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72 (
); 1-2

India and COVID – 19 Pandemic - Standing at Crossroad!!!!!

Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
Department of Precision Oncology and Research, Shalby Hospital, Mumbai, Maharashtra, India
Corresponding author: Ashish Gulia, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, 93, Ground Floor, Main Building, Mumbai - 400 012, Maharashtra, India.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Gulia A, Panda PK, Parikh P. India and COVID – 19 Pandemic - Standing at Crossroad!!!!! Indian J Med Sci 2020;72(1):1-2.

Current COVID -19 Pandemic is indeed a testing time for entire humanity and especially India where we are mystified in a unique situation and facing a real Dharam Sankat (Dilemma) to balance preventive health measures or revive economy to prevent future growth setbacks. This moment calls for some deep introspection regarding the steps taken so far and novel initiatives added at the moment to contain the pandemic. There have been constant debates as to what are the exact statistics of infection and mortality in India, given the enormous Indian population as the denominator. We believe there is under-reporting of the cases due to limited testing capacities (similar situation in many other countries) and longer duration of asymptomatic infectivity – which can also lead to inadvertently transmission of the pathogen through carriers.

The WHO declared the Covid-19 as a pandemic only on March 11, 2020, almost 3 months after its outbreak in Wuhan, China; at a time when the situation had already spiraled out of control impacting over 113 countries, with more than 100,000 confirmed cases and over 4000 deaths.[1] Had the WHO declared Covid-19 as a pandemic in January, the situation would have been vastly different from what we are facing now. Countries would have got sufficient time to prepare their action plans, mobilize resources, and implement quarantine policies in time. The WHO chief, in early February 2020, had stated, “There is no reason for measures that unnecessarily interfere with travel or trade. Now that it has been proven that proven the early infections, which later escalated to community outbreaks, are due to the international travel history, the WHO’s approach in dealing with the situation is under serious scrutiny.[2] Did WHO act too little and too late?


Although we are getting global appreciation to be the early risers, we might have been a bit late in completely sealing our international borders. With current confirmed cases touching 6000 and associated mortality reaching almost 200, it can be assumed that the infection rate in India will result in significant morbidity and mortality given the Indian Social dynamics. Even though the Indian Council of Medical Research (ICMR) has increased the number of testing centers (by allowing private laboratories to also collect and test samples), we are testing <10/million populations.[3] As more and more people get infected and become symptomatic, the strain on our health-care infrastructure will be immense. With dismal doctor to patients, beds to patient, and ventilators to patient ratios, the Indian health-care sector is over stretched to take on these loads. India, the world’s second most populous country has large numbers of poor living in crowded, unsanitary conditions, and a weak public health infrastructure, with just 0.7 hospital beds/1000 persons, compared with Italy’s 3.4, and the United States’ 2.9.[4] The question in everyone’s mind is “How can be optimize our readiness to take care of imminent tsunami of Covid-19 infected patients.” Large number of personnel protective gear, personal protective equipment (PPE) which is vital during this time is being manufactured and imported to ensure safety of patients and health-care providers. We have to ensure that the moral of the new frontline warriors (treating doctors, nurses, and other health-care personnel) is strengthened – after all they are the real combatants in today’s contagion war. The Indian government has taken significant proactive steps, which have been lauded by the Western world. The silver lining is data from ICMR indicating that India has still not entered the Phase-3 (the community transmission phase). Thus, we still have some crucial time to augment our preparations further. India releasing a significant amount of hydroxychloroquine for countries in the grip of the most severe pandemic mortality also reflects that we are conscious of our global responsibility to humanity – tradition alive and well since Vedic times.


Governments of many other countries across the globe delayed implementation of social distancing measures, fearing impact of lockdown on economic costs, and social disruption. We see its catastrophic results Italy, Spain, the USA, and Australia. The Indian government took the bold and timely step of implementing a nationwide 3-week lockdown from March 24.[5] Its objective was to prevent, delay and flatten the transmission of the Covid-19 pathogen in the community.[6] Millions of Indians, especially the daily wage workers, were now faced with no source of income or access to resources essential for survival. Certain areas witnessed exodus of migrant laborers using all possible means of transport to reach their hometown before lockdown measures were fully implemented. Conscious of the pain that the masses would face, the Indian government announced a $23 billion economic package on March 26. If BSE SENSEX is any indication, the market sentiment in the robustness of our economy is very evident – it is having bounced up by 1400 points on April 9 to reach more than 31,160 and an overall recovery of about 20%.


With the number of new cases and mortality continuing to rise exponentially, India and the world are not out of the woods as yet. The benefit of the current nationwide lockdown is evident and clearly outweighs the inconveniences caused in day-to-day life. Measures still need to continue, and perhaps tightened in specific focus areas, until there is evidence of flattening the curve of infection rate. We should also focus on lateral thinking to find innovative ways to exit from the lockdown, when it becomes possible. The economy will need our combined effort to stimulate growth. How to effectively implement sliding scale lockdown strategies with partial opening of the manufacturing, financial, and agriculture sector while also enforcing curfew lockdown for hot spots will be a delicate balancing act. Utilization of this “Golden Time” to ramp up medical infrastructure for effective and swift management of the patients holds the key to face the forthcoming health sector challenges. We must try to shift the battlefields away from hospitals, who can easily become hotspots for COVID-19 positivity. The community needs to be taught how to practice social distancing and adequate hygiene measures in a more effective manner.[7] It is time community leaders show that they need step up and take responsibility for their own health. May we all use our wisdom to choose the right path at this crossroad.


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