India’s national lockdown is coming to an end.
As of Monday, May 4, the country moved into what is being called Lockdown 3.0. In some ways, this phase is more of a Re-opening 1.0, since certain activities are now permitted in all zones – green, orange and red – with full restrictions only applying to containment zones.
For example, even in red zones where the numbers of Covid-19 cases are still high, private establishments are allowed to operate at 33% staff strength, and non-essential movement is permitted between 7 am and 7 pm. Here is a list of what is permitted and prohibited in Lockdown 3.0.
After more than five weeks of a complete ban on the movement of anything but essentials, India is slowly limping back to normality. The massive crowds that gathered outside liquor shops as well as the spike in traffic data were clear signs of a shift.
Delhi Chief Minister Arvind Kerjiwal echoed the voices of many leaders around the county when he declared that it was time to re-open the capital, saying, “We will have to be ready to live with coronavirus.”
But what does that actually mean?
What did five weeks of one of the world’s harshest lockdowns – announced with just four hours’ of notice – achieve? And does this mean your life goes back to normal?
Here is what we know.
No decline despite lockdown
When he announced what was initially supposed to be a three-week lockdown back in March, Prime Minister Narendra Modi said that the aim was to break the chain of transmission of the virus, warning Indians that if they were not vigilant over the next 21 days, it could set the country back by 21 years.
India locked down very early into the spread of the novel coronavirus in the country, with around 500 cases and 10 deaths. As of May 8, it has 56,342 cases and 1,886 deaths.
The numbers haven’t grown as quickly as many expected them to, an indicator that suggests the lockdown may have helped reduce the spread of the virus.
But worryingly, the lockdown doesn’t seem to have led to a downward trend in the number of new cases, as All India Institute of Medical Services Director Randeep Guleria, who is part of the country’s core Covid-19 team, has noted.
“The major problem right now is that we are not seeing a declining trend,” Guleria told Mint. “After 40 days of stringent lockdown, which got further extended, the case count should have come down. Many other countries have recorded a downward trend in their covid-19 curve.”
If you compare the number of daily new cases in India with other countries that went into a lockdown, often a lot less restrictive than India’s, they have tended to see an initial spike in cases followed by a peak after which number of new cases begins to come down.
India’s chart instead shows a steady rise in new cases.
The trends are somewhat hard to read for India, not least because each state has its own approach. But what is clear is that the infection numbers – and the rate of growth of new cases – are continuing to rise.
“According to figures shared by the Union Health ministry, the 7-day compounded daily growth rate of Covid-19 cases started dipping on April 8,” reported the Indian Express. “The overall downward trend continued till May 1 when the curve started rising again. Since May 3, the 3-day CDGR curve has remained above the 7-day CDGR.”
What this means is that even when India pulled out the nuclear option – a national lockdown that would mean the entire economy remains shut leaving millions in distress – the virus has continued to grow.
Why is the lockdown being eased?
Modi’s initial explanation for the lockdown was that it was meant to “break the chain of transmission” of the virus. If, by that, he meant eradicate Covid-19 from India by ensuring it doesn’t spread beyond those who already had it at the time, that has clearly not happened.
Over the last five weeks, the stated aim of the lockdown has also shifted constantly. First it was to break the chain of transmission. Then, on April 17, more than three weeks after the lockdown was announced, the government said it had reduced the “doubling time” of infections, meaning the number of days for cases to double.
Though that number has indeed come down from the early days of the lockdown, the government never identified a stated level it wanted to reach before it would start to relax restrictions.
India cannot claim to have reached the peak of new infections, or even a good sense of when that peak might come, since it moved into the lockdown so early.
What that means is that the easing of restrictions appears to be coming primarily because the country simply can’t afford to be shut for much longer. The effects on livelihoods and indeed lives would be too much, even if there is a clear explanation of what has changed now versus, say, three weeks ago.
However, this lack of a clear approach leaves open the possibility that what are now cluster containment zones – areas with a high number of cases where full lockdowns remain in place – will continue to grow if case counts go up.
A lockdown was never going to kill Covid-19
It is worthwhile remembering: no matter what the WhatsApp forwards about sunlight and clanging pots and pans may have said – and despite outrageous graphs put out by Indian authorities – the lockdown was never going to be a way for India to bring its infected count down to zero. That simply isn’t how highly infectious diseases work.
The idea of flattening the curve through social distancing – as we explained back at the start of March – is to reduce the number of people who get infected at the same time, so that the health system is not suddenly overwhelmed in a way that might lead to avoidable deaths.
A lockdown is the most extreme version of social distancing, since it is government mandated and comes at considerable cost to the economy and individuals. Its aim is to buy time for the authorities to prepare for a further outbreak and for health departments to ready hospitals and infrastructure for a deluge of patients.
Has this happened?
Authorities around the country have begun to prepare hospitals and care centres to treat Covid-19 patients. Some of this appears to have happened later than expected, with the Centre only enumerating health infrastructure at the district level in week five of the lockdown.
Similarly, although the internal migrant crisis was apparent from the very first few days of the lockdown, the Union Health Minister spoke to states only five weeks later about a strategy to prevent the spread of the virus into rural areas by migrants, who are finally being allowed to move. It is unclear why the government didn’t take this action before ordering that migrants can return home.
Bureaucratic mess-ups both in the procurement of Personal Protective Equipment and rapid testing kits have somewhat frittered away the time bought by the lockdown. This has meant that, even without a massive spike in numbers, hospitals in Mumbai – the worst-hit city so far – already appear overwhelmed.
Down to Earth took a close look at what the country did over the course of the lockdown, with conclusions that do not inspire much confidence.
Now, as cities and states open up, and people begin to gather and mix again, the numbers will inevitably go up. The lockdown was meant to prepare India for that second wave. Unfortunately, it is likely that the first wave has yet to recede.
Indian immunity, heat and Aarogya Setu: No magic solutions
As the virus rampaged through China, Western Europe and then the United States, many wondered why India wasn’t badly hit by Covid-19 – especially since nearby Iran saw a huge spike in cases.
Although some of that may have been down to India’s decision to prevent people from coming into the country and locking down early into the spread of the virus, many theories went around suggesting that maybe Indians had some sort of immunity to the disease, or that it didn’t spread as easily in hotter places.
There is as yet no conclusive evidence to suggest that Indians have any sort of natural immunity to the virus. Other theories have also yet to be substantiated, such as the suggestion that India’s lower numbers may have been aided by the BCG vaccine – meant to protect against tuberculosis.
A more pervasive trope was the idea that countries further north seemed to have a harder time handling the virus, giving hope that the hot and humid conditions expected in India over the next few months will reduce its spread.
A survey of existing research suggests that the virus does die out quicker if there is higher heat and humidity, but academics caution against presuming this will be a silver bullet, especially since dense cities like India’s or the usage of air conditioners could nullify those effects.
Finally, the government has pushed Aarogya Setu, a contact-tracing app, as a solution to the virus, just as it used the idea of a lockdown as a weapon with which to defeat Covid-19.
Aside from all the privacy concerns about the app, the simple fact is that it will at best complement existing approaches.
Contact-tracing apps work by recording everyone you come into close contact with over a set period of time. If one of them tests positive, everyone who has been in touch with that person is notified, while authorities can work to isolate and test all of those potential contacts. The apps are meant to complement the testing-tracing-isolating strategy that will have to be done by people on the ground.
For them to work, however, there needs to be a substantial amount of usage – which, even with India making the app nearly mandatory, might be difficult because of the tens of millions who still do not have smartphones. And the country also needs to be testing extensively. As it stands, no major economy is testing fewer people per million than India.
Moreover, the app does not itself fix anything. While it may assist a testing-tracing-isolating strategy, if India’s hospitals are unprepared for a surge of Covid-19 patients, the app will do little to help.
The density of India’s cities may also make its advisories meaningless, especially if its accuracy is as patchy as this post suggests:
This is not to say that contact tracing apps are unhelpful, just that the government seems to be selling them as a solution to the virus – just as it did with the lockdown – rather than appropriately representing them as just one of many tools that will have to work in concert for India’s Covid-19 response to be successful.
Don’t expect a vaccine soon
A tremendous amount of effort and money is being put into vaccine research.
The Associated Press says that about 100 research groups globally are pursuing vaccines, and a dozen are at the early stages of human trials. The European Union held a global fundraiser that eventually saw $8 billion contributed towards vaccine development. And various statements have been made about how, if everything works out there is hope of a vaccine later this year.
In the face of all of this, it is important to remember that vaccines usually take years to make it out of the testing stage alone. And once the testing is complete, there is still the matter of doing large-scale manufacturing and distribution at a time when the whole world wants to get its hands on a vaccine.
The New York Times has a handy explainer on what it actually takes to put together a vaccine.
Meanwhile, other approaches are also being looked at. For example, the United States and Japan have cleared the usage of the drug remdesivir for Covid-19 patients, since it appears to reduce the recovery time. India’s health ministry is looking into the production of the drug in the country, though it is important to remember that it will only be used to speed up recovery.
Other researchers have managed to isolate antibodies that can prevent infection. But previous treatments that have relied on antibodies have tended to be “high-cost, niche medicines available mainly in wealthy countries.”
In sum, few expect any sort of scalable medical solution in 2020. That means we have to make it through the rest of this year, at the very least, with the tools that we already have.
So, what happens next?
If it isn’t clear from the weight of all of those details, here is what is likely: the number of cases will continue to rise in India, and the danger of contracting the novel coronavirus will remain very real, even if the lockdown ends.
Containment zones and contact tracing might attempt to slow down the spread of the virus, but these tasks will become even more difficult for authorities once the lockdown has ended and people are mixing much more. Heat and humidity might have an effect, but India’s dense cities will remain vulnerable regardless.
That means we can expect numbers to keep rising over the next few months.
“Currently, the cases are continuing to grow at a flat rate, even more at times, so it’s very difficult to predict when the peak will come,” said Guleria, the AIIMS director. “But a peak is expected near June or July. That is the reason why we need to be prepared for it and more vigilant to bring the number of cases down.”
In fact, Guleria calls for the lockdown to be extended. Others have made the case for a waxing-and-waning of movement restrictions, as and when numbers spike, in order to prevent hospitals from being overwhelmed.
It is unclear as of yet what the government’s plans are for after May 17, when the third phase of the lockdown ends. But even if the government stops calling it a lockdown after that date, it is unlikely that life will return to normal.
Social distancing guidelines will remain in place – in public spaces, on public transport, in offices, on airplanes and beyond. Many countries have banned large gatherings until later in the year, and question marks remain about the future of businesses like gyms, bars, movie theatres, music concerts and sports leagues, all of which are difficult to operate without large crowds. Travel, especially across states and countries, will not be the same.
A global team of epidemiologists led by scientists from US-based University of Minnesota and Harvard TH School of Public Health estimated three different scenarios for Covid-19 cases over the coming months.
Their conclusion suggests that we have to be prepared to live with Covid-19 – and all the safety measures it necessitates – until 2022.
“Whichever scenario the pandemic follows (assuming at least some level of ongoing mitigation measures), we must be prepared for at least another 18 to 24 months of significant COVID-19 activity, with hot spots popping up periodically in diverse geographic areas,” the researchers said. “As the pandemic wanes, it is likely that SARS-CoV-2 will continue to circulate in the human population and will synchronize to a seasonal pattern with diminished severity over time.”