India scrambles to fight its hidden coronavirus epidemic: ‘The explosion is already here’

India has been praised for its response to Covid-19, but expert tells Adam Withnall country could still be heading for 300 million cases by July – and a refusal to test widely means the government is driving blind through the crisis

A live broadcast of Indian prime minister Narendra Modi's address to the nation (EPA)

In a rare address to the nation on Thursday night, India’s prime minister Narendra Modi appealed for the country’s older generations, the most vulnerable to severe infection, to call on their “wartime” experience of prolonged blackouts and national drills to beat coronavirus.

While the country’s tally of virus cases is just over 200, measures are being taken at the federal and state levels to place the country on a lockdown tighter than many worse-affected nations.

Schools and cinemas in major cities have already been closed for some time, and now restaurants in Delhi have been shuttered. In Mumbai, the capital of the worst-hit state Maharashtra, all but essential shops and offices have been ordered to close.

Mr Modi’s address was preceded by a government order telling all over-65s and under 10s to stay at home, and an already stringent travel ban has been extended – a near total ban on international aviation into (and therefore, practically speaking, out of) the country from Sunday.

And the prime minister called on people to observe a “people’s curfew” from 7am to 9pm on Sunday, punctuated by a collective celebration of the medical and emergency services at 5pm, with the ringing of bells and banging of pots and pans from balconies.

“This people’s curfew will in a way be a litmus test for us, for our nation,” Mr Modi said. “This is also the time to see and test how prepared India is for fighting off a corona-like global pandemic.”

Clearly, the thrust of the prime minister’s speech was that India must take the threat of Covid-19 seriously. But it is also a lack of widespread testing, and an insistence from officials that communal transmission is not yet present in the country, that is contributing to the very complacency that Mr Modi warns against.

Warning of the “rapid pace” at which the virus can get out of control, Mr Modi spoke of an “explosion” in cases in other countries. “In such a situation, it is very natural to get worried,” he said.

Yet the fact is that India’s lack of testing – only about 14,000, the equivalent of 10 people per million, have been checked – means the country is driving blind in its response to the crisis, argued Dr Ramanan Laxminarayan, director of the Washington-based Centre for Disease Dynamics, Economics and Policy.

Asked if India should expect its own explosion of cases, Dr Laxminarayan told The Independent: “I think India is already experiencing that. I don’t think a prime minister of a country goes to the population at prime time and tells them to be prepared for something similar to a world war based on [then] only 160 cases.”

Experts like Dr Laxminarayan put India’s true number of cases in the thousands, or even tens of thousands, and say that the same computer modelling being applied to the likes of the UK and US – where between 20 and 60 per cent of the population is expected to get infected – applies to India as well.

“This is an infection to which nobody has any immunity,” he said. “I think that by the end of July we’re probably going to end up having somewhere between 300 and 500 million infections.”

India has “really dropped the ball” when it comes to testing, he said. “I would give the government 9 out of 10 in terms of its initial response, waking up to the threat and proactively shutting borders. But I would give them a 3 out of 10 for testing.”

Some Indian states have received glowing praise for the way they have handled confirmed cases – Kerala had three imported coronavirus patients at the start of February, yet through good old-fashioned detective work traced hundreds of contacts for those people and appeared to stem the spread.

But plenty more stories have emerged of infected patients being discharged from isolation units, skipping quarantine or even fleeing the country to spread the disease elsewhere.

One woman from Maharashtra, who asked not to be named for fear of repercussions, described landing in Delhi on a flight from Spain at the start of this week and being told she and the other 158 passengers would have to stay in a government-run quarantine facility.

“On arrival, passengers started protesting and arguing, refusing to enter the facility until they got their passports back,” she recalled. “This continued for a while and ultimately the officials in charge decided to allow everyone to sign self-declarations stating they were asymptomatic. All their passports were returned and they boarded the bus again, which took them back to the airport.”

Three passengers, the woman included, said they stayed at the facility but were not provided with water throughout the night, harassed by police officers and then simply “discharged” in the morning and allowed to go where they wanted.

“It was a harrowing experience to be honest,” she told The Independent. “The entire process was extremely disheartening from start to finish. It makes you wonder what incentive citizens have to cooperate with the government’s policies when they are treated poorly for doing so – and can simply have their way and avoid any consequences by refusing to cooperate.”

Dr Laxminarayan said failures in quarantine and infection control were inevitable due to shortfalls in India’s uneven healthcare system that “you simply can’t fix in the short term”. “If you don’t have a strong public health system in peacetime you can’t suddenly have one during a war,” he said.

But there is still time to prepare for when the strain on the healthcare system hits its peak, he said, and now was the time for the mass ordering of ventilators and the requisitioning of stadiums and hotels as isolation wards.

“India can do amazing things are short notice,” he said. ”While there are some things we can’t fix, there are some we can. But we don’t have much time, we’re scrambling against time to do this.”