As India prepares to partially relax the national lockdown for COVID-19 in zones that do not have high concern, from April 20, attention is focused on how successful ‘flattening the curve’ of infection has been. There is some evidence, based on reported cases put out by the Health Ministry that for a 48-hour cycle ending April 17, the growth in total cases was slower than during the preceding comparison period — 16% versus 28%. These data, and others indicating a slowing pace of case doubling, must be viewed against the backdrop of vastly different testing rates among States. Delhi has ramped up tests per million people and also reported a higher percentage of positive cases, compared to populous West Bengal and Madhya Pradesh which have done far fewer tests and yet find a higher share of positive cases. Kerala has managed to test, trace, quarantine and treat effectively, preventing new infections. The highest prevalence can be mapped to States with high economic output or significant urbanisation, or both, such as Maharashtra, Delhi and Tamil Nadu. Other factors may be driving up case numbers in Madhya Pradesh, Gujarat, Telangana, Rajasthan, Uttar Pradesh and Jammu and Kashmir. The most recent ICMR data appear to show a spike — 2,154 new cases in a single day reported on April 18. These are clear pointers for the Centre and States, as they try to reconcile public health and economic measures to alleviate the deep distress and damage caused to millions.
Given the uncertainties surrounding the long-term effects of SARS-CoV-2 on people, including medical outcomes for those who have recovered from severe infection, India’s COVID-19 strategy has to focus on testing, containment and treatment on the one hand, and distress alleviation for vulnerable sections on the other. As the disease has demonstrated once again, pandemics have the ability to quickly expose underlying inequalities. From a medical perspective, it has laid bare the inadequacy of the public health system to roll-out enough tests in all States, to determine where containment measures would achieve the best outcomes, and also to provide intensive treatment for acute respiratory illness. Looking ahead, the need for testing can only grow when a phased exit strategy is attempted. The testing data generated by all laboratories should be complete and shared in real time transparently by the Centre to aid policy-making. As psychologists are pointing out, the response to HIV testing over two decades ago dramatically improved when people saw hope of treatment, got access to tests and were protected against stigmatisation and xenophobia. This would apply in good measure to COVID-19. Flattening the curve will require clear messages on preventive health, and steps to help people maintain strict quarantine where indicated without suffering economic losses, and carry out regular surveillance testing and symptom monitoring.
