In order to contain the spread of the novel coronavirus in the country, Prime Minister Narendra Modi, on March 24, announced a three-week-long nationwide lockdown. Incidentally, the country saw a steep rise in the number of new cases of coronavirus between March 24 and March 31.
To give it a global perspective, while 861 new cases were reported in India between March 24 and March 31, Italy reported 25,203 new cases, Spain had 38,137 cases and the United Stated reported 1,03,095 cases.
While the optimists among us might believe that despite the rising cases, the rate of transmission of COVID-19 in India is significantly lower than the global rate. But, what does this mean? Do we even know how far the pandemic has spread its tentacles in India, considering we haven’t proactively tested patients for coronavirus? Have we really managed to turn the tide or are we being complacent or overconfident? We spoke to various experts to understand the situation.
Why are the numbers going up?
While we get regular updates from many official sources, the common man is trying to figure out if the lockdown has helped contain the spread of the virus and also what happens next after the lockdown ends.
“I am sure we are in the community transmission stage,” said Dr Siddhartha Srivastav, chief scientist at Neuberg Center of Genomic Medicine, Ahmedabad.
The community transmission stage — technically known as Stage 3 — is the most critical stage when an epidemic spreads really fast. On March 28, Girdhar Gyaani, the founder of the Association of Healthcare Providers, had said: “Yes, it is the beginning of Stage 3 and the next 5-10 days would be crucial to control the pandemic.”
The number of cases has in fact risen sharply since that day. On March 28, we had 987 cases; by April 2, we had 2,032.
“The increase in the number of cases now is reflective of the fact that we are testing more. But, at this stage, more than the absolute numbers, we should concentrate on the rate of increase. The good news is that our spread is not translating into deaths,” said Dr Srivastav.
Is lockdown working?
According to TV Venkateswaran, a senior scientist at Vigyan Prasar, an autonomous organisation under the Department of Science and Technology: “The length of time an individual can transmit the infection to others is not known precisely, but it is possibly up to 10-14 days. Artificially reducing the contagious period is a crucial method of reducing the overall transmission. Hospitalisation, isolation, lockdown and quarantine are all effective methods.”
So, how effective has the lockdown been?
“The symptomatic cases that are coming up now are 14-15 days old, that is before the lockdown was imposed. The mortality rate that we are witnessing now is of patients who tested positive before the lockdown. We will come to know the exact impact of the lockdown only after April 6,” said Ayyaj Tamboli, the collector of Bastar in Chhattisgarh, who is also a medical professional.
“Two things might happen after the lockdown. The number of cases might taper or there will be a spike if those who have moved back from cities to villages carried the infection along with them,” he said.
According to Dr Srinivas Rajkumar, general secretary, Resident Doctors Association, All India Institute of Medical Sciences (RDA, AIIMS), New Delhi, the purpose of the lockdown was to buy time to prepare ourselves to deal with the situation because, in case of a pandemic, the number of cases spikes suddenly.
“The lockdown was imposed to flatten the curve. We must use this time to increase the level of preparedness so that we are able to handle more patients. We must use this time to increase the number of intensive care units (ICUs) and isolation wards,” he said.
“A lockdown is not a permanent solution”
“This is how it works. If 100 cases are showing up, around 50 will be symptomatic, the rest will not be. Around 20 of the 50 symptomatic cases will need hospitalisation. And of these only 5-10 will need to be put on ventilators. Also, I will get a week’s time between the first positive case and the 50th. I think we should ramp up our capacity when the lockdown is on. That was the purpose,” said Dr Ayyaj.
The common man is wondering if the lockdown is going to be extended, which will bring in a new set of problems.
“Well, it’s a global pandemic. We can only slow it to some extent, but we won’t be able to stop it unless we have a vaccine. Whether this lockdown should continue or not, that decision has to be taken at a higher level. But the world can’t isolate itself forever. Lockdowns work in well-funded countries like those in Europe, not in countries like India where people don’t have access to basic facilities. If the lockdown continues, people may die of starvation or other illnesses,” said Dr Rajkumar.
Echoing his sentiments, Dr Ayyaj said: “It’s novel coronavirus, we all know very little about it. Two months back, it was a Chinese problem, now it’s a Western problem. It’s spreading in Africa, too. Who knows, after 2-3 months, the epicentre might shift to Pakistan or Bangladesh. All we can and should do now is to be prepared. We should concentrate on the treatment side; if nothing, have as many ventilators on a stand-by.”
Why didn’t we test?
“We have a simple message to all countries — test, test, test,” the World Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus said in mid-March.
Now, let this sink in.
“Korea is conducting 6,000 tests per million people and India is conducting 20 tests per million,” said Dr Ayyaj. “And this when all we should be doing is to test people, identify them and isolate them, especially our senior citizens, as they are the most vulnerable.”
According to the Indian Council of Medical Research (ICMR), in India, 42,788 coronavirus tests have been conducted so far, which represents 36% of our capacity. The organisation’s website says 123 labs have been made functional and 49 private labs have been given permission to test for the virus.
For a densely populated country of 1.3 billion people, the number of cases is still relatively low compared with Europe and the US. This is believed to be linked to both low levels of testing and poor access to an already overstretched healthcare system.
According to Dr Srinivas, the reason we didn’t test patients is because we simply don’t have the facilities.
“The Indian Council of Medical Research first allowed only the AIIMSto conduct COVID tests. Then they allowed government hospitals and now private players are being allowed. But there is a huge backlog now,” said Dr Ayyaj.
Dr Harjit Singh Bhatti, national president of the Progressive Medicos and Scientists Forum (PMSF) and a former AIIMS doctor, said: “The steps for testing
that the government has taken now should have been taken long back. One million testing kits have been ordered on behalf of the government, but how long will they take to arrive? We are only testing patients suffering from fever, shortness of breath and cough. Unless there is massive testing and infected people are kept in isolation, this chain will not break.”
There are just 51 government-approved testing centres across the country. At private labs, there is a backlog and some have not even started testing yet.
Unipath Lab in Ahmedabad, which has received the permission from the ICMR to undertake Covid tests, had not started testing samples as on March 2. Dhiren Bhatt, a spokesperson from the lab, said: “The state government has audited our facilities and the testing will begin after 2-3 days.” When asked how many samples would be tested and the cost factor, he said he didn’t have any more details.
Pune-based Mylab became the first company to receive commercial approval from the Central Drugs Standard Control Organisation (CDSC) to conduct Covid tests. Replying to an email questionnaire, a Mylab spokesperson said: “In the next few weeks, we will be ramping up the production of Covid-19 testing kits.” This will help increase the number of tests from 1.5 lakh a week to 20 lakh a week, the spokesperson said. But the company refrained from commenting on other questionsand said, “As a testing laboratory, we would not like to comment on any policy decisions taken by the government.”
“We were poorly prepared”
India spends only about 1.3% of its GDP on public health, among the lowest in the world. “This has resulted in the current situation. The public sector is alone managing the Covid burden. Where are the private players? Where are their ventilators? Where are their expensive ICUs? This pandemic has exposed the vulnerability of India’s poor healthcare system. We knew this was coming. We were poorly prepared,” said Dr Rajkumar.
However, countering this, Dr Srivastav said: “We were definitely not prepared to deal with a pandemic. But it would be unfair to put our government in the dock. Even developed countries don’t have spare ventilators. But now the government should come up with a strategy and at least have a system in place so that, if the need arises, we should be able to produce equipment, like say, ventilators, in weeks. But I would definitely criticise the government for not having enough doctors.”
Was the lockdown a wise decision?
In the case of a pandemic, the initial aim is to quickly build a model so that we can predict how it’s spreading, how much time the virus is taking to double the number of infections, how much time it is taking to spread from an infected person to a healthy person, and while we do this, we also have to keep the masses informed, said Dr Srivastav.
“We couldn’t build a model because we were not testing enough. The government opted for a lockdown to reduce the transmission so that our young people don’t transmit it to our old. Say people start testing positive. Now, it is the government’s responsibility to figure out if we have so many quarantine facilities. If the patients are serious, do we have enough hospitals? In India, all the three factors — testing, quarantine facilities and hospitals — are compromised. The government did what it could; to nip it in the bud. It did a good job in tracking people down.”
Mass exodus made the poor vulnerable
The lockdown has triggered a massive movement of migrant laborers and wage workers from cities back to rural villages. Many migrants were seen defying the lockdown and walking up to 500 miles to get back home. Overcrowding at public transport stations has raised concerns about the virus spreading further.
“Mass congregations like this carry the risk of spreading Covid-19 even further. These migrants might carry the virus to rural areas, where the health infrastructure is weak, or even non-existent,” said Oommen Kurian, head of health initiative at the Observer Research Foundation, an independent think-tank based in New Delhi.
“About 2,000 people have come back to Bastar, my district. Similarly, lakhs of migrant workers from across India have moved back to their villages and native places. We argue that they were not screened or tested at state borders. But how effective was the screening at airports? What if there were people who popped up paracetamols and showed up? We should have first banned international flights, then the domestic ones, then trains and buses. We should have given a chance to migrant workers to return home. It’s unfair that we are spraying disinfectants on them now. We should have started sanitising our flight in January. We could have been in a much better situation today,” said Dr Ayyaj.
