A police vehicle sits parked near the empty Gateway of India monument in Mumbai during a lockdown
More than 50 days after Prime Minister Narendra Modi locked down India, the pandemic's human and economic toll is worsening -- even as new cases of the coronavirus surge at a record pace.
On Sunday, India marked its highest daily tally of fresh infections, about 4,400, and the total now is more than 78,000. The Markit Purchasing Managers' Index for India, a measure of business activity, has fallen to the lowest worldwide over the course of the lockdown. The economy is headed for its first annual contraction in forty years, and the human cost has piled up in the form of hunger and untreated disease.
The economic devastation rippling through the nation is forcing the government to start easing restrictions even as new cases climb. Lockdown curbs are expected to be loosened further next week in many parts of the country.
That's raising worries the disease could spread faster as people are allowed out over the coming weeks. Meanwhile, even as the government has scaled up testing to identify new cases, bureaucratic snafus have slowed the process, leaving some wondering if the multiple extensions to the initial lockdown have been worth the hefty price.
"The overall cost-benefit in India is not favorable," said T. Sundararaman, the New Delhi-based global coordinator of the People's Health Movement, a public health group. "After having increased deaths on other counts, and increased deaths and suffering due to economic distress, you haven't curbed the coronavirus at all."
India's experience reflects the balancing act that countries worldwide are facing during the pandemic, even as emerging nations face a particularly steep cost with millions poised to fall into poverty.
The PM Modi administration argues that India would have had as many as 820,000 cases by April 15 if it hadn't been for the lockdown. At the very least, the shutdown has slowed the virus's trajectory for now, even though it hasn't flattened the curve as much as hotspots like Spain and Italy did with their lockdowns.
A mobile Covid-19 testing van operating in New Delhi, on April 20
On Wednesday, Union health minister told reporters that the lockdown had helped India significantly lower the rate at which infections were doubling. Cases are doubling in about 12 days, he said, compared with three to four days when the lockdown began.
India's total number of recorded cases is also still low compared to other countries like the U.S., where cases have touched 1.4 million. But the difficulties in testing India's vast population has also left lingering questions about whether the official tally reflects the true scale of the outbreak.
The South Asian country may not yet have seen the worst of the epidemic. Government experts have begun to acknowledge the outbreak won't peak in the country until June or July. While countries like the U.S., Germany and Italy must worry about a second wave of infections as they exit their lockdowns, India's plan to ease its measures on Monday will come as its first wave continues to grow.
"India's case and death numbers are increasing every single day," said Madhukar Pai, Canada research chair in epidemiology and global health at McGill University in Montreal. "This means the peak is yet to come."
The economic hit has been stark. About 122 million Indians were forced out of their jobs last month, according to estimates from a leading private sector think tank, pushing up the jobless rate to 27.1% compared with 22% implied for the U.S. In recent days, Modi has pledged a $265 billion stimulus package to shore up the economy.
Still, ratings agency Crisil Ltd. projects that Indian companies will have their worst revenue performance in at least a decade. The strict stay-at-home curbs have posed a number of hurdles for market participants. The curbs have led to thinning of volumes and an increase in volatility, prompting the central bank to shorten trading hours for bonds and currency markets.
Meanwhile, hundreds of thousands of laborers who'd migrated from India's villages to its megacities were left with little choice but to start walking home, in many cases hundreds of kilometres, as train and bus services were suspended.
Migrant workers and their families on the outskirts of Delhi make the journey back to their villages.
In one particularly tragic case, 15 migrants were killed by a freight train while walking along the tracks trying to get home. In recent days, steps have been taken to help the migrant workers home via special trains but that shift will mean that thousands will be moving across state borders right when the number of cases are climbing.
People should have been given advance warning to prepare and some movement should have been allowed before the initial lockdown began, said K. Sujatha Rao, a former health secretary.
"What they should have done earlier they're doing at the very end," Sujatha Rao said about the government's policies. "It's so badly sequenced and so badly implemented."
Most public health experts agree that the purpose of a lockdown is not to stop the disease entirely, but to buy time to build capacity so the health-care system isn't overwhelmed when cases pick up again. On these preparations the Modi government claims progress.
Where early in the pandemic doctors reported shortages of protective equipment like face masks and gloves, some of those concerns have eased as more Indian companies were pressed into manufacturing them.
Despite difficulties acquiring test kits amid a global shortage, India has managed to test more than 80,000 samples a day so far in May, more than the U.K. or Italy, according to data compiled by Our World in Data. And over the full course of the lockdown the government has created 656,769 isolation beds in the country for those with mild illness, and about 34,000 intensive care beds, according to official statements.
It's unclear if that will be enough in a country with crowded cities and slums where social distancing is almost impossible. One forecast from the Brookings Institute estimates the country will need as many as 220,000 ventilator-equipped critical care beds.
India's huge population means its testing covers a relatively small portion of its citizenry. It's doing about 0.06 tests per thousand people per day, compared to 0.7 in Italy and 0.9 in Australia.
The country's premier government health body, the India Council of Medical Research, first purchased and then recalled faulty Chinese anti-body testing kits, meant to show if a person has had the virus in the past. Local testing kit manufacturers say their testing products have been held up because they haven't been able to get access to samples of the virus, allowing mainly imported kits to be used.
"Without the samples, it is not possible to standardize the product, and scale up commercial production," said Pavan Kumar, executive director of Bengaluru-based Bhat Bio-tech India Pvt Ltd. India's health ministry and ICMR did not respond to a request for comments.
Even as the lockdown is poised to ease and people set to emerge, India's public health system is already stretched thin. Other diseases like diabetes and tuberculosis are going increasingly untreated because resources have been shifted to fight the virus and patients are reluctant or unable to visit hospitals. Every month of lockdown will translate into an additional 71,290 tuberculosis deaths over the next five years, according to a study from the Stop TB Partnership.
"Essential health services, whether it's clinic visits, admissions, deliveries, surgeries, are all down," said Naman Shah, a doctor who runs a hospital system in one of India's poorest states, Chhattisgarh. "I think we have to ask what was the goal of the lockdown and did it achieve that."