Last week, Prime Minister Narendra Modi ordered a three-week lockdown of the country, telling citizens that they were not to leave their homes, because of the coronavirus pandemic. The scope of this order is hard to comprehend: India is a country of more than a billion people; it has extreme poverty in many areas; and many of its cities, such as Mumbai and Kolkata, are extraordinarily dense. Since people who live in India often travel between different states for work, the lockdown also left hundreds of thousands of migrant workers stranded; many of them are trying to return home on foot. So far, there have been only a few more than two thousand confirmed cases in India, and fifty-four confirmed deaths, but a major outbreak in a country with huge public-health deficiencies is likely to have devastating, far-reaching consequences.
At present, India is in an earlier stage of the epidemic. It’s probably running about two weeks behind the United States, and about four weeks behind Italy, in terms of when the first seeding of cases happened. Like in these other countries, it probably happened because of airline traffic—but not because of people coming from China, all of whom were quarantined very early, but likely because of Italians who had carried the virus, who were tourists here. And a number of the early cases actually involved Italians. So it arrived after it had fully seeded in Italy, and the testing was pretty small at the beginning. It was restricted to people who were stepping off the plane, or someone who had been in contact with a confirmed COVID-19 case.
And so we’ve had a very limited read on how the disease is progressing to date. It’s only a thousand cases and just over thirty deaths. So that’s small for a country the size of India. What we expect is that this is probably because of testing not being adequate.
There is no evidence that the temperature and the humidity are slowing down the virus. And we’ve got a lot of compounding problems, which are that the health-system capacity is generally weak across the country.
And it’s also got a population that has tuberculosis and respiratory issues and pneumonia and high rates of smoking and air pollution. So, the trajectory of the disease in this population is going to be unclear. The other thing is that India also has a lot of hypertensives. About a third of the country’s adults are hypertensive, and about one-tenth of them are diabetic. And, so, all of this is likely to compound the problem. Of course, we don’t know anything for sure until the numbers actually start going up. But these are all the reasons why people of India are worried.