India had its first case of onavirus infection on 30 January. It was confirmed in Kerala’s Thrissur district when a student who had returned home for a vacation from Wuhan University in China was found positive. After that the Central and state governments began to undertake a series of measures aimed at preventing the spread of contagion. It started with intensive screening of incoming flyers and compulsory quarantine, leading to flight restrictions form countries which were hotbeds of infection, to manual contact tracing of positive patients. As the infections further spread, India implemented visa suspensions and increasing flight restrictions, this was done much before other countries at the same time. Stricter measures starting from the Prime Minister’s announcement on 24 March 2020 of voluntary lockdown called Janta Curfew to lockdown phases 1-5 followed soon. Meanwhile extensive testing, contact tracing — physical followed by technology based contact tracing, augmentation of health services, relevant advisories and mobilisation of the administrative machinery. Initial measures worked well for India and the number of days to reach 10,000 cases from 100 was 64, one of the slowest in the world, comparatively the US took only 25 days, Spain 30 and Italy took only 36 days to reach a similar figure. However, country comparisons should be made with caution as India’s population of 1·3 billion across diverse states, health services and access inequalities, economic and social disparities, political and administrative asymmetries add to the complexity of the problem. India’s own contact tracing app Aarogya Setu today has more than 128 million users, this app has helped form a fair picture of the contagion, hotspots in different areas and efficacy of lockdown measures by providing an aggregated picture of the spread over time. After initial fears of government surveillance by using this app, the authorities took the bold step of putting the source code of the app out in open source on GitHub for allaying any privacy related fears.
Infrastructure
During the initial phase of Covid-19 crisis, not even a single PPE kit was manufactured in India, and only N95 masks were available and exported (embargo was imposed by the government for export so as to fulfill local needs). As on date almost two lakh PPE kits and 2 lakh N95 masks are manufactured in India per day. In order to augment the required infrastructure to deal with Covid-19 cases across the country, an amount of Rs. 2000 crores in PM CARES Fund are marked for purchase of 50,000 ‘Made-in-India’ ventilators to be provided to the government run Covid-19 hospitals in all States/ UTs,for better treatment of the critical Covid-19 cases.
As on 10 May 2020, around 7,740 facilities in 483 districts have been identified in all the States/ UTs that include hospitals and facilities of the State/ UT govts as well as the central government. There are around 65,6769 isolation beds, 30,5567 beds for confirmed cases, 35,1204 beds for suspected cases, 99492 oxygen supported beds, 1,696 facilities with oxygen manifolds and 34,076 ICU beds.
India has been instrumental at international level by providing aid by supplying hydroxychloroquine. Another instrumental step towards creating infrastructure for tackling Covid-19 patients was by Indian Railways to earmark 5,000 coaches for providing isolation facilities having around 80,000 beds.
Testing and treatment
As on 9 June 2020, there are total 823 Operational (initiated independent testing) Laboratories reporting to ICMR with 590 government laboratories and 233 private laboratories. With three different modalities of testing such as: –
– Real-Time RT PCR for Covid-19: 520 (Govt: 340 + Private: 180)
– TrueNat Test for Covid-19 : 240 (Govt: 227 + Private: 13) – CBNAAT Test for COVID-19: 63 (Govt: 23 + Private: 40)
The Union Civil Aviation Ministry availing services of Air india, Alliance Air, Indian Air Force, pawan Hans and private carriers launched ‘Mission Lifeline Udan’ to ensure supply of ICMR consignments of Covid-19 diagnostic materials such as enzymes, regents, medical equipment, testing kits and PPE, masks, gloves and other essential items reaching every laboratory across the country in a timely manner amid the nationwide lockdown. In the last 2 months, despite the lockdown, approximately 40 tonnes of testing material was transported in more than 150 flight operations, reaching out to the remotest corners of the nation. To streamline the flow of supplies to the last mile doorstep deliveries were coordinated with India Post, several courier companies and state governments.
Research
The centre demarcated an amount of Rs. 100 crore from the PM Cares Fund for the research of Covid-19 vaccine developers designers. This additional amount to catalyse the vaccine development will be utilized under the supervision of the Principal Scientific Advisor.
The ICMR in its press release quoted that the council is working relentlessly to implement scientific interventions to combat the Covid-19 pandemic and the decision to join the WHO solidarity trial is an important step in this endeavour. Solidarity trial is an international clinical trial to compare four untested treatment options against standard of care to assess their effectiveness which includes remdesivir, lopinavir/ritonavir, lopinavir/ ritonavir with interferon beta-1a and chloroquine or hydroxychloroquine. The ICMR’s National AIDS Research Institute (NARI) was designated as the national coordination site for the trial in India.
After obtaining required regulatory and ethical approvals, recruitment of covid-19 patients as participants for trial has begun and around nine sites have been approved for such trials.
This step of the Indian government is applauded widely and is the foundation for India’s role in both research as well as manufacturing once trials conclude successfully.
As per Ministry of Health when the first lockdown started, the recovery rate was around 7.1%. The recovery rate during the second lockdown was 11.42%, it then rose to 26.59%. During the third lockdown, the recovery rate was 39.62%, currently it has improved to 47.99% amongst Covid-19 patients, the rate of recoveries has been moving steadily upwards.
conclusion and recommendations
India’s response to the Covid19 pandemic has been a well calibrated one, it preemptively announced stringent measures much before WHO declared a global pandemic. Despite serious challenges of diverse nature, India’s deaths and cases per million population are one of lowest in the world. As the country contemplates a relaxation of the lockdown measures to balance life versus livelihood, it has to be extremely careful about a second wave of infections which many countries have experienced.
The Government Response Stringency Index created by researchers from Blavatnik School of Government at the University of Oxford rates countries across the world on their corona response. It is a composite measure based on nine response indicators including school closures, workplace closures, and travel bans, rescaled to a value from 0 to 100. In a data set from 73 countries, that calculates governments’ response to Covid-19, India’s response has been shown to be one of the most stringent in the world, topping the chart.
As India fights corona, it has to take urgent measures to revitalise and revive the economy, augment the capacity of the health sector to handle a demand surge as efforts are taken to flatten the curve and also stem a wave of misinformation leading to public order crises which can potentially have large disruptive consequences. It is time when states and centre work in unison, fighting a common enemy and showing to the world that this democracy and nation can survive shocks, fight calamities on its own and even rebound to rally on a path of growth and prosperity.
(Brijesh Singh, is Inspector General of Police, Maharashtra and Khushbu Jain is a practicing advocate, Supreme Court of India).