India's Figures
India has the third highest number of cases of COVID-19 in the world after the USA and Brazil. At the time of writing, there have been 1,582,581 cases and 34,995 deaths. (1)
Within India, Delhi in the north, Mumbai and Thane in the west and Chennai in the east are the most severely affected places but the entire country has been affected. (2)
India confirmed its first case of COVID-19 on 30 January 2020 in the state of Kerala in a student who had recently returned from Wuhan. A further two cases were diagnosed in Kerala between then and 3 February 2020. (3)
February saw no further cases after these initial three and some were optimistic that India would escape the worst of the pandemic and fare much better than countries in Europe. (4)
However a report by the Indian Council of Medical Research written in February 2020 estimated that the most likely pandemic scenario for India would see 1.5 million cases in Delhi with around 500,000 cases each in the major cities of Mumbai in the west, Kolkata in the east and Bengaluru in the south with the peak of the outbreak in August. They also estimated a worst case scenario which would see 10 million cases in Delhi and 4 million in Mumbai by mid-April 2020. (5)
To date Delhi has confirmed a total of approximately 132,000 cases, Maharashtra state (whose capital is Mumbai) 391,000 cases and Tamil Nadu state (whose capital is Chennai) 228,000 cases. The researchers' worst case scenario has not materialised but their projection of a peak in August may prove correct as case numbers continue to rise on a daily basis. (6)
Lockdown in India
India has had one of the world's strictest lockdowns in terms of how swift and severe its restrictions were. On 24 March 2020, when the total number of confirmed cases across the country was only 550, Prime Minister Narendra Modi ordered the entire nation to remain confined within their homes with the one exception of essential workers. The announcement was given with just four hours notice and saw the closing down of the entire country including all of the transport network. This precipitated a huge humanitarian crisis in a country which relies on millions of rural migrants who found themselves stranded in cities with no work, no food and no money. With no public transport operating many attempted to get back to their villages on bikes or on foot often facing journeys of hundreds of miles. It is estimated that up to 90 million people became stranded during lockdown and some did not reach their home villages but died en route from exhaustion.The irony was that during the panic that ensued as lockdown was so swiftly enforced large swathes of people had no choice but to congregate in huge crowds as they tried to find food, water and any possible transport thus creating ideal conditions for the virus to spread. (7)
Unlike some world leaders, Prime Minister Modi clearly took the threat of the virus very seriously at the outset. However the lockdown of any country has to be matched by a robust healthcare system to have its greatest effect and the disparate standards of hospital and health facilities across the country meant that a draconian lockdown alone could never halt the spread of the virus. A combination of factors around testing and healthcare infrastructure resulted in the lockdown not making even the slightest impact on the virus.
There is very limited testing capacity across the country. In the state of Uttar Pradesh, India's poorest and most populated, there is only one laboratory able to test for COVID-19 for 30 million people. In terms of the number of tests carried out per 1 million of the population India ranks 130th out of the 215 nations and territories of the world. (The UK ranks 14th and the USA 21st.) There has also been concerns expressed by public health experts that there is a political pressure to keep the testing numbers low so that the case numbers remain artificially low. (8) (9) (10)
Many of the public hospitals in India, whilst free to attend, are inadequate with squalid conditions and people often choose to avoid them however ill they are. The better, usually private, hospitals offer a higher standard of care but are already overstretched as they respond to the pandemic. For the millions of people living in the slums there is only ever the most rudimentary access to health care. This is in sharp contrast to countries such as the UK and many in Europe where there is free access to healthcare for all across the nation.
(11) (12)
The Current Situation
On 12 May 2020, when the infection number has risen to 71,000, the Prime Minister adopted a different approach to the pandemic telling the nation that they would have to learn to live with the virus and should go back to work. He gave a televised address saying, "Corona will remain part of our lives for a long time but we cannot allow our lives to be confined only around corona.” However many have remained fearful of returning to work and schools and many businesses remain closed. (9)
Some aspects of lockdown are continuing. Uttar Pradesh is currently deploying weekend lockdowns and the state of Bihar has instigated a two week lockdown after a 60% rise in its cases.
In another television address on 27 July 2020 the Prime Minister made the following claim, "Friends, the way right decisions were taken at the right time has resulted in our country being in a far controlled situation compared with other countries." [sic]
However health experts disagree and the World Health Organization's (WHO) chief scientist, Dr Soumya Swaminathan, has predicted that India will experience waves of infections over the months to come. (13)
Deaths in India appear to be much lower than many other places with the Indian Health Ministry claiming the country has one of the lowest death rates in the world. However with a norm of up to a fifth of all deaths never registered in India and only a quarter of the registered deaths actually certified by a doctor, plus allegations of deliberate under-reporting of COVID-19 deaths, any claim to have a low death rate should be viewed with caution. (14)
The Indian Health Ministry also claims that community transmission does not happen with COVID-19, a complete contradiction to all the known facts about the virus. The states of Kerala and East Bengal have broken away from this official stance and declared that community transmission is occurring in their populations. (15) (16)
Random testing for antibodies to COVID-19 in three districts of Mumbai have shown that more than half the residents (57%) of the slums have been infected with the virus compared to just 16% of people living in the same areas but not in the slums. The overcrowding and lack of sanitation facilities in the slums is the likely underlying reason for the difference. The study will be repeated in August in an effort to understand how the virus is behaving. (17)
India's experience so far with COVID-19 thus far shows that lockdowns alone will not control the virus. Swift diagnosis of infected people with tracking and tracing of their contacts combined with high standards of medical care for the seriously ill are imperative in coping with the pandemic. Without these tools at its disposal in a country of more than 1.3 billion people, a quarter of whom live in the slums of the major cities, the spread of the virus in India is virtually unstoppable. (18)
(13) https://www.aljazeera.com/news/2020/07/months-experts-india-coronavirus-crisis-200727091515912.html
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