The impact of COVID-19 and the policy response in India

Subscribe to global connection, maurice kugler and maurice kugler professor of public policy, schar school of policy and government - george mason university @kugler_maurice shakti sinha shakti sinha senior fellow - world resources international (wri india).

July 13, 2020

Much has been written about how COVID-19 is affecting people in rich countries but less has been reported on what is happening in poor countries. Paradoxically, the first images of COVID-19 that India associates with are not ventilators or medical professionals in ICUs but of migrant laborers trudging back to their villages hundreds of miles away, lugging their belongings. With most of the economy shut down, the fragility of India’s labor market was patent. It is estimated that in the first wave, almost 10 million people returned to their villages, half a million of them walking or bicycling. After the economic stoppage, the International Labor Organization has projected that 400 million people in India risk falling into poverty .

Agriculture is the largest employer, at 42 percent of the workforce, but produces just 18 percent of GDP. Over 86 percent of all agricultural holdings have inefficient scale (below 2 hectares). Suppressed incomes due to low agricultural productivity prompt rural-urban migration. Migration is circular, as workers return for some seasons, such as harvesting.

Evidence of Indian labor market segmentation is widely available—with a small percentage of workers being employed formally, while the lion’s share of households relies on income from self-employment or precarious jobs without recourse to rights stipulated by labor regulations. Only about 10 percent of the workforce is formal with safe working conditions and social security. Perversely, modern-sector employment is becoming “informalized,” through outsourcing or hiring without direct contracts. The share of formal employment in the modern sector fell from 52 percent in 2005 to 45 percent in 2012. During this period, formal employment went up from 33.41 million to 38.56 million (about 15 percent), while nonagricultural informal employment increased from 160.83 million to 204.03 million (about 25 percent) .

Most informal workers labor for micro, small, and medium-sized enterprises (MSMEs) that emerged as intermediate inputs and services suppliers to the modern sector. However, workers struggle to get paid, which the government identifies as great challenge. Payroll and other taxes, as well as limited access to subsidized credit for large firms, are disincentives to MSME growth. Although over half of India has smartphone access, relatively few can telework. Retail and manufacturing jobs require physical presence involving direct client interaction. Indeed, income for families unable to telework has fallen faster.

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The government’s crisis response has mitigated damage, with a fiscal stimulus of 20 trillion rupees , almost 10 percent of GDP. Also, the Reserve Bank of India enacted decisive expansionary monetary policy . Yet, banks accessed only 520 billion rupees out of the emergency guaranteed credit window of 3 trillion rupees. In fact, corporate credit in June is lower than June last year by a wide margin after bank lending’s fall. S&P has estimated the nonperforming loans would increase by 14 percent this fiscal year . Corporations have deleveraged retiring old debts and hoarding cash, as have households. Recovery through investment and consumption has stalled . These trends are exacerbated due to the pandemic. The manufacturing Purchasing Managers Index (PMI) recovered 50 percent since May but at 47.2 it remains in negative territory. Services contribute over half of GDP but its PMI, even after bouncing back , remains low at 33.7 in June. Consumption of electricity, petrol, and diesel have regained from the lockdown lows but are still 10-18 percent below June 2019 levels . Agriculture has been the bright spot, with 50 percent higher monsoon crop sowing and fertilizer consumption up 100 percent. Unemployment levels had spiked to 23.5 percent but with a mid-June recovery to 8.5 percent—and then crept up again marginally.

The National Rural Employment Guarantee Scheme (MNREGA) and supply of subsidized food grains have acted as useful buffers keeping unemployment down and ensuring social stability. Thirty-six million people sought work in May 2020 (25 million in May 2019). This went up to 40 million in June 2020 (average of 23.6 million during 2013-2019 period). The government has ramped up allocation to the highest level ever, totaling 1 trillion rupees. Similarly, in addition to a heavily subsidized supply of rice and wheat, a special scheme of free supply of 5 kilograms of wheat/rice per person for three months was started and since extended by another three months, covering 800 million people. There have also been cash transfers of 500 billion rupees to women and farmers .

However, MNREGA has an upper bound of 100 days guaranteed employment and it also does not cover urban areas. Agriculture cannot absorb more labor, with massive underlying disguised unemployment. A post-pandemic survey shows that the MSME sector expects earnings to fall up to 50 percent this year. Critically, the larger firms are perceived healthier. However, small and micro enterprises, who have minimal access to formal credit, constitute 99.2 percent of all MSMEs . These are the largest source of employment outside agriculture. Their inability to bounce back could see India face further economic and also social tensions. The economy is withstanding both supply and demand shocks, with the wholesale prices index declining sharply .

We identified labor market pressures toward increased poverty, both in the extensive margin (headcount) and intensive margin (deprivation depth). India needs to ramp up MNREGA, introduce a guaranteed urban employment scheme, and boost further cash transfers to poor households. Government efforts have been enormous in macroeconomic policy (fiscal stimulus and monetary loosening) to mitigate adversity but fiscal space is narrowing, requiring the World Bank and other international financial institutions to step up and help avert even greater hardship. Also, ongoing advances towards structural economic policy reforms have to continue.

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India’s future and role in the post-COVID-19 world

Entering the Taj Mahal at the sunrise… The view was and is breathtaking

India will prioritize economic expansion and sustainability for sustained growth and influence on the world stage. Image:  Unsplash/Julian Yu

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india's response to covid 19 essay

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Stay up to date:.

  • We are gradually moving into a post-COVID dispensation.
  • There is a trend towards a more multipolar world and the power centre of the global economy is shifting to Asia.
  • In this new era, India will prioritize economic expansion and sustainability for sustained growth and influence on the world stage.

Almost two years after the World Health Organization declared COVID-19 a pandemic , the world is coming to terms with the disruptions caused by the virus. The most profound and consequential impact has been the pandemic’s toll on healthcare systems . And then there has been the more persistent and reverberating economic toll.

Government action to counter infections and contain the spread of the virus led to global supply shocks , especially in manufacturing, and lockdowns and other containment measures caused widespread business disruption. It is now clear that the pandemic has brought the world to the second great economic and financial crisis of the 21st century and is likely to have long-term structural repercussions. What’s more, it has laid bare the fragilities of the global economic and geopolitical order.

The churn in the international order, however, had begun even before the pandemic; power equations had already started to change because of geopolitical shifts. There was an indisputable trend towards a more multipolar world and the power centre of the global economy began to shift to Asia .

The current world order has been substantially altered and this is bound to give rise to a new post-COVID dispensation. In this state of flux, space has been created for aspiring and emerging powers to take centre stage and help shape a new world with a better future for all.

Indeed, rays of recovery are beginning to emerge in our economies. The International Monetary Fund (IMF) projects that the global economy will grow by 6% in 2021 , and forecasts 9.5% growth in the Indian economy . At the same time, the world is seeing exponential growth in digital services and infrastructure, from the adoption of large-scale work-from-home arrangements to the use of cloud services and videoconferencing.

Many tech leaders have noted that the advancements in digital transformation that were achieved within a couple of months would have normally taken two to three years. These are hopeful signs, but there is still much work to be done.

Have you read?

This indian state's response to covid-19 could be a model for equitable healthcare, 50 ways india’s last-mile covid-19 responders are leading the way to a just recovery, asian universities are on the rise. this is what it means for the rest of the world.

India ’s future on the world stage

Despite the economic devastation caused by the virus, India’s agile response has been commendable, especially as the country rallied to manage a deadly second wave of the virus early in 2021. India was the first country to feel the impact of the virulent Delta variant but quickly swung into action to ensure that as many people as possible were vaccinated. One billion doses of the vaccine have already been administered.

In addition to protecting its own population, India has also acted in the world’s best interest by providing medical supplies and equipment to more than 150 countries across the globe and placing a critical supply of the COVID-19 vaccine on the world market. Indeed, the pandemic is an inflection point for India to introspect on its potential as a global leader, especially coming at a time when the country is celebrating 75 years of independence .

For years, India has supplied crucial drugs and medications to the global market, more recently investing in the supply of the COVID-19 vaccine to ensure equitable access around the world.

Each of our Top 50 social enterprise last mile responders and multi-stakeholder initiatives is working across four priority areas of need: Prevention and protection; COVID-19 treatment and relief; inclusive vaccine access; and securing livelihoods. The list was curated jointly with regional hosts Catalyst 2030’s NASE and Aavishkaar Group . Their profiles can be found on www.wef.ch/lastmiletop50india .

Top Last Mile Partnership Initiatives to collaborate with:

#BackTheFrontline - Dasra Covid Action Collab Covid Livelihoods Coalition – CoLive Creative Dignity Migrants Resilience Collaborative Rapid Rural Community Response (RCRC) REVIVE Alliance Rural Access Coalition Saath Nirbhar - vartaLeap Coalition and ComMutiny SAMRIDH Sanjha Collective - Goonj Swasth

india's response to covid 19 essay

Top 50 Last Mile Responders to get behind: Aajeevika Bureau Adhyayan Foundation Antarang Foundation ARMMAN Arpan Barefoot College International Breakthrough Center for Wildlife Studies Conserve India Dasra Society Of Development Alternatives Dharma Life Doctors For You Dream a Dream Eleutheros Christian Society Every Infant Matters Frontier Markets Glocal Healthcare Goonj Haqdarshak Hasiru Dala Healing Fields Foundation Hemkunt Foundation iKure Indian Society of Agribusiness Professionals Indus Action Industree Foundation Jan Sahas Just Organik Karuna Trust LabourNet Services Lakshya Manah Wellness MAHAN Trust, Melghat Mann Deshi Foundation Mission Oxygen - Democracy People Foundation Naireeta Services Nidan Noora Health Pink Maharani Reap Benefit SaveLIFE Foundation SELCO Foundation Sevamob SEWA Cooperative Federation Spandan Samaj Seva Samiti Study Hall Educational Foundation (SHEF) Sustainable Environment and Ecological Development Society (SEEDS) Transforming Rural India Foundation Ziqitza Health Care Limited

At the start of the COVID crisis, India's South Asian Association of Regional Cooperation (SAARC) initiative held the first multilateral summit, inspiring the G20 and others to follow suit. With the country taking over the G20 presidency in December 2022 , it will certainly play a leading role in the post-COVID global recovery process.

Away from the pandemic, India is meeting other global commitments including living up to its climate mitigation promises . It is also well ahead of target to achieve other ambitious commitments such as making renewables 40% of its energy mix by 2030 and managing the sequestration of 2.5 billion tonnes of carbon.

At the ongoing United Nations Climate Change Conference of the Parties (COP26) taking place in Glasgow, Scotland, Prime Minister Narendra Modi committed India to an ambitious Panchamrit pledge that will see the country address five key sectors of its economy to reduce its greenhouse gas emissions. The five sectors - energy, mobility, industry, infrastructure and cities, and agriculture - are critical to achieving the global 1.5-degree Celsius warming target.

A recent report from the World Economic Forum - Mission 2070: A Green New Deal for a Net-Zero India - outlines how India’s path to net zero will have an estimated economic impact of over $1 trillion by 2030 and around $15 trillion by 2070. In addition, India has prioritized cooperation, technology, and digitalization as part of its efforts to support the achievement of the United Nation’s Sustainable Development Goals (SDGs).

Challenges and opportunities

India is marking 30 years since the deregulation of its economy , which is another significant turning point in its history and a testament to its ability to reinvent itself. Successive governments have been focused on achieving inclusive growth and self-sufficiency not just for the current generation but for generations to come. But the current administration’s efforts to promote digital empowerment and last-mile financial inclusion are especially noteworthy. Under the auspices of a government-backed digital payment system, millions of poor, unbanked families have entered the formal economy and can now access basic financial services.

On the global stage, India’s diplomatic efforts are driven by the philosophy of vasudhaiva kutumbakam - the world is one family. This is the kind of narrative the world needs for such a time as this. Indeed, India’s call for renewed and reformed multilateralism is resonating with global leaders and policy-makers.

In the past few years, major structural reforms have been launched by the Indian government to boost the long-term outlook of the economy. The government’s vision to catalyze India’s transformation is evident in the launch of several initiatives including the Gati Shakti National Master Plan and the Atmanirbhar Bharat mission.

The government has also announced the National Infrastructure Pipeline and National Monetization Plan to boost infrastructure development. This wide-ranging development agenda supports initiatives across multiple sectors including reforms to consolidate multiple and disparate labour laws, drafting of the Insolvency and Bankruptcy Code, and banking reforms. India must maintain the momentum of these laudable initiatives and continue to enhance the robustness and vitality of its economy. At the same time, these and other structural reforms should be aimed at ensuring equitable and inclusive growth.

This is critical because the pandemic has exposed and exacerbated existing inequalities and their impact on vulnerable groups who are mainly employed in the informal sector. These are inequalities that the Indian government was addressing even before the pandemic struck through inclusive and equitable development that includes the provision of income support for farmers, safe and affordable housing, safe drinking water and electricity for all.

Going forward, India will have to prioritize economic expansion and sustainability to maintain its trajectory of growth and influence. The country must continue to embrace transformational, rather than incremental change to shape an economic policy that supports rapid growth. This will require a continued commitment to wide-ranging and systemic sectoral reforms, with strong measures to restore fiscal balance and strengthen the banking system.

India will also need to continue making strides to increase competitiveness and the ease of doing business. The country will also have to ramp up its infrastructure efforts, not just for roads and bridges, but for health and education too. Equally critical is the need to ensure that India’s demographic advantage becomes a dividend and that millions of young people entering the workforce every year gain meaningful employment.

How Asia and Africa are finding innovative ways to plug the COVID-19 health gaps

3 lessons from india in creating equal access to vaccines, cop26: what is the uk and india's 'green grids initiative'.

One must also mention India’s renewed focus on the space sector via the recently launched Indian Space Association . Back here on planet earth, however, the Indian government is also placing due emphasis on manufacturing. With the reshoring of global supply chains and quest for geographical diversification in their redistribution, India offers a safe and stable destination and could emerge as an important hub for global manufacturing. India has a demographic advantage, skilled workforce, technical know-how, and the research and development capacity needed to create a strong niche for itself in the global market.

Last but not least, India is also expeditiously moving forward on its energy transition journey: the government’s plan to establish a National Hydrogen Mission is a step in the right direction. India also has a unique opportunity, and an important role, in fostering regional co-operation in South Asia, thus creating new opportunities for growth and prosperity.

Amid the ongoing volatility and change, India has a rare opportunity to undertake several policy changes to not only address the short-term public health challenges but also to become an important axis of power and influence in the post-COVID world. The World Economic Forum stands with India in its efforts to assume new leadership roles and to help propel the world into a better, brighter, and more sustainable future for all.

This article first appeared here .

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Pandemic lessons from India

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Lesson one: don’t declare success too early

In January 2021, global observers marvelled at India’s smooth passage through the first wave of the covid-19 pandemic. 1 By the end of April this sentiment was replaced by alarm at a surging second wave that threatened to spill over into other countries, along with variants of SARS-CoV-2. 2 This dramatic and distressing reversal offers valuable lessons on the consequences of prematurely declaring control of covid-19.

In late March 2020, India began a long nationwide lockdown lasting over two months. Incidence of covid-19 was low when the lockdown began. Though cases rose after the lockdown eased, they were successfully contained from around mid-September onwards. By early January 2021, daily cases, deaths, and test positivity rates had plummeted and victory was declared. 3 Some opinion makers urged caution, concerned about a possible second wave, 4 but others claimed that India had attained herd immunity. 5

India then turned its back on the virus, but the virus did not turn its back on India. As local and state elections, large religious gatherings, unrestricted travel, and unmasked people offered the virus a fast track to a large and susceptible population, cases spiked and then surged across the country. Variants arrived through travellers (B.1.1.7) or emerged in India (B.1.617 and B.1.618) to add speed and scale to the surge. 6 As daily cases hit record numbers, the world closed its doors to travellers from India, fearing contagion, particularly with new variants.

The health system was overwhelmed, but not uniformly. Southern states that had invested in robust health systems, such as Kerala and Tamil Nadu, could withstand the pressure with competence and confidence while states in other regions were challenged beyond their capacity. Even the capital, Delhi, ran short of hospital beds and oxygen. Long queues of bereaved families waited outside crematoriums, unable to provide a dignified departure for their loved ones. By early May, vaccines had been administered to 12% of the country’s population—only 2% had received both doses. 7

Be prepared

Even as India strives to contain transmission, with several states implementing complete or partial lockdowns, the world can learn several lessons from the country’s recent experience. The most obvious is not to take control of this virus for granted by neglecting production of oxygen and vaccines, closing temporary hospitals, and permitting super spreader events.

In the longer term, countries cannot generate a strong and swift response to a public health emergency if they have not previously invested in building an efficient and equitable health system. Chronic underfunding has weakened health systems in many regions of India. Public financing of health hovers around 1% of gross domestic product (GDP), and about 7% of the population every year face being pitchforked into poverty by high out-of-pocket expenditure on healthcare. 8

While large cities boast of world class hospitals vying for global medical tourists, primary and secondary care facilities remain weak even in urban areas. The size of the healthcare workforce falls far short of global norms 9 and is unevenly distributed across the country. It is challenging for such health systems to deal simultaneously with detection and care of covid-19, routine and covid-19 vaccinations, and a high burden of non-covid conditions.

Although distressed hospitals attract most attention, primary care systems are vital for effective pandemic responses. Primary care is central to case detection, timely testing of suspected cases and traced contacts, home care, triage, referral, post-covid care, vaccination, and surveillance for reinfections or vaccine escape, in addition to the usual detection and management of pre-existing health conditions that influence severity of covid-19 and prognosis. India’s experience teaches that states which value primary care fare better.

Several states have now imposed complete or near complete lockdown. Others are restricting crowded events, with partial success. Masks are mandated by central and state governments but not universally worn in rural areas. Courts are monitoring and mandating the supply of resources to needy states. 10 Temporary hospitals, dismantled recently, have been resurrected. Oxygen concentrators and generation plants are being imported, along with vaccines. Retired doctors have been recalled. Final year medical and nursing students have been inducted for clinical care. 11 Non-governmental organisations have been invited to provide points of contact and social support for affected communities. Home care, for mild cases, is being promoted. Testing rates and genomic analyses of positive samples are being scaled up.

Absence of a national health service means that care is not standardised in public and private hospitals across India. Though some states have assured free vaccinations and free care for patients with covid-19, this is not uniform across the country. 12 India’s mixed health system, which evolved by default rather than design, is being put to severe tests of coverage and quality.

Even as India struggles to quell the virus and the world rallies to its cause, the pandemic has turned teacher to sternly remind us that strong health systems are vital for sustainable, stable, and secure development. That lesson must enter the DNA of future societies, even after this RNA virus ceases to be a threat.

Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: Commissioned; not externally peer reviewed.

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

  • ↵ Biswas S. Coronavirus: is the epidemic finally coming to an end in India? India Today 2021 Feb 15. https://www.bbc.co.uk/news/world-asia-india-56037565
  • ↵ Shrivastava B, Gretler C, Pradhan B. There’s a new virus variant in India. How worried should we be? Bloomberg Quint 2021 Apr 16. https://www.bloombergquint.com/coronavirus-outbreak/india-has-a-double-mutant-virus-variant-should-we-be-worried
  • ↵ PM Modi at Davos: despite doomsday predictions, India defeated covid and helped 150 other countries. India Today 2021 Jan 28. https://www.indiatoday.in/india/story/pm-modi-at-davos-despite-doomsday-predictions-india-defeated-covid-and-helped-150-other-countries-1763662-2021-01-28
  • ↵ Ray K. Covid-19 vaccine is here, but this is no time for complacency or carelessness: Deccan Herald 2021 Jan 12. https://www.deccanherald.com/opinion/panorama/covid-19-vaccine-is-here-but-this-is-no-time-for-complacency-or-carelessness-k-srinath-reddy-937965.html
  • ↵ Kapur M. Has the Covid-19 pandemic effectively ended in India? Quartz India 2021 Feb 18. https://qz.com/india/1973946/has-india-achieved-herd-immunity-against-coronavirus
  • ↵ Basu M, Sen S. B.1.117 to B.1.618, India has many Covid variants causing infections. Here are the dominant ones. The Print 2021 Apr 23. https://theprint.in/health/b-1-117-to-b-1-618-india-has-many-covid-variants-causing-infections-here-are-the-dominant-ones/644693/
  • ↵ India coronavirus: Over-18s vaccination drive hit by shortages. BBC News 2021 May 1. https://www.bbc.com/news/world-asia-india-56345591
  • ↵ Ravi S, Ahluwalia R, Bergkvist S. Health and morbidity in India (2004-2014). Brookings India Research Paper No 092016. 2016. https://www.brookings.edu/wp-content/uploads/2016/12/health-morbidity_sr052017.pdf
  • Negandhi H ,
  • ↵ Tripathi A. Supply 700 MT oxygen to Delhi daily, don't make us go firm: SC tells centre. Deccan Herald 2021 May 7. https://www.deccanherald.com/national/north-and-central/supply-700-mt-oxygen-to-delhi-daily-dont-make-us-go-firm-sc-tells-centre-983346.html
  • ↵ Malavika PM. Govt to rope in medical interns, final yr MBBS students to fight new Covid wave. Hindustan Times 2021 May 3. https://www.hindustantimes.com/india-news/govt-to-rope-in-medical-interns-final-yr-mbbs-students-on-covid-duty-101620039305815.html
  • ↵ Free covid-19 care in all Aarogyasri hospitals: Jagan. Deccan Chronicle 2021 May 7. https://www.deccanchronicle.com/nation/current-affairs/070521/free-covid-19-care-in-all-aarogyasri-hospitals-jagan.html

india's response to covid 19 essay

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  • Published: 24 February 2021

India’s crusade against COVID-19

  • Manisha Madkaikar   ORCID: orcid.org/0000-0001-6380-3116 1 ,
  • Nivedita Gupta 2 ,
  • Reetika Malik Yadav 1 &
  • Umair Ahmed Bargir   ORCID: orcid.org/0000-0001-6785-8042 1  

Nature Immunology volume  22 ,  pages 258–259 ( 2021 ) Cite this article

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The COVID-19 response in India has been rapid, strategic and multipronged and has adapted to the evolving pandemic situation.

The COVID-19 pandemic has impacted almost every country in the world. With 9.93 million people infected, India is one of the worst-affected countries and is faced with multiple challenges. It is the world’s largest democracy, with a population of more than 1.35 billion, of which 2.75 million are below the poverty line, and an additional 300–400 million are working in informal sectors, making them vulnerable to economic stress caused by the lockdown. India’s health infrastructure is grossly inadequate, with government spending on healthcare being only 1.17% of GDP. Private-sector healthcare accounts for 55% of the total hospital bed capacity and 90% of the doctors (Rajagopalan, S. & Choutagunta, A. Assessing Healthcare Capacity in India . (Mercatus, 2020; https://doi.org/10.2139/ssrn.3570651 ), and healthcare needs are largely met as out-of-pocket expenditures.

india's response to covid 19 essay

Despite challenges and setbacks, the overall response of India to the COVID-19 pandemic has been commendable. The ‘Oxford COVID-19 Government Response Tracker,’ which assesses countries on key policies implemented by governments, gave India a score of 100% in the crucial initial months. The pandemic and subsequent lockdowns set a new normal in India. The entire healthcare system was meticulously reoriented to tackle the pandemic. By May, an operational network of 7,700 dedicated COVID-19 care hospitals, health centers and COVID-19 care centers with a systematic referral system was established. Central and state health departments conducted several virtual training workshops for healthcare professionals on diagnosis, clinical management and infection control practices. The laboratory network was massively expanded from a single lab to 2,250 labs, with a testing capacity of 1.2 million per day. This expansion was steered by the Indian Council of Medical Research (ICMR) through daily virtual interactions, troubleshooting with labs and quality assurance and quality control programs to ensure high-quality testing. ICMR also established 24 diagnostics validation centers across the country, which enabled the evaluation of 1,100 COVID diagnostic products. Of the 600 approved kits, 397 are indigenous. Local manufacturers were guided through processes to improve quality and availability.

The efforts of the government were equally supported by community participation, generous contributions from philanthropists and the engagement of the private sector. Many inspiring success stories like the ‘Dharavi model’ (combating COVID-19 in the world’s largest slum) have emerged through efficient governance, public–private partnership and community engagement.

A National Task Force on COVID-19 was set up by the Indian Government to carve out the research roadmaps. It was steered by ICMR, Niti Aayog and the Ministry of Health. Leading research organizations, including ICMR, Department of Science and Technology (DST), Council of Scientific & Industrial Research (CSIR), Defence Research & Development Organisation (DRDO) and Indian Institutes of Technology (IITs), were recruited to conduct COVID-19-related research and development activities. This massive effort resulted in two nation-wide serological surveys to determine the seroprevalence of SARS-CoV-2, indigenous diagnostic kits and vaccine development, the establishment of COVID-19 biorepositories and clinical registries in 15 tertiary medical institutes, and a national consortium for genome sequencing of SARS-CoV-2. Additionally, India participated in multiple clinical trials like the WHO SOLIDARITY trial and the world’s largest plasma therapy trial (PLACID). Reusable nanofiber N95/99 masks and portable ventilators were also developed. Hundreds of antiviral molecules have been screened, and the promising ones are being pursued further. The potential of traditional medicine as antivirals or immunomodulators is also being explored. Following a phase of severe crisis due to the limited availability of personal protective equipment (PPE) in February, India has now emerged as one of the major global PPE manufacturers.

Being the largest global vaccine provider, India has taken the lead in the development and production of COVID-19 vaccines. Two indigenous vaccine candidates, COVAXIN from Bharat Biotech International and ICMR and a DNA vaccine (ZyCov-D) from Cadila Healthcare, along with other vaccines developed in partnership with foreign collaborators, including the Oxford–AstraZeneca ChAdOx1-S, manufactured by Serum Institute of India (SII) as Covishield; the RBD-S protein vaccine from Biological Evans; the mRNA vaccine of Gennova; and the Sputnik V vaccine, are in various stages of clinical trials . The Indian regulator has provided restricted emergency use authorization for Covishield and Covaxin. On 16 January 2021, India launched the world’s largest immunization program for COVID-19 with the two indigenous vaccines. So far, 2.5 million healthcare workers have been immunized.

Despite the encouraging response, the COVIDization of systems has caused a major setback to research activities in non-COVID areas, especially those involving fieldwork. Non-COVID healthcare has also suffered enormously. To address this issue, the Ministry of Health has focused on promoting telemedicine since March 2020. This action provided much-needed relief to non-COVID patients and a boost to the health-tech sector. Telemedicine has emerged as a useful tool for quality care provision in rural and remote areas.

With the academic curriculum being taught online, the lack of human interaction and excessive exposure to electronic media are likely to have a lasting psychosocial impact on the youth. The indefinite postponement of admissions processes, the cancellation of fellowship programs and problems in online evaluation systems are taking a toll on students.

However, on a positive note, the high-level engagement of the population to understand the disease transmission dynamics; testing modalities; public health preventive actions, particularly vaccine development; and expected timelines of delivery was overwhelming. Intensive campaigns promoting hand hygiene, the use of masks and the adoption of hygienic social habits will have a positive impact in reducing the overall burden of tuberculosis and other respiratory infections in India in the near future.

Though the pandemic has hit hard, India is attempting to overcome the challenges through innovation and self-reliance as ‘Atma-Nirbhar Bharat’, a nation that has the capacity to walk tall in the world with the ideology of ‘Vasudhaiva Kutumbakam’ (the world is one family).

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Manisha Madkaikar, Reetika Malik Yadav & Umair Ahmed Bargir

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Madkaikar, M., Gupta, N., Yadav, R.M. et al. India’s crusade against COVID-19. Nat Immunol 22 , 258–259 (2021). https://doi.org/10.1038/s41590-021-00876-7

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India’s Response to COVID-19: A Soft Power Perspective

The COVID-19 crisis has caught the world off-guard. However, from a soft power perspective, this adversary could be turned into an opportunity to build a credible image at the world stage and to enhance nations’ soft power profile. As per Harvard Professor Joseph S. Nye, soft power grows out of nations’ “culture, domestic values, and foreign policies.” This blog post surveys India’s response to COVID-19 and argues that a comprehensive and timely approach against the Coronavirus crisis might enhance India’s soft power appeal. 

Stringent Decisions and Effective Messaging

With the exception of only essential services, India is witnessing an eight-week nationwide lockdown (March 23 to May 17) announced in three phases. Given the population density, it was the only choice for India. However, managing a humongous population was not easy, the predicament of internal migrants remains one of the biggest challenges. So far, the lockdown seems to have saved India from entering into a catastrophic phase of community transfer. India is also the fifth country to isolate the COVID-19 virus strain.

In view of a series of early responses , Indian policymakers seemed cautious and professional toward this pandemic. In order to prevent rumor-mongering, data on COVID-19 patients have been released by a single source, i.e., the Ministry of Health and Family Welfare. Notably, unlike some Western counterparts, India remained consistent in its narrative toward the graveness of the coronavirus crisis and has not made the mistake of taking it lightly. Also, through credible messaging and diligence, state/local governments have been successful in preventing civilians from panic buying, regulating the supply chain, black-marketing, etc. 

Use of Digital Tools

Wide use of every possible digital tool across government departments for public outreach turned out to be effective in the time of crisis. From educating and informing the public about the novel coronavirus to combating fake news, contact tracing, catering to emotional well-being and supporting the underprivileged financially, technology played a pivotal role. Public-private partnerships have also been significant here. Delhi Corona Relief is another interesting example where technology has been used to maximize the benefits of government plans. Indian Scientists’ Response to CoViD-19 (ISRC) , a voluntary group comprising scientists from eminent Indian institutes to support evidence-based action, provides scientific data and resources to local administrations and groups fighting on the ground; they have developed various apps to bridge communication gaps and debunk COVID-19 hoaxes .

The Culture of Service

The indigenous idea, seva paramo dharma (service is the greatest virtue), resonates in the actions of individuals, faith centers, NGOs and even diaspora groups at this time of crisis. Delhi’s Gurudwara Bangla Sahib alone is serving 40,000 meals per day; the same religious community is serving 30,000 meals in New York for Americans in self-isolation and to elderly groups in the UK . A number of NGOs have been providing grocery services and other essentials to poor and elderly communities.

Federalism, Frugality and Innovative Measures

As against one-size-fits-all, implementation of unique regional models of cluster containment at three district hotspots seemed to be effective, viz., the Agra Model (Uttar Pradesh), the Bhilwara Model (Rajasthan) and the Pathanamthitta Model (Kerala), each representing Indian states from North, West and South respectively. These innovative "regional models" convey what Shashi Tharoor calls the "power of example" and could lead even nations with limited health infrastructure.

Again, India never disappoints when it comes to frugal and innovative measures. Use of low-cost indigenous testing kits, bandanas as protection masks, sidewalk chalks to maintain social-distancing, hand stamps to mark the quarantine period of individuals and turning railways trains into isolation wards are a few examples that could be agreeably imitated by neighboring countries with limited resources. 

India’s Global and Regional Diplomatic Outreach

Global solidarity and a human-centered approach remained at the crux of India’s diplomatic outreach during this pandemic. Apparently, no country, even the richest and the most developed, can fight against COVID-19 purely on its own. India has been an active and responsible state-actor in reaching out­­—be it initiating virtual SAARC meeting and creating the COVID-19 Emergency Fund , or the country’s roles in the G20 Leaders Summit and the recent BRICS and NAM meetings.

Last month, India also revoked the partial ban on exporting some generic medicines including hydroxychloroquine “ depending on humanitarian COVID situation ” upon request by the United States and Brazil and has been persistent in supplying pharmaceutical aid to nearly 85 close and extended neighbors in Asia, Europe, Africa and Latin America.

Amid this crisis, India’s "neighborhood-first-policy" remained at work; India evacuated foreign nationals from ground zero in Wuhan, China (including nationals from Bangladesh, Myanmar and Maldives). Indian medical experts are also providing online health training and are exchanging valuable information to contain the virus. In another unexpected and pleasant event popularly reported in Indian media, Pakistan's Air Traffic Controller applauded the efforts of state-run airline Air India saying, “we are proud of you,” while the airline was operating special flights from India to Frankfurt carrying relief materials.

Seemingly, India is navigating through this crisis well. However, the spread of fake news on social media and WhatsApp has been in full swing­—be it COVID-19 hoaxes or communal bigotry. Irrational and violent behaviors emanating from such misinformation could affect India’s image abroad. Although the government has given stringent direction s to prevent circulation of fake news; rigorously tracing and penalizing such perpetrators could help in setting examples.

Another challenge in augmenting soft power is generalizing and stereotyping India’s image in foreign media. India’s portrayal as a land of cow-worshippers and snake charmers; or a poor, shabby and under-developed nation continue, continue to dominate the foreign media even today. No wonder, India’s response to this crisis has also been underrated in foreign media.

Reflecting upon if India could contain the virus with a low number of deceased, India would have a soft power edge over countries like China or the U.S.

Nonetheless, India’s comprehensive response against the coronavirus crisis would be a valuable input for making a "joint-protocol" against such crises in the future.

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India’s social policy response to Covid-19: Temporary relief in a rigid welfare landscape

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The Indian government’s response to the global Covid-19 pandemic prioritised economic and fiscal measures, relied on the existing inadequate safety net, and was not timely enough to support millions of inter-state migrants, suggest the findings.

Keerty Nakray , Associate Professor, Jindal Global Law School, O.P. Jindal Global University, Sonipat, Haryana, India.

Stefan Kuhner , Department of Sociology and Social Policy, Lingnan University, Hong Kong.

Daniel Neff , Federal Institute for Vocational Education and Training (BIBB), Bonn, Germany.

This essay summarises the broad contours and key characteristics of the Indian government’s social policy response to the global Covid-19 pandemic and the ensuing nationwide lockdown. The principal strategy of the Indian government was to implement a large and at times bewildering array of temporary relief measures by ordinances after adjournment of the Indian parliament in March 2020. 

Not a single new piece of legislation was implemented in direct response to the Covid-19 crisis, although recent federal labour law reforms are likely to shape the Indian social and economic recovery. Collectively, the Indian government’s relief measures have not been able to adequately alleviate the Covid-19-related social pressures and risks. 

While there is still a dearth of adequate statistical data to assess how well the relief measures were implemented, the initial picture suggests that the Indian government’s response to the global Covid-19 pandemic prioritised economic and fiscal measures, relied on the existing inadequate safety net, and was not timely enough to support millions of inter-state migrants. 

The public health crisis and ensuing nationwide lockdown have not resulted in a path-breaking trajectory away from the entrenched Indian welfare paradigm.

Published in: Global Dynamics of Social Policy, CRC 1342, University of Bremen, Germany.

To read the full article, please click here.

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India’s response to Covid-19 reflects the power, problems, potential of federalism

Response to covid-19 shows carving out roles through consensus can address challenges to federal governance..

india's response to covid 19 essay

India’s response to the COVID-19 pandemic — still a moving target having infected more than 5 million people in the country and claimed in excess of 80,000 lives — reflects the power, problems and potential of federalism in the country’s polity. In spite of the rather unilateral response in terms of imposing a nationwide lockdown, the Centre eventually chose to work carefully with the states. And, the most cynical of the chief ministers professed working with the Centre and other states to deal with a variety of challenges posed by the pandemic. In the past few months, the country has witnessed an interesting and remarkably coordinated effort by the Centre and states in addressing a collective challenge. This exigency response will help us a great deal in understanding Centre-state relations as well as in improving mechanisms of federal governance.

The experience offers an opportunity to revisit the recent debate around the federal organisation of powers under the Constitution’s Seventh Schedule. It has been argued that such organisation of powers is not cast in stone and the arrangement requires a review. Such an exercise is indeed necessary, but what should be its broad contours? The review should allow the carving out of the roles of the Centre and states to address hitherto disregarded and emerging concerns — a viral pandemic or climate change, for instance.

india's response to covid 19 essay

In one of his columns in this newspaper, Bibek Debroy argued for the need to re-examine the distribution of powers under the Seventh Schedule so as to rationalise the Centrally Sponsored Schemes (CSSs) under which the Centre extends support in sectors pertaining to the State List (‘ Spending issues ’, IE, September 12, 2019). Why should the Centre spend, Debroy asked, on a state subject like health and why couldn’t states contribute to a Union subject like defence? His argument sparked a debate. Also, in this newspaper (‘ Leaning on the states ’, IE, September 24, 2019), M Govinda Rao argued that defence is a “national public good” and has to be a Union subject. “The constitutional assignments between the Centre and subnational governments in federations,” Rao pointed out, “are done broadly on the basis of their respective comparative advantage”. That is why “the provision of national public goods is in the federal domain and those with the state-level public service span are assigned to the states”. The debate seems to have settled on at least three counts.

One, the federal organisation of powers can be revisited and reframed. Two, the CSSs must continue but they should be restructured. In addition to the schemes’ rationale of reducing the horizontal and vertical imbalances among states, the Centre is also obligated to address the externalities of the states’ developmental efforts under the subjects allocated to them. Three, there is a need for an appropriate forum to discuss the complex and contentious issue of reviewing federal organisation of powers and restructuring of central transfers.

Should such a review chop and change the subjects in the Union, State and Concurrent Lists? A perusal of the country’s response to the COVID-19 indicates that the exercise be guided by a more nuanced perspective.

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Opinion | India should opt for income support so that pandemic does not turn into a financial crisis

Consider the manner and the content of reconciliation and repositioning between the Centre and states in the course of the response to the pandemic. The Centre’s efforts are now primarily focused on achieving economies of scale in vaccine procurement, knowledge production for setting standards and guidelines for the states, and mitigating inter-state externalities. States continue to play the dominant role in the execution of the actual response to the health crisis. In other words, the fundamental principles of comparative advantage prevailed, but they were organised on the basis of certain functional roles and responses.

So, here is the key takeaway. In spite of health being a state subject, the response to collective threats linked to the subject required some kind of organisation of federal responsibilities on a functional basis.

How can such coordination be sustained on a long-term basis? A typical response is to recommend shifting subjects to the Concurrent List to enable an active role for the Centre. This is how the High-Level Group, constituted by the 15th Finance Commission, recommended shifting health from the State to the Concurrent List. A similar recommendation was made earlier by the Ashok Chawla Committee for water.

But is such shifting of subjects from the State to Concurrent List really feasible in these times of acute sub-nationalism, deep territorialisation and competitive federalism? Will the aspired cooperative federalism get the states to agree to ceding powers and conceding space, particularly in their traditionally exclusive domains? That seems unlikely. Yet, the most collective threats and the challenges of coping with emerging risks of sustainability are linked to either the State List subjects or the ones that rely on actions by states — water, agriculture, biodiversity, pollution, climate change. Some of these also require ensuring sustainability of common pool resources — water, for example.

This extended role of ensuring security against threats to sustainability of resources forms a new layer of considerations. This should define the contours of a coordinated response between the Centre and States — as it happened during the pandemic. In fact, such threats and challenges require the states to play a dominant role. At the same time, the Centre must expand its role beyond the mitigation of inter-state externalities and address the challenges of security and sustainability.

Opinion | Fatigue in the Covid fight grows

The GST reforms is the most recent instance of such reworking of the Centre-state roles for a greater and collective goal. It involved a tortuous, but a new consensus building approach to implement the reforms. Former Finance Minister Arun Jaitley , who spearheaded its implementation, suggested a similar consensus-building for sectors like health, rural development and agriculture. The country’s response to the pandemic has shown that carving out roles through consensus can address new challenges to federal governance.

What should be an appropriate forum for this purpose? The experience of the GST Council may help here as well. The ongoing friction between the Centre and the states over GST reforms tells us that consensus-building is not a one-time exercise. It has to allow sustained dialogue and deliberation. Is there an institutional space that offers the necessary resilience and credibility? Perhaps it is time to revisit the proposal for an elevated and empowered Inter-State Council.

This article first appeared in the print edition on September 18, 2020 under the title ‘Pandemic and federalism’. The writer is MoJS Research Chair — Water Conflicts and Governance Centre for Policy Research, Delhi . Views are personal.

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  • v.77(Suppl 2); 2021 Jul

Prevention and control of COVID-19 in India: Strategies and options

Rajneesh k. joshi.

a Assistant Director Health & Senior Advisor (PSM), HQ 15 Corps (Med), C/o 56 APO, India

Sanjay M. Mehendale

b Former Additional Director General ICMR, New Delhi & Director Research, PD Hinduja Hospital & Medical Research Centre, Mumbai, India

Introduction

COVID-19 has changed the way we live, work and interact with others, like no other disease. In spite of intensive global and national efforts for more than one year, the pandemic continues to spread unabated and has taken a heavy toll on human health and economy. Till 05th May 2021, 154 million cases and 3.2 million deaths have been reported globally due to COVID-19. 1 Similar to other countries as the USA, UK, Brazil, France, Russia, South Africa and Turkey, India is experiencing the second COVID-19 wave, which is much larger and steeper than the first wave observed in Aug–Oct 2020. 1 , 2

Timing of relaxation in restriction policies by the central and state governments, resumption of public transport, opening up of market places and businesses, large gatherings at social, religious and political events, noncompliance of COVID appropriate behaviour by the general public and emergence of new mutant strains presumed to have high infectivity potential, are thought to be factors resulting in the second COVID wave in India. 3 Daily more than 350 thousand cases are being currently reported and the number of deaths per day has also crossed the 3500 mark in this wave. 1

India is facing tremendous challenges in its efforts to control second wave of COVID 19. A huge rise in number of new cases are clearly reflective of the inadequacy of current prevention efforts and failure in breaking the chain of transmission. In states such as Delhi, Maharashtra, Uttar Pradesh, Madhya Pradesh and Chattisgarh, the health system is overburdened and stretched by a sudden surge in COVID cases. The focus of the policy that was adopted when the first wave started declining was on test, trace and treat, continued emphasis on COVID-specific prevention behaviour, conservative stepwise approach to reverse lockdown restrictions and anti-COVID-19 vaccination drive beginning with health care and frontline workers and subsequently addition of senior citizens and people with comorbidities, followed by people above 45 year of age in a stepped approach. The original anticipation that these measures would be able to curtail the spread of SARS-CoV-2 in the community did not yield the anticipated results and could not prevent the occurrence of second wave of COVID-19 in India.

A theoretical simplistic model for control of COVID-19 pandemic can be built around the two-pronged strategy of preventing the spread of infection and reducing mortality among infected people. Designing the policies and strategies for the surge of COVID-19 cases must be based on the lessons learnt and evidence generated during the first wave. It should be pragmatic, flexible and sustained. 4 There could be some long-term strategies which are not sustainable and likely to adversely affect the economy. Conversely, there could be some expensive, manpower and technology intensive strategies which can yield quick results. The national- and state-level policy should design a guidance framework for prevention and control of COVID-19 transmission duly factoring in the cost-benefit, cost-effectiveness, community acceptability and sustainability of the proposed interventions ( Table 1 ).

Relative importance of available options for prevention and control of COVID-19 pandemic.

Prevention and control measures: Re-emphasising on previously implemented strategies

Sustaining covid appropriate behaviour.

It appears that the major debate on transmission of SARS-CoV-2 is settling in favour of airborne transmission of the virus rather than the surface transmission. 5 This potentially highlights the importance of correct use of face masks, social distancing and avoiding crowded places as a huge priority. The utility of hand hygiene must be continued to be emphasised during the epidemic situation; but excessive perceived fear and anxiety of COVID-19 transmission associated with handling of doors handles/knobs, elevators buttons, newspapers, vegetables and eatables needs to be addressed with appropriate information, education and communication (IEC) campaigns. These measures involve low cost and minimal hindrance in daily living and can directly benefit the individuals practising these behaviours. However, their sustained acceptability would require persistent IEC efforts at all levels as well as change in the mindset at the individual level and also at the societal level which would help in community-level prevention and control of spread of COVID-19.

Contact tracing, testing and quarantine

As the disease is spreading very rapidly across the country, operationalising measures for tracing, testing and placing the infected individuals in quarantine is becoming an arduous task with severe pressure on the public health system. Although these measures are typically more impactful during initial stages of the epidemic, they must also be continued in the second phase. The real challenges to implementation of this strategy include its limited use in the situations of community transmission and occurrence of a large proportion of asymptomatic individuals. As this activity is manpower and money intensive, finding these resources is likely to be a great challenge during the second wave when community based transmission appears to have actively set in all over the country.

Government imposed restrictions

Government imposed restrictions such as weekend curfew, night curfew, shutting down or restrictions on use of public transport, closure of markets, complete lockdown etc. should be the last resort as they have limited effectiveness and also result in economic loss. Moreover, the hindrance in daily life of general public and economic hardships faced by people during the past year are likely to result in community reactions and instances of societal unrest. Such measures have a more profound impact on the poor and vulnerable people. Hence, restrictions and lockdown kind of measures should be employed only in exceptional circumstances when there is no other option left.

Prevention and control measures: introducing newer approaches and tools

Vaccination.

In addition to behavioural measures for COVID prevention, the biological prevention option of vaccines has also been made available. It might take some more time to arrive at a concrete evidence explaining the relative roles of humoral response in the form of neutralising antibodies vis-à-vis cellular response in COVID prevention and disease progression particularly in the context of ability of the currently employed COVID-19 vaccines to elicit the same. The fast-track vaccine development and use of newer platform technologies to develop mRNA, viral vector–based, protein or subunit vaccines has been truly unprecedented and several vaccine candidates have been given emergency use authorisation. This tool was not available during the first COVID wave and having a range of vaccines in 12–14 months after the first report of COVID is a remarkable scientific achievement. The Phase I and II trials as well as interim analyses of Phase III trials have given very encouraging evidence of safety, immunogenicity and efficacy of various COVID-19 vaccine candidates and their wide spread use will certainly help in building of herd immunity and eventually breaking the chain of transmission. COVID-19 vaccines have possibly played a significant role in curtailing the second wave of COVID-19 in countries such as the USA, Israel and UK. Articles have been published documenting efficacy of vaccines in health care workers and front-line workers. 1 , 6 , 7 Modelling forecasts that even a 65–70% efficacious vaccine with 85% or more coverage or a 85–90% efficacious vaccine with 65–70% coverage will succeed in breaking the chain of COVID transmission. 8 Hence, vaccination drive should be carried out at a very fast pace so that maximum population can be covered in a short span of time.

India has developed Covaxin indigenously and along with Covishield of AstraZeneca has been made available for the Indian people. It is very likely that the vector-based Sputnik V vaccine, Janssen's adenovirus vector-based one shot vaccine and mRNA vaccines of Moderna and Pfizer are likely to be available in India after their approval for emergency use. On 20th April 2021, the Government of India has announced availability of the COVID vaccines in the open market and permission has been given for vaccination of all above 18 years of age from 1st May 2021. Availability of vaccines to the younger and more mobile population is likely to assist in breaking the chain of COVID transmission.

However, as majority of the vaccines are unlikely to have 100% efficacy, some cases of breakthrough COVID infections are expected to occur. The real problem would be if such cases happen to be asymptomatic or mildly symptomatic because they would continue to spread the virus, despite vaccination, possibly due to nonadherence to COVID-specific behaviour. However, the early evidence indicates that even though vaccinated individuals might get COVID infection, they do not progress to severe or complicated disease requiring hospitalisation and deaths are expected to be very rare. 7

Antivaccine lobby is active even in the present COVID scenario and will continue to work against any new vaccine. It would be important to address critical issues such as duration of vaccine-induced protection, correlates of immune protection, vaccine portability and interchangeability by providing strong research-generated evidence. This would help in reducing vaccine hesitancy and improve vaccine coverage.

Increasing care and treatment capacity to minimise complications and mortality

Indian response in creating large care and containment facilities in the first wave was excellent. However, by December 2020 to January 2021, the process of dismantling these facilities and dispensing the manpower had begun. This proved to be a miscalculation because in March 2021, we started witnessing flaring up of COVID-19 cases as the second wave started building. Consequently, we are currently struggling with deficiencies in hospital beds, beds with oxygen facility, ICU beds and ventilators across the country. The trained and experienced manpower was also dispensed with and hence we are also facing shortage of manpower. Capacity building should be augmented manifold in view of upsurge in number of cases. Building or creating adequate facilities in terms of hospital beds, oxygen supply, medicines, ventilators and other critical care facilities in each district to provide proper medical care to moderate and severe cases is critical. We must start using standardised clinical protocols for patient management throughout the country and avoid use of expensive medications wherever possible. This will help in reducing the financial burden on the patients and their families. Models must be worked out to facilitate assessment of clinical condition on digital platforms and referral for hospital admission and treatment in a centralised manner in specified geographical locations. It would also be critical to insist on home-based treatment for milder cases to reduce unwanted occupation of hospital beds, but community acceptance to this will improve only if it is supported by high-quality home-based care by competent teams.

Prevent panic

The current scenario appears to be of widespread panic, misinformation and chaos which is influenced by furious use of social networking platforms and aggressive coverage in print and visual media. Wrong messages get forwarded even without checking the rationality and authenticity of the source. We are getting bombarded with information and misinformation related to interpretation of test results, vaccine-related information (adverse reaction, efficacy etc), diet and medicines for COVID patients and for COVID prevention and many other topics. It is important to prevent panic as it leads to undue pressure on health system, unjustified demand for testing and hospitalisation and shortage of essential medicines and equipment. 10 Media has an important role in pandemic settings and media should be constructively involved in prevention and control activity for COVID-19 possibly by making the media a partner in COVID prevention and control.

Prevention and control measures: What is the role for strategizing as per local situation?

Various regions, states and districts of India are at different stages or levels of COVID pandemic. In certain areas, community transmission is evident while in some areas there are few cases/clusters. Action plan for COVID prevention and control should factor in the level of transmission and capacity of local health system to respond to the situation. 9 Activities such as vaccination, COVID appropriate behaviour, testing and treatment of cases, IEC and surveillance are core activities which should be carried out on priority in all districts of India while other activities such as contact tracing, restrictions on gatherings, closure of business and travel restrictions should be undertaken based on prevalent scenario in an area ( Fig. 1 ).

Fig. 1

Priority prevention and control measures based on level of transmission and response capacity of health system.

The principle of “one size does not fit all” probably fits India well. In the first wave, community response and accountability to control measures and impact, responsiveness and adaptability of local health system resulted in extremely variable economic impact on the general population. Economies of certain industrialised states got badly impacted. Therefore, during the second wave, it might be important to implement innovative and locally relevant approaches which will be readily accepted by the community. We also need to plan to mitigate the impact of COVID in Tier II/Tier III cities and in rural areas, where medical resources may be insufficient to respond to the COVID crisis.

What do we do to prevent the third wave of COVID-19 in India?

Once peak of the second wave is over, all future actions should be planned with a basic presumption or anticipation of the third wave. Surveillance for new cases, COVID-related mortality and viral variants must be continued sufficiently long after the flattening of the second wave. Similarly, emphasis on COVID appropriate behaviour, cluster containment, contact tracing, testing and quarantine will have to be continued much beyond the second wave. It might be critical to attain self-sufficiency in the area of COVID vaccine production and availability in India and it is certainly possible because at least 3–4 Indian COVID 19 vaccines are expected to be available by the end of 2021. We will have to address the issues surrounding vaccine hesitancy and create dependable evidence to mitigate the same. We have to strengthen our health care infrastructure and enhance the laboratory capability of detection and diagnosis of emerging infections in the country, forecasting impending outbreaks, increase the number of beds with oxygen supply, ICU beds, ventilators and infection control practices in general. A continuous dialogue with people of India about the current and emerging situations will help us to face the challenges in future more efficiently and effectively.

Disclosure of competing interest

The authors have none to declare.

IMAGES

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