Medical expert warns India could be next coronavirus hotspot

By Wasantha Rupasinghe
21 March 2020

Several medical experts have warned that India is at risk of a devastating coronavirus outbreak throughout the country. With a crisis-ridden public health system that lacks basic facilities and suffers from widespread staff shortages, and hundreds of millions living in extreme poverty, especially in high density cities like New Delhi, Mumbai, Chennai and Kolkata, the country is vulnerable to a rapid spread of the pandemic.

Having reported over 223 positive cases and four coronavirus-related deaths so far, however, the government of Prime Minister Narendra Modi has refused to initiate mass testing. Indian authorities have limited their response to the imposition of travel restrictions, tests for incoming travellers and contact tracing of those who have registered a positive result.

These steps alone are woefully inadequate to halt the progress of the pandemic in a country of 1.3 billion people. Even though it is weeks since the first COVID-19 case was confirmed, just 14,175 tests have been conducted across the country.

Despite a growing number of infections, the ministry of health has asserted that there is “no evidence” of person-to-person transmission within India in a bid to justify the lack of mass testing.

Dr. T. Jacob John, the former head of the Indian Council for Medical Research’s Centre for Advanced Research in Virology, has warned that while infection rates appear to be relatively low so far, the number of cases will likely increase ten-fold by April 15.

In comments reported by NDTV on March 18, John warned that the authorities were “not understanding that this is an avalanche. As every week passes, the avalanche is growing bigger and bigger.”

Health ministry officials have called for social distancing as a means of slowing the spread of the coronavirus, however medical experts have warned that this is impractical in high density areas.

Across India, an average of 420 people live in every square kilometre, compared with just 148 per square kilometre in China. More than 400 million people live in cities. In Mumbai alone, the population density is 21,000 per square kilometre. Nearly half of Delhi’s 18 million residents live in overcrowded shanty-towns.

Under these conditions, Dr. K. Srinath Reddy, president of the Public Health Foundation of India has bluntly declared that “social distancing is something often talked about but only works well for the urban middle class.”

Reddy, who is also adjunct professor of epidemiology at Harvard University’s T.H. Chan School of Public Health, told NDTV: “It doesn’t work well for the urban poor or the rural population where it’s extremely difficult both in terms of compactly packed houses, but also because many of them have to go to work in areas which are not necessarily suitable for social distancing.”

The response of the Indian ruling elite, like its counterparts around the world, has been criminally negligent. Despite these warnings, the Modi government has done nothing to prepare mass testing or to boost funding to the shambolic public health system.

In an interview with Indian Express on March 17, Nivedita Gupta, senior viral scientist at the Indian Council for Medical Research (ICMR), stated that India had limited its testing to symptomatic travellers and contacts of confirmed cases. Only on Tuesday was it announced that testing would be extended to health workers who are at risk due to contact with infected patients. According to Gupta, India currently has a capacity for 6,000 tests per day. There are around 150,000 test kits in 51 labs.

Responding to World Health Organisation guidance for countries to test as many people as possible to curb the pandemic, Balaam Bhargava, head of the ICMR said mass testing would be “premature” for India. Bhargava sought to justify this position by claiming that community transmissions had yet to be detected.

This assertion has been countered by a number of medical experts. Ramadan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy told the Hindustan Times on Thursday: “Community transmission began in India two to three weeks ago, around the same time as other countries. India is not an exception to the way the virus behaves,” he stated. “We just haven’t tested a representative sample that the country’s population of 1.34 billion demands.”

The Times also quoted an anonymous public health expert who warned: “Unless you test, you won’t know. Enough testing is not happening. In the initial phase of the epidemic, there are very few cases. But once it begins, it spreads like wildfire.”

Millions of people’s lives have already been placed in danger by the slow response of the authorities.

Indicating the prospects of a mass catastrophe, Dr. T. Jacob John wrote in the Economic and Political Weekly on March 14: “If 10 percent (80 million)—out of India’s total 800 million adult population—get infected and 10 percent of them developed severe illness (8 million; in particular the elderly, those with diabetes, chronic lung diseases, etc. who are more vulnerable), 80,000 may die at a 1 percent case fatality rate and 160,000 at 2 percent case fatality rate, all in one year.”

The Indian government has claimed that its response has been aimed at preventing mass panic and ensuring that the country’s hospital system is not overwhelmed by testing. In reality, its primary concern is to limit public spending amid an ongoing drive to slash costs and drive up the fortune of the country’s investors and wealthy elites.

While no money is made available to fight the pandemic, the Modi government allocated $US66 billion for defence in this year’s national budget, the third largest annual spend by any government in the world. The same budget provided just $9.7 billion for healthcare. This demonstrates that for the Indian elite, boosting its military power to pursue its predatory geo-political interests is a greater priority than the health, and the very lives of ordinary people.

Meanwhile, a tiny and corrupted super rich layer has accumulated a mountain of wealth. Oxfam’s “Time to Care” report released earlier this year found that India’s richest 1 percent hold more than four-times the wealth of the poorest 70 percent of the country, some 953 million people. The collective wealth of the country’s 63 billionaires is more than the annual national budget.