How successful was India’s lockdown?
India, a country of 1.2B people went into severe lockdown on 23rd March, when it had only ~500 cases(20,000+ tests) of COVID-19. All cases till then were related to International travelers & their family. A random testing of 500 SARI patients showed no signs of community transmission. All international borders were closed. A strict no-movement policy & ban on district-district movement was enforced. It was probably not too foolish then to expect that the disease would completely go away soon.
But, we probably completely underestimated the contagiousness of COVID & it’s severe impact on high density regions. With such high population & a long lockdown, cluster outbreaks were bound to happen and they did! In 3 months, it has brought three of India’s most populous cities — Delhi, Mumbai & Chennai to its knees. But, the government has kept “opening” the country since then & unleashed a “Unlock-1” on Jun 1st with mixed responses. This has led to some criticism & wide-spread misuse of statistics just to prove one’s point. Like below, from the leader of India’s grand old party (the absurdity of which I will not even go into):
So, what actually happened?
In the above graph, the most basic error is comparing countries with 50–100M population with a gigantic dense “sub-continent”. And the devil always hides in the details.
India state and central governments came up with a slick method to isolate each district & further divided them into Red, Yellow & Green zones based on trend of active cases.
All major Indian states (population>30M) can be sub-divided into three distinct categories: Successful, partially-successful & unsuccessful based on the level of outbreak control they achieved post lockdown.
Successful States
These states managed to flatten the curve to various degrees & had lot of green zones by May. They managed to isolate clusters if any(Ex: Mysuru), tested extensively (enough to keep cases/test below a staggering <5% in all and <2% in many states), enforced strict lockdown & it bore fruit.
Green line marks the beginning of lockdown. Red line marks the coming home of 10M+ migrants workers from states with high cases(They are isolated but I do not have a way of removing them from the data. Let me know if you do). That spike in the end should go down in 2–3 weeks once all travelers are tested.
These 8 states shown have a combined population of 620M (62 Cr). There are others like Haryana, Assam which I have not shown. In total, >60% of the country achieved this result, which is staggering. The silicon city of Bengaluru with 10M+ population has only ~500 cases till date! The state of Kerala which saw India’s first case even managed to get active cases down to a mere 30.
Note: As of 22nd June, 4836 out of 9399 of Karnataka’s cases are of people who returned from Maharashtra (link). UP, OR, BH have a much higher migrant population returning! Hard to believe how many cases are originating from MH.
Partially Successful States
These states account for 12% of India’s population & managed to handle the pandemic with mixed results. There were many major cluster outbreaks — Tablighi Jamat (which hit TN, DL especially hard), Koyambedu market etc.
India’s two metro cities — Chennai & Delhi are hit hard with >20% of tested cases being positive recently. A big positive here is that TN is testing more than any other state hence detecting cases even in asymptomatic contacts which explains the stunning<1% mortality rate. On the other end, DL and GJ are seriously lacking in testing
Unsuccessful states
MH & WB are two of the bigger states with high population densities (200M, 16% of India). Due to various issues of highly crowded places (Dharavi Covid Outbreak — Asia’s biggest slum), migrant agitations & ineffective governance, cases have continued to increase. It becomes really hard to contain in cases of big slums having common toilets!
Mumbai, India’s financial capital has been the center of outbreak, while monickers like India’s New York City (19% of India’s total cases in Mumbai). WB especially has seen several lockdown violations & that may just be a part of the problem.
Supplementary Statistics
Growth rate of cases in India is well below other major outbreak countries.
In most regions (except parts of MH, TN, DL & GJ), testing has been high & sufficient. For a country with huge population, stats like Test/Million make no sense. Better ways to track testing sufficiencies is Cases/Test and Deaths/Case, both of which are low in India. For Ex: NYC in its peak had 30% and Mumbai now has 20% of tested cases positive. This can only happen when only the severe symptomatic cases are being tested. In most successful states, Cases/Test are well below 2% which is exemplary (shows they are testing a lot of contacts & asymptomatic people). Death rate of under 3% with already >50% recoveries is a staggering number compared to other countries (Death rate is a maturing number)
Contact Tracing correlation
Most of the “successful” states occupy the top half of the table below and it is not a coincident. Wider the net casted, higher the chance of early identification of clusters. With 47 contacts tested for each positive case, Karnataka leads the list by a huge margin. Is it any wonder that it’s capital city Bengaluru has only 500 odd cases!?
TN is an exception here. Thanks to aggressive testing, >80% cases are asymptomatic. This also explains why it has <1% death rate & . But, this also rings a lot of alarm bells as to the true number of cases in other outbreak regions!
What to do from here? A 10 point plan …
0. Treat healthcare workers & other essential workers with utmost respect & enforce rules against obstruction of their activities
- The method of dividing regions into Green and “containment” is spot-on. The implementation of such rules has to be strict from here on though. Highly dense cities, especially Mumbai, Delhi & Chennai to be locked down ASAP
- Wide spread contact tracing. It has proven effective throughout the world
- Religious places, though they are important to many, must remain closed. We have seen enough clusters starting from people spending time in enclosed spaces. In India, people have the habit going to Temples, Mosques & Churches on a daily/weekly basis. This can lead to disastrous consequences. At the very least, a no talking policy to be implemented (virus spreads mostly through bodily fluids). If people want to pray, let them do so silently — Need I remind patient 31 from S.Korea? The Choir group from New Rochelle?
- Strict quarantine of all positive cases & travelers from outside to be enforced like before
- No gatherings of any sort. Malls, Cinemas should remain closed (in place). Remember, longer the exposure, higher the risk of spreading
- Masks & social distancing compulsory (in place)
- If possible, even at the cost of economy, close state-state borders at the minimum and district-district borders at max. Major cities to remain closed off
- Stricter rules by municipalities in high density areas. Restrictions on movement, public spaces, markets etc.
- High scale up in testing, esp. in MH, GJ, TN & DL [It is hard for new labs to start testing though — many requirements, including biosafety]
- Stay at & work from home unless necessary
Conclusion
India’s lockdown was majorly a success, so much so that I shudder to think of what would’ve happened if not for such strict restrictions. Before joining the bandwagon of curated idiotic reports making claims for political gains, do some digging on your own. Stats are dangerous in the wrong hands.
India still has a long long way to go to contain this outbreak till a more feasible solution shows up(drug, vaccine etc.). Especially, bringing down the outbreak in three of India’s major cities will be a huge challenge. Also, preventing further clusters from the “successful” states will be crucial. As much as possible, stay home & educate people around you on this aspect. Wear a mask, be safe!
Part 2 of the article : https://medium.com/@sk4356/indias-lockdown-current-scenario-analysis-part-2-c1bd415a1066
Acknowledgement: The plots of Active case counts is from this amazing dashboard(&API). Do check it out: https://www.covid19india.org/