India’s population density bodes poorly for virus containment

India could become the next global hotspot for virus cases, with experts warning containment measures that proved successful elsewhere in Asia may not work in the world’s second-most populous country.

The South Asian nation, which has so far reported 125 infections and three deaths, is trying to contain the virus by closing its borders, testing incoming travelers and contact tracing from those who tested positive. But some experts in the nation of 1.3-billion people say that won’t be enough to contain the spread. Other measures, such as widespread testing and social distancing may not be feasible in cities with a high population density and rickety health infrastructure.

While growth in total numbers has been slow until now, “the number will be 10 times higher” by April 15, said Dr T Jacob John, the former head of the Indian Council for Medical Research’s centre for advanced research in virology, a government-funded institution.

“They do not understand that this is an avalanche,” said John, who was also chair of the Indian government expert advisory group on polio eradication and chief of the National HIV/AIDS Reference Centre at the Christian Medical College in the southern city of Vellore. “As every week passes, the avalanche is growing bigger and bigger.”

Financial capital

So far, India has been relatively unscathed from the virus compared with other countries in Asia. Countries from Italy to Malaysia have started locking down large parts of the country, following China’s move to reduce the pace of new infections by isolating Hubei province, where the outbreak first took hold.

Prime Minister Narendra Modi has said India’s doing it’s best to fight the spread of the virus.

A key concern in India is Maharashtra, the state with the highest urbanisation in India and home to the financial capital Mumbai and benchmark stock exchange, which has reported the biggest spread of the infection with 39 cases.

Its government called for a virtual lockdown of cities in the state on March 16 — shuttering all public places and putting off university exams and asking government offices and private companies to allow employees to make sure at least half their staff work from home at any given time.

“Maharashtra is in the second stage at the moment,” Rajesh Tope, Maharashtra’s health minister told reporters in Mumbai. “But if we don’t curtail or stop the infection from spreading  we could slip to stage three and that would mean a spike in the number of infections. We have to contain this disease under any circumstances.”

Population density

In the city of Pune a trade association has decided to shut all shops and markets for three days to try to stem infections.

Apart from its sheer size, India’s other challenge is the density of its population: 420 people live on each square kilometre, compared with 148 in China. Its cities are crammed with slums and low-income housing clusters where the living conditions are tight.

While South Korea was able to test even asymptomatic people, India’s population “makes it extremely difficult,” said Dr K Srinath Reddy, adjunct professor of epidemiology at the TH Chan School of Public Health at Harvard University and president of the New Delhi-based health think-tank Public Health Foundation of India.

“Social distancing is something often talked about but only works well for the urban middle-class,” he said. “It doesn’t work well for the urban poor or the rural population where its extremely difficult both in terms of compactly packed houses, but also because many of them have to go to work in areas that are not necessarily suitable for social distancing.”

On Tuesday, India announced that state-authorised private laboratories would be allowed to conduct tests. But the government has yet to release the list of authorised labs, according to Dr Lokesh Kumar Sharma, spokesperson for the Indian Council of Medical Research.

Surging infections

The pandemic — which has infected 183,000 worldwide, with nearly 80,00 recovered, and deaths topping 7,000, according to the John Hopkins University corona research centre on Tuesday — has a pattern of surging after an initial slower phase. This was seen in nations such as South Korea and Italy — the worst-affected countries outside of mainland China, where the highly contagious pathogen first emerged in December.

South Korea, which had a 2,000% jump in cases in a week last month, slowed the outbreak and deaths by testing hundreds of thousands of people in clinics and drive-through stations.

More than 5,200 potential cases have been identified through contact-tracing and put under surveillance, the health ministry said late on Monday. Last week, India suspended most visas in a bid to halt the spread of the coronavirus. It decided on Friday to limit international traffic through the land route to 19 of 37 border check posts.

The country’s response to the coronavirus spread is led in large part by the limitations of its public-health system, Reddy said. India’s healthcare spending is among the lowest in the world at  just 3.7% of GDP. That’s left it with a patchwork of overcrowded public hospitals, and private ones that are unaffordable for many people.

“I have reservations about our capacities to deal with this,” said Reddy. “Right now our responses are strategic to the extent that our resources permit.”

Bloomberg