A disease can be way more fatal than a

bullet shot on a person.

Covid-19
And its effects on India

Himesh Martha
COVID-19 pandemic in India
The COVID-19 pandemic in India is part of the worldwide
pandemic of coronavirus disease 2019 (COVID-19) caused by
Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2).
The first case of COVID-19 in India, which originated from China,
was reported on 30 January 2020. India currently has the largest
number of confirmed cases in Asia. As of 23 May 2021, India has the
second-highest number of confirmed cases in the world (after the
United States) with 26.7 million reported cases of COVID-19

infection and the third-highest number of COVID-19 deaths (after

the United States and Brazil) at 307,231 deaths.
The first cases of COVID-19 in India were reported in the towns of
Thrissur, Alapphuza and Kasargod, all in the state of Kerela, among
three Indian medical students who had returned from Wuhan.
Lockdowns were announced in Kerala on 23 March, and in the rest
of the country on 25 March. By mid-May 2020, five cities accounted
for around half of all reported cases in the country: Mumbai, Delhi,
Ahmedabad, Chennai and Thane. On 10 June, India's recoveries
exceeded active cases for the first time. Infection rates started to
drop in September, along with the number of new and active cases.
Daily cases peaked mid-September with over 90,000 cases reported
per-day, dropping to below 15,000 in January 2021.

A second wave beginning in March 2021 was much larger than the
first, with shortages of vaccines, hospital beds, oxygen cylinders
and other medicines in parts of the country. By late April, India led
the world in new and active cases. On 30 April 2021, it became the
first country to report over 400,000 new cases in a 24-hour period.
Health experts believe that India's figures have been underreported
due to several factors.

India began its vaccination programme on 16 January 2021, and by

April was administering 3–4 million doses a day. India has
authorised the British Oxford-AstraZeneca vaccine (Covishield), the
Indian BBV152 (Covaxin) vaccine, and the Russian Sputnik V
vaccine for emergency use. As of 25 May 2021, the country had
administered over 200 million vaccine doses.

Timeline
2020:
On 12 January 2020, the WHO confirmed that a noval coronavirus
was the cause of a respiratory illness in a cluster of people in
Wuhan, Hubei, China, which was reported to the WHO on 31
December 2019.
On 30 January 2020, India reported its first case of COVID-19 in
Thrissur, Kerela, which rose to three cases by 3 February 2020; all
were students returning from Wuhan. Apart from these, no
significant rise in transmissions was observed in February. On 4
March, 22 new cases were reported, including 14 infected members
of an Italian tourist group. Transmissions increased over the month
after several people with travel history to affected countries, and
their contacts, tested positive. On 12 March, a 76-year-old man,
with a travel history to Saudi Arabia, became the first COVID-19
fatality of India. A Sikh preacher, who had a travel history to Italy
and Germany, turned into a superspreader by attending a Sikh
festival in Anandpur Saheb during 10–12 March. 27 COVID-19 cases
were traced back to him. Over 40,000 people in 20 villages in
Punjab were quarantined on 27 March to contain the spread.

On 31 March, a Tablighi Jamaat religious congregation event in

Delhi, which had taken place earlier in March, emerged as a
superspreader event, after numerous cases across the country were
traced back to it. On 18 April, the Health ministry announced that
4,291 cases were directly linked to the event. As of 4 April, about
22,000 people who came in contact with the Tablighi Jamaat
missionaries had to be quarantined.
On 2 May, around 4,000 stranded pilgrims returned from Hazur
Sahib in Nanded, Maharashtra to Punjab. Many of them tested
positive, including 27 bus drivers and conductors who had been
part of the transport arrangement. By 13 May, 1,225 pilgrims had
tested positive.
In July 2020, it was estimated based on antibody tests that at least
57% of the inhabitants of Mumbai's slums may have been infected
with COVID-19 at some point.
A government panel on COVID-19 stated in October 2020 that the
pandemic had peaked in India, and could come under control by
February 2021. This prediction was based on a mathematical
simulation referred to as the "Indian Supermodel", assuming that
India reaches herd immunity. That month, a new SARS-COV-2,
Lineage B.1.617, was detected in the country.

2021:
India began its vaccination programme on 16 January 2021. On 19
January 2021, nearly a year after the first reported case in the
country, Lakshadweep became the last region of India to report its
first case. By February 2021, daily cases had fallen to 9,000 per-day.
However, by early-April 2021, a major second wave of infections
took hold in the country; on 9 April, India surpassed 1 million active
cases, and by 12 April, India overtook Brazil as having the second-
most COVID-19 cases worldwide, behind only the United States.
Multiple factors have been proposed to have potentially contributed
to the sudden spike in cases, including highly-infectious variants of
concern such as Lineage B.1.617, a lack of preparations as
temporary hospitals were often dismantled after cases started to
decline, and new facilities were not built, and health and safety
precautions being poorly-implemented or enforced during
weddings, festivals (such as Holi on 29 March, and the Haridwar
Kumbha Mela in April), sporting events (such as IPL), state and in
several states, and in public places. An economic slowdown put
pressure on the government to lift restrictions, and there had been
a feeling of exceptionalism based on the hope that India's young
population and childhood immunisation scheme would blunt the
impact of the virus. Models may have underestimated projected
cases and deaths due to the under-reporting of cases in the country.
The Haridwar Kumbh Mela was linked to at least 1,700 positive
cases between 10 and 14 April alone, and 68 cases among Hindu
seers between 5–14 April. Politicians and activists have been
criticised for holding rallies during the pandemic. Due to high
demand, the vaccination programme began to be hit with supply
issues; exports of the Oxford–AstraZeneca vaccine were
suspended in order to meet domestic demand, there have been
shortages of the raw materials required to manufacture vaccines
domestically, while hesitancy and a lack of knowledge among
poorer, rural communities has also impacted the programme.
By late April, India passed 2.5 million active cases and was
reporting an average of 300,000 new cases and 2,000 deaths per-
day. Some analysts feared this was an undercount; epidemiologist
Bhramar Mukherjee has estimated that the actual death toll of the
pandemic in India may be two to five times higher than the official
totals. On 26 April, India reported 350,000 new cases and over
2,800 deaths in one day. On 30 April, India reported over 400,000
new cases and over 3,500 deaths in one day.
The second wave placed a major strain on the healthcare system,
including an ongoing shortage of liquid medical oxygen due to
unanticipated demand, delays in transport, and a lack of cryogenic
tankers. On 21 April, 22 COVID-19 patients who required
ventilators died at a hospital in Maharashtra after an accident
caused a leak in its main oxygen supply. On 23 April, Modi met via
videoconference with liquid oxygen suppliers, where he
acknowledged the need to "provide solutions in a very short time",
and acknowledged efforts such as increases in production, and the
use of rail (with the Indian Railways transporting tankers via
"Oxygen Express" trains) and air transport to deliver oxygen
supplies. On 25 April, the PM CARES Fund announced that it would
allocate funding to install 551 oxygen plants using pressure
swing adsorption at public health facilities.
A number of countries announced that they would provide
emergency aid to India. European Union member states
announced that they would send oxygen supplies, medicines and
ventilators through the EU Civil Protection Mechanism. The
United Kingdom planned to send oxygen concentrators and
additional ventilators. Following political pressure, the United States
offered to provide personal protective equipment and to lift export
controls on vaccines and their materials in order to send raw
materials for producing the Oxford–AstraZeneca vaccine. This was
the first time in 16 years that India started accepting gifts,
donations and aid from foreign nations, including buying equipment
from China. Head of the U.S. National Institute of Allergy and
Infectious Disease (NIAID) Anthony Fauci stated that the country
had not ruled out sending supplies of the AstraZeneca vaccine—
which has not yet been approved in the U.S.—to India.
On 8 May, The Lancet published a report which estimated that
India might reach as many as one million deaths by August 2021.
The number of new cases had begun to steadily drop by late-May;
on 25 May, the country reported 195,994 new cases—its lowest
daily increase since 13 April. However, the mortality rate has
remained high; by 24 May, India had become the third country after
the United States and Brazil to exceed 300,000 deaths attributed to
COVID-19. Around 100,000 deaths had occurred in the last 26 days,
and 50,000 in the last 12.
On May 31st 2021, the World Health Organization declared that the
B.1.617.2 COVID variant first found in India will be referred to as
'Delta' while an earlier found variant in the country (B.1.617.1) will
be known as 'Kappa'.

India's two waves versus Delhi's four waves in the same time period taking into
account daily COVID-19 cases.

Response
Health care and testing:
The Union Health Minister's war room and policy making team in
New Delhi decide how coronavirus should be tackled in the country,
and consists of the ministry's Emergency Medical Response Unit,
the Central Surveillance Unit (IDSP), the National Centre for
Disease Control (NCDC) and experts from three government
hospitals among others. In March 2020, India's strategy was
focused on cluster-containment, similar to how India contained
previous epidemics, as well as "breaking the chain of transmission".
52 labs were named capable of virus testing by 13 March.
On 14 March 2020, scientists at the National Institute of
Virology (NIV) isolated a strain of the novel coronavirus. India was
the fifth country to successfully obtain a pure sample of the virus.
The Indian Council of Medical Research (ICMR) said that
isolation of the virus will help towards expediting the development
of drugs, vaccines and rapid diagnostic kits in the country. NIV has
shared two SARS-CoV-2 genome sequences with GISAID. In May,
the NIV introduced another antibody test kit ELISA for rapid testing,
capable of processing 90 samples in a single run of 2.5 hours.
COVID-19 Dashboard
339,039,86
Total samples tested
1
Total positive cases 27,718,520
New samples tested 2,070,508
New Positive cases 170,815
New Positivity Rate 8.24%
Total active cases 2,227,540
Total deaths 322,364
Total recovered cases 25,168,616
205,720,66
Total Doses administered
0
People vaccinated 1st 161,850,09
dose 2
People vaccinated 2nd
43,870,568
dose Do's & Don'ts of COVID-19 released by
As of May 28, 2021 Government of India.

Initial testing:
Initially, the labs tested samples only from those with a travel
history to 12 countries designated as high-risk, or those who had
come in contact with anyone testing positive for the coronavirus, or
showing symptoms as per the government guidelines. On 20 March
2020, the government decided to also include all pneumonia cases,
regardless of travel or contact history after the country saw a sharp
increase in the number of cases. The first and second confirmatory
tests for the virus has been made free by the government. On 9
April, ICMR further revised the testing strategy and allowed testing
of the people showing symptoms for a week in the hotspot areas of
the country, regardless of travel history or local contact to a patient.
The Ministry of Health said that only 10 per cent of test capacity
had been used per day till 15 March 2020, claiming that the number
of tests was enough. However experts thought they were not,
saying that community transmission may go undetected without
adequate testing. They also wanted to add more testing centres by
including private laboratories. In mid-March the government
authorised accredited private labs to test for the virus.

Expansion of tests:
On 17 March 2020, the Union Ministry of Health decided to allow
private pathology labs to test for COVID-19. The ministry said that
National Accreditation Board for Testing and Calibration Laboratories
(NABL) accredited laboratories may soon be allowed. Once set up, a
person could get a COVID-19 test at a private lab after a qualified
physician in a government facility recommended it. The ICMR
appealed private labs to offer the tests for free as the government
labs do.
On 18 March, the Indian arm of Roche Diagnostics was given Food
and Drug Administration (FDA) emergency approval to conduct
tests for COVID-19. At the end of March 2020 the government also
issued guidelines to cap the cost of sample testing by private labs
at ₹4,500.
On 19 March, Ramanan Laxminarayan, director of the Center for
Disease Dynamics, Economics & Policy stated that India could
be facing a "tsunami of cases within a few weeks" as testing
increases and the reason for the low number of confirmed cases
currently is due to under-testing. He also said that according to
mathematical models applied in the US or UK at least 20%–60% of
the population will be affected. Applying the same models in India
means that at the lower end of the estimate there could be 300
million cases of which 4–8 million could be severe.
111 additional labs for testing became functional on 21 March. On
24 March, Pune-based molecular diagnostic company Mylab
Discovery Solution became the first Indian company to have
received regulatory validation for its RT-PCR tests. In April,
Institute of Genomics and Integrative Biology, Delhi had
developed a low cost paper-strip test that could detect COVID-19
within an hour. Each test would cost ₹500.00 (US$7.00). On 13
April, ICMR advised pool testing in the low infection areas with a
positivity rate less than 2% to increase the capacity of the testing
and save resources. In this process maximum five samples are
tested at once and samples are tested individually only if a pool
tests positive. On 16 April 2020, 650,000 rapid antibody test and
RNA extraction kits were dispatched from China, and over 2
million kits were to be sent in next 15 days. On 21 April, health
department of West Bengal alleged that large number of testing
kits supplied by ICMR-NICED were giving inconclusive results. ICMR-
NICED admitted that there was problem in the kits and said that
they were addressing the issues. Rajasthan stopped using rapid
testing kits as they were giving low accuracy of 5.4% as compared
to expected 90% accuracy. Later, ICMR advised all states to stop
using rapid testing kits for next two days until their on-ground
teams validates these kits. The Chinese manufactures of the rapid
testing kits said that the testing kits were approved by ICMR and
that the problem was not with the kits but with the way they were
being used. However, Chinese manufacturers promised to
cooperate with Indian authorities to resolve the issue. Amid this,
ICMR asked states to return the faulty kits which would be sent back
to the Chinese suppliers. Order for remaining kits were cancelled.
Lockdowns:
First wave: Nation-wide
The Epidemic Diseases Act, 1897
and Disaster Management Act,
A passenger being tested for Covid-19 at 2005 was invoked in mid-March
the New Delhi railway station during 2020. All commercial domestic and
second wave of the pandemic. international flights were suspended
in March. A number of cities and states
announced that they would restrict
public gatherings, dine-in
restaurants, or order the closure of
various non-essential businesses
through 31 March to slow the spread
of A testing facility at the National Centre for COVID-19. On 19 March 2020, Prime
Disease Control in Delhi. Minister Modi asked all Indians to
observe a 14-hour Janata curfew ("people's curfew") on 22 March,
and to thank essential workers by clapping or ringing bells at 5 p.m.
outside their homes. The curfew was used to evaluate the feasibility
of a national lockdown.
On 24 March, with 519 confirmed cases and 9 deaths in the country,
the Prime Minister announced that India would be placed under a
"total lockdown" for at least three weeks. All non-critical
businesses and services were ordered closed except for hospitals,
grocery stores, and pharmacies, and there was a "total ban" on
leaving the home for non-essential purposes. All public transport
was suspended.
On 16 April, districts were divided into zones using a colour-coded
tier system based on incidence rates, classified as a "Red"
(hotspot), "Orange", or "Green" (little to no transmission) zone. All
of India's major cities fell into Red zones. Beginning 20 April,
agricultural businesses and stores selling farming supplies were
allowed to resume operation, as well as public works programmes,
cargo transport, and banks and government centres distributing
benefits. Phase 3 and 4 of the lockdown extended till 31 May, with
incremental relaxations and changes. The country began a phased
lifting of restrictions on 8 June. This phased lifting of restrictions
continued in a series of "unlocks" which extended into November
2020.
The government was criticised for not utilising the lockdown to
prepare the health system for when the lockdown would be lifted.
Second wave: State-wide and localized
Cities in Maharashtra such as Amravati and Nagpur started
imposing curfew restrictions and lockdown measures in late
February and early to mid-March 2021. On 4 April, Maharashtra
imposed a weekend lockdown and night curfew among other
restrictions. By early to mid-May, 35 of 36 of India's states and
union territories had some form of state-wide and localized
restriction. The second wave of the pandemic in India has seen no
nationwide lockdown. Phased unlocking was announced starting
June in Delhi, Tamil Nadu, Maharashtra, Uttar Pradesh and a number
of other states.

Impact:
Displacement of migrant workers:
The 2020 lockdown left tens of millions of migrant workers
unemployed. With factories and workplaces shut down, many
migrant workers were left with no livelihood. They thus decided to
walk hundreds of kilometres to go back to their native villages,
accompanied by their families in many cases. In response, the
central and state governments took various measures to help them.
The central government then announced that it had asked state
governments to set up immediate relief camps for the migrant
workers returning to their native states, and later issued orders
protecting the rights of the migrants.
In its report to the Supreme Court of India on 30 March 2020, the
central government stated that the migrant workers, apprehensive
about their survival, moved in the panic created by fake news that
the lockdown would last for more than three months. In early May,
the central government permitted the Indian Railways to launch
"Shramik Special" trains for the migrant workers and others
stranded, but this move had its own complications. On 26 May, the
Supreme Court admitted that the problems of the migrants had still
not been solved and ordered the Centre and States to provide free
food, shelter and transport to stranded migrant workers.

Education:
On 16 March 2020, the union government ordered the closure of
schools and colleges. On 18 March, Central Board of Secondary
Education (CBSE) released revised guidelines for examination
centers incorporating social distancing measures. On 19 March,
CBSE and JEE examinations for the Indian Institute of
Technology and other engineering college admissions were
postponed. States across the country postponed or cancelled school
examinations; younger students were either automatically
promoted or promoted based on prior performance. The Union
Public Service Commission also postponed the interview for the
Civil Services Examination. Only a few educational institutions in
India have been able to effectively adapt to e-learning and remote
learning; the digital divide is further impacted by serious
electricity issues and lack of internet connectivity.
Economy:
Due to limited social movement restrictions during the second wave
relative to lockdown measures during the first wave, the economic
impact of the second wave to date is less severe than that of the
first wave. Socio-economic indicators such as power demand,
labour participation, and railway freight traffic fell less during the
second wave as compared to the first wave. The first wave has
strengthened domestic economic resilience, visible during the
second wave, despite the severity of the second wave. The Indian
Finance Ministry, in their Monthly Economic Review for April 2021
released on 7 May 2021, wrote that "economic activity has learnt to
operate 'with Covid'". Since the beginning of the pandemic in India,
poverty has increased, and livelihoods have been affected.

Indian stock markets witnessed a flash crash on 2 March 2020 on

the back of the Union Health Ministry's announcement of two new
confirmed cases. On 12 March 2020, Indian stock markets suffered
their worst crash since June 2017 after WHO's declaration of the
outbreak as a pandemic. On 23 March 2020, stock markets in India
posted its worst losses in history. SENSEX fell 4000 points (13.15%)
and NSE NIFTY fell 1150 points (12.98%). However, on 25 March
2020, one day after a complete 21-day lock-down was announced
by the Prime Minister, SENSEX posted its biggest gains in over a
decade. The domestic stock markets have been in a positive rally
from October 2020 to April 2021.