India’s Moment of Truth

COVID-19 Magazine National

India is struggling to contain an epidemic it barely comprehends and is quite unprepared to handle

Nissim Jacob

The Novel Coronavirus pandemic has shocked the world with the steadily rising number of infections and deaths with each passing day. Across the world, governments are scrambling to take appropriate measures  to contain its spread and reduce the fatality rate. Several countries were initially lackadaisical in dealing with the outbreak, officially known as Covid19. Services and transportation facilities continued to operate as normal even as newer cases were emerging, and they are now paying a heavy price for their complacency. 

With over 30,000 deaths, the United States’ death toll has far surpassed that of China’s, where Covid19 had originated, and it is now the worst affected country in the world. Western Europe as whole has seen widespread infection, with Italy, Spain, France and Germany badly affected, leading the World Health Organization (WHO) to declare Europe as the epicentre of the pandemic.

Taking a cue from the exponential rise of cases in countries like Italy, the Indian government announced a lockdown much early on to prevent community spread. The prime minister announced a lockdown for three weeks stating that if we don’t, “the country would go backwards by 21 years.” This lockdown has now been extended until May 3. India has registered over 14,500 cases and close to 500 deaths. The importance of social distancing to prevent community spread of the infection is now the most widely accepted measure worldwide to contain Covid19. 

While the decision to impose a lockdown to contain the disease has been welcomed in most quarters, the implementation is posing a challenge and requires interventions using technology as well as community involvement. Based on a recent study, the Indian Council of Medical Research (ICMR), estimated that India can reduce its caseload by 62% if social distancing and quarantine measures are implemented effectively.

Although India has followed the Wuhan model, several countries such as Singapore and Taiwan have limited themselves to contact tracing, testing, hospitalization and treatment. South Korea and Japan, which were feared to become the next hotspots of Covid19 after China, have been able to rein in the number of new cases without imposing a lockdown. South Korea has significantly increased the testing of suspected patients. Aggressive testing has been integral to its efforts to contain the outbreak and it allowed health authorities to quickly isolate and treat the patients. 

The WHO has also recommended testing as the most effective way to reduce community spread and to “flatten the curve” of the rate of infection. Even in Wuhan, which had imposed a lockdown, testing of suspected cases remained a priority and was followed by hospitalization, to ensure that other members of the family did not become infected. India would thus need to combine the lockdown with other health-based community measures such as identification of suspected cases, testing and their subsequent treatment. 

India has a very low testing rate of just 5 per million population compared to South Korea’s testing rate of 5,200 per million. India has a shortage of testing kits and facilities, and its health infrastructure is woefully unequipped to deal with an upsurge of infected cases. India has less than 100,000 beds in Intensive Care Units and, at best, 40,000 functioning ventilators. “There is a need to scale up testing exponentially if we want the lockdown to work,” says Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy in Washington. 

While there is no certainty over how the disease is going to play out in India over the course of next few months, experts are making estimates based on the pattern of the pandemic across the world. Says Gautam Menon, professor of biology at Ashoka University in Sonepat and an expert on infectious disease models and their role in public policy, “Epidemiological models help in understanding the trajectory of the disease, rate of increase and the factors determining that increase. They also help in understanding the role played by interventions such as social distancing and lockdowns.”

Temperature checks have become a daily routine |Credit: Getty Images

Scientists and public health experts are using SEIR models to predict epidemics. The SEIR model charts the flow of people between four states: susceptible (S), exposed (E), infected (I), and resistant (R). Based on the measures that are undertaken by the government and using an online tool created by Gabriel Goh, a machine learning researcher using the SEIR model, IndiaTodayTech, a tech news website says, “Depending on what measures the country takes, and what impact these measures have on Covid-19 infections in India, coronavirus may end up killing around 1,000 people to 5 million people in India, according to the Epidemic Calculator.”

The huge range in possible outcomes depends on the efforts to flatten the curve, lowering the rate at which infections spread, and the stage at which the lockdown was enforced. The Epidemic Calculator by default assumes that the lockdown is imposed after the 100th day of the first reported case. At a death rate of 2%, the number of infected cases will be 1 million, and the number of deaths around 20,000. But as the lockdown was implemented much earlier in India, a better scenario can be hoped for.

In a best-case scenario (an effective response, death rate under 2%, healthcare infrastructure holds up and quarantine successful), the coronavirus will only infect around 15,000 people. This estimate takes into consideration that the first case was identified on 30th January and the lockdown was enforced on 24th March. In a worst-case scenario (inaccurate data, quarantine fails, healthcare system overwhelmed) the calculator estimates 180 million infected cases and over 5 million dead. 

Experts also have differing opinions on when the disease might peak in India. While some like K Srinath Reddy, president of the Public Health Foundation of India (PHFI) and member of executive group of the steering committee of the WHO-led solidarity trial on Covid-19, believe that India’s coronavirus outbreak may peak in late April, others like Dr. T Jacob John, a retired professor of clinical virology at the Christian Medical College in Vellore say that it could peak in June-July.

However, we must remember that epidemiological models provide only an approximation of the spread of a disease and countries across the world are showing different trends. There are also uncertainties regarding the rate of spread. Whether Covid19 can re-infect people who recover is also unknown. There is also a lack of clarity on the period of infectiousness as well as the period of hospital stay. Says Dr Giridhar R Babu, an epidemiologist at PHFI in Bangalore, “Epidemiological models become more realistic when they are combined with the efforts of those of people who have worked on the ground. If assumptions are not based on ground realities, you might end up with results that are exaggerated.”

More than anything else, the pandemic has brought to the fore the stark economic disparities in our society. While the lockdown will have a devastating impact on the economy, affecting all sectors and all income groups, the worst affected will be those working in the unorganized sector, particularly migrants who come to work in the cities from rural areas and other states. Many daily wage earners found themselves without the means to support themselves and were trapped in places far away from their homes. Several of them attempted to go back to their homes on foot, only to be stopped at the borders by the police forces. 

While many in the middle class have been able to work from their homes and practice social distancing in some measure, the poor simply cannot when they live in congested dwellings in densely populated slums. Appeals to protect ourselves from the coronavirus by regularly washing our hands ring hollow for people who have no regular water supply or even access to clean drinking water. India’s entrenched callousness towards its poor has come back to haunt it.


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