- India has reported 519 coronavirus cases and 10 deaths.
- Prime Minister Narendra Modi is putting the entire nation — more than 1.3 billion people — on lockdown for 21 days starting Wednesday.
- Experts fear that testing rates in India are being kept low to prevent panic and to keep healthcare costs down. But that may hide the true scope of the outbreak.
- India faces several hurdles in its fight against COVID-19, including high population density, lack of hygiene, and insufficient healthcare funding.
- Visit Business Insider’s homepage for more stories.
India, the world’s second-most populous country, is going into lockdown in a bid to ward off the coronavirus pandemic.
Home to more than 1.3 billion people, India has reported 519 coronavirus cases and 10 deaths.
In order to keep India’s caseload down, Prime Minister Narendra Modi announced on Twitter that a “curfew-like” lockdown will be enforced starting 11:59 p.m. on Tuesday and last for 21 days (until April 14).
“There will be a total ban of coming out of your homes,” he said, according to The New York Times, urging people to stay put, wherever they are. “Every district, every lane, every village will be under lockdown.”
The country needs three weeks of social distancing to break the infectious cycle, he explained, stressing, “If we’re not able to manage the pandemic in the next 21 days, the country and your family will be set back for 21 years.”
On the Twitter page of his political party, the Bharatiya Janata Party, Modi said the move “will have a huge economic cost but this is necessary for saving human lives.”
China’s Hubei province went into lockdown in late January. As of Tuesday, China — whose population is 1.4 billion — has reported more than 81,000 cases and 3,200-plus deaths. But the country has recently reported a steep decline in the number of new cases, and Wuhan’s lockdowns are being lifted.
Italy, the world’s second-worst-hit nation, has confirmed nearly 64,000 cases and over 6,000 deaths. It is closely followed by the United States’ nearly 46,500 cases and 590 deaths.
“We must understand that the health services in Italy and USA are considered the best in the world,” Modi said. “In spite of that, these countries couldn’t mitigate the impact of coronavirus.”
Testing numbers kept low to avoid ‘paranoia’
Experts worry that India’s case counts may not be accurate. The country was conducting only about 90 tests per day as of March 17, the Associated Press reported, and only 11,500 Indians had been screened. The country has the capacity to test up to 8,000 people a day, however.
The World Health Organization is urging governments to step up testing as the coronavirus outbreak grows.
“We need to be geared to respond to the evolving situation with the aim to stop transmission of COVID-19 at the earliest to minimize the impact,” Dr. Poonam Khetrapal Singh, the WHO’s director for the region that includes India, told the AP. “We need to act now.”
However, India has only been screening people who have either traveled from a country that’s been badly affected, have come into contact with a patient, or are presenting symptoms themselves, the AP reported. Officials have since expanded the criteria to include medical workers who are treating COVID-19 patients and have symptoms.
Balaram Bharghava, who heads the Indian Council of Medical Research (ICMR), said last week that the WHO guidance was “premature” for India because the coronavirus’ rate of spread is not as rapid as it has been in other countries and community transmission hasn’t been detected yet.
“Therefore it creates more fear, more paranoia, and more hype,” Bhargava said, according to AP.
Officials said they were also trying to avoid overloading hospitals to keep costs down.
India’s health-care expenditure amounts to 3.7% of its GDP, NDTV reported. Public hospitals can be overcrowded, many can’t afford private healthcare, and funding is lacking to combat conditions like tuberculosis, malnutrition, and HIV/AIDS. In the case of COVID-19, patients aren’t charged for tests in India, but each one costs the government about 5,000 rupees ($67).
So, many people who may have come into contact with the virus are being sent home without being tested, the AP reported.
A British citizen was turned away from a public hospital even though she had a cough, shortness of breath, and a private doctor’s referral, the AP said. The woman informed officials that she may have been exposed to a coronavirus patient due to her work in the hospitality industry. When she tried to get tested a second time, she was rejected again, forcing her to leave India for France, where her family is based.
Such accounts have sparked concerns that the Indian statistics are far lower than the country’s real coronavirus count.
“Given the pattern of disease in other places, and given our low level of testing, then I do think that community transmission is happening, ” Dr. Gagandeep Kang, director of the Translational Health Science and Technology Institute, told the AP.
High population density creates social-distancing challenges
India’s population density also makes social distancing difficult, since cities are overcrowded and many residents live in slums, low-income dwellings, single- and multiple-family homes, and skyscrapers. NDTV estimated that around 420 people live on just 0.4 square miles of land in many of India’s largest cities.
“Social distancing is something often talked about but only works well for the urban middle class,” Dr. K. Srinath Reddy, an adjunct professor of epidemiology at Harvard University, told NDTV.
He continued: “It doesn’t work well for the urban poor or the rural population where its extremely difficult both in terms of compactly packed houses, but also because many of them have to go to work in areas which are not necessarily suitable for social distancing.”
Shreyanka Rao, a resident of New Delhi, echoed the sentiment.
“While it’s easy to say maintain social distancing, it’s still something that can only be practiced by privileged people who have the time, space and wherewithal to do so,” she told Business Insider. “While the [South] Korean and Singaporean approach is laudable, their systems, resources and volumes are in a different league.”
Lack of hygiene complicates the fight against the coronavirus
India’s fight against the coronavirus’ spread is also plagued by a lack of clean water. Experts have said that using hand sanitizer and washing hands for at least 20 seconds is helpful in warding off the infection.
But Dharam Singh Rajput, like many residents, can’t afford hand sanitizer and doesn’t have access to clean running water, the AP reported. Rajput lives in New Delhi, but open sewers and piles of garbage can be found across his neighborhood.
“The kind of water we have access to has the potential to cause more diseases instead of warding off the virus if we use it to wash our hands,” Rajput told the AP.
Some reports also suggest that people have run away from some Indian hospitals because of substandard hygiene. In the state of Maharashtra, five people were tested for coronavirus. One of them tested negative, but the entire group left the isolation ward before the others’ results came in because it was too dirty, the AP reported.
Aditya Bhatnagar, who was quarantined with 50 other people following a flight from Spain, said more than half a dozen people were packed into each room while quarantined and noted that the quarantine spaces didn’t have clean bedsheets or sanitary restrooms. No one was given masks or hand sanitizer, either, he told the AP.
“I don’t think these measures would be enough to contain the pandemic,” Bhatnagar said, explaining that some people had decided to tell shell out 4,000 rupees a night ($55) and await their COVID-19 test results at a private hospital instead.
‘Unnecessary movement’ is restricted
Government officials are particularly worried about the situation in Maharashtra, which is home to India’s financial hub and its highest number of cases.
Ganga Pandit, who lives in Pune, told Business Insider on March 19 that only five people at a time are being allowed into major grocery stores, where he noticed that people are panic-buying medicines, antiseptic creams, soap, and face masks.
India has also already closed schools, theaters, malls, and other public spaces. University exams have been called off, and government and private offices have been ordered to switch to remote work schedules, NDTV reported.
Modi asked people to stay home from 7 a.m. to 9 p.m. on March 22, but encouraged everyone to go out on their balconies and doorsteps or lean out of windows for five minutes at 5 p.m. to thank medical, airport, and government workers, as well as policemen and delivery personnel by clapping hands and ringing bells.
India has also enforced wide-sweeping travel restrictions. Modi has banned all international flights from landing in India, effective March 22, and also suspended all domestic flights, except cargo-carrying planes, starting March 25, the Guardian reported. Rail travel, a lower-cost mode of travel that’s popular among Indian, has already been halted.
“They are not understanding that this is an avalanche,” Dr. T. Jacob John, the former head of ICMR’s Centre for Advanced Research in Virology, told NDTV. “As every week passes, the avalanche is growing bigger and bigger.”