Chindia Alert: You’ll be Living in their World Very Soon
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MUMBAI/NEW DELHI (Reuters) – India is likely to receive 102% rainfall of a long-term average this year, the state-run weather office said on Monday, raising expectations for higher farm output in Asia’s third-biggest economy, which is reeling from the new coronavirus pandemic.
In July India could receive 103% rainfall of its long-term average and 97% in August, M. Rajeevan, secretary at the Ministry of Earth Sciences, told a news conference.
The IMD defines average, or normal, rainfall as between 96%and 104% of a 50-year average of 88 centimetres for the entire four-month season beginning in June.
Image copyright GETTY IMAGESImage caption Within a week of reopening, India has seen a sharp spike in cases
India is roaring – rather than inching – back to life amid a record spike in Covid-19 infections. The BBC’s Aparna Alluri finds out why.
On Saturday, India’s government announced plans to end a national lockdown that began on 25 March.
This was expected – the roads, and even the skies, have been busy for the last 10 days since restrictions started to ease for the first time in two months. Many businesses and workplaces are already open, construction has re-started, markets are crowded and parks are filling up. Soon, hotels, restaurants, malls, places of worship, schools and colleges will also reopen.
But the pandemic continues to rage. When India went into lockdown, it had reported 519 confirmed cases and 10 deaths. Now, its case tally has crossed 173,000, with 4,971 deaths. It added nearly 8,000 new cases on Saturday alone – the latest in a slew of record single-day spikes.
Image copyright GETTY IMAGESImage caption Fast food chains like McDonald’s have begun reopening outlets in parts of India.
So, why the rush to reopen?
The lockdown is simply unaffordable
“It’s certainly time to lift the lockdown,” says Gautam Menon, a professor and researcher on models of infectious diseases.
“Beyond a point, it’s hard to sustain a lockdown that has gone on for so long – economically, socially and psychologically.”
From day one, India’s lockdown came at a huge cost, especially since so many of its people live on a daily wage or close to it. It put food supply chains at risk, cost millions their livelihood, and throttled every kind of business – from car manufacturers to high-end fashion to the corner shop selling tobacco. As the economy sputtered and unemployment rose, India’s growth forecast tumbled to a 30-year-low.
Raghuram Rajan, an economist and former central bank governor, said at the end of April that the country needed to open up quickly, and any further lockdowns would be “devastating”.
The opinion is shared by global consultant Mckinsey, whose report from earlier this month said India’s economy must be “managed alongside persistent infection risks”.
Image copyright GETTY IMAGESImage caption As restrictions ease, Indians are slowly getting used to the new normal
“The original purpose of the lockdowns was to delay the spike so we can put health services and systems in place, so we are able handle the spike [when it comes],” says Dr N Devadasan, a public health expert. “That objective, to a large extent, has been met.”
In the last two months, India has turned stadia, schools and even train coaches into quarantine centres, added and expanded Covid-19 wards in hospitals, and ramped up testing as well as production of protective gear. While grave challenges remain and shortages persist, the consensus seems to be that the government has bought as much time as possible.
“We have used the lockdown period to prepare ourselves… Now is the time to revive the economy,” Delhi Chief Minister Arvind Kejriwal said last week.
The silver lining
For weeks, India’s relatively low Covid-19 numbers baffled experts everywhere. Despite the dense population, disease burden and underfunded public hospitals, there was no deluge of infections or fatalities. Low testing rates explain the former, but not the latter.
In fact, India made global headlines not for its caseload but for its botched handling of the lockdown – millions of informal workers, largely migrants, were left jobless overnight. Scared and unsure, many tried to return home, often desperate enough to walk, cycle or hitchhike across hundreds of kilometres.
Perhaps the choice – between a virus that didn’t appear to be wreaking havoc yet, and a lockdown that certainly was – seemed obvious to the government.
But that is changing quickly as cases shoot up. “I suspect we will keep finding more and more cases, but they will mostly be asymptomatic or will have mild symptoms,” Dr Devadasan says.
The hope – which is also encouraging the government to reopen – is that most of India’s undetected infections are not severe enough to require hospitalisation. And so far, except in Mumbai city, there has been no dearth of hospital beds.
The government, for instance, has been touting India’s mortality rate as a silver lining – at nearly 3%, it’s among the lowest in the world.
But some are unconvinced by that. Dr Jacob John, a prominent virologist, says India has never had, and still doesn’t have, a robust system for recording deaths – in his view, the government is certainly missing Covid-19 deaths because they have no way of knowing of every fatality.
Image copyright GETTY IMAGESImage caption Indians are venturing out again but it’s unclear how many of them are asymptomatic.
And, he says, “what we must aim for is flattening the mortality curve, not necessarily the epidemic curve”.
Dr John, like several other experts, also predicts a peak in July or August, and believes the country is reopening so quickly because the “government realised the futility of such leaky lockdowns”.
A shift in strategy
So is the government gearing up for another lockdown when the peak comes?
While Dr Menon believes the lockdown was well-timed, he says it was too focused on cases coming from abroad.
“There was a hope that by controlling that, we could prevent epidemic spread, but how effective was our screening [at airports]?”
Now, he adds, is the time for “localised lockdowns”.
Media caption Coronavirus: Death and despair for migrants on Indian roads
The federal government has left it to states to decide where, how and to what extent to lift the lockdown as the virus’ progression varies wildly across India.
Maharashtra alone accounts for more than a third of India’s active cases. Add Tamil Nadu, Gujarat and Delhi, and that makes up 67% of the national total.
But other states – such as Bihar – are already seeing a sharp uptick as migrant workers return home.
“Initially, most of your cases were in the cities,” Dr Devadasan says. “But we kept the migrant workers in cities and didn’t allow them to go home. Now, we are sending them back. We have facilitated transporting the virus from urban areas to rural areas.”
While the government has said how many infections have been avoided – up to 300,000 – and lives saved – up to 71,000 – by the lockdown, there is no indication of what lies ahead.
There is only advice: The day the government began to ease restrictions, Mr Kejriwal tweeted, urging people to “follow discipline and control the coronavirus disease” as it was their “responsibility”.
Image copyright GETTY IMAGESImage caption Social distancing will prove to be India’s biggest post-lockdown challenge
Because the alternative – of curfews and constant policing – is unsustainable.
“My worry is more the circumstances of people – it’s not as though they have an option to practise social distancing,” Dr Menon says.
And they don’t – not in joint family homes or one-room hovels packed together in slums, not in crowded markets or busy streets where jostling is second nature, or in temples, mosques, weddings or religious processions where more is always merrier.
The overwhelming message is that the virus is here to stay, and we have to learn to live with it – and the only way to do that, it appears, is to let people live with it.
Image copyright GETTY IMAGESImage caption India has more than 150,000 reported infections
On the face of it, things may not look bad.
Since the first case of coronavirus at the end of January, India has reported more than 150,000 Covid-19 infections. More than 4,000 people have died of the infection.
To put this in some context, as of 22 May, India’s testing positivity rate was around 4%, the death rate from the infection around 3% and the doubling rate of infection – or the amount of time it takes for the number of coronavirus cases to double – was 13 days. The recovery rate of infected patients was around 40%.
All this is markedly lower than in the countries badly hit by the pandemic.
Like elsewhere in the world, there are hotspots and clusters of infection.
More than 80% of the active cases are in five states – Maharashtra, Tamil Nadu, Delhi, Gujarat and Madhya Pradesh – and more than 60% of the cases in five cities, including Mumbai, Delhi and Ahmedabad, according to official data.
More than half of people who have died of the disease have been aged 60 and older and many have underlying conditions, hewing to the international data about elderly people being more vulnerable to the disease.
The more than two-month-long grinding lockdown, official data suggests, has prevented the loss of between 37,000 and 78,000 lives. A paper published in Harvard Data Science Review appears to support that – it shows an eight-week lockdown can prevent about two million cases and, at a 3% fatality rate, prevent some 60,000 deaths.
“Infection has remained limited to certain areas. This also gives us confidence to open up other areas. It is so far an urban disease,” says VK Paul, who heads the medical emergency management plan on Covid-19.
This is where such claims enter uncertain territory.
Image copyright GETTY IMAGESImage caption India has conducted some 180,000 tests so far
Infections are rising sharply, up from 536 cases on 25 March when the first phase of the world’s harshest lockdown was imposed. The growth of infections is outpacing growth in testing – tests have doubled since April but cases have leapt fourfold.
Epidemiologists say the increase in reported infections is possibly because of increased testing. India has been testing up to 100,000 samples a day in the past week. Testing criteria has been expanded to include asymptomatic contacts of positive patients.
Yet, India’s testing remains one of the lowest in the world per head of population – 2,198 tests per million people.
The bungled lockdown at the end of March triggered an exodus of millions of informal workers who lost their jobs in the cities and began returning home in droves, first on foot and then by train. Some four million workers have travelled by rail from cities to their villages in more than half a dozen states in the past three weeks.
There is mounting evidence that this has already led to the spread of infection from the cities to the villages. And with the messy easing of the lockdown earlier this month, there are growing fears of infections spreading further in the cities.
Rising infections and a still-low fatality rate possibly points to milder infection in a younger population and a large number of asymptomatic cases. The focus, says Amitabh Kant, CEO of the government think-tank NITI Aayog, should be “bringing down fatalities and improving the recovery rate”.
But if the infection rate continues to grow, “things are going to get pretty grim in a few weeks time,” a leading virologist told me.
Image copyright GETTY IMAGESImage caption Millions of workers have fled the cities and returned to their villages after the lockdown
Doctors in the capital, Delhi, and the western city of Mumbai tell me they are already seeing a steady surge in Covid-19 admissions and worry about a looming shortage of hospital beds, including in critical care.
When the infection peaks in July, as is expected, a spike in infections could easily lead to many avoidable deaths as hospitals run out of beds for, or delay treatment to, infected patients who need timely oxygen support and clinical care to recover.
“That is the real worry. A critical-care bed needs an oxygen line, a ventilator, doctors, nursing staff. Everything will be under pressure,” Dr Ravi Dosi, who is heading a Covid-19 ward at a hospital in Indore, told me. His 50-bed ICU is already full of patients battling the infection.
With the lockdown easing, doctors are feeling jittery. “It’s a tactical nightmare because some people have begun going to work but there is a lot of fear”, says Dr Dosi.
“One co-worker sneezed in the office and 10-15 of his colleagues panicked and came to the hospital and demanded they get tested. These are the pressures that are building up.”
One reason for the confusion is the lack of – or the opacity of – adequate data on the pandemic to help frame a strategic and granular response.
Most experts say a one-size-fits-all strategy to contain the pandemic and impose and lift lockdowns will not work in India where different states will see infection peaks at different times. The reported infection rate – the number of infections for every 100 tests – in Maharashtra state, for example, is three times the national average.
“The infection is not spreading uniformly. India will see staggered waves,” a leading virologist, who insisted on anonymity, told me.
The lack of data means questions abound.
What about some 3,000 cases, which are not being assigned to any state because these people were found infected in places where they don’t live? (To put this into context, nine states in India have more than 3,000 cases.) How many of these cases have died or recovered?
Also, it is not clear whether the current data – sparse, and sporadic – is sufficient to map the future trajectory of the disease.
There is, for example, no robust estimate of carriers of the virus who have no symptoms – last month a senior government scientist said at least “80 out of every 100 Covid-19 patients may be asymptomatic or could be showing mild symptoms”.
Image copyright GETTY IMAGESImage caption More than 4,000 people have died of Covid-19 in India
If that is indeed true, then India’s fatality rate is bound to be lower. Atanu Biswas, a professor of statistics, says the predicted trajectory could change “with the huge inclusion of asymptomatic cases”. But, in the absence of data, India cannot be sure.
Also, epidemiologists say, measures like the doubling time of the infections and the reproduction number or R0 have their limitations. R0, or simply the R value, is a way of rating a disease’s ability to spread. The new coronavirus, Sars-CoV-2, has a reproduction number of about three, but estimates vary.
“These measures are good when we are in the middle of a pandemic, less robust with fewer cases. You do need forecasting models for at least a month’s projection to anticipate healthcare needs. We should always evaluate an aggregate of evidence, not just one measure, but a cascade of measures,” Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, told me.
Others say even calculating the number of recorded infections every day is “not always a good indicator of how an infection is spreading”.
A better option would be to look at the number of new tests and new cases every day that would provide a “degree of standardisation”, K Srinath Reddy, president of the Public Health Foundation of India, told me.
Likewise, he believes, a measure of how many Covid-19 deaths have occurred compared with the size of a country’s population – the numbers of deaths per million people – is a better indicator of the fatality rate. Reason: the denominator – the country’s population – remains stable.
In the absence of robust and expansive data, India appears to be struggling to predict the future trajectory of the infection.
It is not clear yet how many deaths are not being reported, although there is no evidence of large scale “hidden deaths”.
Image copyright GETTY IMAGESImage caption A Covid-19 isolation ward in India
Epidemiologists say they would like to see clearer data on deaths due to pneumonia and influenza-like illnesses at this time over the past few years to quantify excess deaths and help with accurate reporting of Covid-19 deaths.
They would also like to see what racial disparities in infections and deaths there are to help improve containment in specific community areas. (In Louisiana, for example, African Americans accounted for 70% of Covid-19 deaths, while comprising 33% of the population.)
What is clear, say epidemiologists, is that India is as yet unable to get a grip on the extent of the spread of infection because of the still limited testing.
“We need reliable forecasting models with projection for the next few weeks for the country and the states,” says Dr Mukherjee.
Epidemiologists say India needs more testing and contact-tracing for both asymptomatic and symptomatic infections, as well as isolation and quarantine.
There’s also the need to test based on the “contact network” to stop super-spreader events – frontline workers, delivery workers, essential workers, practically anybody who interacts with a large group of people.
“We have to learn how to manage and minimise risk in our daily lives as the virus is going to be with us,” says Dr Mukherjee.
Without knowing the true number of infected cases India is, in the words of an epidemiologist, “flying blindfolded”.
That can seriously jeopardise India’s fight against the virus and hobble its response in reviving the broken economy.
Image copyright GETTY IMAGESImage caption Delhi’sair quality has improved remarkably during the shutdown
When India shut down last month and suspended all transport to contain the spread of coronavirus, the skies over its polluted cities quickly turned an azure blue, and the air, unusually fresh.
As air pollution plummeted to levels unseen in living memory, people shared pictures of spotless skies and even Himalayan peaks from cities where the view had been obscured by fog for decades.
On one social messaging group, a resident of the capital, Delhi, which regularly records some of the foulest air in the world, celebrated the city’s “alpine weather“. Politician and author Shashi Tharoor wrote that the “blissful sight of blue skies and the joy of breathing clean air provides just the contrast to illustrate what we are doing to ourselves the rest of the time”.
Media caption India coronavirus lockdown cleans up Ganges river
Less than six months ago, Delhi was gasping for breath. Authorities said air quality had reached “unbearable levels”. Schools were shut, flights were diverted, and people were asked to wear masks, avoid polluted areas and keep doors and windows closed.
Delhi and 13 other Indian cities feature on a list of the world’s 20 most polluted. It is estimated that more than a million Indians die every year because of air pollution-related diseases. Industrial smoke, vehicular emissions, burning of trash and crop residue, and construction and road dust are the major contributors.
As urban Indians gazed at the skies and breathed clean air inside their homes, researchers hunkered down to track data on how the grinding lockdown – now extended to 3 May – was impacting air pollution across the country.
Image copyright GETTY IMAGESImage caption Lucknow is another city on the top 20 world’s most polluted list
“This was an unprecedented opportunity for us to take a close look at how air pollution levels have responded to an extraordinary development,” Sarath Guttikunda, who heads Urban Emissions, an independent research group that provides air quality forecasts, told me.
Dr Guttikunda and his team of researchers looked at the data spewed out by the 100-odd air quality monitoring stations all over India. They decided to concentrate on the capital Delhi and its suburbs – a massive sprawl called the National Capital region, where more than 20 million people live. Last winter, air pollution here had reached more than 20 times the World Health Organization’s safe limit.
Image copyright HINDUSTAN TIMESImage caption The financial capital Mumbai also seems very different
The deadliest particle in Delhi’s foul air is the tiny but deadly PM 2.5, which increases the likelihood of respiratory and cardiovascular diseases. They primarily come from combustion – fires, automobiles and power plants.
Urban Emissions found the levels of PM 2.5 in Delhi during the lockdown plummeted to 20 micrograms per cubic metre with a 20-day average of 35.
To put this into context, between 2017 and 2019, the monthly average of PM 2.5 in the capital was up to four times higher. (The national standard is set at 40, and the WHO has an annual average guideline of just 10 micrograms per cubic metre.)
“If 35 is the average lowest available PM2.5 with limited local emissions, it means that at least 70% of the pollution is locally generated,” Mr Guttikunda told me.
Media caption India coronavirus lockdown cleans up Ganges river
His study also found a marked dip in PM 10, caused mainly by road and construction dust, and nitrogen dioxide, which comes mainly from vehicular emissions, and nearly 90% of vehicles are off the road.
“The current crisis has shown us that clear skies and breathable air can be achieved very fast if concrete action is taken to reduce burning of fossil fuels,” says Sunil Dahiya, of the Centre for Research on Energy and Clean Air, which has also been tracking air pollution levels during the lockdown.
But will this prompt change? After all, urban Indians’ and the media’s panic and outrage during the deadly winter pollution every year soon gets lost in the fog of summer heat and concerns over monsoon rains and droughts.
“We don’t yet have a democratic demand for clean air,” Arunabha Ghosh, Chief Executive Officer of the Council on Energy, Environment and Water, a leading climate think tank, told me. Orders to clean up the air have almost always come from the courts, responding to pleas by NGOs.
Image copyright GETTY IMAGESImage caption Pollution in Delhi peaks during winter
However, Dr Ghosh still hopes that “the experience of blue skies and fresh air could be a trigger to create a democratic demand for clean air in India”.
Crises often trigger life changing reforms. A fatal four-day “pea-souper” that engulfed London in 1952 and killed thousands provoked the passing of the Clean Air Act to reduce the use of smoky fuels.
China tried to clean up its air several times before hosting marquee international events – like the Beijing Olympics in 2008, the World Expo in Shanghai and the Guangzhou Asian Games in 2010 – before sliding back to grey, smoky skies.
But many believe the 2014 Apec meeting in Beijing, when China hosted 21 heads of Asia-Pacific economies, was a turning point. The rare blue skies over Beijing spawned the phrase ‘Apec blue‘. In a rush to clean its air, China introduced a set of far-reaching measures. Over the next four years, this resulted in a 32% drop in average pollution across major Chinese cities.
So could a lockdown to prevent the spread of a pandemic, which has imperilled the health and livelihoods of millions, trigger similar policy changes to clean up India’s air?
Image copyright GETTY IMAGESImage caption The movement for clean air has been sporadic and mainly pushed by NGOs
Could it move to a shift in reducing traffic on the road by asking people to work from home in shifts now that millions have experienced clean air for the first time in years? (Facing energy shortages after the loss of the Fukushima nuclear power plant, Japan unleashed a Cool Biz campaign to cut down air conditioning in workplaces and reduce carbon emissions by asking office workers to shed their suits.)
Or can India use some of the money from an inevitable stimulus to help kick-start the economy go towards helping green industries? Renewables, experts say, creates more jobs than coal: India has already created nearly 100,000 jobs in solar and wind energy firms.
Can the country use the windfall revenues accruing from the steep decline in oil prices – most of India’s oil is imported – to provide rebates to polluting factories to set up much-needed emission control equipment?
“We have to learn lessons to deploy the economic recovery from the pandemic. We need growth, jobs and sustainable development,” says Dr Ghosh. Cleaning up the air could be the key. For too long, India – and Indians – have ignored their right to breathe easy.
What’s more, if China can reduce air pollution by 32% in four-and-a-half years, why can’t India pledge to reduce pollution by 80% in 80 cities by 2027, which is our 80th anniversary of Independence? asks Dr Ghosh.
Indian defence officials have reported a coronavirus outbreak at a key naval base in the western city of Mumbai.
Twenty-one personnel have tested positive for Covid-19 at INS Angre, which is the seat of the force’s western command, the navy said in a statement on Saturday.
It added that there are no infections aboard any ships or submarines.
India has 11,906 active infections and 480 deaths, according to the latest data from the ministry of health.
The Navy said that they had tested a number of personnel who had come into contact with a soldier who had tested positive earlier this month. Many of those who had tested positive for the virus, the statement added, were asymptomatic.
All 21 personnel live in the same residential block, which has been declared a containment zone and has been placed under lockdown.
In a video message to personnel last week, Navy Chief Admiral Karambir Singh stressed the importance of keeping ships and submarines free of the virus.
“The coronavirus pandemic is unprecedented and it has never been seen before. Its impact has been extraordinary across the globe, including India,” he said.
The navy has been playing an active role in India’s response to the Covid-19 outbreak.
It has set up isolation facilities to treat patients at one of its premier hospital units and is also running quarantine camps.
The outbreak aboard the Indian naval base follows reports of outbreaks aboard vessels belonging to other nations.
More than 500 sailors on the USS Roosevelt have tested positive for the virus and one of them died earlier this week. And nearly a third of the sailors serving with France’s aircraft carrier Charles de Gaulle – 668 out of nearly 2,000 – have been infected with coronavirus.
Image copyright GETTY IMAGESImage caption More than a billion people have been staying at home during the lockdown
Will India extend its rigorous 21-day lockdown to slow the spread of coronavirus beyond its end date next week? By all accounts, yes.
On 24 March, India shut its $2.9 trillion economy, closing its businesses and issuing strict stay-at-home orders to more than a billion people. Air, road and rail transport systems were suspended.
Now, more than two months after the first case of Covid-19 was detected in the country, more than 5,000 people have tested positive and some 150 people have died. As testing has ramped up, the true picture is emerging. The virus is beginning to spread through dense communities and new clusters of infection are being reported every day. Lifting the lockdown could easily risk triggering a fresh wave of infections.
A harsh lockdown is certain to slow down the disease. Virologists I spoke to believe India is still at an early stage of the infection. The country still doesn’t have enough data on the transmissibility of the virus or even how many people could have been infected and recovered to develop adequate herd immunity. (It is slowly beginning finger prick blood tests to look at the presence of protective antibodies.)
More than 250 of India’s 700-odd districts have reported the infection. Reports say at least seven states have a third of all infections, and want the lockdown extended. Six states have reported clusters of rapidly growing infections – from the capital Delhi in the north to Maharashtra in the west and Tamil Nadu in the south.
Economic fallout
Not surprisingly, the lockdown is already hurting the economy. Many of the early hotspots are economic growth engines and contribute heavily in revenues to the exchequer. Mumbai, India’s financial capital and Maharashtra’s main city, accounts for more than a third of overall tax collection. The densely populated city has reported more than 500 cases and 45 deaths, and numbers are steadily rising. Authorities say the infection is now spreading through the community. Mumbai has made wearing face masks mandatory.
Image copyright GETTY IMAGESImage caption India has ramped up testing during the lockdown
Many of these hotspot clusters are also thriving manufacturing bases. The spread of infection means that they will be under lockdown for a longer period of time.
The services industry, which generates almost half of India’s GDP, is also likely to remain shut for some more time. Construction, which employs a bulk of migrant workers, will remain similarly suspended. The unemployment rate may have already climbed to more than 20% after the lockdown, according to a report by the Center for Monitoring Indian Economy.
For the moment, economists say, the government will have to prioritise farming over everything else to ensure the livelihoods of millions and secure the country’s future food supplies.
Half of India’s labour force work on farms. The lockdown happened at a time when a bumper winter crop had to be harvested and sold, and the rain-fed summer crop had to be sowed. The immediate challenge is to harvest and market the first crop, and secure the second.
Moving trucks to pick up produce and take them to markets, with adequate social distancing and hand washing will be something the government will have to move on quickly.
“The immediate challenge is to ensure that rural India is not hit,” says Rathin Ray, an economist. “Realistically, a complete lockdown cannot be continuously maintained beyond early May. We don’t have a choice but to reopen gradually after that.”
Image copyright GETTY IMAGESImage caption India has been under a lockdown from 24 March
There is little doubt about that. For his part, SK Sarin, who heads a government advisory panel on combating the disease, says the lockdown can be only eased in a “graded manner in areas that are not hotspots” and that the hotspots remained cordoned off.
Like other affected countries, India will have to prepare itself for what Gabriel Leung, an infectious disease epidemiologist and dean of medicine at the University of Hong Kong, describes as several rounds of “suppress and lift” cycles.
During these periods “restrictions are applied and relaxed, applied again and relaxed again, in ways that can keep the pandemic under control but at an acceptable economic and social cost.”
Also, Dr Leung observes, “how best to do that will vary by country, depending on its means, tolerance for disruption and its people’s collective will. In all cases, however, the challenge essentially is a three-way tug of war between combating the disease, protecting the economy and keeping society at an even keel”.
It is now clear that shutdowns need to continue until transmission has slowed down markedly, and testing and health infrastructure has been scaled up to manage the outbreak.
Experts from the southern state of Kerala, a striking outlier that is containing the infection thanks to a transparent government and a robust public health system, say it isn’t time to lift the lockdown yet and have recommended a three-phase relaxation.
For most countries, easing the lockdown is a tricky policy choice. It sparks fears of triggering a fresh wave of infection and presents the inevitable trade-off between lives and livelihoods. French Prime Minister Edouard Phillipe, says relaxing the lockdown in his country is going to be “fearsomely complex”. In a crisis like this, according to his Dutch counterpart Mark Rutte, leaders have to “make 100% of the decisions with 50% of the knowledge, and bear the consequences.”
Image copyright GETTY IMAGESImage caption India’s financial capital, Mumbai, is emerging as a hotspot
It is going to be tougher for India with its vast size, densely packed population and enfeebled public health system. Also, no country in the world possibly has so much inter-state migration of casual workers, who are the backbone of the services and construction industries.
How will India manage to return these workers to their work places – factories, farms, building sites, shops – without a substantial easing of public transport at a time when crowded trains and buses can be a vector of transmission and easily neutralise the gains of the lockdown? Even allowing restricted mobility – allowing social distancing, temperature checks and passenger hygiene – would put considerable pressure on the public transport system.
The policy choices are fiendishly tough, and the answers are far from easy. India bungled the lockdown by not anticipating the exodus of millions of migrant workers from cities. The weeks ahead will tell whether the fleeing men, women and children carried the infection to their villages. The country simply cannot afford to make similar mistakes again while trying to relax the lockdown. Nitin Pai of The Takshashila Institution, a think tank, believes states should be left to decide on easing restrictions, and decisions “should be based on threat [of infection], which should be determined by extensive testing”.
This week Prime Minister Narendra Modi said that the “situation in the country is akin to a social emergency”. His government now needs make sure that the looming threat to the nation’s health and economic progress is tackled skilfully.
Image copyright GETTY IMAGESImage caption Millions are workers are defying a curfew and returning home
When I spoke to him on the phone, he had just returned home to his village in the northern state of Rajasthan from neighbouring Gujarat, where he worked as a mason.
In the rising heat, Goutam Lal Meena had walked on macadam in his sandals. He said he had survived on water and biscuits.
In Gujarat, Mr Meena earned up to 400 rupees ($5.34; £4.29) a day and sent most of his earnings home. Work and wages dried up after India declared a 21-day lockdown with four hours notice on the midnight of 24 March to prevent the spread of coronavirus. (India has reported more than 1,000 Covid-19 cases and 27 deaths so far.) The shutting down of all transport meant that he was forced to travel on foot.
“I walked through the day and I walked through the night. What option did I have? I had little money and almost no food,” Mr Meena told me, his voice raspy and strained.
He was not alone. All over India, millions of migrant workers are fleeing its shuttered cities and trekking home to their villages.
These informal workers are the backbone of the big city economy, constructing houses, cooking food, serving in eateries, delivering takeaways, cutting hair in salons, making automobiles, plumbing toilets and delivering newspapers, among other things. Escaping poverty in their villages, most of the estimated 100 million of them live in squalid housing in congested urban ghettos and aspire for upward mobility.
Image copyright GETTY IMAGESImage caption Informal workers are the backbone of India’s big city economies
Last week’s lockdown turned them into refugees overnight. Their workplaces were shut, and most employees and contractors who paid them vanished.
Sprawled together, men, women and children began their journeys at all hours of the day last week. They carried their paltry belongings – usually food, water and clothes – in cheap rexine and cloth bags. The young men carried tatty backpacks. When the children were too tired to walk, their parents carried them on their shoulders.
They walked under the sun and they walked under the stars. Most said they had run out of money and were afraid they would starve. “India is walking home,” headlined The Indian Express newspaper.
The staggering exodus was reminiscent of the flight of refugees during the bloody partition in 1947. Millions of bedraggled refugees had then trekked to east and west Pakistan, in a migration that displaced 15 million people.
Image copyright GETTY IMAGESImage caption Migrant labourers feel they have more social security in their villages
This time, hundreds of thousands of migrant workers are desperately trying to return home in their own country. Battling hunger and fatigue, they are bound by a collective will to somehow get back to where they belong. Home in the village ensures food and the comfort of the family, they say.
Clearly, a lockdown to stave off a pandemic is turning into a humanitarian crisis.
Among the teeming refugees of the lockdown was a 90-year-old woman, whose family sold cheap toys at traffic lights in a suburb outside Delhi.
Kajodi was walking with her family to their native Rajasthan, some 100km (62 miles) away. They were eating biscuits and smoking beedis, – traditional hand-rolled cigarettes – to kill hunger. Leaning on a stick, she had been walking for three hours when journalist Salik Ahmed met her. The humiliating flight from the city had not robbed her off her pride. “She said she would have bought a ticket to go home if transport was available,” Mr Ahmed told me.
Others on the road included a five-year-old boy who was on a 700km (434 miles) journey by foot with his father, a construction worker, from Delhi to their home in Madhya Pradesh state in central India. “When the sun sets we will stop and sleep,” the father told journalist Barkha Dutt. Another woman walked with her husband and two-and-a-half year old daughter, her bag stuffed with food, clothes and water. “We had a place to stay but no money to buy food,” she said.
Then there was Rajneesh, a 26-year-old automobile worker who walking 250km (155 miles) to his village in neighbouring Uttar Pradesh. It would take him four days, he reckoned. “We will die walking before coronavirus hits us,” the man told Ms Dutt.
He was not exaggerating. Last week, a 39-year-old man on a 300km (186 miles) trek from Delhi to Madhya Pradesh complained of chest pain and exhaustion and died; and a 62-year-old man, returning from a hospital by foot in Gujarat, collapsed outside his house and died. Four other migrants, turned away at the borders on their way to Rajasthan from Gujarat, were mowed down by a truck on a dark highway.
As the crisis worsened, state governments scrambled to arrange transport, shelter and food.
Image copyright SALIK AHMED/OUTLOOKImage caption Ninety-year-old Kajodi Devi is walking from Delhi to her village
But trying to transport them to their villages quickly turned into another nightmare. Hundreds of thousands of workers were pressed against each other at a major bus terminal in Delhi as buses rolled in to pick them up.
Delhi chief minister Arvind Kejriwal implored the workers not to leave the capital. He asked them to “stay wherever you are, because in large gatherings, you are also at risk of being infected with the coronavirus.” He said his government would pay their rent, and announced the opening of 568 food distribution centres in the capital. Prime Minister Narendra Modi apologised for the lockdown “which has caused difficulties in your lives, especially the poor people”, adding these “tough measures were needed to win this battle.”
Whatever the reason, Mr Modi and state governments appeared to have bungled in not anticipating this exodus.
Mr Modi has been extremely responsive to the plight of Indian migrant workers stranded abroad: hundreds of them have been brought back home in special flights. But the plight of workers at home struck a jarring note.
“Wanting to go home in a crisis is natural. If Indian students, tourists, pilgrims stranded overseas want to return, so do labourers in big cities. They want to go home to their villages. We can’t be sending planes to bring home one lot, but leave the other to walk back home,” tweeted Shekhar Gupta, founder and editor of The Print.
Image copyright GETTY IMAGESImage caption There is a precedent for this kind of exodus during crisis
The city, says Chinmay Tumbe, author of India Moving: A History of Migration, offers economic security to the poor migrant, but their social security lies in their villages, where they have assured food and accommodation. “With work coming to a halt and jobs gone, they are now looking for social security and trying to return home,” he told me.
Also there’s plenty of precedent for the flight of migrant workers during a crisis – the 2005 floods in Mumbai witnessed many workers fleeing the city. Half of the city’s population, mostly migrants, had also fled the city – then Bombay – in the wake of the 1918 Spanish flu.
When plague broke out in western India in 1994 there was an “almost biblical exodus of hundreds of thousands of people from the industrial city of Surat [in Gujarat]”, recounts historian Frank Snowden in his book Epidemics and Society.
Half of Bombay’s population deserted the city, during a previous plague epidemic in 1896. The draconian anti-plague measures imposed by the British rulers, writes Dr Snowden, turned out to be a “blunt sledgehammer rather than a surgical instrument of precision”. They had helped Bombay to survive the epidemic, but “the fleeing residents carried the disease with them, thereby spreading it.”
More than a century later, that same fear haunts India today. Hundreds of thousands of the migrants will eventually reach home, either by foot, or in packed buses. There they will move into their joint family homes, often with ageing parents. Some 56 districts in nine Indian states account for half of inter-state migration of male workers, according to a government report. These could turn out to be potential hotspots as thousands of migrants return home.
Image copyright GETTY IMAGESImage caption The fleeing migrants could spread the disease all over the country
Partha Mukhopadhyay, a senior fellow at Delhi’s Centre for Policy Research, suggests that 35,000 village councils in these 56 potentially sensitive districts should be involved to test returning workers for the virus, and isolate infected people in local facilities.
In the end, India is facing daunting and predictable challenges in enforcing the lockdown and also making sure the poor and homeless are not fatally hurt. Much of it, Dr Snowden told me, will depend on whether the economic and living consequences of the lockdown strategy are carefully managed, and the consent of the people is won. “If not, there is a potential for very serious hardship, social tension and resistance.” India has already announced a $22bn relief package for those affected by the lockdown.
The next few days will determine whether the states are able to transport the workers home or keep them in the cities and provide them with food and money. “People are forgetting the big stakes amid the drama of the consequences of the lockdown: the risk of millions of people dying,” says Nitin Pai of Takshashila Institution, a prominent think tank.
“There too, likely the worst affected will be the poor.”
But in Delhi and the financial capital, Mumbai, people fearing shortages quickly thronged shops and pharmacies.
“I have never witnessed such a chaos in my life,” the owner of one store in the Shakarpur district of Delhi said, quoted by the Press Trust of India.
“All our stocks, including rice, flour, bread, biscuits, edible oils, have been sold out.”
Police in the busy city of Ghaziabad, in Uttar Pradesh state, patrolled the streets with megaphones to tell residents to stay indoors.
Image copyright AFPImage caption People in Mumbai rushed to stock up on essentials following Mr Modi’s address
Under the new measures, all non-essential businesses will be closed but hospitals and other medical facilities will continue to function as normal. Schools and universities will remain shut and almost all public gatherings will be banned.
Anyone flouting the new rules faces up to two years in prison and heavy fines.
In his address, Prime Minister Modi also:
Stressed that the 21-day lockdown was “very necessary to break the chain of coronavirus”
Emphasised the seriousness of the situation and said that even developed countries had faced problems in combating it
Said that “social distancing was the only way to stop” the virus spreading
Announced that nearly $2bn (£1.8bn) would be made available to boost the country’s health infrastructure
Called on people not to “spread rumours” and to follow instructions
His announcement came after several Indian states introduced measures of their own, such as travel restrictions and the closure of non-essential services.
India has already issued a ban on international arrivals and grounded domestic flights. The country’s rail network has also suspended most passenger services.
Many parts of India, including cities such as Delhi and Mumbai, are already under tight restrictions. But this move extends those provisions to every corner of the country.
An earlier one-day curfew, which was seen as a trial, was flouted by many.
Mr Modi called on Indians to clap and cheer the emergency services from their balconies on Sunday. But many misunderstood the call and congregated in the streets as they danced and chanted.
“It’s impossible to fathom the cost that India may have to pay if such irresponsible behaviour continues,” Mr Modi warned at the time. “Social distancing is the only option to combat coronavirus.”
The implications of a total lockdown in India are huge, not just economically, but socially.
This is a nation where community is everything. Going to worship at a temple, mosque or church is an essential part of daily life for so many.
This is a seismic cultural shift but – like the rest of the world facing similar restrictions – a necessary one.
What’s the latest from around Asia?
Neighbouring Pakistan has almost twice as many confirmed cases – 878 as of Monday evening. Sweeping restrictions are in place although the government has stopped short of imposing a nationwide lockdown. However, several provinces have announced them independently. The army is being brought in to help enforce the restrictions
Bangladesh, which has reported 33 cases and three deaths, is also deploying its armed forces to help maintain social distancing and boost Covid-19 preventive measures. The soldiers will also monitor thousands of quarantined expatriate returnees. Across South Asia, there are concerns that the actual number of cases could be much higher than is being reported.
Indonesia, which has 49 confirmed Covid-19 deaths – the highest in South East Asia – has converted an athlete’s village built for the 2018 Asian Games into a makeshift hospital for coronavirus patients. A state of emergency was declared in Jakarta on Monday
In Thailand, a month-long state of emergency which will include curfews and checkpoints will begin on Thursday. The government has been criticised for failing to take strong action so far. Four people have died and nearly 900 tested positive
The most populous country that was without a case until now – Myanmar – has announced two cases
And what about the rest of the world?
Elsewhere, governments are continuing to work to stem the spread of the virus which has now affected more than 190 countries worldwide
More than 2.6 billion people are in lockdown now India has introduced its new measures, according to a tally by the AFP news agency
Media caption Reality Check tackles misleading health advice being shared online
Europe remains at the epicentre of the pandemic. On Tuesday, the death toll jumped by 514 in a single day in Spain and other European countries also reported sharp increases
Italy is the worst affected country in the world in terms of deaths. The virus has killed almost 7,000 people there over the past month
The World Health Organization (WHO) has warned that the US has the potential to become the new epicentre of the pandemic
In other developments, Japanese Prime Minister Shinzo Abe said the International Olympic Committee has agreed that the 2020 Tokyo Olympics should be postponed by a year
Image copyright GETTY IMAGESImage caption Many passengers have been wearing masks while travelling on the network
One of the world’s busiest urban rail systems will be shut down for ordinary commuters from Monday morning to prevent the spread of coronavirus infection in Mumbai, one of India’s most populous cities. Only government workers in “essential services” will be allowed to travel on a truncated service.
This was waiting to happen.
Consider this. Eight million people take Mumbai’s crowded suburban train network every day. Packed to nearly three times its capacity, this is one of the busiest railway systems in the world.
The 459km (285-mile) network is the lifeline of India’s financial and entertainment capital, accounting for nearly 80% of all commuting trips in the populous western city. The suburban trains “cover almost the distance up to [the] moon in one week,” the network’s website says.
The 66-year-old network carries 60,000 passengers per km per day, the highest among all the leading commuter rail systems in the world, say officials. The coaches are sturdy enough to carry a “super dense crush load”, a phrase coined by the railways to describe the intense crowding on Mumbai’s trains. This means that a nine-car train designed for 1,800 standing passengers will often carry up to 7,000 passengers, according to Monisha Rajesh, author of Around India in 80 Trains. “Mumbai’s local trains were certainly not for the fainthearted,” she wrote.
Image copyright GETTY IMAGESImage caption Mumbai’s suburban train network carries eight million passengers every day
Now consider this. The western state of Maharashtra, of which Mumbai is the capital, has confirmed more than 60 coronavirus infections, the highest in India so far. Scores of long distance trains out of the city have been cancelled, but the suburban network has continued to rumble on, raising fears of the mass spread of the virus on these packed trains. The crowded service was an easy target of a terror attack in 2006 when serial blasts ripped though a number of trains. At least 180 people were killed and more than 800 injured – the high casualty figure was attributed to overcrowding.
“From ports and landing places the local transport networks, particularly the railways, carried the virus from large cities to the smallest, remotest settlements,” said a report on the spread of the flu in Britain in 1918-1919.
So should one of the world’s busiest rail networks be shut down to stop a possible spread of the virus in a city that many fear could turn into a coronavirus hotspot?
Image copyright GETTY IMAGESImage caption Officials say ridership on the trains has dropped by 17% after the coronavirus scare
Economists like Shruti Rajagopalan believe so.
“India is conducting the fewest tests per million at the moment. If the virus is truly within the community, then given these two issues, the Mumbai outbreak cannot be contained and people will die without healthcare.
“Mumbai trains are the fastest and surest way to spread the virus (if it is within the community) to the densest parts of the city,” she told me.
There is enough precedent: China stopped trains, ferries, planes and buses from leaving the city of Wuhan; and on Thursday, London officials announced that up to 40 stations on the London Underground network are to be shut as the city attempts to contain the outbreak.
Others are not so sure about linking the spread of a pandemic to public transport systems. One study does not support the effectiveness of suspending mass urban transport systems to reduce or slow down a pandemic because, “whatever the relevance of public transport is to individual-level risk, household exposure most likely poses a greater threat”.
“I have not seen any data on the relative risk of public transportation compared with [dense places like] workplaces or schools,” Timothy Brewer, a professor of epidemiology at the University of California Los Angeles told Vox.com.
He said data from China suggested that “household contact was an important means of transmission outside of Wuhan, suggesting that prolonged contact [with a sick person] increases the risk of transmission”.
“If correct, then the time spent commuting and the density of people commuting could be important factors in assessing if public transportation is a risk factor for the disease’s transmission.”
Image copyright GETTY IMAGESImage caption Trains on the network are being scrubbed clean to avoid the spread of infection
Shivaji Sutar, a senior communications officer of the railways, told me that the network was running an aggressive campaign to ease the rush: awareness announcements, posters and videos containing virus information.
They were also monitoring crowds, scrubbing the trains, taking the temperature of willing passengers and embarking on a drive against public spitting, he said.
A combination of awareness and panic has already led to a 27% drop in traffic on the network. But millions of people continue to take the train to work and home every day.
“This is more because of fear than anything else. Most of us have to take the network because we have to come to work. There is still no government directive to all companies to work from home. And apart from passengers wearing masks, I haven’t seen any other precautions being taken,” Rekha Hodge, who has been using the network for three decades, told me. That is bad news.
Image copyright GETTY IMAGESImage caption Small groups of young people can be seen playing sports as schools, colleges and even gyms are shut.
Life in India has changed dramatically as the world’s second-most populous country grapples with the coronavirus outbreak.
Otherwise crowded and chaotic cities have quietened down as people stay home, traffic slows and even weddings shrink in size and scale.
India has confirmed 151 active cases and three deaths – but public health experts fear that the low count is the result of limited testing and under-reporting. The country has only conducted about 12,000 tests so far, partly because of a shortage of testing kits.
So it’s still unclear if and to what extent community transmission exists in India – community transmission means a patient had no known contact with another confirmed case or travelled from a country badly affected by the pandemic.
However, India’s central government, several state governments and city administrations have already responded with drastic measures.
Image copyright GETTY IMAGES
The Indira Gandhi international airport in the national capital Delhi, is the country’s busiest airport but it appears deserted nowadays.
India has barred entry to everyone, including citizens, flying from certain countries, including the UK and most European nations. It has also cancelled most entry visas to people (excluding citizens) flying in from other countries.
This has led to numerous flight cancellations.
Airlines are also struggling as fewer people are flying even within India, wary that new regulations could see them stranded away from their homes. Two of India’s top airlines are reportedly considering grounding planes amid plummeting demand for flights.
Image copyright GETTY IMAGES
Popular Indian monuments – such as the 16th Century Red Fort in Delhi – have been shut to visitors to prevent large gatherings.
Taj Mahal, the country’s most iconic monument, closed its doors on Tuesday, along with more than 140 other monuments and museums.
With fewer people visiting and closures of public places likely to go up, tourism is expected to take a huge hit across India – the Taj alone draws as many as 70,000 people a day.
Image copyright GETTY IMAGES
Bangalore, an IT hub in southern India, is among the major cities that has shut down its malls – such as the one above – and schools, colleges, cinema halls and other public places have been closed since late last week. Other major cities such as Delhi, the financial hub Mumbai and Hyderabad in the south, have done the same.
City officials have also imposed restrictions on large gatherings such as weddings, cricket matches or any public ticketed events.
Image copyright GETTY IMAGES
Some of Delhi’s busiest spots, such as Connaught Place, are mostly empty.
There has also been a significant drop in the number of people using trains, which remain the most popular form of transport in India.
Image copyright GETTY IMAGES
The service from Mumbai to Pune city – which takes about three to four hours – has seen about a 30% fall in passenger traffic, according to some estimates.
The western state of Maharashtra, where both cities are located, has reported the highest number of cases in India so far. The central railways has already cancelled 23 long distance trains going to and from Mumbai – officials say the reason is both the virus and the lower number of passengers.
Overall, more than 150 trains have been cancelled across India. This number could increase in coming days.
Image copyright GETTY IMAGES
Many holy sites, including the Golden Temple – one of the holiest shrines in Sikhism – remain open, although the footfall is much lower. It’s quite unusual to see such few people in what is one of India’s busiest shrines.
Tirumala Tirupati, the richest Hindu temple, has cancelled many of its daily rituals and is restricting the number of pilgrims for the first time.
Some major Hindu temples, such as the Siddhivinayak temple in the heart of Mumbai, and the Vaishno Devi cave shrine, have closed.
Image copyright GETTY IMAGES
City officials in Delhi have begun sanitising auto rickshaws and taxis to contain the spread of the virus.
Public transport poses a major challenge to containing the outbreak. But it continues to be used regularly across India, even as governments encourage people to stay home as much as possible.
But not all offices have work from home options, and this is especially a challenge for the millions who work in India’s informal sector – these include domestic help, street vendors and daily wage workers.
Image copyright GETTY IMAGES
Surprisingly, sit-in protests against India’s controversial new citizenship law continue in some cities, including Delhi and Bangalore.
The most prominent of these, pictured above, is happening in Delhi’s Shaheen Bagh neighbourhood. Thousands of protesters, mostly Muslim women, have been demonstrating against the law, which critics say is anti-Muslim, since December.
But Delhi has shut down schools, colleges, gyms, night clubs, spas and swimming pools – and Chief Minister Arvind Kejriwal has said all social, political and religious gatherings with more than 50 people would be stopped.
Image copyright GETTY IMAGES
Temperature checks have become a common feature across cities – here, people are being screened before they enter the high court in the eastern city of Kolkata (formerly Calcutta).
This practice has been adopted at airports, corporate offices and several other places that remain open despite the restrictions.
Image copyright GETTY IMAGES
In the southern city of Hyderabad, students appeared for their school-leaving exams, but they came armed with masks.
Delhi, however, has postponed all school examinations.
Experts say India could impose more sweeping lockdowns as the toll climbs further.
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