What India Needs On 14 April

Publication for Observer Research Foundation

India is halfway through the 21-day lockdown announced by Prime Minister Modi on 24 March to tackle the growing challenge of COVID-19. At the outset, it was clear that the lockdown was not a cure. It was a drastic measure to break the transmission chain and also gain an additional valuable 21 days to prepare a plan and put in place systems to implement it effectively after the lockdown was lifted.

India had an invaluable lead time in February when only three cases were registered in Kerala between 30 Jan and 3 Feb, all students returning from Wuhan. The next round of cases began in March which included patients with history of travel from other parts of the world. During this period, the numbers in China went up from 10000 to 78000 and the disease spread to 60 countries with new clusters emerging in South Korea, Italy and Iran. Yet, other than putting into place screening measures for people coming from certain countries, little was done to prepare for the impending outbreak. Universal screening was introduced on 4 March; all visas for India were suspended after a week, followed by a ban on all international flights on 18 March.

During February, no plans for procuring or producing test kits were prepared because internal debates about testing criteria continued. Even as the global numbers crossed 100000 on 6 March (it crossed a million 26 days later), India struggled with plans for adequate safety equipment like masks, gloves and protective suits for the health service workers as well as estimates for essential equipment like respirators, ventilators and adequate beds in isolation wards.

Meanwhile, the virus continued to spread. After reaching a hundred cases on 16 March, it began to double every four days. After a trial run with a “Janata Curfew” on 22 March, the 21-day lockdown began on 25 March. PM Modi has since spoken twice, once during his Mann ki Baat radio address on 29 March when he “apologised” to the people for the hardships caused by the lockdown and again on 3 April when he exhorted people to light a candle or diya for nine minutes on 5 April at 9 PM after switching off lights, in an act of solidarity. In all likelihood, he will speak again on 14 April to inform the nation of the next decision, whether to continue, partially relax or lift the lockdown. On what will this decision be based?

We know that the initial decision was intended to break the chain of transmission. So has that happened? The current assessment is that COVID-19 has a Basic Reproductive Number (Ro) of 2.9; this is the number of people that each patient is likely to infect further. Breaking the transmission chain means bringing this number to below 1, implying cutting it by two-thirds or more. A conclusive determination can only be made on the basis of data. As on 3 April, according to ICMR, only 70000 tests had been conducted across the country. The officially declared increase in the number of cases continues its four-day doubling cycle. On the basis of this limited data, the transmission chain is yet to be broken. In coming days, the data set needs to be expanded significantly; testing needs to grow to a hundred times the number of cases to enable arriving at a definitive conclusion.

However, ICMR continues its flip-flop on tests. In addition to the more accurate real-time Reverse Transcription Polymerase Reaction test (rRT-PCR), a faster and simpler (though less reliable) serum test to detect antibodies is now gaining widespread acceptance. A positive result with this needs to be further verified by using the PCR test. However, ICMR is undecided and a protocol regarding the antibody test, about where this should be employed is still awaited.

On 24 March, PM Modi had announced a Rs 15000 crore package for rapid strengthening of the healthcare sector. The resources were intended to step up procurement of protective equipment, ventilators, build quarantine centres and train medical workers. Large orders have been placed for these but deliveries have yet to pick up. Ramping up domestic production is difficult during a lockdown because of supply chains of inputs – fabric, special coated synthetics, zips, pressure valves etc, down the chain and employment of labour at each stage; global supplies have become scarce.

It is correct to claim that the pandemic has to be fought on a war footing; however, without data and without protective equipment, it is like fighting a war blindfolded and without weapons.

Every war has its share of the unexpected. However, the impact of the lockdown on the economic chain, even if expected certainly did not anticipate the extent of the reverse migration of the migrant labour. It has thrown up new challenges of ensuring food security and adequate welfare measures. Partial reversals could ease the economic pain but would adversely affect the objective of breaking the transmission chain. Yet it is important to remember that economic pain can be reversed but death cannot be, whether due to disease or other aggravations.

It is likely that government may therefore consider a partial relaxation. Such a suggestion was implicit in the video conference that PM Modi undertook with the CMs of the states on 2 April. Yet a common exit strategy cannot be uniformly applied across all states because the spread of the disease is not uniform. From 18% districts (132 out of 729) affected when the lockdown was announced, the disease has now spread to 33% districts (238). Certain regions are more highly impacted even as there are areas that are clear. These would be likely candidates for relaxation of lockdown after 14 April so that economic activity can recommence even as careful monitoring and testing ensures that these districts remain green zones. It will also help in staggered harvesting.

Technology needs to be used extensively. Mobile phones enable location tracking, extensively employed in other countries for contact tracing provided it is accompanied by widespread testing. Road movement cross-verified with petrol/diesel offtake and mapped with disease helps anticipate and correlate spread with movement. Districts remain the fundamental administrative unit and it is here that the battle has to be fought and won.

Planning has to be done on the basis of tracking the disease using data to develop epidemiological models that can predict the movement of disease. Strategy implementation has to be done at the district level for which resource allocation and sharing becomes the state and central responsibility.

The lead time gained with the 21-day lockdown will come to an end in another ten days. It will not see the end of COVID-19 and more sacrifices by the people will still be called for. But hopefully, on 14 April, PM Modi will be able to provide the nation with a strategy based on scientific analysis developed as a result of consultations with states, based on a clear understanding of available resources at the national level. Therein lies the key to solidarity that remains the need of the hour.

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