India's Covid-19 lockdown: the good, the bad and the ugly

By South Asia correspondent James Oaten and Som Patidar for the ABC

Thousands of confirmed Covid-19 cases are being added every day to India's national tally, but it's not enough to guarantee disaster is on the horizon.

Around a third of all coronavirus cases have recovered and the death rate is relatively low, but victory is not yet in sight.

India has now surged past 90,000 confirmed cases and is recording more than 4000 new cases a day. It has also passed China's tally.

And yet the country, groaning under huge internal economic and social pressure, is easing restrictions to get the economy moving again.

Interstate trains are resuming operations to get poor migrant workers back home, posing a real risk of spreading the coronavirus to rural areas where medical services are poorest.

So how did it get here? And why, after six weeks of one of the world's strictest lockdowns, is the country still in such an uncertain position? Here's what we know.

The good: early lockdown measures

India imposed one of the world's strictest lockdowns, when confirmed cases of the coronavirus had just passed 500.

Almost everything, except essential services and businesses that related to food or medicine, was shut, causing a sudden shift in community sentiment - as if confirmed cases had shot up.

But along with some unease, there was also a sense of national pride. India, it seemed, was tackling the issue head on.

"India started off reasonably well," said the Public Health Foundation of India's Professor K Shrinath Reddy.

"India did take several measures that were fairly effective and ahead of many of the western countries."

According to researchers at Oxford University, who have rated the strength of lockdowns across the world from zero to 100 using a "stringency index", India's lockdown scored the highest rating of 100.

In comparison Australia - which at the time had four times the confirmed cases - scored 63. And even when Australia had the same number of cases as India, its lockdown measures scored 34.

"There was a great sense of vulnerability, because of the large population and the overcrowded slums and cities," Professor Reddy said.

"As well as the relatively weak health system, and the frightening images of overwhelmed health systems and hospitals coming in from Europe and North America.

"That led to the decision that we must have a lockdown, and there was not much resistance to the lockdown from the general public."

The good: extraordinary 'humane social response'

India's measures suppressed the curve and hospitals have not been inundated as many had feared, although experts have suggested the country's young demographic is likely to have helped the latter.

"If you look at deaths per million, we are way, way low down," Professor Reddy said.

"[There have been] 1.27 deaths per million population compared to 700 plus in Belgium and more than 200 in Europe, and close to 200 in the US."

Many of India's cases are concentrated in a few metropolitan areas and hotspot clusters, which have been quarantined, while more than 40 percent of India's regional and municipal districts - accounting for a quarter of the population - have been labelled "green zones".

This means they have not had a confirmed case of the coronavirus for at least 21 days.

The southern state of Kerala, a region renowned for quality health care and high literacy rates, was the first state to register cases of Covid-19 and of the more than 500 confirmed cases its had since, only about 30 are still active.

"The southern states, especially Kerala, had an extraordinarily efficient public health response, as well as a humane social response," he said.

The bad - not enough testing and 'PPE not being available to everyone'

While India's aggressive lockdown and social distancing measures were praised by the World Health Organisation, the country's initial response was lacking in another crucial area: testing.

Its testing regime focused on those with symptoms who had been in contact with a confirmed case, or who had travelled to a hotspot country, but it's now evident asymptomatic cases were slipping through the country's defences.

"No lockdown can be 100 per cent foolproof," renowned public health expert Anant Bhan said.

"People were allowed to go out and get milk, to get groceries, to buy vegetables and there were cases, for example, where that was the source of infection [or] sometimes it was through delivery of food, like pizza delivery."

Home to more than 1.3 billion people, India's testing regime per capita was always likely to rate low - although it has increased the number of daily tests from around 5000 in late March to just under 100,000.

The country appears to now be paying the price for its slow start.

"We never really knew how much it had spread in the community prior to the lockdown and during the lockdown," Dr Bhan said.

"A lot of police and health care workers got infected because the infected ended up being asymptomatic as well."

The state of Maharastra and particularly its capital Mumbai, the country's financial and entertainment capital, has been the hardest hit, accounting for a third of all coronavirus cases.

Hundreds of neighbourhoods in Mumbai have been turned into containment zones, where residents cannot leave.

More than a 1000 cases have been recorded in Asia's largest slum, Dharavi, where social distancing is near impossible to maintain.

Hospitals last week ran out of beds for critically ill patients , and at least 15 hospitals have been partially or fully placed into quarantine, after doctors and nurses became infected.

According to Dr Bahn, there were a few reasons behind this, including "poor quality personal protective equipment or PPE not being available to everyone".

The ugly - millions of migrant workers left without an income

When India's lockdown was announced, Prime Minister Narendra Modi gave just four hours' notice, leaving millions of migrant workers who live hand-to-mouth without an income or a bed as factories and construction sites closed down.

Lines of young men desperately trying to walk hundreds of kilometres to their home town or village, without food or water, became a common sight in Delhi and other cities during the early days of the lockdown, while those left behind were turned into beggars.

"It's worse than I ever imagined," journalist Saba Naqvi said.

"They were proud people. Many of these people work with their hands - they have been reduced to a condition where they have to beg for food."

It prompted Modi to apologise to the poor for causing "immense suffering" and the government to announce huge relief packages and set up quarantined accommodation for migrant workers.

But it remained on the backfoot. At least 47 people have died due to starvation, 26 to exhaustion, and 83 to suicide due to lockdown hardship, according to a study by a group of academics and activists.

Last week, 16 migrant workers were crushed to death after falling asleep on train tracks as they tried to get home.

Many have defended the government's snap decision to impose a lockdown, saying migrant workers would have exited cities en masse anyway, elevating the risk of the virus spreading. But Professor Reddy is doubtful.

"The migrants, because of the nature of their occupations and the places of their stay, would have had very little exposure to the virus," he said.

"They could have been assisted in returning home."

The ugly - a mass event and Islamophobic fake news

The ferocity of the coronavirus's ability to spread became clear after an outbreak at a congregation of supporters of the Sunni Islamic movement, Tablighi Jamaat, in defiance of the city's restrictions on mass gatherings.

It prompted anger to again start mounting towards Muslims, just weeks after deadly violence erupted between Muslims and Hindu nationalists in the nation's capital.

Islamophobic rumours started taking off on social media, and Muslim workers and street vendors were being chastised.

"When the event broke out, we immediately knew what was to follow," said journalist Archis Chowdhury, who authored a study on fake news for factcheck website Boom Live.

"We were doing one fact check every day about a rumour that was targeting Muslims with false allegations of spreading coronavirus purposefully."

Chowdhury said a video showing a couple of Muslim youths licking plates "went viral [falsely claiming] Muslims are spreading their spit and the coronavirus with it".

"It's a very old video from 2018 and it's of the Dawoodi Bohra community, who have this practice of licking their plates clean to avoid wastage of food," he said.

So what's next for India?

India may be at a crucial turning point, but it will have to make many more manoeuvres in coming weeks and months.

"It is absolutely improper to start marking [how India is going] at this stage," Professor Reddy said.

"We've seen how South Korea has had a setback; we've seen how Singapore has had a setback.

"We have to mark stage by stage and start learning. How fast a learner you are, and how fast you apply those learnings, is going to be important.

"Now comes the big challenge."

- ABC