India Is the World's Second-Most Populous Country. Can It Handle the Coronavirus Outbreak?
As the world grapples with the
COVID-19 pandemic,
some experts say India — a country of more than 1.3 billion people —
likely has many more cases than the conservative numbers currently being
reported. The outbreak of the new coronavirus, which causes COVID-19,
began in China and has since
infected more than 124,000 people across more than 110 countries and territories around the world. More than 4,500 people worldwide have died after being infected with COVID-19.
India has conducted nearly 5,000 COVID-19 tests so
far, according to the World Health Organization, which says that the
“country is responding with urgency as well as transparency.” But so
far, India has only reported
74 confirmed COVID-19 cases and
one death,
on Thursday. Dr. Ashish Jha, director of the Harvard Global Health
Institute tells TIME that count is “just not right.” He believes there
must be many more cases, but they have just not been identified. “I’m
deeply worried that there’s a lot of community transmission and we are
just not aware of it because there is not widespread testing,” he says.
Jha expects there will be a large uptick in cases
over the next two to three weeks as testing capabilities improve. Jha
and other experts worry that misinformation from government officials
and BJP lawmakers touting cow products and unproven homeopathic remedies
as ways to prevent infection add to the country’s challenges in
containing an outbreak.
Analysts also say that enacting strict social
distancing measures, like the widespread lockdowns and quarantines used
in Italy and China, would be almost impossible in India’s many rural and
overcrowded regions. Those living in poverty would likely be among the
hardest hit in a potential widespread outbreak as much of India’s
privatized health care system is expensive and public hospitals are
overwhelmed and often sub-par.
Here’s what to know about how prepared India is for a major COVID-19 outbreak.
How is India responding?
The Indian government has recommended residents
avoid or postpone mass gatherings until the spread of COVID-19 is contained. The Ministry of External Affairs
has advised against conducting the Indian Premier League, a popular global cricket tournament, but noted that the final decision will rest with organizers.
Only government-run hospitals administer the COVID-19 test, which is free,
according to Quartz. At least 52 labs across India can test for COVID-19, according to the WHO.
Experts say India’s responses to previous disease
outbreaks have been relatively strong. When Ebola hit West Africa in
2014, India developed some good testing centers and protocols, Jha
notes. When
Nipah,
a virus with a mortality rate around 95%, hit Kerala in 2018, the
human-to-human transmission was contained, although 17 people died. But
Nipah was significantly more localized than COVID-19. Containing the new
coronavirus is significantly more complicated than responding to Nipah
and Ebola and requires a more sophisticated response from the public
health system, especially because COVID-19 has flu-like symptoms and is
sometimes asymptomatic, Jha adds.
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India’s travel restrictions
On Wednesday, India announced the suspension of “all
existing visas”until April 15, apart from certain special exemptions,
diplomatic and employment visas among them. The change will not apply to
foreigners already in India but no more tourists will be able to enter
starting on Friday at 12 p.m. GMT from the port of departure.
All incoming travelers to the country, including
Indians, who visited China, Italy, Iran, the Republic of Korea, France,
Spain or Germany after Feb. 15 would be
quarantined for at least 14 days, authorities said on Wednesday. The Indian army is
setting up quarantine facilities
across India to house about 1,500 people, according to national media.
Bellur Prabhakar, Senior Associate Dean for Research and professor of
microbiology and immunology at the University of Illinois College of
Medicine, tells TIME that this is an extremely small amount given
India’s population.
More than 1 million passengers have so far been screened at airports, according to health officials.
Indian citizens have been advised to
avoid all non-essential travel abroad and India’s government says it has so far
evacuated more than 900 people from COVID-19 affected countries, including Iran, China and Japan.
Health care challenges
Jha notes that while he was concerned about the
relatively high volume of travel to and from China and Iran, now
community spread is more likely to drive a national epidemic than
foreign cases.
Experts say that elderly individuals with underlying
health conditions are most at-risk to a COVID-19 infection. There is a
high prevalence of cardiovascular disease and diabetes in India, notes
Prabhakar. Another less obvious threat is the “
extraordinarily poor quality of air”
in urban centers, which can cause respiratory disease. “One of the
first lines of defense we have before our immune system kicks in is our
respiratory tract’s ability to shut the virus [down] or to push it out
but if those underlying conditions are compromised you are going to be
much more vulnerable to respiratory infections” like COVID-19, Prabhakar
says.
One particularly vulnerable community are those in
poverty, especially because private health care is expensive and
inaccessible to many while public hospitals lag behind in quality. About
176 million Indians were living in extreme poverty as of 2015, according to a World Bank brief from last year.
India likely lacks enough hospital beds for the
number of people likely to be infected, Jha says. But beyond a question
of hospital capacity is a question of trust in the public health system.
Many public hospitals in India are overcrowded, lack staff, and Jha
says patients have shared concerns with him about being treated badly at
public hospitals — an experience that may lessen their chances of
willing to go again.
The key to managing the COVID-19 outbreak is to
identify people with symptoms early so they can be isolated but often
people don’t come forward until they have advanced symptoms and have
spread the disease. “The only way they will come early is if they think
you can do something for them,” Jha says. “I can imagine in rural areas
with a weak primary health care infrastructure people are not going to
come forward because they’re not convinced that coming forward will mean
much.”
Experts also believe that extreme social distancing
measures like those taken by China and Italy, which has quarantined the
entire country of 60 million people, is not “remotely possible in India”
because of the large number of people who live in slums and crowded
conditions. Data from India’s 2011 national census indicates that
one in six urban Indians live in cramped slum housing conditions, according to The Guardian.
India has a remarkably dense population and there is
overcrowding on public transport as well as public spaces, like markets,
Prabhakar notes. “A bus that is supposed to carry 40 passengers will
have 80 passengers,” he says.
Health
department officials and police personnel seen wearing masks while
conducting a mock drill in which doctors educated people about COVID-19
on March 12, 2020 in Amritsar, India.
Sameer Sehgal/Hindustan Times—Getty Images
Government-sponsored misinformation
Misconceptions about the coronavirus are sweeping
through the country primarily through Whatsapp, but also with the help
of the right-wing Hindu nationalist government. In January, the Indian
government through the Ministry of AYUSH, which promotes alternative
forms of medicine,
published questionable advisories about homeopathy and unani (a type of herbal practice) as ways to prevent coronavirus infection. Homeopathy has been
widely dismissed by public health experts as not being
effective for any health condition.
The Indian fact-checking website Alt News determined
the government’s claims were “false” and “dangerous.” “The homeopathic
drug ‘Arsenicum album 30’ cannot prevent a COVID-19 infection as claimed
by the Ministry of AYUSH,” said Sumaiya Shaikh, a neuroscientist
working in Sweden and science fact-checker for Indian fact-checking
agency Alt News,
in a post on the website
after reviewing research papers on the drug. Shaikh tells TIME that she
found an “immense number of faults” in these studies, including “data
fudging” and “bad statistics.” Homeopathy, which involves treatments
that are so heavily diluted that there is barely any drug left in the
final solution, “will always be popular where there is distrust in the
regular medical health system,” Shaikh says. These remedies also tend to
be cheap, she notes, which could explain
homeopathy’s popularity in India even as some countries have banned funding for the practice.
Elected officials from Prime Minister Narendra Modi’s
Bharatiya Janata Party have promoted unproven therapies, too. Suman
Haripriya, a BJP lawmaker in Assam, suggested that
cow urine and dung could
be used to cure the coronavirus. Chief Minister of Uttar Pradesh Yogi
Adityanath suggested that COVID-19 and other diseases could be overcome
with the
help of yoga.
Some false news circulating in India has targeted China. Alt News
debunked a BJP Maharashtra spokesperson’s
tweet,
which linked to an article alleging that China was seeking a court’s
approval to kill more than 20,000 COVID-19 patients to contain the
virus.
Messages from Indian leadership have been mixed. On
Saturday, Prime Minister Narendra Modi gave somewhat vague advice to
Indians, telling them not to “
believe in hearsay and rumours on what to do and what not to do on coronavirus” in a speech.
“While the Prime Minister is saying don’t spread
misinformation about coronavirus, [India’s health officials] are
propagating misinformation,” Pratik Sinha, co-founder of Alt-News, tells
TIME. “On top of that, there are BJP office-bearers who are saying
certain cow products can cure coronavirus.” Sinha adds that a huge
section of the Indian population may believe this inaccurate information
because of the trust they place in the government.
Jha was frustrated upon hearing about these novel
approaches to combating the virus. “It made me want to rip my hair out,”
he says. “The [government is] undermining their own credibility.” Jha
worries that if authorities then ask the public to adhere to more
strenuous measures, like abstaining from the temple or shutting down
schools, people may not listen.
Although misinformation can be common during an
outbreak across different countries, India’s problem involves more than
just arbitrary messages. “This is government-sponsored misinformation,”
Sinha says. “It’s a lot more dangerous. It’s misinformation coming from
people who are very influential.”
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