The Unlock 4 guidelines of the Home Ministry allowing all but a few activities that attract large crowds, with supportive measures by States, reflect deep economic distress. India resorted to the world’s most rigorous lockdown early on in the COVID-19 pandemic, when infection spread had just begun; there were just over 600 cases on March 25 . It has now liberalised most activities, restricting only those that witness gatherings in excess of 100 people. This comes at a time when daily infections are scaling new highs — 78,512 on Monday — and growing at a rate faster than in the U.S. and Brazil, which have held the top spots globally . Resumption of economic activity, including Metro and other public transport services, will ease the pain for many, and prevent a further precipitous decline in earnings and spending, but if it is not accompanied by rigorous infection control, a major public health penalty could lie ahead. Successful unlocking requires enabling movement, including international travel, within a scientific regime of identification, testing and inexpensive quarantine where needed. When the pandemic was unfolding, a major concern was that of a wildfire spread overwhelming a lopsided health-care system, in which intensive care is meagre, urban-centric and expensive even for the middle class. This painful reality, of the virus retaining high transmissibility and unpredictable disease impacts, is as relevant today as it was then, as people resume their jobs and travel. Students, meanwhile, continue to be despondent, as there is no escape from high tuition fees, while online teaching remains experimental. Worryingly, many lockdown-weary people have begun to disregard safety norms, abandoning masks and distancing norms.
India is proceeding with its unlock strategy against the backdrop of scientific models that estimate that the actual infections could be 10 times the reported 3.6 million. The implication, which was voiced by the Harvard Global Health Institute, taking antibody test data into account, is that the tally for positive cases could be between 35 million and 70 million, given India’s high population. Evidence also indicates that a deceleration in disease spread should reflect in a lower test positivity rate. If Indian States have 8% or higher positivity, compared to 1% in over-the-peak locations such as New York or South Korea, it indicates far more undetected infections in the population and significantly low testing. These insights point to the tenuous nature of the unlock programme, the need for constant vigil and the irrationality of exuberance. The pandemic cannot yet be viewed in the past tense, and there is a long wait for a possible vaccine. The impending scenarios underscore the need for wider testing and safe behaviour. The new normal requires governments to prioritise work-from-home and actively support green mobility such as walking and use of bicycles. It must, in parallel, identify infections and scale up health-care access.