What did Narendra Modi do to curb COVID spread in India?

US president Donald Trump’s rather dramatic COVID-19 infection has put the global spotlight back on the coronavirus and how countries have dealt which the pandemic that has bedevilled the world since the beginning of this year. At the heart of the debate are essentially two questions. First, whether the measures taken by the governments of respective countries have been effective in containing the spread of the virus and second, what has been the effect of these measures on the economy of the country?

Any attempt to answer such a question for the purposes of evaluating a replicable model must also factor in the following parameters. First, whether the country is free and democratic or not, for totalitarian measures adopted by autocratic regimes are really not replicable models for the rest of the world. Second, is the country large enough in terms of both population and area. Finally, is the country globally connected and diverse, for relatively remote countries with little global traffic may have managed to isolate themselves in a way which is again not replicable for much of the world.

With these caveats in place, let us look at the performance of India and assess whether India offers a model or not?

As of 6 October 2020, the worldometers.info website reports total cases in India at 6.68 million and total deaths at 103,600. This puts India as the second most infected country, just after USA, and the third in list with most deaths, after USA and Brazil. So, should we just stop here and declare India is a failed case? Or is there more to the story?

While many countries are yet to resolve lives versus livelihood debate to any degree of certainty, India got both ends of the spectrum broadly right. The “Jaan Bhi, Jahaan Bhi” (life as well as livelihood) paradigm of India saw among the strictest early lockdowns which broke the initial exponential chain, while the economy is also on recovery track much earlier than predicted

- Akhilesh Mishra

Let’s look at another data. Total combined population of the Top 15 most infected countries (minus India) as of 6 October, is 1.49 billion. India’s population is in the same ballpark range at 1.38 billion. How does the combined data of the Top 15 most infected countries compare with India? Total 21.4 million cases in the Top 15 and total deaths at 721,598. For India the equivalent numbers are 6.68 million and 103,600. Total combined cases per million in Top 15 infected countries is 14,316 while that for India is just 4,830. For total deaths, the equivalent numbers are 481.8 and 75. The Top 15 include such countries as the USA, UK, France and Spain — all countries with much more advanced health systems than India!

Comparing India with the world

Let’s consider another data set based on when countries first achieved their highest score on Oxford University COVID-19 Government Response Stringency Index.

On 21 March, when the USA first achieved its highest score (72.69), it had 16.24 daily confirmed COVID cases per million.

On 26 March UK (75.93) already had 21.39 daily confirmed COVID cases per million population, 2.74 daily deaths per million population and 10.22 total COVID deaths per million population.

On 30 March, Spain (85.19) already had 123.33 daily confirmed COVID cases per million population, 17.92 daily deaths per million population and 139.62 total COVID deaths per million population.

Similarly, on 12th April, Italy (93.52) already had 77.64 daily confirmed COVID cases per million population, 10 daily deaths per million population and 322 total COVID deaths per million population.

On 6 May, Brazil (81.02) already had 32.63 daily confirmed COVID cases per million population, 2.82 daily deaths per million population and 37.27 total COVID deaths per million population.

In contrast to all these examples, when India first achieved its highest score (100%) on the Stringency Index on 25 March, it had only 0.04 daily confirmed COVID cases per million population, 0 daily deaths per million population and less than 0.01 total COVID deaths per million population.

What has been the result of this extraordinarily quick decision making by India?

As of 6 October, UK has 7,584 total cases per million population, Spain is 18,239, Italy is 5,420, Brazil is 23,138 and the USA is 23,135, compared to India’s just 4,830 total cases per million population. Similarly, with respect to COVID deaths, as of 6 October, UK has 623 total deaths per million population, Spain is 689, Italy is 596, Brazil is 689 and the US is 648, in contrast to India’s just 75 total deaths per million population.

India's size and demographic

Let’s look at a third data set. With almost equivalent combined population, Europe (740 million) and North America (540 million) together have 14.6 million cases and 542,311 deaths despite having much stronger health systems, as compared to India — 6.68 million cases and 103,600 deaths.

Consider Sweden, which adopted a model different from much of the democratic world — no lockdown and more reliance on herd immunity. Sweden has 5,895 COVID deaths, i.e. 584 deaths per million population. If we extrapolate Sweden’s deaths per million number to India’s population, it would equal 805,920 deaths. This is despite the fact that Sweden is 30 times richer than India and with a much lower population density. It has one of the best public health care systems in the world and a highly aware population.

So, the question then is, what did India do right that has kept it per million total cases and more importantly per million total deaths significantly below peers, despite having much greater population density than the richer countries of Europe and USA and relatively weaker health systems?

First, India was among the quickest to react at the government and institutional level. China notified the world on 7 January about the Wuhan virus. India had a mission meeting on 8 January itself and started screening passengers from 17 January, among the first countries in the world to do so. First case in India was detected on 30 January and aggressive containment and screening measures were instituted then and there. On the other end of the spectrum, India was among the first to introduce Rapid Antigen Tests along with RT-PCR tests. India was criticised initially for this strategy but now the WHO itself has adopted this model and promoting it the world over. Similarly, large parts of India made masks mandatory way back in April itself, with Modi himself wearing masks in public since early April, while the WHO waited till June before recommending it the world over.

Decisive national lockdown

Second, India set the template by imposing firm and decisive national lockdown at a very early stage of the virus spread. When India imposed a complete lockdown on 24 March, it had just about 500 total country wide cases. India could have waited or delayed imposing a lockdown and risked going down the European or USA trajectory. At the time of lockdown in third week of March, India was just about entering into the exponential phase. The growth rate of new cases had increased from 10.9% to 19.6% in just one week and the doubling time was just over 3 days. That is when Prime Minister Narendra Modi took the decision to impose a national lockdown, which till then no other country had taken so early. This one decision changed India’s trajectory. As of today, the doubling rate in India is 51.4 days. As per various estimates, the lockdown prevented approximately 2 million cases and 60,000 deaths that were projected to happen by May end itself. If that had happened, the cumulative growth numbers by now on India’s population size would have been catastrophic.

According a paper recently published in the globally respected Science journal, the Rt=Effective Reproductive number i.e. the number of contacts a positive case would infect, was 4 to 5 persons before the lockdown in two states (Tamil Nadu and Andhra Pradesh) where the research was done. But after lockdown, it declined dramatically, and notwithstanding fluctuations, ultimately this rate is only between 1 to 1.5 (Rt=1-1.5). The spread of COVID-19 infection was thus dealt a permanent blow during the lockdown.

Third, Prime Minister Modi built a national and voluntary model of participatory compliance. The behavioural change required to deal with the pandemic, at such a large population scale in a democratic society, was not easy. Modi understood it could only be done through a participative model. From the Janta curfew (people’s curfew) before the lockdown to periodic national addresses to Modi himself wearing masks in all his public appearances — the responsible leadership template was set at the highest executive level itself.

Relatively very low death count

Fourth, the lockdown was not wasted but utilised to build capacities. As an example, India before the lockdown manufactured zero PPE kits — everything was imported. Today it manufactures almost a half-a-million PPE kits per day! As of today, there are almost 1.5 million dedicated isolation beds, almost 250,000 oxygen supported beds and more than 60,000 ICU beds. In January 2020, India had only one testing lab. Today India has 1869 labs. In January 2020, per day testing capacity was less than 500 tests. Today it is 1.5 million tests per day! It is this kind of ramping up of facilities during the lockdown that prevented hospital facilities from being overwhelmed when the lockdown was eased and has kept India’s death count relatively very low as compared to peer countries.

Fifth, India timed its unlock process just about right. The first quarter of India’s fiscal year (April-June 2020) was a washout as is the case with almost every other country. However, latest data available for the month of September is indicative of a recovery much sharper and widespread than anyone previously imagined. Manufacturing PMI was at 56.8, which is the highest after 2012! Exports in September were up 5.27% YoY; Railway freight loading was at 102.12 MT, which is up 15% YoY and the highest ever; Petrol sales are back to January 2020 levels; power demand is up 4.6% YoY; GST collections are almost back to pre-COVID period; India’s biggest car-maker (Maruti) saw a 30.8% increase in sales YoY while India’s biggest two wheeler manufacturer registered a 16.9% sales increase YoY.

The real estate benchmark market of Maharashtra registered similar trends. Daily average property registrations were the highest in September 2020 after May 2019! E-Way bills generated in September was the highest ever, pointing towards a healthy road traffic as well.

What this has meant is that while many countries are yet to resolve lives versus livelihood debate to any degree of certainty, India got both ends of the spectrum broadly right. The “Jaan Bhi, Jahaan Bhi” (life as well as livelihood) paradigm of India saw among the strictest early lockdowns which broke the initial exponential chain, while the economy is also on recovery track much earlier than predicted.

Prime Minister Narendra Modi has had to make some very difficult calls at various points of time during the course of what is still an ongoing pandemic. Till now, he has been on the mark and for a country of such diversity and scale as India, Modi has created a template of decision making which can serve as an useful model for the democratic world.