Its Coronavirus Caseload Soaring, India Is Reopening Anyway

By Kai Schultz and Sameer Yasir

Worried for its economy, India loosened tough restrictions and may lift them entirely this weekend. But infection numbers are climbing fast.

Caring for a Covid-19 patient at a New Delhi hospital on Thursday.
Caring for a Covid-19 patient at a New Delhi hospital on Thursday.Credit...Danish Siddiqui/Reuters

NEW DELHI — Its coronavirus cases are skyrocketing, putting it among the world’s most worrisome pandemic zones in recent weeks. Nonetheless, India is reopening, lifting its lockdown at what experts fear may be the worst time.

Migrant workers are becoming infected at an alarmingly high rate, leading to fresh outbreaks in villages across northern India. Public hospitals in Mumbai are so overwhelmed that patients have taken to sleeping on cardboard in the hallways.

Doctors fear that the lockdown, which started over two months ago, has been eased too soon, after slowing the virus but failing to flatten the new-case curve as effectively as other nations have. If India does not find a way to curb the virus in high-risk states, epidemiologists project that its total caseload could approach a million within several weeks.

“India is not out of the woods,” said Dr. Ashish Jha, the director of the Harvard Global Health Institute.

“From a public health point of view, I do think the lockdown has brought the disease under control,” he said. “But of course, as restrictions have lifted in the last week or 10 days, the number of cases has started to rise quickly.”

At first, India moved aggressively to contain the coronavirus. In late March, Prime Minister Narendra Modi implemented one of the most severe lockdowns anywhere, ordering all Indians to stay inside, halting transportation and closing most businesses.

ImagePreparing a quarantine center in Mumbai this month.
Preparing a quarantine center in Mumbai this month.Credit...Atul Loke for The New York Times

But the lockdown was brutally hard on the poorest Indians and those who rely on day labor to survive. And the country’s economy, which had already been ailing, was sustaining deep wounds. Government officials began lifting some restrictions last month, hoping to ease the suffering, and the lockdown may end entirely as soon as Sunday, if Mr. Modi does not decide to extend it.

Infections are rising quickly now, however, with outbreaks in some states that had reported few cases. This month, India’s doubling rate for new infections averaged about 12 days, putting it on par with countries of high concern like Brazil.

That number compares poorly to those of other nations where stay-at-home orders were imposed. In the United States, the doubling rate improved from around 26 days at the start of May to about 50 days on Monday. Italy crossed the 100-day mark early this month.

But in India, a nation of 1.3 billion people, locking down has posed different challenges than in many Western societies. Its metro areas are among the world’s densest, with millions living in packed slums, sometimes sleeping eight to a room.

Almost half of India’s cases have been traced to just four cities: New Delhi, Mumbai, Chennai and Ahmedabad.

“Social distancing is inherently very difficult in India,” Dr. Jha said. “I don’t know if India could realistically get to 26 days, or 50 days.”

Migrant workers at a train station in Dadri, in the Indian state of Uttar Pradesh. Many migrants apparently brought the virus home to their villages after work dried up in the cities.Credit...Rebecca Conway for The New York Times

Testing has also been severely restricted, making it tough to gauge the scope of the outbreak. India has administered only two tests for every 1,000 people, one of the lowest ratios among the world’s worst-afflicted countries.

Dr. G.C. Khilnani, a public health expert and pulmonologist, said a peak in infections might not be reached until the end of July. He said India’s relatively low number of total cases per capita (about 160,000 infections and 4,706 deaths) should not be taken as a sign that the country had necessarily escaped the worst.

“Nobody can predict to what extent the numbers will go up,” Dr. Khilnani said.

As many parts of India continue to see days with record-high infections, a political consensus on how to fight the virus has deteriorated, giving way to acrimony and finger-pointing.

“We are the only country in the world where the virus is exponentially rising,” Rahul Gandhi, a leader of the opposition Indian National Congress party, said in a video statement. “What India is facing now, in front of us, is the result of a failed lockdown.”

Demonstrating contact-free Covid-19 testing at a Mumbai hospital last month.Credit...Atul Loke for The New York Times

Amit Malviya, a spokesman for Mr. Modi’s Bharatiya Janata Party, fired back in a television interview. He accused Mr. Gandhi of not taking stronger action to contain infections in Maharashtra, India’s hardest-hit state, which is governed by a coalition that includes the Indian National Congress.

“Maharashtra is completely over the top, it’s bleeding, people are dying, the health infrastructure’s crumbled,” Mr. Malviya said. Health officials have traced nearly 40 percent of India’s cases to the state.

Questions have also been raised about whether the lockdown played a role in spreading the virus to remote areas of India.

When Mr. Modi announced the restrictions, he gave Indians just four hours to prepare before they went into effect. Millions of migrant workers were stranded in cities. With bus and train services suspended, some walked hundreds of miles to reach their villages, using dirty pieces of cloth to cover their faces. The human suffering has been staggering.

Shiv Dutt Gupta, a member of a government task force crafting the lockdown exit plan, partially attributed the surge in new cases to laborers bringing the coronavirus into rural India.

Test results for several hundred migrant workers who traveled from New Delhi to the state of Bihar this month found that one in four had contracted Covid-19. Bihar now has one of the steepest infection curves in India, and troubling clusters have also been tracked to laborers traveling to their homes in Uttar Pradesh, the country’s most populous state.

Handing out food this week in Dharavi, Mumbai’s largest slum.Credit...Atul Loke for The New York Times

“The rate of positive cases among the migrant workers is very high,” Mr. Gupta said. “That is alarming.”

  • Updated May 28, 2020

    • States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

    • The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

If the lockdown continues, Mr. Gupta said, “We will be devastated economically.”

Officials have justified loosening rules by pointing out that not all of India has been hit equally, with hopeful improvements in states like Kerala. And doctors note that the lockdown did buy the government time to ramp up infrastructure in the country’s already overburdened health facilities.

“Two months of lockdown has helped us fine-tune our treatment protocols, our isolation protocols, our quarantine protocols,” said Naresh Trehan, a prominent Indian surgeon.

Now, the resumption of cross-country transportation and industry has raised the prospect that previously spared states may find themselves confronted with imported outbreaks.

But many Indians seem ready to venture out, despite the numbers.

After weeks of self-isolating at home, Mujtaba Rizvi, an artist living in Chennai, said he went for a walk last weekend and was stunned by what he saw. Streets were clogged with cars. Shoppers spilled out of crowded shops without wearing masks or observing social distancing.

At this point, Mr. Rizvi said, it appeared there was no turning back.

“Freedom comes at a price, and people seem to be ready to pay,” he said. “Even if more people die now, it would be difficult to send us back into isolation.”

Dharavi at night. Almost half of India’s infections have been traced to four cities, including Mumbai.Credit...Atul Loke for The New York Times

Suhasini Raj contributed reporting.