NEWS  January 30, 2021 marked one year since India detected its first case of Covid-19  in Kerala.

CONTEXT  Analysing the country’s response to the novel coronavirus pandemic so far reveals a mix of successes and failures along with the possibilities of more to be looming ahead, that urgently need to be addressed to limit damage and get back to the path of economic and social recovery.

SITUATION TILL NOW

Till date the country has recorded 1,07,90,183 cases and 1,54,703 deaths due to COVID­19 — the second largest in the world in terms of cases, after the United States, and fourth in terms of deaths.

ANALYSIS- INDIA Vs THE WORLD

• FATALITY- Official statistics reveals that India has fared better on rates of infections and deaths than many higher income countries.
• For example, India’s case fatality ratio on February 3 stood at 1.4% compared to 2.8% in the United Kingdom or 3.1% in South Africa, while India’s deaths per million is 112, compared to 1,362 in the United States, 1,486 in Italy or 1,831 in Belgium.
• However, it has not done so well compared to countries of similar income and demography in South Asia. For example, while India’s case fatalities ratio was lower than Bangladesh (1.5%) and Pakistan (2.1%) it was significantly higher than Bhutan (0.1%), Nepal (0.7%), the Maldives (0.3%) and Sri Lanka (0.5%).
• Deaths due to COVID­19 per million population in Bangladesh was 50, Pakistan was 54 and Sri Lanka was just 16, lower than in India.
• POLITICAL COMMITMENT- India’s initial response was marked by political commitment at the highest level, with several steps taken early in screening international travellers, restricting inbound traffic from severely affected countries, and preparing quarantine facilities for those testing positive.
• However, like many other countries, India too has not been able to figure out till now what the best way to open its borders to normal travellers is while keeping out those carrying COVID­19 infection, particularly the new more virulent strains.
• LOCKDOWN- India was among the few countries to announce a stringent nationwide lockdown much before it had a significant number of cases, while developed countries like, U.K. and the U.S. hesitated to impose a lockdown, costing many lives due to their late response.
• However, the Indian lockdown was imposed at very short notice without stating the strategy or specific objectives. No evidence based justification was provided for such a sudden imposition of the lockdown without any lead time, nor was its purpose clearly communicated to the public leaving behind many questions, like:

Was the lockdown meant to eliminate the epidemic through contact treatment, isolation and case management?  Was the valuable time gained to be used to strengthen the health system and prepare for the expected rise in cases?

AFTER LOCKDOWN

• As the result of the hasty and unplanned decision, when the lockdown was lifted up , the number of confirmed cases were already on rapid rise and continued to rise till late December, 2020.
• The lockdown was marked by excessive dependence on security forces to ensure enforcement of physical distancing measures and quarantine related restrictions.
• An unintended offshoot of the lockdown was the large scale exodus of migrants. Families were forced to walk hundreds of kilometres back to their homes in the countryside. Dozens died in this exodus and horrific road accidents. Also, there were deaths due to lack of sufficient food, drinking water and the shear stress of travelling.
• These incidents highlighted the plight of poor workers due to the lack of a social safety net.

LESSONS LEARNT

• First, in the context of the country’s federal structure: no public health response can be successful without ownership at the state level. The lack of consultation with State governments resulted in the hesitant implementation of COVID­-19 response policies without much initiative or innovation. Hence, there is a need for a rethink of the top-down approach towards States at the national level for public health response policies.
• Second, in all epidemic responses, generation and use of strategic information plays a crucial role. Given India’s global reputation as a software superpower, the pandemic would have been an ideal staging ground for fast tracking plans to create an integrated digital health information system to improve the efficiency and transparency of the COVID­-19 response.

But, the Integrated Disease Surveillance Programme (IDSP), India’s national disease surveillance framework, was not visible throughout the response.

The surveys conducted were limited in coverage and periodicity, as a result, it is still unclear to what percentage of India’s population have been infected with the virus — an indicator of herd immunity.

ROLE OF CIVIL SOCIETY

• Earlier occasions such as polio eradication and AIDS response, were marked by an important preventive and promotional role played by civil society in bringing the infections under control.
• On the contrary, this response was marked by a lack of involvement of civil society organisations as partners with state agencies.
• Even in the present when the vaccination programme has been launched, the end game strategy for it remains unclear, raising questions about sustainability of its benefits in the long term.

WIDENING DIVIDE

• Another critical unknown in India’s COVID­19 response is over its plans to revive the economy and restore livelihoods of millions of people, who are today in danger of starvation and for whom even basic health care has become unaffordable.
• The pandemic period has exacerbated existing social inequalities and the poor face a ‘lost decade’ ahead, a challenge which needs to be addressed on priority.

Thus, there is an urgent need to examine all these critical gaps and implement the lessons learnt in the response to the pandemic. Without an open inquiry and widespread debate, India will miss yet another chance to learn the right lessons and ensure a more robust, well thought out and humane response to similar crises in future.

Reference:

1. https://www.thehindu.com/opinion/lead/a-year-on-mind-the-gaps-in-the-pandemic-response/article33753447.ece