‘Deaths will rise ... and rise sharply.’ India’s deepening coronavirus crisis

Experts say unfolding disaster exacerbated by mistimed lockdown ordered by Narendra Modi

Doctors and nurses with a  coronavirus patient at the intensive care unit of the Sharda Hospital, in Greater Noidam India, on July 15th. Photograph: Xavier Galiana /AFP via Getty Images

Doctors and nurses with a coronavirus patient at the intensive care unit of the Sharda Hospital, in Greater Noidam India, on July 15th. Photograph: Xavier Galiana /AFP via Getty Images

 

Narendra Modi has cultivated a reputation for making dramatic decisions to respond to India’s complex policy challenges. Addressing the nation on primetime television about coronavirus on March 24th, the prime minister was true to form.

India then had about 550 confirmed infections, and many Indians believed their repeated exposure to a wide range of germs would enable their immune systems to ward off the virus. But Modi warned coronavirus had “rendered even the most developed countries of the world helpless”. India’s recent socio-economic progress, he warned, would be set back decades unless it could “break the chain of infection”.

With that, he ordered India’s 1.4 billion people into one of the world’s most stringent lockdowns, warning them not to step out of their homes – “whatever happens” – for the next 21 days. “We must accept that this is the only way before us,” he said of strictures that took effect less than four hours later, at the stroke of midnight.

The draconian lockdown – imposed with no warning, no planning and no transparency into the policy deliberations or scientific advice behind it – fit perfectly with the prime minister’s highly-personalised, muscular leadership style. Virtually all economic activity – including logistics, manufacturing, public transport and most healthcare – did come to a near total standstill. Around 140 million vulnerable workers were thrust into crisis as their earnings collapsed.

Yet for all the human suffering and economic damage it inflicted, India’s lockdown failed to flatten – or even slightly bend – the country’s coronavirus curve. With limited testing capacity and restrictive testing policies, authorities struggled to identify infected patients and trace their contacts. Fears of being hauled off to squalid public hospitals or quarantine centres meant that many who became infected were reluctant to come forward. New cases rose steadily.

Deepening crisis

Under pressure in the following weeks to resuscitate the collapsing economy and give desperate workers a chance to earn again, Modi then changed tack. On May 12th, as confirmed infections rose to about 71,000, Indians were told to learn to live with the virus, and get back to business.

“Corona will remain part of our lives for a long time,” Modi said in a national televised address. “But we cannot allow our lives to be confined only around corona.”

But two months on, India is still facing severe disruptions to normal life, as the virus circulates ever more widely – a deepening crisis that experts warn could hamper the country’s development for years to come.

Today, India has recorded more than 1.4 million confirmed coronavirus infections – the world’s third biggest caseload after the US and Brazil. New infections are rising to new all-time highs almost every day – exceeding 49,000 on Thursday. Fatalities too are on an upward trend, with more than 32,000 deaths in total.

 

A security guard sits at a containment zone amid the coronavirus lockdown in Kolkata, India, on July 27th. Photograph: Piyal Adhikary/EPA
A security guard sits at a containment zone amid the coronavirus lockdown in Kolkata, India, on July 27th. Photograph: Piyal Adhikary/EPA

The true magnitude of India’s pandemic – and its death toll – is likely far higher. India has one of the lowest testing rates of any major economy, due both to continued limited capacity – especially in small towns and rural areas where the virus is now spreading – but also political pressure to limit testing to keep the official case count low.

Health experts warn of the need for more effective containment. Ashish Jha, director of the Harvard Global Health Institute, says India’s new infections could soon be rising by 100,000 a day – an alarming spectre given its overstretched health system.

“The virus is probably much more widespread than what the statistics show,” said Prof Jha. “I am deeply worried that in the days and weeks ahead, hospitals are going to really get strained, and people are going to start dying in much larger numbers. Deaths will rise, and I worry they will rise sharply.”

Lack of control

Failure to control the pathogen will also cast a shadow over India’s economic prospects, with the gloomy scenario Modi foretold in March seeming evermore likely. Tech and industrial hubs like Bangalore, Pune, Chennai and Aurangabad, and entire states like Bihar, are undergoing new localised lockdowns, while the populous state of Uttar Pradesh and nearby Punjab impose stifling “weekend lockdowns”.

Even without official restrictions, many urban Indians are too fearful to step out of their homes. Rural migrants are wary of returning to urban workplaces. Small businesses have reopened only to shut down again as employees were infected. Reopening schools – closed since early March – isn’t even a topic of public discourse. Welfare schemes – like midday meals and vaccinations – have been disrupted, as resources are diverted to the pandemic.

“I don’t think today there is any ambition to actually get rid of the virus,” says prominent businessman Naushad Forbes, chairman of engineering company Forbes Marshall, and a past president of the Confederation of Indian Industry. “Today it’s very much control, contain and ensure we have the right kind of health capabilities so we can limit morbidity.”

All this will extract a heavy toll on an economy that was already struggling to regain momentum after a protracted slowdown. Nomura, the Japanese investment bank, forecast that India’s gross domestic product will contract by 6.1 per cent this year, while HSBC expects a dip of 7.2 per cent. Domestic rating agency ICRA is gloomier, projecting a 9.5 per cent contraction.

“The pace of normalisation is far more uneven than what one would have assumed,” says Aurodeep Nandi, a Nomura economist. “People have started getting more risk averse. Unless you solve the health crisis, the economic crisis will not solve itself.”

Nor will the pain end quickly. Economists warn that the pandemic has created new financial stresses that will weigh on India’s growth potential for years. Strained public finances are deteriorating further, with analysts forecasting the combined central and state deficit could rise to 12 per cent of GDP.

Banks, which have struggled for several years to reduce non-performing loans, face a new wave of stressed assets. Lay-offs are increasing, and may accelerate further once a bank moratorium on debt repayments expires at the end of August.

“India’s potential rate of growth certainly has come down and these issues will remain in the system for several years,” says Sunil Kumar Sinha, principal economist of India Ratings & Research.

Undercounted

Despite this gloomy outlook, Modi’s government – with its sophisticated public communication tools – has persuaded many Indians that his leadership has enabled them to fare far better than many richer, more advanced nations.

As evidence, New Delhi cites India’s low number of deaths compared to its population, and low case-to-fatality ratio. “The whole world is witnessing how one of the most successful battles against Covid-19 is being fought here,” Amit Shah, the home minister, said recently at a public forum.

But public health experts say India’s official death toll is almost certainly undercounted - and that such statistics mean a lot less in a situation where the number of new infections is rising rapidly. Harvard’s Prof Jha also fears that New Delhi’s tendency to minimise the magnitude of the current threat – or simply divert public attention – could backfire, encouraging people to let down their guard as the virus becomes more widespread.

 

India;s prime minister Narendra Modi pictured in New Delhi on July 15th during the India-EU virtual summit. Photograph: EPA/Government of India
India;s prime minister Narendra Modi pictured in New Delhi on July 15th during the India-EU virtual summit. Photograph: EPA/Government of India

“Politicians have often tried to approach this disease like a political campaign – you are just trying to win the day and win the news cycle,” he says. “But downplaying the virus is actually a really harmful strategy because you can confuse people about what their action should be.”

With new infections surging and the economy wilting, the focus is inevitably returning to the government’s initial response to the pandemic and the rushed decision in March to shut down the country.

For some observers, the lockdown strategy was driven as much by Modi’s political persona – and his desire to demonstrate that he was the man in charge – as it was by a clear scientific and public health analysis of the problem.

Authorities in the then-hardest hit regions of Maharashtra state and the capital city, New Delhi, had already imposed curfews as local cases rose. Some public health experts say Modi shut down the whole country to assert his leadership over India’s pandemic response.

The shutdown reflected Modi’s impulse to rely on the might of the state to enforce shock-and-awe tactics - and discipline what his ruling Hindu nationalist Bharatiya Janata party sees as a wayward society – rather than mobilise India’s extensive network of grassroots community organisations and civil society groups in a campaign to educate people about the virus.

“Big dramatic action – the world’s biggest lockdown – fits the pattern of the prime minister’s thinking about how to deal with the problem,” says Dr T Jacob John, former head of the department of virology and microbiology at Christian Medical College (Vellore).

The lockdown reaffirmed Modi’s stature in the eyes of many middle-class Indians, who saw it as a reflection of his courage and willingness to act decisively against a looming threat. Business owners were less impressed, feeling the magnitude of the disruption was avoidable.

But lockdown failed to deliver the promised results. In mimicking tactics adopted from authoritarian China, and rich European countries, the government failed to account for the gritty realities of urban India, where millions live in crowded slums sharing toilets and water taps with hundreds of others, or depend on daily wages for that evening’s meal.

“Police cannot do public health,” says former health secretary K Sujatha Rao, who worked extensively on India’s successful Aids control programme. “It cannot be done by force. It has to be done through persuasion.”

‘Speculative wisdom’

As India’s poorest desperately scrambled for food and transport back to their villages, fertile conditions were created for the virus to spread.

“You cannot just give an order and everything will be resolved,” says Dr Smarajit Jana, former head of the Aids control programme. “Any good public health policy must consider the context of the country in question – the population density, the socio-economic context and the way people live.”

Dr Harsh Vardhan, India’s health minister; Dr Vinod Paul, the paediatrician who has been one of Modi’s key advisers on the pandemic; and Dr Balaram Bhargava, the cardiologist who leads the Indian Council for Medical Research, did not respond to requests for interviews about India’s coronavirus strategy.

However, Swapan Dasgupta, an MP close to Modi, says the premier acted on “conventional wisdom”, after Italy, Spain, France and the UK – where health systems were already under heavy pressure – imposed controls on their citizens.

“It was imagined that if you have 18 or 21 days of very intensive lockdown, you’ll be able to get over this problem,” Dasgupta said. “That was the conventional wisdom – or speculative wisdom. The thinking was, if you are able to stop this at this point, you will be able to get rid of it for the future.”

A closed market during a weekend lockdown in Jammu, India, on July 25th. Photograph: Jaipal Singh/EPA
A closed market during a weekend lockdown in Jammu, India, on July 25th. Photograph: Jaipal Singh/EPA

Dr John believes India’s lockdown was “mistimed”. It was imposed too early in the epidemic, when case numbers were still too low, he says, and when the infections were so narrowly concentrated that it did not require such draconian action across vast swaths of the country that had no cases at the time.

Today, he says the virus is circulating more widely than ever, yet there is little effort to warn people, or any aggressive campaign to promote correct and comprehensive mask wearing, which he believes is critical to reduce and slow the spread of the pathogen.

“The lockdown instilled fear and when the lockdown was lifted the fear is gone, and the virus is hitting everybody,” says John. “It’s the crying wolf story ... When the wolf really came, nobody cared.” – Copyright The Financial Times Limited 2020

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