavirus threat, he is compelled to go to work to keep the pot boiling at home. “Every day when I leave for work, my mother asks if I’m carrying a mask. Of course, I am scared. I want to stay home, but missing pay is not an option,” says Randive.

A 2017–18 government survey, the Periodic Labour Force Survey, found that 54.2 percent of regular wage workers in India’s nonagriculture sector were not eligible for paid leave, 71.1 percent had no written job contract, and 49.6 percent were ineligible for any social security benefits. Reddy feels that along with social distancing, India will need an “empathetic, humanitarian response,” as in any disaster situation like floods or earthquakes, where essential supplies are provided free for people in India’s informal workforce.

“If you advise them to remain in isolation from travel and work, you also have a moral responsibility to ensure that you are looking after their immediate survival needs,” he says.

The informal nature of their work is not the only challenge confronting India’s poor. In Indian cities, there’s simply not enough room for social distancing. As per World Bank data for 2018, India has a population density of 455 people per square kilometer, as opposed to 148 in China, 275 in the United Kingdom, and 36 in the United States. India ranks 29th in the world in terms of population density, and its cities, which house 31 percent of its 1.3 billion people, fare much worse on the density scale. With a population of 20 million, Mumbai, for instance, has a population density of more than 32,000 per square kilometer—one of the most crowded urban areas in the world. Over 41 percent of Mumbai’s population lives in its slums, and the city’s largest slum, Dharavi—spread over 2.1 kilometers—houses 277,136 people per square kilometre. Social distancing in such a crowded setup is far from practical, say experts.

Inequality in access to basic necessities is also a roadblock in approaching measures like washing hands, prescribed by the World Health Organization. “If there is no water, how will they wash their hands?” asks Yogesh Jain, co-founder of the Jan Swasthya Sahyog, a public health NGO based in the central Indian state of Chhattisgarh. According to a 2016 report, nearly 76 million Indians do not have access to a clean water supply.

“Social distancing is for the middle class and upper middle class, hardly a possibility for the poor population of the country. What India really requires is physical distancing and social solidarity. With the raging caste and class issues, we are already a very distant society,” says Jain. “The WHO guidelines are applicable to the world, but not to the world’s poor.”

Anant Bhan, a global health, bioethics, and health policy researcher, meanwhile feels that there should be a certain accountability on the part of contractors and employers. “They must ensure that these workers have paid leavesas well as access to personal protection items like soaps and sanitizers,” he says.

While a solution looks far from the offing, domestic workers like 45-year-old Surekha More continue to go to work. More migrated from her remote village in the western Indian state of Maharashtra to Mumbai a year ago. Previously employed as a daily wage farmworker in her village, she would earn Rs 100 (U.S.$1.30) for 10 hours of work every day. Now, she lives in a 50-square-foot decrepit shanty in an overcrowded slum with her husband and four children.

“There’s barely a place for the five of us to sleep,” says More. “How do we keep distance?”