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Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 839
Tackling Covid-19: Critical Evaluation of India’s Response
Shibu John1, Akshita Kukreja2
1Professor
& Head, Department Of Healthcare And Pharmaceutical Management, Jamia Hamdard,
New Delhi, 2Pursuing Post Graduation In Healthcare Management, Department Of Healthcare And
Pharmaceutical Management, School Of Management & Business Studies, Jamia Hamdard, New Delhi
Abstract
Today the entire world is observing an unprecedented health emergency due to the COVID-19 pandemic.
Severely affected are the first world countries, which have the best of technology and healthcare
infrastructure. Most of them, like Italy, the US, Spain and Germany, have seen exponential growth patterns.
Despite the best possible efforts, almost no country has been able to flatten the curve convincingly. This
pandemic is more challenging than its predecessors because it is highly contagious and roughly three-fourth
of the infected people has not shown any known symptoms. The unavailability of quality testing kits makes
early detection difficult. India has not seen the worst part of this evil as yet, possibly due to timely measures
like behavioural interventions as well as movement and travel restrictions. Based on various studies that have
been considered to develop this analysis, the mortality rate in India is around 3.2 per cent among the diseased,
which is much less than the global rate. Due to drastic variations in public health infrastructure, demographic
pattern and geography, the spread of the disease in India is, not uniform. The current restrictions have
disrupted all economic activity, and the worst affected are the labourers and migrant workers. This is
undoubtedly a testing time for India, but if we have to avoid under-preparedness in another similar situation,
it depends on how India strengthens its public healthcare, legal and economic framework.
Keywords: COVID-19, Combat strategy, Community transmission, Healthcare infrastructure, Post-
COVID-19 India.
Introduction Not long after China’s first fatal case of coronavirus on
January 11, 2020, India also confirmed its first case of
Having its first cases reported from the city of
the disease on January 30, 2020.
Wuhan, in central China, the 2019-nCoV has afflicted
its wrath on over 210 countries and territories, causing WHO (World Health Organization) declared this
26,60,763 infections and 1,85,502 deaths already1. as a PHEIC (Public Health Emergency of International
Even the best healthcare experts and systems have been Concern) in the end of January 2020.3 On March
stunned by this pandemic’s spread. Most of the countries 11, 2020, the WHO declared it as a “Pandemic”. As
affected by it, like Italy, the US, Spain and Germany, per expert opinion, India is still in the early stages
have seen exponential growth patterns which rendered of an outbreak, and it is crucial to make predictions
their healthcare systems overwhelmed. Fortunately, to regarding the course this disease will follow. The
date, the rate of causalities in India is only 1.68 %2. diverse demographic and socioeconomic characteristics
countrywide have led to a varied impact. The
countrywide lockdown that commenced on March 25,
Corresponding author: 2020 was applauded as a commendable move made in
Dr. Shibu John, Phd just in time to curb the disease. This has reduced the
Professor &Head, Department Of Healthcare And number of cases significantly and prevented ‘community
Pharmaceutical Management, Jamia Hamdard, New transmission’ of the disease. On the contrary, some areas
Delhi, (Phone: 9873668705 & have also reported infections without coming in contact
E-Mail: Shibu.john14@Gmail.com) with any positive case which hints the opposite. The
840 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
cases in India are increasing every day by differential of 2005, pertaining which, the current restrictions
growth rates in different states. According to an analysis are being imposed, are foggy on the matters of
published on March 22 by the COVID-19 Study Group, risk communication and crisis management in the
a team of epidemiologists based in the US, India could country. Going by expert opinion, the current measures
see between around 100 000 and 1.3 million confirmed will not be feasible in the long term since it can only
cases of COVID-19 by the middle of May if the virus stop the spread of the disease and prevent a massive,
continues to spread at its current rate4. unbearable outbreak.
Methodology Three major reasons could explain the uncertainty
of COVID-19’s widespread. First, the highly contagious
The study deliberates on the effect of COVID-19
nature of the disease as compared to other viral diseases
worldwide with special reference to India’s response
likes influenza. A metric called R0 (R-naught) explains
to handling the crisis. Morbidity and mortality due to
contagiousness, which refers to the average numbers
COVID-19 have not followed any uniformity in different
of people that one positive case infects. It is used to
parts of the world. This leads to a more in-depth analysis
predict the extent and pace of disease spread. An R0 of
of reasons and consequences in different countries with a
less than 1 implies a decreasing trend, while more than
focus on India. The authors of this article have consulted
1 depicts an increasing trend. R0 value for COVID-19 is
many databases on COVID-19, and data were considered
being estimated between 2.2 to 4.0 by different agencies.
up till April 20 2020. Extensive subject literature, review
Secondly, it is challenging to identify and isolate
articles and research papers were reviewed during paper
COVID-19 positive cases because 75 – 80% of cases are
development. Raw data from various databases like
asymptomatic, and they are called as ‘Secret Spreaders’.
worldometer.com, covid19india.org, Indian Council
These cases underwent tests only when they were
for Medical Research (ICMR), Corona Virus Resource
suspected of having come in contact with COVID-19
Centre, John’s Hopkins, International Monetary Fund
positive cases. A total of 130 of 166 new infections
(IMF) among others were taken to study the global and
(78%) identified in the 24 hours to the afternoon of
Indian phenomenon. These databases are maintained
Wednesday, April 1 were asymptomatic, said China’s
and updated regularly, by various governmental and
National Health Commission5. Scientists suspect there
non-governmental agencies.
is an undetected pool of people who have mild or no
symptoms, but they can infect others. Implications of
Study Findings
asymptomatic cases infecting others are hazardous.
It is distressing that the world is observing an Thirdly, the availability and quality of diagnostic
unprecedented health emergency. The worst-hit are testing kits that detect COVID-19 are questionable.
those who have the best of technology and healthcare The sensitivity and specificity of testing kits used for
infrastructure. Despite the best possible efforts, detection are crucial. Most of the countries are facing
almost no country has been able to flatten the curve problems in acquiring accurate testing kits. An ideal
convincingly. There are many quandaries about the diagnostic test should have reasonably high specific
economic impact and cost-effectiveness of the measures and sensitive value, which means that the test should
being used to tackle the disease. The national lockdown correctly identify positive and negative cases, without
which now stands extended has been by far the largest reporting any false positives or false negatives. The RT-
worldwide and has quarantined a total of 1.38 billion PCR kits being used currently, meet both criteria, with
Indians. If and when the country emerges triumphant specificity and sensitivity rates of 90 per cent and above.
over the virus, all its resources will be significantly
drained, and the economy will be crippled. Despite the India’s Response
optimism of various international bodies regarding
The World Health Organization has commended
India, including the UN, the Indian economy will
India’s robust and timely efforts to control the spread of
most likely reach stagnation if not a contraction,
coronavirus. There has been no community transmission
on the whole. Both, the Epidemic Disease Act of
of coronavirus since the country went into lockdown,
1897 and the National Disaster Management ActIndian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 841
and the growth factor of cases has declined by 40%, has decently better than other already affected countries,
according to recent statements by the Union Health it’s due to the precautionary measures8. At the same
Ministry6. The Ministry has stated that India will be time, many experts believe that India could have done
following a strategic approach taking into account much better, had we taken necessary steps at the very
different possible scenarios – travel-related cases, local beginning when the first few cases were reported. The
transmission of COVID-19, large outbreaks amenable to current measures have successfully bought the healthcare
containment, and widespread community transmission system some time to be better equipped and put suitable
of COVID-197. The scenario of INDIA on COVID-19 strategies in place. India’s doubling rate of COVID-19
positive cases has gone up from 3.4 days to 7.5 days.
(Source https://www.worldometers.info/coronavirus/country/india/)
In the first week of February 2020, India had three known examples. It is often argued that a similar
COVID-19 positive cases, but universal screening at situation is highly likely for COVID-19 as well,
the airports started nearly a month later. Most of our given the fact that it is on the average a relatively
procurement process for Masks, Ventilators, PPE kits, mild infection, and many positive patients across
Testing kits and other equipment started in the latter India may be missed through misdiagnosis or missed
part of March when the positive cases already reached diagnosis 9. The states have also reported cases of
above 500. When the nationwide lockdown commenced people who were tested negative in airport screenings,
on March 25, 2020, India already crossed 600 positive which ascertains that ‘asymptomatic transmission’ was
cases. Though India has not witnessed the USA or occurring since the very beginning. A paper published
Europe-like spike in the cases, the number is still by scientists at ICMR, suggested that symptomatic
tickling. Unfortunately, there has been a history of people with no travel history should also be tested if
under-reporting disease and death due to systemic India intends to delay the outbreak effectively10.
deficiencies; Malaria and Tuberculosis are well-
Graph 1: Day-wise total number of COVID19 positive cases and deaths against tests performed (tests in ‘10)
(Source: icmr.nic.in)842 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
India’s testing numbers are drastically lower as confirmed cases and test numbers. This could be
compared to different countries worldwide. As of a plausible explanation to why our cases are low.
April 20, 2020, India has performed a little above Notably, the death percentage among COVID-19
400,000 tests, bringing its Tests Per Million (TPM) patient is 3.2 % compared to 6.9% globally. Death
ratio to around 291 tests/million population. This is percentage among closed cases is 15% compared to
far less than the global average. We can see from 20% worldwide.
the graph that there is a strong relationship between
Graph 2: Number of cases, recoveries and deaths due to COVID-19 reported state wise
India had more than 650 deaths as on April of them to die on the journey. Despite the government’s
21, 2020, with over 20,000 confirmed COVID-19 measures to handle the crisis, like distribution of food
patients. There is a vast difference in the number on a massive scale or establishment of quarantine
of cases, recovery, and deaths among different facilities, among others, still more needs to be done as
states of India, which highlights the way different this ‘humanitarian crisis’ continues to unfold in front of
states are dealing with this public health calamity. the whole world.
Maharashtra, MP, Gujarat and Karnataka have
Furthermore, the long-prevailing of this pandemic
witnessed higher mortality rates than national
may significantly increase the number of stress,
average whereas southern states, Kerala and Tamil
depression and anxiety patients, and it will ultimately
Nadu have less than 1% mortality rates. Kerala has
knock down the doors of other fatal human disorders12.
managed to limit the cases with its extensive testing,
Uncertainty and unpredictability are creating a
followed by a detailed contact-tracing process and
more stressed environment which may increase the
extended quarantine duration. Kerala faced a “potentially
number of psychologically disordered patients13.
disastrous challenge” from the coronavirus, given the
There should be a particular focus on the complications
high number of expatriates and foreign tourist arrivals
faced by the migrant women, who are inarguably one
in the state11.
of the most vulnerable groups victimised by the virus.
From another perspective, the current movement This mass exodus of the workers from bigger cities to
and travel restrictions have adversely affected millions their hometowns also poses the threat of community
of people earning their daily bread in the unorganised transmission of the virus in India.
workforce, The daily wagers are stranded and the
Economic Impact
growing insecurity has led them to travel back to their
native villages, in search of a haven, also causing several The post-COVID-19 India will be economicallyIndian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 843
weaker and financially frailer. Couple of months of measures15. However, speculations point towards the
social distancing and quarantine would have saved need for more substantial financial support.
millions of lives but at the same time, it would
The International Monetary Fund (IMF) slashed
have financially dented several million families14.
India’s growth estimate for FY21 to 1.9% from 5.8%
Complete movement restrictions have resulted in no
estimated in January, warning that the “worst recession
economic activity and contractions in many types of
since the Great Depression” will dwarf the economic
employment. Many sectors, like auto, construction,
damage caused by the global financial crisis a decade
travel, hotel industry, have crashed. Depending on
back16. It also said that India and China would be the
the nature of the industry, stock markets had already
only two major economies likely to register positive
down by 25%. To boost the sentiments of the
growth, with all others contracting. IMF in its April 2020
population, the finance ministry had rolled out a ₹1.7
update, said that the COVID-19 pandemic would shrink
trillion relief package towards food security and cash
world output by 3% in 202017. The growth forecast is
transfer, to tackle the loss of livelihood17. Last week, the
marked down by more than 6 percentage points relative,
Reserve Bank of India (RBI) cut the reverse repo rate,
an extraordinary revision over such a short period.
provided better liquidity support to non-banking finance
and microfinance companies, facilitated increased
emergency funding for state governments, among other
(Source: Businessstandard.com)
Conclusion returns. The National Health Policy of India (2017)
articulates increasing investment in health to 2.5%
COVID-19 is highly contagious but less fatal
of the national GDP by 2025 from a meagre 1.15% in
compared to its predecessors and is not expected to be
2017. Even if complied with the National health policy,
eradicated anytime soon. If we have to combat such a
India’s allocations stand far lesser than a large number
situation effectively, public health has to be prioritised
of developing and developed countries19. COVID-19
on a national development agenda. The current efforts
has proven that a more significant increase in healthcare
of the Indian government to contain the COVID-19
expenditure is direly needed. The allocated funds should
pandemic have been fruitful so far, but there are
establish comprehensive services without any further
fundamental challenges ahead in health infrastructure18.
delay as the Indian healthcare system may crumble
It is a well-known fact that the investments in public
if the COVID-19 situation becomes like the USA or
healthcare provide considerable returns in the long term,
Europe. National Pandemic Preparedness Plans (NPPP)
all of which may not be measurable as direct economic844 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
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in anticipation of an influenza pandemic. We may use 4. Pulla P. Covid-19: India imposes lockdown for 21
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does not come under the purview of any committee March. Available from:https://www.mohfw.gov.
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Source of Funding: - Self
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