Via Financial Times

When Indian authorities ordered Mumbai, the country’s buzzing financial capital, to lock down to prevent the spread of coronavirus, it triggered a mass exodus of migrant workers.

Tens of thousands of people who normally drive taxis, run food stalls and work in other small businesses fled for their homes in rural India. Even the suspension of all inter-city train services and public buses failed to stop people streaming out of India’s cities, making long journeys home on foot as a sudden curfew brought most activities to a halt. 

On Tuesday, Prime Minister Narendra Modi ordered all of the country’s 1.37bn people to stay inside their homes for the next 21 days to try beat the virus. But many experts fear that migrant workers may have already unwittingly carried coronavirus into India’s rural hinterland, where the fragile health infrastructure is woefully unprepared to cope with a surge of critically ill patients. 

“Given that travel right now is our biggest source of infections, this great movement from cities to rural areas is only going to make it worse,” said Shamika Ravi, the director of research at Brookings India, a think-tank. “But there is a lockdown without an economic package, [so] what are people to do? They’ll walk home even if they don’t have trains.” 

The inability to anticipate the flight of migrant workers out of the big cities — or prevent it with a relief package and other initiatives to keep people in place — is symptomatic of India’s wider challenges in dealing with the virus. 

Until last week, Mr Modi’s government was assuring Indians that it had the outbreak under control, citing its travel restrictions on countries hit hard by the virus and its airport screening. 

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But with confirmed cases surging to 536 and 11 people already dead, Mr Modi was forced to act more decisively, bringing virtually all economic activities to a standstill. In a television address on Tuesday, Mr Modi said the curfew was necessary to prevent the deadly pathogen from “spreading like wildfire”.

It was a tacit admission that authorities have little idea how pervasive the virus is among the population, many of whom are vulnerable because of chronic malnutrition and ill health. 

Public health experts say New Delhi ignored warnings that airport screening was of little use, given coronavirus carriers could be asymptomatic for weeks. New Delhi also appeared ambivalent about increasing coronavirus testing, which experts warned was critical to trace how the virus was spreading and help slow transmission. 

“There was a denial about whether the epidemic would definitely come or not,” said an Indian public health expert involved in official coronavirus discussions. “This denial was more psychological than scientific. Science was always on the side of the inevitability of the epidemic.” 

New Delhi is now gearing up for what epidemiologists have warned will be an inevitable surge of coronavirus cases that would overwhelm the country’s chronically underfunded health system, which only has an estimated 70,000 intensive care beds and even fewer ventilators. 

In his address on Tuesday, Mr Modi announced a special $2bn allocation for medical supplies to tackle the disease, including protective equipment for doctors. 

“India is a country where in a crisis everything comes together,” said one senior government health official, who asked not to be identified.

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“The idea is to prepare for the surge. If the numbers that we see in the studies are correct, we will be having millions of people infected. Our current health system is not geared to respond to that number of people. Massive efforts are going on in terms of creating capacity.” 

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The government aims to set up specialised wards for coronavirus patients, some in normal hospitals, while others will be housed in other types of government facilities, including hostels, schools and sports facilities, to prevent the spread of the virus to other patients. 

While empty buildings may be available, specialised medical equipment will be harder to obtain, given the huge global demand. “It’s like the US in World War 2,” the health official said. “It’s like another war here. We’ll have to ask anyone who can to produce ventilators or personal protective equipment.” 

Tests too are still in short supply. “They are desperate for some tests,” said an executive at one testing company. “That’s the total sense I am getting.” 

As India begins its protracted lockdown, experts are ruing that India did not expand its restrictive testing protocol far earlier. The delay will cause even more difficulties for millions of poor families, already reeling from a long economic slowdown. 

“If you manage pre-emptive screening, surveillance and isolating, then you don’t need massive lockdowns later,” said Ms Ravi. “We are not investing in the knowledge required to stem this thing. It’s not just a health crisis. It’s a humanitarian crisis.” 

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Additional reporting by Stephanie Findlay in New Delhi.