DISCLAIMER: The information and views set out in this article are those of the author(s); and do not necessarily reflect the views of the Centre for Policy Studies or the Indian Institute of Technology Bombay.
On 11th March, 2020, the Director General of the World Health Organization (WHO) characterized the spread of COVID-19 as a pandemic (WHO, 2020). Pandemics are situations in which a disease rapidly spreads to a large number of people in several different countries all over the globe, in a relatively short period of time (Hays, 2005). Epidemics refer to such a spread in a given population at a certain location, and when epidemics go global (or pan world) we have a pandemic on our hands. While there has been criticism around the alleged delay in WHO’s labelling of the spread of the novel Corona virus as a pandemic, some experts have pointed it out to be merely symptomatic of the apathy and tardy response from the Industrialized Global North (Gebrekidan, 2020). The United States, in its self-declared role as the leader of the free world, has responded to the global crisis in a woefully inadequate manner (Beaubien, 2020). Italy, now the centre of a catastrophic health system crisis brought on by the pandemic, has been severely criticized for a slow and faulty approach (Donadio, 2020). The crisis has reached Spain, which failed to react promptly to the transmission of the virus (Jones, 2020) and the UK is currently being scrutinized for what many think is an unconscionably conservative and ultimately disastrous approach to control the pandemic within its borders (Boseley, 2020). In contrast, the responses from Singapore, Taiwan, South Korea, and the country of origin of the pandemic, China have had considerable success in containing the outbreak (McCurry et al.,2020). The variable global response may be attributed to the perception of risk by national governments. Countries which were geographically proximal to the origin of the epidemic in China were justified in a rapid response, while Europe and North America assumed lesser risk given the distance between those continents and East Asia. However, in a globalized world of speedy jet travel, human bodies and germs move rapidly and spread far and wide. As India enters a critical period in the fight to contain the transmission of COVID-19, it may be a good time to review the prevention efforts in place and contextualize the reasons for them.
The first case of COVID-19 infection in India was reported on the 30th of January 2020, in Kerala, in a person who had travelled from the city of Wuhan in China, the centre of the epidemic (Rawat, 2020). This marked the beginning of what was the first stage of transmission, when new cases are brought in from outside the country. The second stage began last week where individuals tested positive for the virus in Jaipur, Agra and parts of Kerala (“Cases Reach 62”, 2020), and they had most likely contracted the disease from persons who got infected while they were travelling outside the country. This is called the stage of local transmission. Experts opine that the next thirty days will be crucial in halting the pace of the rise of transmission rates (Thacker,2020). Once the nature of transmission moves on to the third stage, that of community transmission (when people test positive for the virus, and it cannot be traced to a case of ‘imported disease’, i.e. to a person travelling from one of the countries with a known outbreak) the number of cases are expected to rise sharply, and containment efforts will yield limited results (Heymann & Shindo, 2020). Italy and Spain have entered this phase quite rapidly, and are now suffering the consequences.
The present period offers a window for intervention to the Indian authorities. The idea is to delay – if not break – the chain of transmission before it proceeds to the community transmission stage. Here it is useful to understand that the disease caused by the virus resembles the common influenza and produces mild and self-limiting symptoms in most individuals. However, initial evaluation of the data from China since December 2019 shows that in around 20 percent of the cases (mostly in the elderly or those with other conditions such as diabetes or pre-existing lung disease), patients develop severe pneumonia and require intensive care with about 2 percent of the cases succumbing to the condition (Xu et al., 2020). The concern remains that if there occurs a rapid transmission of the virus which leads to a large number of infections over a short period of time, it will produce a considerable case load of patients who require intensive care. Dealing with such numbers over a short period of time can easily overwhelm the health service capacity (number of hospital intensive care beds and care providers) of a country. Italy, at present, is in the midst of such a crisis where doctors are being forced to triage their case load (Monella, 2020). In other words they have to decide to not treat severe cases (e.g. persons above the age of eighty) who have a low chance of survival in order to prioritize their resources for those (younger and without other disease conditions) who probably have a better chance and hence represent a better outcome for the amount of resources diverted to them. The goal in India and other low transmission countries is to take pre-emptive measures to avoid such a catastrophic situation.
The prevention effort consists of two aims at present. First, to prevent the influx of new cases, and second to identify existing cases and isolate them so as to prevent transmission to uninfected persons. The first is achieved through travel bans. The second is much more difficult to implement. Quarantines at ports of entry and testing of persons who are suspected to either have the symptoms of the disease or to have been in contact with those who are suspected to have the disease, forms the cornerstone of this approach. Those who test positive for the virus are isolated. Furthermore the general public is encouraged to take hygiene precautions (see here for details), maintain social distancing, and discouraged from accessing places with large crowds. Schools, colleges, gyms and certain offices have been closed down in several Indian cities and towns. People have been advised to practice self-quarantine at home whereby they minimise contact with persons from outside their homes and work from home. All these measures are expected to reduce the rate of transmission and create a more ‘flat curve’ of disease occurrence (see here for more on what is meant by flattening the curve).
Travel bans, quarantines, and large scale suspension of economic activity in a bid to prevent transmission of a disease is not a frequent occurrence in the life of a modern nation state. Such measures are associated with economic losses, and are often difficult to implement given the resistance of citizens to these admittedly coercive measures. It is almost impossible for those engaged in the gig economy, daily wage work, domestic work, and the service industry to be able to self-quarantine or practice social distancing. Bans, restrictions and quarantines may also magnify extant inequalities of wealth, gender, class and caste; and care must be taken to ensure the protection of individual rights even as authorities try to enforce strict rules of conduct. In the short run, the goal remains to curb transmission rates and avert a rapidly spreading epidemic. However in the long run India will need to engage with the question of preparedness for public health emergencies such as the one we currently find ourselves in. Particularly because if predictions are to be believed, we face many more such rapid outbreaks of new diseases in the not so remote future.
Beaubien, J. (2020, March 12) Singapore Wins Praise For Its COVID-19 Strategy. The U.S. Does Not. Retrieved 17 March 2020, from NPR: https://www.npr.org/sections/goatsandsoda/2020/03/12/814522489/singapore-wins-praise-for-its-covid-19-strategy-the-u-s-does-not
Boseley, S. (2020, March 12) Health expert brands UK’s coronavirus response ‘pathetic’. Retrieved 17 March 2020, from The Guardian: https://www.theguardian.com/world/2020/mar/12/health-expert-brands-uks-coronavirus-response-pathetic
The New Indian Express Online Desk. (2020, March 11). Cases reach 62 in India as Jaipur person tests positive, one critical in Kerala. Retrieved on 17 March 2020, from The New Indian Express: https://www.newindianexpress.com/live/2020/mar/08/coronavirus-live-updates–cases-reach-62-in-india-as-jaipur-person-tests-positive-one-critical-in-kerala-2113779.amp
Donadio, R. (2020, March 8) Italy’s Coronavirus Response Is a Warning From the Future. Retrieved 17 March 2020, from The Atlantic: https://www.theatlantic.com/international/archive/2020/03/italy-coronavirus-covid19-west-europe-future/607660/
Gebrekidan, S. (2020, March 12). The World Has a Plan to Fight Coronavirus. Most Countries Are Not Using it. Retrieved 17 March 2020, from The New York Times: https://www.nytimes.com/2020/03/12/world/coronavirus-world-health-organization.html
Hays, J. N. (2005). Epidemics and pandemics: their impacts on human history. Santa Barbara, USA: Abc-clio.
Heymann, D. L., & Shindo, N. (2020, Feb 13). COVID-19: what is next for public health?. The Lancet, Volume 395, Issue 10224, 542-545. doi: https://doi.org/10.1016/S0140-6736(20)30374-3
Jones, S. (2020, March 14). Spain orders nationwide lockdown to battle coronavirus. Retrieved 17 March 2020, from The Guardian: https://www.theguardian.com/world/2020/mar/14/spain-government-set-to-order-nationwide-coronavirus-lockdown
McCurry, J., Ratcliff, R., Davidson., H. (2020, March 11). Mass testing, alerts and big fines: the strategies used in Asia to slow coronavirus. Retrieved 17 March 2020, from The Guardian: https://www.theguardian.com/world/2020/mar/11/mass-testing-alerts-and-big-fines-the-strategies-used-in-asia-to-slow-coronavirus
Monella, L.M. (2020,March 13). Coronavirus: Italy doctors ‘forced to prioritise ICU care for patients with best chance of survival’. Retrieved 17 March 2020, from EuroNews: https://www.euronews.com/2020/03/12/coronavirus-italy-doctors-forced-to-prioritise-icu-care-for-patients-with-best-chance-of-s
Rawat, M. ( 2020,March 12). Coronavirus in India: Tracking country’s first 50 COVID-19 cases; what numbers tell. Retrieved 17 March 2020, from India Today: https://www.indiatoday.in/india/story/coronavirus-in-india-tracking-country-s-first-50-covid-19-cases-what-numbers-tell-1654468-2020-03-12
Thacker, T. (2020, March 14). Community Transmission of COVID-19 is inevitable: ICMR. Retrieved 17 March 2020, from The Economic Times: https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/community-transmission-of-covid-19-is-inevitable-icmr/articleshow/74621197.cms?from=mdr
WHO. (2020, March 11). WHO Director-General’s opening remarks at the media briefing on COVID-19. Retrieved 17 March 2020, from WHO: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020
Xu, Z., Shi, L., Wang, Y., Zhang, J., Huang, L., Zhang, C., … & Tai, Y. (2020, Feb 18). Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet Respiratory Medicine.