India scrambles to escape crisis. So far, it’s working

“I am not scared. I eat, party, sleep,” said Akshay Gupta, an accountant who was bar hopping on Saturday night. “The scare is overhyped.” India has reported around 125 cases of the coronavirus, and it is a bit of a mystery how the world’s second-most-populous nation, with 1.3 billion people, has remained relatively unscathed while the number of cases explodes to its east and west. That has spawned a sense of almost disbelief about the crisis in some quarters.

Doctors say it is either that there are many more cases in India than have been detected, because of the difficulties of getting tested, or that India has indeed managed to so far escape the worst, possibly because of quick and strict efforts right from the start.

In Kerala, in the south, authorities used GPS technology, CCTV footage and mobile phone records to trace the movements of one Indian family believed to be among the first infected here. They returned from Italy in late February, and within days, medical teams fanned out to all the places they had visited including banks, restaurants and churches and quickly quarantined just about everyone they had come in contact with — nearly 1,000 people.

India was also one of the first nations to essentially shut its borders, canceling visas and denying entry to all but a select few foreigners. Some states, such as Kerala, are beginning to beef up internal borders, taking the temperature of passengers in cars and screening people on trains. Still, the containment measures have been imperfect and fear has started to spread.

In Maharashtra, which has recorded the most cases in India, at least 15 people escaped from two hospitals, according to officials and Indian news outlets. Most of the patients have been found and returned to quarantine. Dr Devendra Paturkar, a medical official in the city of Nagpur, said four patients who fled a hospital there have since tested negative for the coronavirus.

So far most if not all of India’s coronavirus cases have come from travelers — an Italian tour group visiting Rajasthan singlehandedly spread many of the cases. But public health experts fear what will happen if community transmission begins to take off, especially in packed urban areas with poor sanitation and where so many people live face to face.

“The challenge of a large country like India with overcrowding is that some people will always slip the net, wherever you put it,” said Dipanjan Roy, an Indian epidemiologist who has worked for the Centers for Disease Control and Prevention, and the World Health Organization.

He also worried about what he called the “let’s wait till tomorrow” attitude. Indian health officials should have put harsher quarantines into effect in February, he said.

“That month cost them,” Roy said. But he and other doctors said India offered certain advantages, including a decent track record containing flu epidemics and the fact that India is the one of the world’s largest producers of generic drugs.

Antibiotics are often dispensed here without prescriptions, worrying some medical professionals. But in a situation like this, experts said it might help: Many of the people dying from the coronavirus succumb to secondary infections, and some of those can be treated with antibiotics.

Demographics also work to India’s advantage. The population here is considerably younger than in the countries worst hit, and younger people have a much better chance of coping with the virus. Another possible factor is that India’s weather is warmer — and it is about to get really hot — though that has not been clinically proved to have a major effect.

Dr Henk Bekedam, the World Health Organization’s representative in India, said coronavirus cases in the country were all “traceable” and that there was no evidence yet of community transmission or a higher unofficial patient count. He said India had so far managed to keep cases low by responding fast and aggressively to the coronavirus, and urging people to practice social distancing. “I have been quite impressed with India,” Bekedam said. “From the onset they’ve been taking it very seriously.”