India facing the COVID-19 challenge with determination and concern

From the first rumblings of the novel coronavirus, back in late December, to an unprecedented total lockdown of over 1.3 billion people, India has taken on the emergency with unexpectedly low losses so far.

Despite fears of massive outbreaks due to a population density of 420 per square kilometer, a lack of up to date healthcare infrastructure, and a high rate of travel both inside and between states, India may just have one hidden weapon on its side. The heat and humidity may deter the rapid spread of the virus, judging by its pattern of spread thus far.

As of today, there are 727 confirmed cases and 20 deaths. According to the Ministry of Health and Family Welfare, the number of cases is still rising, but the rate of increase has gone down over the last few days.

That doesn't mean that India is safe, by any means. The already high rate of pneumonia and other infectious diseases could cross the limit if the novel coronavirus also joins the race. And if super-spreader cases emerge, the resulting wave of cases could overwhelm India's already groaning healthcare system in no time at all. Harvard public health professor Kasisomayajula Viswanath warns, "Right now they are able to control it, and monitor it, and treat it effectively. But if it is spreading along with other contagious diseases that are already here, then it becomes a matter of considerable concern".

Jodhpur, Rajasthan, India - March 2020: Waiters wearing surgical masks serving food in a restaurant. Image Credit: Stockpexel / Shutterstock
Jodhpur, Rajasthan, India - March 2020: Waiters wearing surgical masks serving food in a restaurant. Image Credit: Stockpexel / Shutterstock

Containing cluster transmission

The current approach focuses on containing cluster transmission before the affected people begin to initiate community transmission. A cluster is a series of cases within a restricted area. The case of Delhi's Italy-returned patient, several cases in Pathanamthitta, Kerala, the Bhilwara hospital case, and the case of the Telengana police-father-son duo, are all examples of cluster transmissions.

The number of cases per state varies widely, with Kerala at the southern tip reporting almost 140 cases, and Maharashtra on the west coast 124, mostly due to returning travelers from abroad, to just 2 cases in the eastern state of Odisha, and four each in the mountainous states of Himachal Pradesh and Uttarakhand.

In such cases, either the contacts of infected people are traced, or if this would take too long, a containment zone of 3 km around the home of the infected individual(s) is demarcated, with an appropriate buffer zone. Then suspected cases and their contacts are traced as well as awareness created about the virus spread and prevention measures in that buffer zone.

The lockdown

The approved containment process includes lockdown, contact tracing, isolation, and testing. Lockdown is almost total, with only a few thousand violations in this nation of over 1.4 billion. The means of enforcing lockdown depend on the police force in many states, while the rate of testing is woefully low, with some centers being unable to process over 50 tests a day.

The government has shut down all international flights from March 22 to April 14, 2020, to prevent viral spread from travelers abroad. Road and rail transport have also primarily ceased. Several foreign embassies have successfully flown out their nationals, in many cases. Internal migrants are still making their way home, however.

Several states plan to release some prisoners to prevent large coronavirus outbreaks illness within jails. And India is gearing up to handle an expected onslaught of infected cases. For instance, the first 1000-bed hospital exclusively for COVID-19 cases is expected to be ready in a fortnight. Currently, these cases are being housed in isolation wards of busy general hospitals. Seventeen other states are building such facilities on the advice of the union government.

While the lockdown is in progress, the union government has announced a slew of measures to mitigate the lack of income for daily-wage earners and other poorer sections of the society. This includes the distribution of up to 7 kg of grain and 1 kg of pulses to each of 80 crore poor families under the Public Distribution System (PDS). Also, it announced an insurance cover for healthcare professionals and workers engaged in working with COVID-19 patients, up to INR 5,000,000 per person (about USD$ 65,300). However, a planned effort to sustain the economy in the face of massive losses suffered by large and small businesses, as well as the substantial middle class, is still not in evidence, raising concerns that India may slide into recession.

Problems with India's lockdown

Despite the best of intentions, India is facing serious problems with the lockdown approach. First and foremost, its police forces, not known for compassion at the best of times, have taken to coercing purported violators of the lockdown.

This is a problem as:

  • Many thousands of millions do not understand the need for the lockdown.
  • People need to go outside their homes to buy essentials, and they have had little time to prepare for a lockdown
  • The police and other authorities have received little or no training on the use of persuasion rather than force.
  • There is no apparent plan to deal with Indians stranded abroad without a valid visa due to the abrupt cancellation of international flights.

These issues may ultimately erode trust in the state's intentions and defeat the very purpose of the lockdown.

Medical workers, meanwhile, face unexpected ostracism from their landlords due to the deep-rooted suspicion that they are carrying the virus to others, as well as difficulty in reaching their workplaces and traveling back home due to the ban on public transport. The government has intervened in many cases, but fresh ones are popping up by the day.

The solution

What is needed at the moment is to educate the public about the goals of the lockdown with clear, accurate, and straightforward information. This must address issues such as why it is essential to stay at home, keeping physically distant from people outside your family, and handwashing. Compassionate and transparent leadership can ensure public cooperation, which is vital to control this epidemic.

The power of technology should be harnessed to provide such information to the most significant number of people possible as quickly as possible, in the most convincing way, and with the opportunity to interact. Other states should follow the lead of Uttar Pradesh, Punjab, Haryana, and Chandigarh, who have offered to deliver essential foods to the doorstep of consumers. Economic and food security are among the most significant worries in India, and more innovative technology can help ensure these needs are met.

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.


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