The first case of COVID-19 in India was reported 67 days ago on January 30 in Kerala. It was only after 55 days that India imposed a countrywide lockdown to prevent the virus from spreading.
In those 55 days, the Coronavirus infected around 500 people — at an average rate of 9 new infections per day.
It was believed that going under a total lockdown for 21 days would prevent the virus from spreading further.
Yet, in the 12 days since the lockdown was imposed, COVID-19 has added another 3,500 or so people to its victim list in India — an average of 292 persons per day.
In other words, the rate of transmission of the disease has gone up manifold since the lock-down was imposed compared to earlier.
Does this mean that India’s Coronavirus lock-down has been a total failure?
THE KERALA EXPERIMENT
While such a conclusion seem tempting and backed by numbers, a deeper analysis — and the experience of Kerala — reveals that it is too early to jump to the conclusion.
Kerala, where nearly every family has a member working outside the state or the country, was the first to detect the virus as students from Wuhan returned home due to the rising cases of Coronavirus infections.
This was followed by an influx of cases from Western Europe — particularly Italy — and the Middle East as non-resident Keralites returned home.
A number of infected tourists from Southern Europe and the UK added to the problem. In all, nearly 215 out of Kerala’s 315 positive cases are people who came with the virus from outside.
Kerala responded early, and imposed strict restrictions — including shutting down schools and restricting all kinds of mass events — on March 10.
A further set of extreme restrictions — including the closure of offices and shops — were imposed on March 23, a day before Indian Prime Minister Narendra Modi imposed similar restrictions across the country.
In all, Kerala has been under some form of lockdown for 27 days, compared to 12 days for the rest of the country.
The Kerala lockdown is, by far, the longest such anti-COVID experience anywhere in India. While most Keralites were sitting at home in early March, their compatriots in Mumbai and Delhi were jostling each other in packed buses and trains on their way to offices and schools.
As a result, the results of a the lock-down strategy are more clearly visible in this state than anywhere else. And the numbers here do tell a story.
While the number of active Coronavirus cases are rising everywhere else in India, they are either flat, or even on the decline, in this state (see chart above).
The highest number of active COVID-19 cases in Kerala, 256, was hit on Thursday, 2 April.
This fell to 251 on Friday as a total of 14 people recovered from the infection while only 9 new cases were reported.
Similarly, on Saturday, 8 more people recovered, but 11 new cases were reported, taking the total infected to 254.
On Sunday, 8 new cases were reported, while 6 recovered, taking the tally back to 256.
In other words, the total net increase in COVID-19 cases in these three days was zero in Kerala. In the rest of India, the net increase was about 1,470.
SUSTAINABLE PROGRESS?
What Kerala’s experience seems to indicate is that a lockdown does indeed work, but you cannot expect results in 1 or 2 weeks.
For the first 1 or 2 weeks after the lockdown imposed on March 10, Kerala too saw sharp increases in the number of COVID cases (see the chart above).
In the three days from Day 10 to Day 12 (March 20-22), Kerala saw a 73% increase in the number of cases. The rising trend continued till April 1.
The reason is not very difficult to arrive at.
Even if people are under lockdown, new cases continue to come to the surface due to two reasons:
First, people who were already infected by the virus when the lockdown came into place will start exhibiting symptoms. This is because it can take up to 14 days for anyone infected with the virus to show symptoms.
These people with symptoms will then seek medical help, where they are tested and added to the tally.
Hence, for the first 14 days of the lockdown, one can, and should, expect new cases to keep popping up, even if the lockdown has a 100% compliance rate. This is just the time that the virus takes to show its symptoms.
However, this is not the only ‘wave’ of new cases that will hit after a lockdown is imposed.
As soon as a lockdown is imposed, people who have Coronavirus in their system — but are not showing any symptoms — will start infecting others in their household.
Given that the lockdown forces members of a household to spend more time together, the transmission of virus to other members of the household can be expected to be very fast. It is therefore expected that everyone else in the household will get the virus within the first seven days of the lockdown.
These people will in turn take another 14 days (at a maximum) to show symptoms.
If, after these 21 days, no one in a household has reported symptoms of Coronavirus, it can be assumed with a degree of precision that the household is free of the virus. This, very likely, is why the lockdown has been kept at 21 days.
A lockdown also helps to identify infections where the patient’s immune system is able to prevent symptoms of COVID-19 from manifesting, as one or the other member of the household will most likely react to the infection.
What all this means is that the number of cases will continue to rise throughout the 21-day lock-down period. This rise is not a sign of the lock-down failing.
If anything, it is proof that many people in the population were ‘silent carriers’ of Coronavirus at the time the lockdown was imposed. If it was not imposed, these people would have spread the virus to many others on buses, trains, on the street and in their offices.
Due to the lockdown, the possibility of viral communication is limited to the members of their household.
This means is that a 21-day lock-down, properly implemented, can help us identify almost 100% of the cases of Coronavirus infection in the country and isolate and treat them.
Once the 21-day period ends, the number of new cases reported will fall drastically, as almost everyone with the virus would already have been identified and isolated.
This is possibly the reason why Kerala has seen a sharp decline in the number of new cases in the last 4 days or so, when it crossed the 21-day mark (March 31).
RISK FACTORS
There are, however, risks to this strategy.
The first and the most obvious challenge is to identify the symptomatic individuals during the lock-down and isolate them.
The success of the lock-down strategy depends on individuals who show symptoms of COVID-19 — such as throat irritation, dry cough, fever and so on — coming forward on their own.
However, this requires a high degree of trust in the authorities.
The citizen must feel that they, and their family, will be well looked after well by the authorities if they come forward.
However, in some places like Indore in Madhya Pradesh, rumors have been circulating that seek to prevent this and are designed to instill fear among citizens.
While the source of such rumors may be from within the country or from outside the country, such messages can prevent people with symptoms from coming forward. Infected individuals may instead try to hide their infection. Once the lockdown is lifted, they may become the source of new outbreaks.
It is therefore essential for the government to command the trust of the citizens.
The second drawback of the lock-down strategy is related to compliance.
If the lock-down is to work, people have to co-operate with the program and restrict their contact to members of their household only. They have to maintain a distance of at least 6 feet between themselves and those who are not part of their household — such as shopkeepers and others they meet on the street.
They must also avoid touching potentially contaminated public surfaces, such as door handles and walls, when they go out, and must disinfect themselves after stepping out.
Compliance with the lock-down has not been as much as desired — especially in the first week of the lockdown. Therefore, it is desirable that the lockdown be extended by a week or so, so that a 21-day, fully compliant lockdown is observed.