From time to time, until the crisis has passed, the HEPL blog series authors will be given the opportunity to provide short updates on their country/region’s continuing response to this worldwide catastrophe and their further reflections on those responses. Each update will be labelled accordingly with the original response at the bottom of each post.

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HEPL blog series: Country Responses to the Covid19 Pandemic

India’s Response to the Coronavirus Pandemic – the August update (2020)

Ramna Thakur*¹, Sujata¹, Shubham Ranjan¹ and M. Faizan¹

[1] Indian Institute of Technology Mandi, Kamand, Mandi 175075, Himachal Pradesh, India.
*Corresponding author

It is evident that all of us have to live with coronavirus until the vaccine is available and the lockdown is just a temporary measure to slowdown the spread of the virus. GoI also realized that further extension of the lockdown will affect the health of the economy severely hence it started preparing for an unlocking process for the end of May 2020. It was not easy for a country like India because of its vast size, densely packed population, and weakened health system to immediately start the unlocking process of the entire country. After four phases of lockdown from 25^th March to 31^st May 2020, GoI decided to have unlocking process in three-stages to arrive at a new normalcy. From 1^st June 2020 onwards, in unlock-1, most of the activities prohibited earlier were opened in areas outside containment zones in a phased manner. The Government allowed the reopening of shopping malls, religious places, and other establishments, but with certain conditions. By June 1, the total fatalities due to COVID-19 were 5,606 and total cases were 0.198 million, while, by the end of June, these figures were 17,409 and 0.585 million, respectively. If we look at the growth rate of COVID-19 cases, June alone contributed a 210.54% increase in total fatalities and 195.3% increase in the total number of cases. By the end of July, total number of fatalities due to COVID-19 rose to 36,551 and total cases to 1.697 million. If we compare the figures of Covid-19 in July with the total number of confirmed cases since March, July alone noticed an increase of 104.8% in fatalities and 180.4% in total cases.

GoI granted more relaxations in Unlock-2 from 1^st July 2020 which included reopening of domestic flights and passenger trains on the routine basis. Educational institutions, metro rail services, cinema halls and gyms remain shut. With more than 1.7 million COVID-19 cases and 37,405 fatalities, India entered Unlock-3 on 1^st August 2020. In this unlock phase further restrictions were eased, including the reopening of yoga centers and gymnasiums by following separate Standard Operating Procedure (SOP) issued by the GoI, along with removing restrictions on the movement of individuals during night times. Schools, colleges, international flights, metro rail services and cinema halls will remain shut until further order and there will not be any relaxation in the lockdown in containment zones. There are several states, such as Maharashtra, West Bengal, Jharkhand, Tamil Nadu, Nagaland, Mizoram, that have extended lockdown in the entire states until 31^st August to curb the spread of the virus. There are new emerging pockets of the spread of the virus in e.g. Karnataka, Andhra Pradesh, Uttar Pradesh, and Bihar, where a sudden rise in cases was observed, which may aggravate the situation in future.

Overall, India is showing a decent recovery rate (48.26% on 1^st June to 59.46% on 1^st July to 65.46% on 1^st August) but at the same time the spread of the virus is very high. During lockdown, the spread of the virus was under control to some extent, but when the unlock started, the number of cases increased rapidly. There are various factors like paucity in the preparedness of the administration, heavy movement of people, and insufficient health infrastructure which have contributed towards the spread to a large extent. In June, the number of active cases in Delhi alone passed 28,000, but by the beginning of August it has been quite successful in bringing this number down to 10,000. This became possible due to the various measures taken by the government, including home isolation and the rapid testing of the people. The Delhi government released a standard operating procedure (SOP) in which mild and asymptomatic positive cases were kept in home isolation after a proper physical verification by a team of district surveillance officers. Furthermore, plasma therapy also proved to be a great step in improving the recovery rate in Delhi. Another example where India has shown great success in fighting the virus is Dharavi, Asia’s largest slum. A fast health recovery rate in this area was a result of 4Ts (Tracing, Tracking, Testing, Treating) strategy. The government of Maharashtra received help from NGOs, local doctors, volunteers and used more than 50 mobile clinics to do door to door testing in this area. Although India is doing better than some of the other worst hit countries in terms of the recovery rate and deaths per million population, there is still a need to have mass testing and a strong focus on the prevention of the growth rate of the virus.

India’s response to COVID-19 pandemic – Updated (May 2020)

Ramna Thakur*¹, Mohammad Faizan¹ and Shubham Ranjan¹

[1] Indian Institute of Technology Mandi, Kamand, Mandi 175075, Himachal Pradesh, India.

*Corresponding author

Overall, in April 2020, India was able to slow down the growth of the virus compared to many other countries in the world, but is still struggling in some states, including Maharashtra, Delhi, Rajasthan, West Bengal, Uttar Pradesh, Tamil Nadu, Punjab, Haryana and Madhya Pradesh.

Recently, the Government of India (GoI) has launched a COVID warriors’ portal to assist in identifying healthcare resource groups (HRGs), to provide psychosocial care and awareness among people about the precautionary measures. GoI has started online training though the iGOT website for Social Emergency Response Volunteers and health professionals to fight the pandemic. In addition to the Containment Plan to manage COVID-19, all districts of the country have been divided into three zones; i.e. Hotspot districts (Red), Non-Hotspot districts with reported cases (Orange), and No cases (Green) zone districts. Out of 733 districts, 130 fall in the red zone, 284 in the orange zone and rest fall under the green zone. This division has allowed the centre and state governments to start economic activities in less affected areas. Furthermore, schools, colleges, hospitality services including hotels and restaurants, and all kind of gathering will remain closed till 17^th May 2020 in all zones. In addition to other treatment and research measures for COVID-19, the GoI has also started exploring a novel blood plasma therapy for COVID-19 patients, and until now, nine patients have shown positive results with this therapy.

GoI has approved exemptions from Basic Customs Duty on the import of medical equipment. The GoI and the Asian Development Bank (ADB) have also signed a $1.5 billion loan for the protection of the poor segments of the society. To feed poor and stranded migrants, the government has permitted charitable organizations to lift food grains directly from the Food Corporation of India. Financial support of INR 312.35 billion has already been received by more than 330 million poor people under the Pradhan Mantri Garib Kalyan Package. For the medium-term plan, the GoI has also approved INR 150 billion under the India COVID-19 Emergency Response and Health System Preparedness Package.

In case of the spread of the virus among health professionals, India has not done well in the last one month. Around a dozen hospitals were turned into coronavirus containment zones. Health professionals, including doctors and nurses, tested positive for COVID-19 in the country, as did some administrators and police. Recently, the GoI has facilitated the inter-state movement of stranded people, including migrant labourers, which is also fueling the fire. In this shifting, some asymptomatic infected people are getting moved to non-infected areas also. One of the recent examples is more than 150 pilgrims who got moved from Nanded, Maharashtra to Punjab, and who tested COVID-19 positive which became the second-largest cause (after ‘Hola Mohalla’ at Anandpur Sahib) of spreading the virus in the state. Instead of home quarantine, there should have been a standard quarantine facility for these shifted people at the panchayat level in the rural areas and at the ward level in the urban areas, accompanied with proper checks and necessary medical facilities.

Furthermore, in the name of helping people and collecting revenue, most of the state governments have opened liquor stores in all zones with some guidelines. The result was shocking – the next morning onwards, long queues (even 1-2 kilometres) have been seen outside liquor shops without social distancing and other precautionary measures. The GoI has extended lockdown in the country three times now, for 54 days in total. All the people, including children and the elderly, are forced to stay at home. We all are aware of the crowdedness of most Indian houses. In many houses, a family of 5-6 members live in a 10*10 feet room and with a maximum of two rooms, especially in the urban areas. For the last forty days, liquor was not available. Several empirical pieces of research have proved that 80-85% of the liquor consumers lose their self-control and become violent after consuming liquor. 80% of the domestic violence against women happened because of the liquor consumption of their spouses. When these liquor consumers,  who are not allowed to go out of the houses but are allowed to drink liquor whenever they want, it is not hard to imagine the effect this has on the peace within the house, the online teaching of the children, and the mental and physical health of the family members. It was evident from the news channels and newspapers that the liquor users often started to be violent in different parts of the country. The state governments should have thought about these consequences along with the collection of revenue for the states.

India’s response to the coronavirus pandemic – Original post (April 2020)

Ramna Thakur*[1], Mohammad Faizan¹ and Shubham Ranjan¹

[1] Indian Institute of Technology Mandi, Kamand, Mandi 175075, Himachal Pradesh, India.

*Corresponding author

India started responding to COVID-19 long before the virus landed on the country. The country had already put in place a comprehensive response system before WHO declared it as a public health emergency of international concern, but did not succeed in preventing the spread of the virus. India issued its first advisory to avoid travel to China in the middle of January 2020. Thermal screening of incoming air passengers from China and Hong Kong started before the first case of coronavirus was detected in India on 30th January, 2020. Other measures such as travel restrictions, followed by the universal screening of all international flights at all international airports, in addition to the screening at 12 major and 65 minor ports and at land borders along with the suspension of visas etc. were also embraced by the government. Later, suspension of all incoming international flights and quarantine measures were also included to try to contain and prevent the spread of virus. State governments have also been regularly requested to maintain and further improve upon their surveillance so that the coverage is complete and there are no gaps. Many state governments also took measures long before the spread of virus in their respective states.

In addition to the travel advisories, other comprehensive advisories about the awareness and precautionary measures including the advisory on social distancing have also been issued by the Government of India (GoI). The closure of all educational institutions, avoidance of non-essential travel, employees of all sectors were encouraged to work from home, minimize or reschedule meetings, exemption of biometric attendance, postponement of all examinations, avoidance of sports events and religious gatherings were some of the aspects of the social distancing advisory.  Later, on 22^nd March 2020 ‘Janta Curfew’ (People’s curfew) was declared in which all transportation, including train services, suburban and metro services were also suspended, which was followed by the complete lockdown of the country for 21 days from  25^th March, 2020.

In order to deal with COVID-19 crisis, GoI has also banned the export of all kinds of personal protection equipment from the middle of March 2020. Exports of this equipment were allowed from the first week of February due to the calamitous need of several countries and because just a few confirmed cases were then in India. Further, the GoI also declared face masks and hygiene items as essential commodities to boost supply and prevent hoarding of these items in the country. GoI has also notified that all medical devices sold in the country would be treated as drugs and regulated in order to keep a check on the quality of the devices and price monitoring.

In addition to these precautionary and supportive measures, there are some other steps that have also been taken by the GoI which include; proposal of the creation of a COVID-19 Emergency Fund, including the emphasis on the creation of a common research platform, a relief package to the poor, amendment in the EPF Scheme (an insurance scheme for health care workers) and the use of Cargo Air Flights and Indian Railways for transporting medical equipment and emergency goods, besides other essential items. Further, the Reserve Bank of India has also taken some steps, i.e. expanding liquidity, relaxing repayment pressures and improving access to working capital etc. to address the stress in financial conditions caused by COVID-19.

Although the country was proactive in building a response system for COVID-19 before the virus had reached India, later few lapses have reduced the control of the spread of the virus in different parts of the country. When the country issued its first travel advisory to thermal scan passengers, it was done only in the case of passengers reporting illness on flights originating from China and disembarking in India and not in the case of all passengers.

The GoI was focusing on the quarantine of passengers having symptoms of COVID-19 but not on the quarantine of all international passengers. This was another lapse, as infected passengers may not have had symptoms due to the incubation period, but later, may become ill when in the community. Further, initially the GoI was focusing only on self-quarantine and not on compulsory quarantine under the supervision of doctors, and some people were reluctant to comply.

According to WHO, the current stock of PPE and respirators was insufficient in the country, yet the GoI kept on exporting this medical equipment to other countries until 19^th March 2020. Now, Indian healthcare professionals are paying the price of these uncalculated decisions, and are at a higher risk of contracting the virus due to the lack of PPE kits. Some of them are even wearing raincoats when treating patients.

Another lapse in containing virus is very typical in India, which is the lack of strict implementation of rules. E.g., social distancing is needed and along with other steps, the Government asked people to avoid any type of gatherings including religious congregations – but due to the negligence of administration, more than two thousand individuals including people from most COVID-19 affected countries were found gathered in a religious institution at the national capital, which is just 50 meters away from the local police station.  Later, a large number of people of this congregation were found positive for COVID-19 in different parts of the country due to their migration, which has increased the risk of disease. This is not a single incidence – there are a number of other similar incidences which have played a crucial role in spreading the virus in the country.

The step of a complete lockdown, announced on 24^th March 2020, was needed to prevent the community transmission of the disease, but it was sudden, without planning and without much thinking about the effects on all sections of society, including daily wage workers. There was a need of strict directives from state and local governments to ensure that poor people will get at least minimum necessities free of cost, if they cannot afford to buy them. There was also a need of complete prior information about the relief camps so that migrants could access places of refuge. This was a big lacuna on all central, state and local Governments’ actions. The result was that more than 600,000 migrant poor and daily wage workers with their family members were out on the road. Mass shifting of migrant daily wage workers from cities has increased the risk of COVID-19 in far flung rural areas of the country, which is lacking in even basic health facilities. The purpose of the lockdown – to prevent the community transmission of infection – was defeated. The lockdown actually aggravated the situation.

There is an impression that the growth rate of COVID-19 cases in the country is low compared to many countries in the world. This may be a distorted impression due to the very low testing of the virus in the country. Up to 3^rd April 2020, India had tested 69,245 samples, which is less than 50 persons per million population.

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