The time to prepare was yesterday; today may already be too late.
Epidemiologists and researchers are groping in the dark to predict when India, the world’s second most populous country, will reach its own peak of Covid-19 infections.
In the first phase of reopening after a 10-week-long lockdown, India’s daily average of 12,000 coronavirus infections has become the cause of worry for the government.
On 14 June, a study funded by the Indian Council of Medical Research (ICMR), predicted that the nationwide lockdown announced by Prime Minister Narendra Modi on 24 March succeeded in shifting the peak of the pandemic by 34 to 76 days. The study suggests it would arrive around mid-November when isolation beds available across the country could be insufficient for 5.4 months, ICU beds for 4.6 months and ventilators for 3.9 months. Hours after India’s premier news agency, the Press Trust of India, released these findings, the ICMR disowned the study on grounds that it was “non-peer reviewed” and “does not reflect the official position” of the Indian government’s top medical research body.
What is, therefore, the official position of the Indian government on the possible and looming coronavirus peak? Frankly, no one knows. A possible reason why most experts are shying away from making any predictions, is the rather complex geographical, demographic and infrastructural issues that vary vastly between India’s various states. There is also an ongoing issue surrounding the government’s data collection and publication methods.
Speaking at a webinar organised recently by the Indian Scientists Response to Covid-19, an initiative comprising some 600 scientists, Dr T. Sundararaman, former executive director of the National Health Systems Resource Centre, claimed, “The ICMR protocol is that ILI (influenza-like illness) cases which are symptomatic, outside coronavirus hotspots and containment zones will not be tested. There’s a phenomenal reluctance to test even symptomatic patients.” Sundararaman warned that despite the routine collection of data by the Indian government, “there’s almost no interoperability”.
Several experts believe that an accurate prediction of the peak would only be possible if one were to be in possession of a uniform testing policy across all states, a substantial ramping up of testing samples, better contact tracing and containment mechanisms, as well as a more micro-level policy-making framework instead of the currently top-down approach of the Modi government. And that would only be a start. Another dominant view is that the peak must be determined state-wise and not for the country as a whole.
“Most countries that successfully contained the infection did so through a scientific approach towards implementing a lockdown with the severity being high in areas that had confirmed cases. India began with a strict nationwide lockdown and then let it all go waste by allowing people to travel all across the country in buses, trains and flights,” Bhupesh Daheria, CEO, Aegis School of Data Science, told TRT World.
Health officials across various states also admit, on condition of anonymity, that the knee-jerk manner of relaxing the lockdown, along with the reverse migration crisis, abetted a faster spread of the virus to smaller towns and villages. As a result, many areas across states like Uttar Pradesh, Bihar, Jharkhand and the northeast region, began reporting a higher number of cases each time the lockdown was relaxed.
While India is heading towards a phase full of uncertainties, mostly owing to the lack of being accurately able to predict when the country might arrive at their coronavirus peak, here's how the infection steadily progressed since the first positive case was reported on 30 January.
Between 30 January and 25 March, when India entered its full lockdown, there were just under 500 Covid-19 positive cases in the country. By mid-May, when the Union government allowed some relaxations on movement of people and opened some public places, the country had reported over 50,000 cases. Less than a week later, the infections had crossed the 100,000 mark. Today, as India exits its first week of what the government has termed “Unlock 1.0”, there have been over 332,000 reported cases of the infection, of which over 150,000 are currently active, and the death toll has crossed 9,500.
Prime Minister Modi gave Indians just four hours to prepare for their full quarantine. As a result, millions of people who were away from their native homes – migrant workers in particular – were left stranded. Predictably, when rail and air services resumed, those stranded rushed to make their travel bookings. As they traveled back home, many to rural and semi-rural parts of the country which had been hitherto isolated from the pandemic, so did the virus. The severity of the initial phases of the lockdown had also brought economic activity to a halt. As Rajiv Bajaj, one of India’s most recognisable business leaders said recently, “the lockdown should have flattened the coronavirus curve but ended up flattening India’s GDP curve”.
In bigger cities and urban towns, migrant workers who found themselves without jobs and income to support their humble households, were forced to journey back to their native towns and villages; walking under the scorching summer sun on national and state highways without food or water for days and weeks on end. Many died on the way – either of hunger and dehydration, or in road mishaps. When rail services finally resumed to ferry these migrants back home, there were reports of as many as 80 people dying on various trains. For some, the haunting image of a young child trying to ‘wake up’ her dead mother on a railway station platform, summed up the tragic circumstances. A common refrain used by migrants in interviews has become, “hunger will kill us before the virus does”.
With this flurry of reverse migration now nearly complete, work places opening up and inter-city or inter-state commuting becoming easier, the risk of community transmission has been haunting medical experts, as well as policy makers and common citizens . As per available data, India presently has 957 dedicated Covid hospitals with a combined capacity of 166,460 isolation beds, 21,473 ICU beds and 72,497 oxygen-supported ones. Additionally, there are also 2,362 dedicated Covid Health Centres which boast a combined capacity of 132,593 isolation beds, 10,903 ICU beds and 45,562 oxygen-supported beds. In addition to all this, 11,210 quarantine centres and 7,529 Covid Care Centres can provide another 703,786 beds available.
This capacity may seem initially impressive, but it may yet fall short for what some, like Dr. Jayaprakash Muliyil, say is coming. Dr Muliyil, chairman of the scientific advisory committee of the National Institute of Epidemiology, believes that once the lockdown is substantially lifted, the virus may claim “up to two million lives in India including some 750,000 of those above the age of 60 years”. He also says that developing herd immunity is the only way out of the crisis.
While Muliyil’s projections may or may not come true, there are other, equally grim, predictions. The required health infrastructure to correspond with these is also woefully inadequate. Take Delhi, India’s national capital, for instance. Over the past week, Delhi alone has reported over 10,000 new Covid cases. The Delhi government claims its designated hospitals presently have a total of 8,575 beds, of which nearly 50 per cent are vacant. However, despite this seeming a sufficient provision, there have been several reports of people dying outside these institutions in the struggle to get themselves admitted. Delhi’s deputy Chief Minister Manish Sisodia recently claimed that an expert committee constituted to study the pandemic’s spread in the national capital, has projected a caseload of over 550,000 by mid-July and a requirement of at least 80,000 hospital beds – this anomaly because mild and asymptomatic patients are being advised to quarantine at home. This, in effect, means Delhi will have to scale up its health infrastructure tenfold within the next month.
This, however, is just the situation in Delhi – a relatively small, albeit populated, city-state which, owing to the primacy it enjoys on account of being the national capital, is endowed with a much better health infrastructure than larger geographical and more populous provinces like Uttar Pradesh, Bihar, West Bengal, Jharkhand, Madhya Pradesh and several others. The coronavirus peak for these states may still be an amorphous concept but the challenges it will throw up when it comes to pass, will be insurmountable. The time to prepare was yesterday; today may already be too late.