India has made progress toward preparing for and mitigating the impacts of pandemics but progress toward meeting the IHR has been uneven, and many countries, including India, have been unable to meet basic requirements for compliance (Fischer and Katz 2013; WHO 2014). The Global Health Security (GHS) Index 2019 assessment indicated India’s standing as shown in the above map.
The epidemic of the novel coronavirus disease, COVID-19, instils fear and anxiety for four reasons: rapid spread, reports of many deaths, lack of specific treatment, and gaps in our knowledge about its spread and behaviour. The current epidemic is unlike all previous ones—mighty spreader, moderate killer. Pandemic influenza H1N1 (swine flu) on the other hand was a rapid spreader, but weak killer. India has faced several such “new disease” outbreaks in the last three decades. HIV that reached India 1984 unnoticed and India enforcing control measures through setting up the National AIDS Control Organization and implementing preventive intervention had made a remarkable programme that currently acclaimed globally. Similarly, the outbreak of Nipah in 2001, the chikungunya (2002), Severe acute respiratory syndrome (SARS) spread in early 2003, the pandemic influenza H1N1 in 2009 and Crimean-Congo haemorrhagic fever (2011) contained without significant morbidity and mortality for the country. In the case of COVID-19, is closer to pandemic flu H1N1 that has persisted as seasonal flu, than SARS that was eliminated quickly. Like with the H1N1, the virus can escape detection in spite of screening.
Faced with the challenges, it would be interesting to note India’s standing in the World Bank Group Pandemic Preparedness Funding Status Report of September 2019 in which India scores as IDA countries on preparedness, laboratory, surveillance and workforce projected in the figure below-
Notwithstanding the above standings, the Governments anticipating widespread transmission and eventual endemic persistence, the outbreak has been declared in India an epidemic in more than a dozen states and union territories in India, where provisions of the Epidemic Diseases Act, 1897 have been invoked. Educational institutions and many commercial establishments have been shut down initially adopting mitigating model for containment. India suspended all tourist visas, as a majority of the confirmed cases were linked to other countries. On 22 March 2020, India observed a 14-hour voluntary public curfew responding to Prime Minister call.
The government followed it up with lockdowns in 75 districts where COVID cases had occurred as well as all major cities. Further, on 24 March, the prime minister ordered a nationwide lockdown for 21 days, affecting the entire 1.3 billion population of India. Scientists stated the lockdown model as measures of ‘hammer and dance’ to buy time for appropriate medicine and vaccine development to mitigate the impact. The ongoing mathematical modelling study by Institute of Medical Sciences, Chennai indicated India’s virus reproductive rate as 1.7, significantly lower than in the worst affected countries, thus as of now, the infection rate remains unalarming relative to population size. A ‘novel coronavirus ’landing on the Ministry of Health website started giving the numbers of phone helplines, as well as detailed advice and guidelines. Even so, the country still faces many of the same challenges as other countries, including limiting unauthorised gathering, restricting inter-state migration of labours, debunking of fake health messages, addressing the flouting of government prohibitions and initiate religious congregation, removing public panic among others. According to a survey study published on 28 March by research agency STATISTA to understand the opinion among Indians on the coronavirus COVID-19, found that about 72 per cent of respondents stated that they are staying alert and taking precautions, but on the contrary, 16 per cent said that they did not believe that the virus can impact them or Indians at large. Health Experts expect that as the virus adapts more to humans over time, its virulence declining, but infectiousness increasing. They opine that it is likely that the virus will spread universally, reminiscent of a pandemic flu, and finally become endemic. This projection is not comforting as mortality depends on spread, virulence, and healthcare standards. The coronavirus scare triggered a burst of stupidity with wild speculations and creativity in India, but once the threat became bigger and death counts of affected persons started pouring in from across states through the media, much of the stupidity observed subsided.
Fortunately for the country, lockdown enforced in the second stage and strict compliance of ‘stay home’ followed should thwart the ‘community transmission’ of COVID-19, as health experts opine. Further, worries about low testing facilities in India being there, there are no reports of people with symptoms crowding hospital as there in many other countries.
In perpetuity, the Union Government has announced stimulus plans to directly aid poorer communities with the finance ministry announced a package worth 1.7 lakh crores for the purpose. The Reserve Bank of India this week introduced measures to pump more rupee liquidity into the banking system. The Prime Minister has allocated Rs.1500 crore for additional healthcare measures to fight the outbreak from escalating. These apart, India’s corporate world has committed or donated more than Rs.2700 crore in direct and indirect aid to help fight the novel coronavirus (COVID-19) as media reported. The most important intervention needed at the present juncture is to ramp up the capacity to save lives through affordable testing facilities, hospital beds, medicines and medical personnel. To this end, India’s manufacturing and service sectors steps in with commitments for manufacturing Ventilators, personal protective equipment, sanitizers, masks, and hospital equipment. A large number of celebrities donating cash generously for the national COVID-19 response. The Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund has been tagged with CSR.
For India to lead the path in containing coronavirus the current lockdown measures through the enforcing social distancing appears the sole option left given the inadequacy in its health infrastructure. Besides, the trends of initial seven days of the lockdown indicated that rate of increase has declined i.e. 5.31% new infection as of March 28 from initial 39.92% recorded on March 21, but unfortunately, a spike in infection witnessed in day 7 & 8 of lockdown due to flouting of rules for a religious congregation involving pan-India and International delegates’ juxtaposition in New Delhi. Still then, the lockdown measures hold potential in a highly populated country like India. Notably, the mathematical model study by Cambridge University indicated that current 21 days lockdown measure may not be enough to contain the virus spread and two alternate models of lockdown proposed i.e. continuous or interim break-wise two lockdowns to counter the second and third wave to reach the baseline.
The Chinese government measures to lockdown Hubei province including Wuhan for 49 days at a stretch found to work as no new infection recorded in Hubei on March 19. The governments at Union and States have so far followed a step-by-step model and been on the front foot and enforcing social distancing. Together with the lockdown, ‘Cluster Approach’,- first with identification of places of all those who have come in contact with COVID-19 infected person as a cluster and then zeroing in on certain hotspots, door to door screening for symptoms and testing of all symptomatic cases required; as it would be practically impossible to do blanket population-wide testing across the vast country, over a short period of time, that too for a test that is quite sophisticated and ‘high risk’ in nature. This approach worked earlier in containing Ebola in West Africa, and probably governments in the country are embarking on the approach on expert advice. In the event that the cluster approach keeps on demonstrating a moderately low disease rate, at that point, India will have helped the lead the path in containing coronavirus.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of The Eastern Herald.