The WHO is urging countries to step up COVID-19 testing, but Indian authorities believe doing so will spark 'more fear, more paranoia, and more hype'
- India is home to more than 1.3 billion people, but so far has only reported 176 coronavirus cases and three deaths.
- Experts fear that testing rates, that are being kept low to prevent panic and to keep healthcare costs down, may be camouflaging the real scope of the outbreak.
- India faces several hurdles in its fight against COVID-19, including high population density, lack of hygiene, and insufficient healthcare funding.
- Officials have already begun cracking down: travel restrictions, schools, restaurants, and public space closures, exam cancellations, and remote work mandates are in effect.
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India, the world's second-most populous country, has remained largely unscathed as the coronavirus continues its relentless march across the globe.
Home to more than 1.3 billion people, India has reported 176 cases and three deaths as of Wednesday. By contrast, China, whose population is 1.4 billion people, reported at least 81,000 cases and more than 3,200 deaths. Even Italy, the worst-hit nation outside Asia, with a population of around 60 million people, has surpassed 35,700 cases and 2,900 deaths.
But India's caseload may not be accurate.
The country is conducting only about 90 tests per day, the Associated Press reported, and only 11,500 Indians have been screened for the COVID-19 virus so far. This, despite the country having the capacity to test up to 8,000 people a day.
The World Health Organization is urging governments to step up testing as the coronavirus outbreak grows.
"We need to be geared to respond to the evolving situation with the aim to stop transmission of COVID-19 at the earliest to minimize the impact," Dr. Poonam Khetrapal Singh, WHO's director for the region that includes India, told AP. "We need to act now."
Testing numbers kept low to avoid 'paranoia'
However, India is only screening people who have either traveled there from a country that's been badly affected or those who have come in contact with a patient or are presenting symptoms themselves, AP said. As of Tuesday, officials have expanded the criteria to include medical workers who are treating COVID-19 patients and have symptoms too.
Balaram Bharghava, who heads the Indian Council of Medical Research (ICMR), said the WHO guidance was "premature" for India because the coronavirus' rate of spread is not as rapid as it has been in other countries and community transmission hasn't been detected yet.
"Therefore it creates more fear, more paranoia, and more hype," Bhargava said, according to AP.
Officials say they are also trying to avoid overloading hospitals and keeping costs down.
India's health-care expenditure amounts to only 3.7% of its GDP, NDTV reported, leading to public hospitals that are overcrowded, private healthcare that many can't afford, and a lack of funding to combat illnesses like tuberculosis, malnutrition, and HIV/AIDs. In the case of COVID-19, patients aren't charged for tests, but each one costs the government about 5,000 rupees ($67).
Many people who may have come in contact with the virus are being sent home without being tested, though, AP reported.
This happened to a British citizen who was turned away from a public hospital even though she had a cough, shortness of breath, and a private doctor's referral - and informed officials that she may have been exposed to a coronavirus patient due to her work in the hospitality industry. She tried to get tested another time, but was rejected again, forcing her to leave India for France, where her family is based, AP said.
High population density creates social distancing challenges
Such accounts have sparked concerns about the government statistics being far lower than the real count.
"Given the pattern of disease in other places, and given our low level of testing, then I do think that community transmission is happening, " Dr. Gagandeep Kang, director of the Translational Health Science and Technology Institute, told AP.
India's bloated population density decreases the chance of social distancing, which experts say is the only way to "flatten the curve" of the coronavirus' infection rate.
But India's big cities are overcrowded with residents, many of whom are stuffed into slums, low-income dwellings, single- and multiple-family homes, and skyscrapers. NDTV estimated that around 420 people live on just 0.4 square miles of land in many of the country's largest cities.
"Social distancing is something often talked about but only works well for the urban middle class," said Dr. K. Srinath Reddy, adjunct professor of epidemiology at the T.H. Chan School of Public Health at Harvard University.
He continued: "It doesn't work well for the urban poor or the rural population where its extremely difficult both in terms of compactly packed houses, but also because many of them have to go to work in areas which are not necessarily suitable for social distancing."
Shreyanka Rao, of New Delhi, echoed the sentiment.
"While it's easy to say maintain social distancing, it's still something that can only be practiced by privileged people who have the time, space and wherewithal to do so," she told Insider. "While the [South] Korean and Singaporean approach is laudable, their systems, resources and volumes are in a different league."
Lack of hygiene complicates bid to fight coronavirus
India's fight against coronavirus is also plagued by a lack of clean water. Experts have said that using hand sanitizer and washing hands for at least 20 seconds is helpful in warding off the infection.
But Dharam Singh Rajput, like many residents, can neither afford to purchase bottles of hand sanitizer nor access clean running water, the AP said. Rajput lives in India's capital city of New Delhi, but open sewers and piles of garbage can be found across his neighborhood.
"The kind of water we have access to has the potential to cause more diseases instead of warding off the virus if we use it to wash our hands," Rajput told AP.
An apparent lack of hygiene has also been reported at hospitals nationwide. There have been reports that some coronavirus cases are fleeing hospitals because of substandard hygiene. In the state of Maharashtra, five people were tested for coronavirus. One of them tested negative, but the entire group left the isolation ward where they were being kept before the others' results came in because it was too dirty, AP reported.
Aditya Bhatnagar, who has been quarantined with 50 other people following a flight from Spain, said more than half a dozen people are packed into each room while quarantined, and noted that the quarantine spaces don't have clean bedsheets or sanitary restrooms. No one's been given masks or hand sanitizer, either.
"I don't think these measures would be enough to contain the pandemic," Bhatnagar told AP, explaining that some people had decided to tell shell out 4,000 rupees a night ($55) and await their COVID-19 test results at a private hospital instead.
'An avalanche' is coming
Government officials are particularly worried about the situation in Maharashtra, which is home not only to India's financial hub, Mumbai, but also the highest number of cases: 39 as of Monday.
Across the nation, India has begun closing down schools, theaters, malls, and other public spaces, university exams have been called off, and government and private offices have been urged to switch to remote work schedules, NDTV reported. Ganga Pandit, who lives in Pune, told Insider that only five people at a time are being allowed into major grocery stores, where he noticed that people are panic buying medicines, antiseptic creams, soap, and face masks.
Since a majority of the country's cases have been "imported" from foreign countries - whether by people traveling there or coming in contact with those who did - India has also enforced strict travel restrictions, Al Jazeera reported.
Tourists and non-Indian residents from China, Iran, South Korea, Turkey, the United Kingdom, and the European Union are prohibited from entering the country. People who travel from or transition through the United Arab Emirates, Qatar, Oman, and Kuwait will be quarantined for 14 days upon landing in India, and its borders with Bangladesh and Myanmar have been mostly closed.
But people, like Sudhanshu Pandey, tweeted his concerns that India is on the fast track to a "worst-case scenario," and called on authorities to lock down big cities, including New Delhi, Mumbai, and Pune.
Experts agree.
"They are not understanding that this is an avalanche," Dr. T. Jacob John, the former head of ICMR's Centre for Advanced Research in Virology, told NDTV. "As every week passes, the avalanche is growing bigger and bigger."
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