Covid-19: What next?

Govt should prepare for increasing caseload

At 425,000 cases and the number of new infections a day steadily climbing to touch 15,000, India is still some distance from peaking. Almost all significantly affected countries barring Brazil have peaked, though the US, China, and South Korea may be in for a second wave. There is less cause for immediate concern in India, given that the recoveries at over 237,196 outstrip the 174,387 active cases and the death tally of 13,699 is still quite low as a percentage of the population. India records about 26,000 deaths a day in normal times and the daily Covid-19 death toll has touched 425-odd, which is infinitesimal. Still, the absolute numbers are high enough for India to rank eighth in the global death tally for Covid-19.

The Union health ministry quoted a June 21 report of the World Health Organization, indicating that India’s Covid-19 cases of 30.4 per 100,000 people is among the lowest in the world (the global average is 114.67). The ministry has quoted this piece of data as evidence of the government’s “graded, pro-active and pre-emptive” approach. But beyond the self-congratulation, there are several issues here. For instance, the accuracy of the official data, given that Indian Council of Medical Research guidelines focus on testing mainly symptomatic patients and asymptomatic direct contacts, which have been drawn up on the assumption that there is no community transmission. Without wider testing, it is impossible to gauge the veracity of this judgement — in smaller countries, wider testing has revealed a high proportion of asymptomatic cases who may be unwittingly spreading the disease. Individual cities in India are now approaching China’s national numbers, and the steadily climbing positive-test ratio could point to the actual numbers being much more than officially reported. It is not out of the realm of possibility that India will cross one million cases, as Brazil has done, while the US has crossed the two-million mark.

The implication of this narrow testing protocol is that the Indian governing establishment may be even less equipped to deal with a possible explosion of the illness. A repeat lockdown is out of the question, given the harm it has imposed on the economy and the government’s inability to provide robust safety nets of the kind Europe, the US, and some Southeast Asian economies have rolled out. The question, therefore, is whether this crisis can overwhelm India in terms of the system’s ability to treat patients. The number of testing centres, at less than 900, about half of them government facilities, is woefully inadequate, not least in the heavily populated states of Bihar and UP. India also has just 700,000 hospital beds in the government sector, which is bearing the brunt of the load. The real shortage may be of doctors and nurses, assuming that temporary hospitals in sports stadia, hotels, and religious sites are providing large numbers of new beds. The production of equipment has also progressed with the bulk of the personal protective equipment and ventilators being made in India, including in engineering and automobile units, with some government oversight on distribution. But perhaps the most eye-opening failure has been the poor quality of response from India’s vaunted private hospitals, where price gouging and the exclusion of poor people are rife. It is unclear why the Centre and state governments are treating them with kid gloves. The impending crisis demands that the private health care system be made to step up to the plate.