India is surging towards the 15 lakh Coronavirus cases milestone and has crossed 14 lakh infections. As the country keeps breaking records every few days, states, cities and towns oscillate between lockdown and partial lockdown. Nearly every day India reports higher single-day increases in the number of COVID-19 cases.
India now has the third-highest number of total cases — 14,35,453 cases and 32,771 deaths — after the United States (40,09,808; 1,43,663) and Brazil (23,43,366; 85,238). Though these are the official figures, testing continues to be limited and deaths in many states, including Gujarat and Madhya Pradesh, have been under-reported or unrecorded.
The Massachusetts Institute of Technology has projected that India is likely to have 287 thousand infections per day by winter 2021. “A large burden of COVID-19 cases will be concentrated in countries such as India, but also Bangladesh, Pakistan and USA as a result of the insufficient responses to perceived risks,” stated the report.
India went into lockdown in March when there were fewer than 550 cases in the country. Many public health experts criticised Prime Minister Narendra Modi’s decision as then the virus hadn’t spread. It took 109 days (Jan 31 to May 18) for Coronavirus infections in the country to touch one lakh milestone. And since then it has been rapidly spreading. The 2-lakh mark was breached just two weeks later on June 2 and in 10 days, India crossed 3 lakh cases. By July 2, we crossed 6 lakh cases and in three weeks, the number of infections doubled to breach the 12-lakh mark by July 23. With the current rate of doubling, India is likely to cross 20 lakh cases by mid-August.
The curve has clearly not flattened, unlike what Niti Aayog member Dr Vinod Paul insisted. He had claimed that India would see no new cases of COVID-19 after May 16 and that gains made during the lockdown would flatten the curve. But contrary to this, on May 16, India registered 4,987 new COVID-19 cases.
“I can only say now that it is difficult to pass retrospective judgements. At that time, Europe and United States were in panic with a large number of deaths. So, it was felt that a lockdown was the best way though our case numbers were not high. In retrospect, it would appear some of the big cities could have been subjected to a lockdown, but the rest of India, particularly the smaller towns, may not have required the lockdown then. I cannot say what factors propelled the decision to go into a lockdown. We could have gone into a differentiated lockdown like in China. Perhaps we could have adopted that approach,” said Dr K Srinath Reddy, president of the Public Health Foundation of India, an initiative to strengthen research and policy in the health system.
India has always been behind the virus, though in the beginning, the country could have been ahead of the virus. Virologist and former professor at the Vellore-based Christian Medical College, Dr T Jacob John stresses that the central government did not warn the states about the high possibility of infections.
“It was a political treatment. The virus doesn’t care about politics. There was a mismatch between the central government’s advice of not to worry and that the 21-days lockdown would stop the virus and what eventually happened,” pointed out Dr John.
Several states across the country such as Bihar, Karnataka and Kerala have seen a spurt of cases last week. Though Kerala cannot be compared to the other two states, it has seen a steady climb of more than 1,000 cases every day last week.
There has been a record spike in Bihar with 2,803 people testing positive on July 25. This took the Coronavirus case tally in Bihar to 36,314. Patna registered the highest number of cases with over 544 persons testing positive for the virus.
“Every state could have done better, but the southern states, Mumbai and Odisha have generally fared better. India is experiencing this epidemic in different parts with different calendars. Some of the big cities which saw substantial increases are now being controlled. Now, the virus is entering some of the smaller cities and we must do our best so that it doesn’t enter the villages. Much of Eastern India was not affected earlier, but Bihar and Eastern UP are seeing an increasing number of cases. So, we can’t say if the cases will subside together in all of India,” added Reddy
“The cases have increased due to increased and mixing movement of people. There was a laxity in public health measures, and everyone thought the worst was over,” underscored Reddy.
As the virus unravelled, Modi has been harping about India’s low death rate. But that, public health experts say, has nothing to do with government policies. India’s average age is lesser than European and American countries, so those with co-morbidities such as diabetes, hypertension and kidney ailments are also fewer in number.
But, India could have reduced even the number of deaths. The minor cases should have been treated at home. The primary strategy should not have been to get everyone to a hospital. “The death rates are not high, but certainly we could have kept them lower by two methods – by reducing the number of cases and ensured treatment facilities were provided promptly for seriously ill patients,” highlighted Reddy.
What we should have done much more actively is surveillance, pointed out Reddy, through efficient primary health care teams supported by citizen volunteers for early detection of symptoms before testing. “There should have been energetic contact tracing and thereby limiting the spread of infection. After the lockdown was relaxed, these measured should have been the most adopted public health measures. We have focussed a fair amount on how to increase hospital capacity but did not pay as much attention to the public health component. This should have been done alongside testing. All of this in tandem would have reduced the infectivity rate. Once you reduce the infectivity rate, even the mortality rate goes down,” explained Reddy.
The Central government never learnt about the virus, asserted John. “Technically, they should have had experts explain to them what this virus is and how it is different. Somebody should have told them social contact is not way for the spread, air droplet inhalation was the way the virus spreads. Make social contact safe by wearing masks. The government didn’t ask or learn. Indians have this tendency to assume to know more than they know. This was a political stunt. US President Donald Trump did it. UK Prime Minister Boris Johnson did it and Indian Prime Minister Modi did it,” said John.
A bio-medical epidemic is still being handled by the government and not by health experts. “The lockdown did not reduce anything. People have to be taught to take precautions and wear a mask. Simply ordering people will not make them do it. Behavioural change requires education, and this means the teacher should learn first and then educate the people. If this was done, people would have taken care of themselves and the epidemic would have slowed down automatically. This is what every textbook tells you about epidemic control – make people partners,” remarked John.
In India, we made people onlookers in the fight, observed John, and we asked them to get out of the way of fighting the virus. “Wrong strategy and wrong approach will get wrong results. Virus is always unstoppable, but the height of the peak could have been reduced. Even today we do not see precautions being taken. Who asked Mr Modi to take leadership instead of public health experts? He voluntarily took leadership instead of the health ministry,” underlined John.