Battle Won: India Prepares For The Long Haul

On 24 March, the Indian Prime Minister Mr. Narendra Modi announced the unprecedented decision to lockdown the country for 21 days. Even though the country was early in its response in border controls and screening, with over eighty thousand international arrivals every day, many from the Gulf and Europe where the novel coronavirus transmission has been widespread, the best that was possible was to delay the inevitable emergence of secondary Covid19 cases.

- Ramanan Laxminarayan

Without strong interventions, India was set to be the next epicenter of the coronavirus. Population densities are high, especially in urban centers like Mumbai and Delhi, and transmission would have been rapid. Even in wealthier countries like Italy and Spain, the health system has been wholly unprepared to take on the flood of cases when the epidemic curve inevitably starts is upswing. In these countries, hospitals have been overrun, and doctors have had to make the difficult decision of how to allocate limited critical care resources between when many patients need them at the same time.

With fewer than a 100,000 ICU beds and 20,000 ventilators (about an eighth of what the US has but for a population four times as large) available nationwide, the impact of Covid19 in India could have been catastrophic. Although case-fatality rates have averaged about two to three percent globally, these were in places where the health system is better equipped. India did not have options of either the strong health system and economic resources of Covid19-affected high-income countries, or China’s ability to control population flows within the country.

In a country where 22,500 people die each day across all causes, picking up both Covid19 related deaths and disease loads would have been difficult unless there had been unusually large clusters as was the case in China. With no direct and observable evidence of a public health crisis, it would have been difficult for Indians to forego mass gatherings and to take the message of physical distancing seriously.