Without a clear mechanism in place, the federal government has ordered states to screen and isolate tens of thousands of stranded workers to prevent them from travelling, adding to the strain on local health services.
India has ordered states to quarantine hundreds of thousands of migrant workers for two weeks with hopes this could prevent them from carrying the coronavirus from the big cities where they were working prior to the lockdown. The South Asian nation is struggling to prevent tens of thousands of people from returning home to the countryside in case they have been infected.
The federal government's order directs states to strictly implement a 21-day lockdown by building "shelters and relief camps" for migrants, who will be quarantined for 14 days after medical screening –– a gigantic effort to block the spread of coronavirus that has already killed 29 people and infected over a thousand.
Last week, Prime Minister Narendra Modi ordered the country's 1.3 billion people to remain indoors until April 15 saying that was the only hope to stop the coronavirus epidemic.
The lockdown left a majority of migrant workers jobless who defied the restrictions, many of them leaving big cities like New Delhi and Mumbai on foot for their homes in rural India. At least five such migrants have died in the exodus.
On Sunday, Modi "apologised" to the poor for the lockdown in a weekly radio address.
The poor "would definitely be thinking what kind of prime minister is this, who has put us into so much trouble," Modi said, urging people to understand there was no other option but to lock down the country.
"Steps taken so far… will give India victory over coronavirus," he vowed.
Authorities estimate around 300,000 jobless and hungry labourers have hit the roads. It's not clear yet how quickly states will arrange for the shelters and how long the workers will be medically screened before they're quarantined.
The western state of Maharashtra, home to Mumbai and another big magnet for migrant labourers, has set up 262 relief camps and was providing shelter to 70,399 people, the state chief minister tweeted.
Authorities ordered that a racetrack outside capital New Delhi that hosted a Formula One race in 2011 to be used to house 5,000 migrant workers.
Uttar Pradesh has announced aid and set up 600 shelter homes that will act as quarantine centres, local official Alok Kumar said. He was unable to say how many people were still on the road.
J: Home Affairs says migrants'll be sent to a 14 day quarantine. how many have been quarantined so far?— Vidya (@VidyaKrishnan) March 30, 2020
Home Affairs: I have no numbers. Repeats the release about govt providing shelter people as per "standard protocol" (which apparently only applies if you are piss poor)
A major concern in India is that the hundreds of thousands of workers going homes will spread the virus deep into the hinterland, said a top health official.
"It’s an evolving situation with daily new challenges coming up like having migratory populations moving from one place to another. Like non-affected states, adjoining affected states," said Dr S K Singh, director of the National Centre for Disease Control, which investigates and recommends control measures for outbreaks.
Many experts doubt the official number of Covid-19 cases and deaths and say that India is testing far too few people.
"This migration has taken it (the virus) to small towns and villages," Virologist Shahid Jameel at the Wellcome Trust DBT India Alliance said.
The numbers are small compared with the US, Italy and China, but experts fear these precautions won't be enough for India's beleaguered, under-funded and under-staffed health system to stave off an epidemic.
Migration compared with 1947 partition
Police said four migrants were killed on Saturday when a truck ran into them in the western state of Maharashtra. Also on Saturday, a migrant collapsed and died in the northern state of Uttar Pradesh, according to a police official.
"We will die of walking and starving before getting killed by corona," said migrant worker Madhav Raj, 28, as he walked by the road in Uttar Pradesh.
For the economic migrants who may test coronavirus positive, "the fatality rates may be higher only because of the long walk back home," Indian economist and migration expert Chinmay Tumbe told The Indian Express.
"The closest comparison of the long walks seen today is the partition of 1947 [when the subcontinent was divided] and even then, transport options were open for some distances and did not affect all parts of India," Tumbe argued.
On Sunday, several hundred migrants in the town of Paippad, in southern Kerala state, gathered in a square demanding transport back to their hometowns.
Indian were also outraged after a video showed migrant labourers and their families forced to take bath in chemical solution upon their entry in Bareilly, northern India. Officials later said the workers were bathed in sanitiser and chlorine mixed with water.
Self-quarantine on top of trees
Many others were shocked after migrant workers quarantined themselves on trees in northeastern West Bengal state.
Several workers, who journeyed from southern Tamil Nadu state, quarantined themselves on banyan and mango trees amid fear of bear and elephant attacks and in absence of separate rooms for self-isolation in their village huts.
The unintended consequence of the lockdown in India.— Bindu Reddy 🔥❤️ (@bindureddy) March 28, 2020
A very disturbing video of migrant workers who have lost their jobs trying to return their villages. Scene in Delhi's bus station.
FWIW, India is claiming to have < 1000 virus cases pic.twitter.com/Nf8OQ3Sdzn
India lost 'good lead time'
India has overstretched its health infrastructure. There's one state-run hospital for every 55,591 people on average and one hospital bed for every 1,844 people.
India needs about 10 times more doctors to meet the norms prescribed by the World Health Organization, a shortfall of at least 500,000 doctors.
Experts fear that an epidemic would cause other routine health care functions to suffer.
"Everything will become about Covid-19. And other routine services like immunisation or taking care of maternal mortality would be affected," said Anant Bhan, a global health and policy expert.
Other experts say India lost "good lead time" when China shared its concerns and when the first coronavirus death was reported in India in January.
"India lost a good lead time when we knew that this was a pandemic in the making. The government had been warned in advance and asked to watch-out, soon after China announced that this was transferred between animals and humans via social contact," said Dr T Jacob John, India's leading virologist, who formerly headed Indian Council for Medical Research's Centre for Advanced Research in Virology.
"The purpose of a lockdown is to buy 21 days before widespread community transmission occurs. The 21-day time is only to buy more time or let's say to delay the transmission so that the government can make frantic preparations," he said.
"A pandemic needed three months to go around the world, and see where we are now. We would have been better off if we [the government] had taken it seriously in early January."
India ranks 184th out of 191 in terms of GDP percent spent on healthcare, as per WHO. It spends slightly over one percent of its total GDP on health care.
India spent an average of $62.72 per person on health care in 2016, compared to China's $398.33.
"The last time a needs-based survey was done for India's health care was in 1946,” Dr John said, adding that the country's "health management system is very inadequate for India's existing problems, let alone new ones."
The WHO says that in addition to tackling the virus, we need to stop the spread of an "infodemic" pic.twitter.com/M9ut1Cc2PP— TRT World (@trtworld) March 30, 2020
Modi's 'unscientific thinking'
While coronavirus makes inroads, Modi's right-wing government has been slammed for willingness to tolerate unscientific thinking for years.
"The prime minister and his colleagues have held intellectuals and experts in disdain, and promoted traditional medicine in the past, undermining the health ministry's efforts to combat misinformation by endorsing homoeopathic prophylactic treatment," senior journalist Vidya Krishnan wrote in The Atlantic.
Before lockdown order, Modi also announced a single-day "people's curfew" for March 22 and asked Indians to beat utensils and ring bells at 5 pm to show support for health workers.
That call was brazenly flouted as rallies were held in many Indian states with festive fervour, undermining the government's social distancing call to avoid coronavirus.
The upshot of #JantaCurfewMarch22, somewhere in West Bengal. The #clapping and #clanging call negated all that the curfew had achieved earlier in the day. If the takeaway from the whole exercise is a sense of triumph over #Corona, India is really in for a catastrophe! #StopCorona pic.twitter.com/ZAkBaRyzTN— Dipankar (@Dipankar_cpiml) March 22, 2020
However, there still appears to be broad support for strong measures such as a lockdown.
But opposition leaders, analysts and some citizens are increasingly criticising its implementation.
In particular, they say Modi's government appears to have been caught off guard by the mass movement of migrants following the announcement, which threatens to spread the disease into the hinterlands.
The government "had no contingency plans in place for this exodus," tweeted opposition politician Rahul Gandhi as images of migrant labourers walking long distances to return home dominated local media.
#ModiMadeDisaster was a top trending topic in India on Sunday on social media site Twitter.