Coronavirus outbreak confronts India with a formidable challenge

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Firefighters disinfect the exteriors of a government-run hospital to limit the spreading of coronavirus disease (COVID-19), in Mumbai, India, on March 24, 2020. (REUTERS/Prashant Waydande)
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A woman and girl wearing masks are stranded at a deserted train station in Mumbai by the nationwide lockdown. (AFP)
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Migrant workers walk along a road to return to their villages, during a 21-day nationwide lockdown to limit the spreading of coronavirus disea
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Updated 27 March 2020

Coronavirus outbreak confronts India with a formidable challenge

  • Fewer than 22,000 Indians, or 16 per million, had been tested for #COVID-19 infection as of March 24
  • Largest global lockdown of any country began in India on March 22 and is scheduled to run 21 days

BENGALURU, India: As the coronavirus pandemic grips the world, a curious datum has emerged from the Indian subcontinent, where the world’s biggest national curfew is now in force.
India, the world’s second-most-populous country — and consistently, despite improvements, at the bottom of many global health indices — is doing better than 40 countries and a ship by the number of coronavirus disease (COVID-19) infections, according to the latest World Health Organization (WHO) data.
Yes, a ship. On March 26, India’s official tally of confirmed cases reached 649 (with 13 deaths). That is fewer than the 712 cases reported in February on the Diamond Princess, a British cruise liner, and fewer than Saudi Arabia or even tiny Luxembourg.
The reason for this anomaly: India is just not testing enough of its 1.3 billion people. As of March 24, fewer than 22,000 Indians had been tested, or 16 per million, compared with 6,551 per million in South Korea, 4,917 per million in Italy or 244 per million in the US.
 

INNUMBERS

  • 1.3 BILLION - India’s population
  • 22 ,000 - Indians tested
  • 649 - Confirmed cases

No one believes that India has 649 infections, not even its conservative government, which insists, contrary to the WHO, that there is no community transmission of the disease.
Cases are now doubling every five days and matching global trajectories. One recent prediction from a team of eight mostly government scientists says widespread community transmission “may take anywhere from a minimum of 20 days to a few months to be visible.”
But there is little question that the pandemic is unfolding, and India knows it: The largest global lockdown of any country began on March 22 and was scheduled to run 21 days.
A national curfew has grounded domestic and international flights and stopped all metro services, public transport and trains.
Thousands, perhaps millions of daily-wage workers frantically trying to reach home after Prime Minister Narendra Modi announced the curfew were stranded, as trains and buses ground to a halt. Many started long treks on foot, trying to walk a few hundred miles home.




Police in Amritsar distribute food during the first day of a 21-day lockdown. (AP)

Aid workers and community organizers urged the government to start income-support schemes, open stadia and halls, and provide free food to the poorest, whose daily incomes have stopped.
But aside from a few states that have organized support programs, most of those stranded have been left to fend for themselves.
“India faces a formidable challenge not just in flattening the curve of infections, but also in sustaining a long halt to activities that keep millions employed and coping with a rapid increase in pressure on its weak medical infrastructure,” Ramesh Venkataraman, a private equity investor and former McKinsey & Co. partner, told Arab News.
“The government should welcome any offers of help, especially from the GCC (Gulf Cooperation Council) bloc, with whom New Delhi enjoys strong diplomatic, trade and strategic ties,” he added.
“India’s recovery, stability and continued economic expansion are of vital interest to the oil-exporting Gulf countries.”

For now, the great danger is that at the current infection rate, which counts only confirmed cases, India is poised to have one of the world’s largest burdens of a highly infectious disease that has no known cure.
One worst-case estimate says up to 300 million to 500 million Indians could be infected (the best-case scenario by the same expert is 200 million).
The numbers depend on whether India will follow the path of South Korea, which leveled the curve and held down deaths despite a high infection rate, or Italy, where the pandemic is raging with no signs of abating.
No Indian expert believes the South Korean model of aggressively identifying and quarantining the infected will work in a chaotic nation where testing is not expanding fast and people have routinely been jumping quarantine and infecting thousands — if not millions —since the first case was reported on Jan. 30.
The good news is that the large majority of these infections may be mild, but that will still leave 10 million with severe illness, said Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy, a think-tank based in Washington DC.
Laxminarayan told an Indian TV network that this level of life-imperiling infections could perhaps be handled if they occurred over a year.
The challenge is that these infections are likely to be concentrated over a period of weeks —and that is not something India can handle.




Health officials and doctors take part in a hospital drill in Allahabad. (AP)

At the best of times, India’s health care system is in crisis. The country spent about 1.28 percent of its gross domestic product on health in 2018.
Saudi Arabia, by contrast, spent 5.74 percent in 2016, and the global average was 5.99 percent.
Up to 75 percent of primary health care in rural areas comes from what are officially called “informal-sector providers,” which means by those unqualified to dispense medical care, either under indigenous or allopathic systems. In other words, quacks.

As the COVID-19 pandemic plays out, India’s shortcomings will take many more lives. The most severe infections are likely to require intensive care and ventilators, which are in critically short supply in the country.
There is no accurate nationwide count, but ballpark estimates of ventilators range from 30,000 to 80,000.
“Even if we’re now able to procure or produce a large number (of ventilators) overnight, making sure they’re functional and operated properly is a huge challenge,” said Manoj Mohanan, associate professor of public policy, economic and global health at Duke University.
He is currently on a year-long sabbatical in India, where he continues to assist several states on issues related to health policy.
“An overarching problem though is that we just aren’t prepared to deal with the epidemic once it starts off in rural areas (where more than 800 million Indians live),” Mohanan told Arab News.
“(If) the common presenting symptoms of COVID-19 (cough, fever, shortness of breath) show up at these providers, we’ll face a ‘damned if they do, damned if they don’t’ problem.”
If any country has extra resources to help India at this point, said Mohanan, getting personal-protection equipment (PPE) would be top of his list because it is tangible and can be done.




People stand on designated areas to maintain social distancing as they queue outside a medical store in Srinagar. (AFP)

Second would be supporting efforts to develop low-cost ventilators, successful deployment of which will require large-scale training and hand-holding to make these effective.
“One of the problems with disasters is a lot of people want to donate equipment or goods/supplies, but there’s no appetite to support staffing, maintenance and operation of the equipment (especially if it was given by someone else),” said Mohanan.
Doctors and other health workers are already reporting shortages of PPE — including hazmat suits and the highest-quality N95 masks — thanks in great part to government delays in stopping exports and ramping up production, despite warnings and alerts from manufacturers, experts and the WHO.
India’s third big requirement will be mobile intensive-care units, which are particularly important because of their scant presence in rural areas.
The poorest Indians will also require income support, as the economy endures a massive shock thanks to the 21-day curfew, during which millions will lose daily-wage jobs and migrant workers will return home.
“It will be months before their income streams are back,” said Mohanan. “The economic consequences of this crisis will be felt long after the virus is contained.”


Lockdowns ease across Europe, Asia with new tourism rules

Updated 49 min 19 sec ago

Lockdowns ease across Europe, Asia with new tourism rules

  • Countries around the Mediterranean Sea tentatively kicked off a summer season where tourists could bask in their famously sunny beaches
  • Around 6.19 million infections have been reported worldwide, with over 372,000 people dying, according to a tally by Johns Hopkins University

ROME: The first day of June saw coronavirus restrictions ease from Asia to Europe on Monday, even as US protests against police brutality sparked fears of new outbreaks. The Colosseum opened its ancient doors in Rome, ferries restarted in Bangladesh, golfers played in Greece, students returned in Britain and Dutch bars and restaurants were free to welcome hungry, thirsty patrons.
Countries around the Mediterranean Sea tentatively kicked off a summer season where tourists could bask in their famously sunny beaches while still being protected by social distancing measures from a virus that is marching relentlessly around the world.
“We are reopening a symbol. A symbol of Rome, a symbol for Italy,” said Alfonsina Russo, director of the Colosseum’s archaeological park. “(We are) restarting in a positive way, with a different pace, with a more sustainable tourism.”
Greece lifted lockdown measures Monday for hotels, campsites, open-air cinemas, golf courses and public swimming pools, while b eaches and museums reopened in Turkey and bars, restaurants, cinemas and museums came back to life in the Netherlands.
“Today, we opened two rooms and tomorrow three. It’s like building an anthill,” Athens hotel owner Panos Betis said as employees wearing face masks tidied a rooftop restaurant and cleaned a window facing the ancient Acropolis. “We can’t compare the season to last year. We were at 95% capacity. Our aim now is to hang in there till 2021.”
A long line of masked visitors snaked outside the Vatican Museums, which include the Sistine Chapel, as they reopened for the first time in three months. Italy is eager to reboot its tourism industry, which accounts for 13% of its economy.
The Vatican Museums’ famous keyholder — the “clavigero” who holds the keys to all the galleries on a big ring on his wrist — opened the gate in a sign both symbolic and literal that the Museums were back in business.
Still, strict crowd control measures were in place at both landmarks: visitors needed reservations to visit, their temperatures were taken before entering and masks were mandatory.
“Having the opportunity to see the museums by making a booking and not having to wait in line for three hours is an opportunity,” said visitor Stefano Dicozzi.
The Dutch relaxation of coronavirus rules took place on a major holiday with the sun blazing, raising immediate fears of overcrowding in popular beach resorts. The new rules let bars and restaurants serve up to 30 people inside if they keep social distancing, but there’s no standing at bars and reservations are necessary.
Britain, which with over 38,500 dead has the world’s second-worst death toll behind the United States, eased restrictions despite warnings from health officials that the risk of spreading COVID-19 was still too great. Some elementary classes reopened in England and people could now have limited contact with family and friends, but only outdoors and with social distancing.
In Asia, Bangladesh restarted bus, train, ferry and flight services Monday, hoping that a gradual reopening revives an economy in which millions have become jobless. Traffic jams and crowds of commuters clogged Manila as the Philippines tried to kickstart its economy.
Around 6.19 million infections have been reported worldwide, with over 372,000 people dying, according to a tally by Johns Hopkins University. The true death toll is believed to be significantly higher, since many died without ever being tested.
In the US, the often-violent protests over the death of George Floyd, a black man pinned at the neck by a white Minneapolis police officer, are raising fears of new outbreaks in a country that has more confirmed infections and deaths than any other.
The US has seen nearly 1.8 million infections and over 104,000 deaths in the pandemic, which has disproportionately affected racial minorities in a nation that does not have universal health care.
Protests over Floyd’s death have shaken the US from New York to Los Angeles. Demonstrators are packed cheek by jowl, many without masks, many shouting or singing. The virus itself is dispersed by microscopic droplets in the air when people cough, sneeze, talk or sing.
“There’s no question that when you put hundreds or thousands of people together in close proximity, when we have got this virus all over the streets ... it’s not healthy,” Maryland Gov. Larry Hogan said.
Some efforts to contain the spread of coronavirus are being upended by the protests. In contact tracing, newly infected people list everyone they’ve interacted with over several days in order to alert them that they may have been exposed. That may be a daunting task if someone has been to a mass gathering.
The process also relies on something that may suddenly be in especially short supply: Trust in government.
South Korea and India offered cautionary tales Monday about just how hard it is to halt the virus.
South Korea reported a steady rise in cases around Seoul. Hundreds of infections have been linked to nightspots, restaurants and a massive e-commerce warehouse near Seoul. The resurgence is straining the country’s ability to test patients and trace their contacts.
“We have been seeing an increased number of high-risk patients who have been infected through family members or religious gatherings,” said Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention. “There’s a particular need for people over 65, pregnant women and those with chronic medical conditions to be alert.”
Incheon, a port city west of Seoul, said Monday it’s considering banning gatherings at 4,200 churches and other religious facilities.
In India, cases increased rapidly but it still eased restrictions Monday on shops and public transport in more states. Subways and schools remain closed as experts said India is still far from reaching the peak of its outbreak. The government eased the lockdown to help millions of day laborers who have lost their jobs and are unable to feed their families.
China, where the global pandemic is believed to have originated late last year, reported 16 new cases Monday, all travelers from abroad. Much of China has already reopened for business and Monday saw classes restart in middle and high schools. Kindergartners and fourth- and fifth-graders will be allowed back next week.
South African President Cyril Ramaphosa says China has pledged to make available 30 million COVID-19 testing kits per month to African countries, which are facing a shortage.
Japan started blood tests Monday to check what percentage of its people have developed antibodies, a sign of past coronavirus infections. The tests will be conducted on 10,000 randomly selected people in three areas including Tokyo and results are expected at the end of the month.