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V OLUME 37 NUMBER 09 APRIL25-MAY 8, 2020 ISSN 0970-1710 HTTPS://FRONTLINE.THEHINDU.COM C OVER STORY U ttar Pradesh: Season of distress 70 Lockdown and after West Bengal: ‘Too low’ on testing 73 In India, decisions on strategies to contain COVID-19 are being Madhya Pradesh: made on the basis of unreliable data, but two things are clear: the Chief without a plan 76 Delhi: In fits and starts 78 number of infections is still on the rise and once the lockdown is lifted Odisha: On the right track 81 4 Jammu & Kashmir: there will be a resurgence of cases. ‘Weaponising’ the virus 84 Judiciary: Disappointing verdicts 87 Trump tilting at windmills 91 Venezuela: Big fightback 94 Global economy: Everybody hurts 97 Why the indifference to people with disabilities 99 BOOKS 102 D ata discrepancy 9 Students in limbo 51 ICMR: Proof of community THE STATES transmission 10 Kerala: Bracing for Temperature not a factor 12 the next wave 53 Maharashtra: Surprise surge 56 Widespread rural distress 29 Mumbai’s ticking bomb 58 Why Kerala stands apart 33 Karnataka: Bengaluru RBI in talks with U.S. Fed for centric efforts 60 a swap line 37 Tamil Nadu: Successes In search of a strategy 15 Interview: Keshav Desiraju 40 and worries 63 High-risk warriors 18 AYUSH and advisories 44 Telangana & Raw deal to States 20 Targeting a community 46 Andhra Pradesh: Jolted Interview: Dr Thomas Isaac 24 Calling out fake news 49 to a start 67 On the Cover The long wait for food during the lockdown, in Patna on April 15. 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In no event can the Owner, Reproduction in whole or in part without written permission is prohibited. Publisher, Printer, Editor, Director/s, Employees of this magazine/ company be held responsible/liable in any manner whatsoever for any e-mail: [email protected] claims and/or damages for advertisements in this magazine. Frontline is not responsible for the content of external Internet sites. M AY 8, 2020 . F RONTLINE 3 A CIVIC WORKER sprays disinfectant on beds at a temporary hospital facility in Mumbai on April 10. C OVER STORY KAKADE/AP AJANISH R 1 for some days can one say that the curve has hit the inflection point from where the slope will become less LOCKDOWN AND AFTER than 1; the peak number can be expected to be around twice the number of infections at the inflection point. In India, decisions on strategies to contain COVID-19 are being made their objective of slowing down the transmission of the D OUBLING TIME infection in the population. This, as mentioned above, is Another way of looking at the progression of the epi- on the basis of unreliable data, but two things are clear: the number of also evident from the fact that the rate of increase in the demic in India is the so-called doubling time: the number number of infections has been coming down since the of days it takes for the number of infections on a given day infections is still on the rise and once the lockdown is lifted there will lockdown began. In the second phase, in fact, it has come to double itself. It is this metric that the government is be a resurgence of cases. The government needs to come up with a down from a 10-15 per cent rate of increase to under 10 using to show the efficacy of the lockdown. In its press per cent, a little flattening of the curve. That this should update of April 20, the Health Ministry said: “The doub- calibrated approach to manage both in the post-lockdown period. happen is intuitively obvious when physical distancing ling rate of COVID-19 cases calculated using growth over between people and person-to-person contacts are min- the past seven days indicates that India’s doubling rate R. RAMACHANDRAN BY imised; the chance of one individual passing the infection for the week before lockdown [March 18-24] was 3.4 and to another has been greatly reduced. has improved to 7.5 as on 19th April, 2020 (for the last AT THE END OF THE FIRST WEEK INTO THE have come down to single digits (Figures 1 and 2). The But the growth factor (the ratio of the changes in the seven days).” second phase of the country’s extended lockdown (April plots in Figure 2, which is on a logarithmic scale (with number of confirmed cases between two consecutive This is not surprising because, as pointed out above, if 21), the number of confirmed COVID-19 cases, the num- each unit on the y-axis increasing by a factor of 10), are days), that is, the slope of the curve, is still consistently you cut off nearly all possibilities of transmission of ber of those recovered and the number of deaths stood at linearly increasing, which is what they would look like if above 1, which means that the curve of infections is still infection by totally switching off social/societal interac- 18,601 (14,759 active), 3,252 and 590 respectively. the number of cases (and correspondingly the number of exponentially increasing, though a little slower than be- tions, this will naturally happen. The rates of increase both in the number of confirmed deaths) are still on an exponentially increasing curve. fore the lockdown, and the country is still far from peak- At the State level, however, there is a wide dispersion cases and in the number of deaths (in percentage terms) The two phases of lockdown have certainly achieved ing and then declining. Only when the slope stays around in doubling times as is evident from the Ministry’s April F RONTLINE . M AY 8, 2020 4 5 F RONTLINE . M AY 8, 2020 F IGURE 3 19 data (see table). The Chennai-based National Institute the number of confirmed cases crossed 50. For compar- of Epidemiology has on its website presented a nice way ison, plots of growth with doubling times of three and five of looking at this with data for eight representative days have also been given in the same graph. As can be States: Andhra Pradesh, Delhi, Kerala, Maharashtra, Ra- seen, except for Kerala (which is clearly an outlier in this jasthan, Tamil Nadu and Telangana (Figure 3; unfortu- set), although most of them were curving towards the nately, this graph has not been updated with latest data, five-day doubling curve, some slower than the others, and the plots are only up to a few days before April 19). there are problematic States such as Maharashtra and The growth has been plotted beginning with the Delhi. When this plot is combined with the Ministry data, (normalised) day “zero” for these States, which is when it is clear that if States such as Delhi, Rajasthan and Tamil Nadu have managed to improve their doubling times—that is, their plots have gone below the five-day FIGURE 1 doubling curve—this has happened only in the last few days. The important question at this juncture, however, is, What is the planned strategy of exit on May 3 when the second phase of lockdown ends? But before one ad- dresses that question, one has to keep in mind an import- ant caveat while interpreting all the data above and in the F IGURE 4 accompanying graphs. The caveat is that all the official ive, but we don’t have criteria to measure…. Our daily data about doubling times, and so on, should be taken counts are not any sign of “flat curve” except in Kerala with a huge dose of salt because it is well known that the (well managed) and in Goa (well managed and some luck surveillance and testing strategy in India has been grossly too, I suspect). Whatever happened till two weeks under inadequate. According to model estimates (see separate lockdown, I will assign to infections occurring before story), the infection detection rate in India is only about 2 lockdown; after that, infections [occurred] under lock- per cent, though it is improving slowly (Figure 4) with the down. So, yes, some speed acceleration should be adoption of the newly broadened criteria and the ongo- expected.” ing efforts at widespread deployment of rapid sero-test- Returning to the question about the post-May 3 ing kits (notwithstanding reported proneness to error). strategy, extension of the lockdown is not a viable solu- So, what is the sanctity or even remote accuracy of the tion, according to Dr Jayaprakash Muliyil, an epidemi- baseline caseload data from which doubling times are ologist also from the CMC: “The virus is out there; you being calculated? For example, many of the cases that get cannot stop it.

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