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COVID-19: Can India Replicate the Chinese Lockdown Model?

COVID-19: Can India Replicate the Chinese Lockdown Model?

Two countries that have effectively used physical distancing slow the spread of the new coronavirus within their borders are China and South Korea. Their region-specific lockdowns – brutal in their economic effects and likely immoral as well – bought important time for their health services to ready themselves, enabled their front-line medical staff to discharge their duties without becoming exhausted, and assured them a steady supply of testing kits, protective gear and medical equipment.

India has implemented a much wider lockdown encompassed its entire population – of 1.3 billion people – so India’s task is more complex and difficult than the challenges the Chinese and the South Koreans had to tackle, thanks to India’s insufficient institutional and financial capacity.

The two principal components of India’s strategy to contain the coronavirus’s spread are to ensure people don’t go hungry during the lockdown, and to “test, test and test”, in the WHO’s words, to identify and quarantine those who have COVID-19.

According to Census 2011, India’s 65 million slum dwellers live in crowded urban settlements with inadequate sanitation and drinking water. As a result, physical distancing is practically nearly impossible in these conditions, at least not without extensive support from the government.

The rationale of physical distancing is to break the virus’s chain of transmission and thus reduce its ability to spread. Without slowing down the rate at which more people become infected, India’s underfunded and understaffed healthcare system will become quickly overwhelmed. And given the lack of protective gear and medical equipment, frontline medical personnel are at high risk of being infected. Ultimately, if doctors start getting infected at a rate greater than the general population, the healthcare system might collapse.

Therefore, if we can identify COVID-19 patients as early as possible, through broad-based screening and testing, we can quarantine them at home, help them recover and slam the brakes on the virus’s transmission. Plus given the state of the relatively poor health of average Indians with respect to the health standards of the young population in developed nations, India might end up having more young patients in hospital requiring medical attention for COVID-19 infections.

Due to the unaffordability of private hospitals, most of India’s population have to rely on public hospitals. The statistical data, unfortunately, suggests that the numbers of beds and ventilators, by any standard, will not be sufficient to accommodate the pressure from exponential spread of COVID-19. According to the economic survey 2018-19, about 60% of primary health centres (PHCs) have just one doctor, while 5% run without any. In states like Jharkhand and Chhattisgarh, the number of PHCs sans doctors are 10% and 20% respectively. While 71% of India’s population live in rural areas, only 36% of the total health workforce are available to them. Such disproportionate distribution of the health workforce between rural and urban India could cause further issues in the fight against COVID-19.

Presently, India’s public healthcare infrastructure consists of about 713,000 beds and 57,000 ICU units. If the Indian government takes the above model seriously, we have reason to believe an impending public health crisis is inevitable.

The number of existing hospital beds would be a gross overestimation of availability of beds for COVID-19 patients, given the fact that the Indian healthcare infrastructure is already saturated and overburdened with regular patients who need emergency attentions such as maternity care, patients with compulsory hospitalised medication such as cancer, tuberculosis, heart disease and terminally ill patients. Therefore COVID-19 patients may have to be admitted at the cost of other non-COVID-19 patients who need essential emergency care parallel.

The situation may worsen further as COVID-19 patients have to be treated in separate wards. This means additional wards and beds need to be set up over and above the existing healthcare infrastructure as soon as possible before the virus transmission breaches the critical level, when doctors have to face trade-offs in attending to non-COVID-19 emergency patients and COVID-19 patients.

Jameel Barkat is a postdoctoral fellow at the Institute of Biomedicine, University of Gothenburg, Sweden. Amit Sadhukhan is an assistant professor of economics, Tata Institute of Social Sciences, Hyderabad.

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