India is in a crucial and especially dangerous phase of the coronavirus pandemic. With the relaxation of the national lockdown, public attention, media focus and the priorities of political leaders have shifted to other things. There is a sense — strengthened by Prime Minister Narendra Modi’s statement — that the lifting of the lockdown is progressive and linear, and Unlock 2 is sure to follow Unlock 1.
Cases are rising almost everywhere in the country, and the doubling rate is back to 18 days. Now, lifting the lockdown was necessary for reasons of survival, but it demanded that the administrative focus expand to ensure adequate physical and social distancing, hygiene and contact traceability. It also demanded that people be put on notice that in case the course of the pandemic worsens, we should expect more containment zones and lockdowns. These did not happen. So while an admirably large number of people and businesses are acting responsibly, our encounters with non-mask-wearing people and crowded public places is increasing. The public discipline of the lockdown period is fast eroding and way too prematurely.
It isn’t over till it’s over
The manner in which local administrations in many parts of India got into mission mode to control the pandemic over the past four months is admirable. War rooms in municipal and state governments across the country are witnessing some outstanding work by administrators and political leaders.
For instance, even amid a major outbreak in Maharashtra state and Mumbai city, the Brihanmumbai Municipal Corporation has succeeded in controlling the virus spread in the city’s Dharavi area from a growth rate of 12 per cent in April to just over 1 per cent in June. This performance reinforces the observation that India’s administration can perform much better than it normally does when it goes into mission mode.
The Kumbh Mela, for instance, is much better governed than an average city in Uttar Pradesh. That is why we should worry that the administrators’ performance will regress back to the normal — with damaging consequences to disease control — if the sense of being in mission mode gives way to a mindset of ‘business as usual’. The tentative gains of the past few months can be quickly lost to the coronavirus’s power of exponential growth. Many cities, especially Bengaluru, which managed to restrict the spread of the disease during the lockdown, are now reporting more cases with Severe Acute Respiratory Illness (SARI), Influenza-Like Illness (ILI) and “under investigation” cases — tell-tale signs of community transmission.
It does not help that the media is — perhaps understandably — on the lookout of success stories. Over the past couple of weeks, several journalists asked me why Bengaluru had done much better than other cities. My answer was that while the state and city officials have been working diligently, it is too early to make even tentative pronouncements, leave alone definitive ones. It is not over until it is over.
Outcomes depend on a trifecta of chance, course and choice. Luck matters. The back history matters. Decisions, how well they are executed and how well people cooperate, matter. It is only later, in the fullness of time, will we be able to conclude why some places fared better than others. Now, this kind of an answer does not make for a good news story, it doesn’t even have heroes and villains. Yet the more the media paints a picture of a successful “model” or “strategy”, the more the risk of people declaring victory and moving on as if things are back to normal again. Premature celebration can be treacherous and must be avoided.
A required ‘run rate’
We need a relentless focus on increasing testing, contact tracing and isolation — in all three types of places: those that seem to be doing well at the moment, those with a large number of cases, and those where we don’t really know what is happening.
Politicians and administrators do not like to see a large number of cases and, worse, the inevitable comparison with other places that seem to be doing better. This creates a tendency to reduce testing to reduce case figures — the consequence of which is a bigger, undetected outbreak and higher risk of community transmission.
To counter this, the Ministry of Health and Family Welfare must set a benchmark testing rate, while leaving it to state governments to decide how many they want to conduct. Currently, Goa (33,000/million), Jammu and Kashmir (23,000/million) and Delhi (18,700/million) far exceed the national average, which is around 5,000/million.
The Union government should set an initial benchmark of 2,500 tests per million population per week across states, districts and municipalities, until a minimum of 2 per cent (20,000/million) of their respective populations has been tested. This benchmark should be scaled up periodically, until a desired test positivity rate (number of positive tests as a fraction of the total number of tests) is achieved and then sustained at that rate on an ongoing basis. India should target a test positivity rate of less than 1 per cent (it currently stands at 7.8 per cent). Of course, this too can be gamed. Even so, setting targets and benchmarks ensures that administrators, media and the public will retain the ‘mission mode’ mentality for there is a “required run rate” to chase.
Aiming much higher
The Union government should also institute benchmarks for contact tracing and share best practices on how to achieve them. Not an arbitrary notification that the Union health ministry bureaucrats come up with, but a synthesis of the experience of various states and local administrators who have practical experience in dealing with the problem.
The rationale for the lockdown was to flatten the Covid-19 curve to enable raising required levels of healthcare capacity. While the lockdown has certainly succeeded in delaying a more rapid spread, figures are unavailable as to how much additional capacity — hospital beds and ICUs — were added in the past few months. That’s another benchmark for the government to set. A recent study by Geetanjali Kapoor and colleagues estimates that India has approximately 1.9 million beds (over 60 per cent of which are in private hospitals), 95,000 ICU beds, and 48,000 ventilators, concentrated in seven states. A good national target would be to double this, with states that have grossly inadequate hospital capacity helped to make an extra effort.
There are many Covid-19 dashboards showing the number of cases and deaths; we also need dashboards showing test rates, test positivity rates, hospital beds and ICUs, state-by-state and district-by-district. That way, there’s a lower risk of us dropping the ball.
The author is the director of the Takshashila Institution, an independent centre for research and education in public policy. Views are personal.