India will restart train services from New Delhi to 15 other cities, and back, starting Tuesday. Of these, 16 trains will run every day, four only once a week, two thrice a week, and the rest twice a week. All the trains will stop at other stations (see pages 1 and 4).
Since this is coming at a time when the number of daily cases of Covid-19 are continuing to rise (which means the curve hasn’t been flattened), it can mean one of two things: One, the government believes that it is no longer economically, politically, and socially viable to continue with a lockdown and restrictions on interstate travel; or two, the government is confident that India’s health care system is now better placed to deal with a spike in cases (than it was on March 24, when the first lockdown was announced).
There are indications that rail services will be expanded over the next few weeks, and that the government could adopt a similar model for the resumption of air services, perhaps as early as next week.
There’s no doubt that the resumption of rail and air services will see a further increase in the number of infections; already, some states are seeing the impact of the return of Indians stranded overseas (Kerala has registered some cases) by air, and that of migrant workers by rail (Bihar has seen a surge in daily cases largely on this score). Some cases will be asymptomatic; many will be mild; but there will be some severe ones that require hospitalisation, maybe even treatment in the critical care unit. Again, the fact that India is going ahead with its plan on the resumption of rail services despite knowing this seems to suggest that it is confident the health care system can deal with the critical cases. An advisory has already recommended that mild cases do not need any hospitalisation, merely isolation at home.
{{/usCountry}}There’s no doubt that the resumption of rail and air services will see a further increase in the number of infections; already, some states are seeing the impact of the return of Indians stranded overseas (Kerala has registered some cases) by air, and that of migrant workers by rail (Bihar has seen a surge in daily cases largely on this score). Some cases will be asymptomatic; many will be mild; but there will be some severe ones that require hospitalisation, maybe even treatment in the critical care unit. Again, the fact that India is going ahead with its plan on the resumption of rail services despite knowing this seems to suggest that it is confident the health care system can deal with the critical cases. An advisory has already recommended that mild cases do not need any hospitalisation, merely isolation at home.
{{/usCountry}}India’s trajectory of cases and deaths has been unique for reasons that are still not clear. The increase in the number of cases has been slower than it has been in other countries. And the death rate is still around 3.2%, much lower than the average global death rate of 6.8% (number of deaths as a proportion of those infected). If India can maintain this trajectory in the weeks ahead, it should be alright. If it can’t, and the number of daily deaths sees a sharp rise, then it is time to revisit the strategy. I’ve said it before, but the key number to track is the number of daily deaths, not the number of cases. India is now at 13th place in terms of the number of cases, and it is only a matter of time before it breaks into the top 10. It will also overtake China in the next week. But none of this should matter as long as it can keep the number of fatalities low.
As India opens up, it is also clear that it will have to significantly push the adoption of its contact tracing app, Aarogya Setu. It is increasingly becoming clear that many countries will have their own contact tracing apps, and insist, perhaps even mandate, that these be used by everyone. Concerns have been raised about the privacy and security aspects of the app, and the government on Monday released data sharing and access protocols to assuage these (see page 5).
To be sure, the utility of the app is likely to be restricted in India, where just around 40% of the population is estimated to have smart phones (and since this estimate is based on the number of phones and not people, the actual proportion may be even lower because some people have more than one phone).
It is equally clear that it will have to scale up testing. On Monday, the health ministry issued guidelines for district-level testing for Covid-19 – weekly pooled RT-PCR (reverse transcription polymerase chain) tests as well as blood tests of both high-risk and low-risk groups in every district in the country. If this is implemented, it will provide public health policy makers critical data on the actual prevalence and the spread of Covid-19 across the country (see page 5).