COVID-19 in India

The first cases of COVID-19 in India were reported on 30 January 2020 in three students from Kerala who had been studying in Wuhan University; on 11 March, the World Health Organization declared the infection to be a pandemic, and on 22 March, the Prime Minister of India, Shri Narendra Modi, asked everyone to observe a 14-hours ‘Janata’ (people’s) curfew when all movements except essential services were banned and pleaded for ‘social distancing’. At 5 pm on that day, at the Prime Minister’s bidding, large crowds of people came out together to ring bells, beat pots and pans and clapped for health workers. However, as it was unlikely that measures like social distancing (an oxymoron, according to the BBC, in such a poor and heavily populated country where up to 10 people share a room in the slums) would work here, on 24 March, the Prime Minster announced a complete lockdown for 21 days. All educational institutions, malls, public events, small shops other than those which sold food were closed and public transport and international flights were banned, and on 14 April the lockdown was extended till 3 May and may now continue indefinitely.

At the time of writing, on 26 April, there were 24,942 cases in India, 779 (3.1%) deaths against a world average of 6.4% (possible because of its young population), an infection rate of 1.7 and a doubling time of 10 days (from two days previously). The states mainly involved are Maharashtra, Gujarat, Delhi and Rajasthan. Kerala, buoyed by its experience with successfully controlling the recent Nipah virus outbreak by testing, contacting and isolating patients, had only 451 patients with four deaths (vs. Maharashtra’s 6817 patients and 301 deaths).¹

The measures taken by India have been appreciated by the World Health Organization, which stated that ‘India has a tremendous capacity’ to control this pandemic.² The government have upscaled the major hospitals and also involved the private sector for testing and treatment. The railways have even converted some of their coaches into COVID-19 wards. A report on 73 countries by an Oxford group mentioned that government policy has scored ‘100’ for strictness.³

However, these strict measures taken to control the spread of infection have come at a great economic and human cost. India has 139 million migrant labourers on daily wages who leave their villages to find jobs, mainly in factories and construction sites in the big cities.⁴ With no jobs and no pay, they have lost their livelihoods and have started moving back to their homes. And with no trains or buses to take them, they have started walking back in hordes with many dying on the way – there was a harrowing story of a 12-year-old boy who, after being on the road for 48 hours, died just before he reached his village. The central and state governments have now started sealing off the borders to prevent this exodus and to prevent infection from spreading from the metro cities to the villages. These poor migrants are being housed in huge government-run camps.

There has also been a shortage of personal protection equipment, with much of it, recently imported from China, being defective.⁵ Domestic manufacturers have been encouraged to increase their of production personal protective equipments, face masks and face shields.^6,7

The third big problem has been violence against healthcare workers and patients infected with COVID-19 who are being seen as responsible for the spread of infection.⁸ This has necessitated the passage of an Ordinance which imposes a fine of five lakh rupees and up to seven years in jail for such acts.

There has also been a surge of communal feeling after 9000 Muslims from 40 countries attended a Tablighi Jamaat congregation in Delhi and are said to be responsible for 30% of COVID-19 infections in the country.⁹ Similar but smaller Hindu congregations have also occurred but not been given as much publicity.

Perhaps the only good news is that air pollution in Delhi is down by 60% and our beloved Ganges river has become much cleaner.

The future is uncertain, with the government having to choose carefully between saving lives and livelihoods. Any major misstep may result in a widespread epidemic and, on the other hand, result in major social unrest.

Declarations

Competing Interests

None declared.

Funding

None declared.

Ethics approval

Not required

Guarantor

SN

Contributorship

AK did the first draft of the article; SN revised and finalised it.

Provenance

Commissioned; editorial review

ORCID iDs

Atul Kakar https://orcid.org/0000-0001-5643-4658 Samiran Nundy https://orcid.org/0000-0002-1757-3919