DH Deciphers | Why hasn't India flattened the coronavirus curve despite 13 weeks of lockdown?

As the Covid-19 pandemic began to spread globally at the start of this year, the worldwide consensus was that a period of lockdown would break the chain of infections. India acted remarkably quickly in comparison to others. The nationwide lockdown here fell into place on March 25, when the country had a paltry 519 cases and only 10 deaths. In contrast, the UK, when it introduced its lockdown on March 24, had already registered 8,077 cases and 422 deaths. Italy ordered a nationwide lockdown on March 11 when it had already registered 631 deaths and 10,149 cases.

Follow live updates on the coronavirus here

But now, nearly 13 weeks later, as India prepares to withdraw the last of its lockdown restrictions, the country’s rate of infection is higher than ever, even as the numbers in the UK and Italy have largely flatlined. So where did India's attempt to flatten the curve go so wrong?

What did Europe do differently that its lockdown flattened the curve?

Simply put, it was stringent social distancing, plus the scrupulous wearing of masks and social welfare measures, that saw Europe through. In Italy and Spain, the data shows, the lockdown had a rapid impact. In both countries, the new cases peaked between 13 and 20 days and thereafter began to decline.

What was the problem with India's lockdown?

The problem is not that India introduced a lockdown early, but that the government failed to implement a series of concurrent measures to ensure that the infections did not resurface.

The fundamental usefulness of the lockdown is to reduce the number of infections for a short period. The government's failure to exploit the lockdown for its true worth is why we are seeing so many cases now, epidemiologists say.

Dr Giridhar Babu, a pandemic expert, says a lockdown alone cannot stop a pandemic. In the absence of large-scale testing to rapidly identify infected individuals and social welfare programmes, a lockdown cannot succeed on its own, he explains.

From March 25 to April 23, during the most stringent phases of the lockdown, India's testing reached a peak of only 0.36 tests per 1,000 people — not enough to gauge the spread of the disease within the population.

The central government now says nearly one lakh tests are being done daily. While these might seem an impressive number, it still translates to roughly only 5.3 tests per 1,000 people, as per data from the Karnataka state Covid war room. In comparison, the UK is currently out 60.4 tests per 1,000 of the population. In Karnataka, the rate is 7.9 tests per 1,000.

So did India bungle social distancing?

A lockdown, intended to freeze people in place, is a good thing while tackling a pandemic, but its value is contingent on how well social distancing is carried out. In the Indian context, dense population clusters and large numbers of people living in the same household made social distancing a tricky proposition, says Dr Vivekanada Jha, Director of the George Institute for Global Health (India).

In the end, the lockdown had the exact opposite effect that it was intended for. "While the lockdown bought us enough time to expand our medical infrastructure, it arguably also expanded the spread of the disease," Dr Jha said. "What the lockdown did was relegate people in densely congested areas where if one person has the disease, then others contract it as well. The result is a larger spread."

A glimpse of this spread dynamic was captured in Bengaluru’s densely populated Shivajinagar where a single hotel worker with the disease infected 46 others in his residential building through the use of a single common toilet.

The government’s failure to enact a financial safety net for ordinary citizens is also said to have inherently doomed the lockdown to failure.

The end result could be less social distancing, post-lockdown, cautioned Suvrat Raju, a theoretical physicist at the International Centre for Theoretical Sciences. "The economic compulsions of people and the fact that marketplaces, malls and businesses will be anxious to rebound from the financial crunch could eventually dilute social distancing norms," he said.

He added that without these concurrent measures, simple mathematical models suggest that "there is a risk that when the pandemic has run its course, it will have extracted almost the same final toll in lives as it would have without the lockdown."

Was the introduction of the lockdown too hasty?

Potentially so, experts say, pointing to the fact that zero notice of the lockdown meant, for example, that millions of migrant workers employed in daily-wage jobs in cities were not able to return to their home states in time.

Although subsequent plans were made to feed stranded daily-wage workers, they were largely a failure, prompting NGOs and private donors to step in. The government’s neglect of migrant workers rebounded when interstate and inter-district travel restrictions were withdrawn in May. Scores of hitherto undetected but infected people crossing state borders have triggered a spike in cases.

This is perhaps the ultimate legacy of India's lockdown: Starting early, but without the heft to ensure that the people's needs were taken care of and then running out of steam before it could have any long-term impact against the pandemic.