An eerie quiet had descended over a city usually overflowing with chaos on Wednesday morning. As Delhi residents woke on the first day of a three-week nationwide lockdown imposed on India’s population of 1.3 billion people in an attempt to halt the spread of the coronavirus, it was to a capital that was a ghost of its former self.
Gone was the wall-to-wall traffic, the overcrowded alleyway fruit and vegetable markets, the auto-rickshaws, the chai wallahs, the chaat stalls, the bicycles piled high with wicker baskets and the overcrowded temples, mosques and gurdwaras. Highways were empty and roads lined with police and paramilitary officers and checkpoints. Chalk circles were drawn on the ground outside grocery shops and hospitals for people queuing to stand in to ensure they kept a healthy distance apart.
Many also awoke to the reality of three weeks of hardship they were not sure they would be able to survive. More than 300 million people in India live below the poverty line, often living a hand to mouth existence as daily-wage workers with nothing in reserve to keep them going.
Ram Yadav, 55, a rickshaw driver in north Delhi, lives in a room he shares with four others at a cost of 1,000 rupees (£11) a month. He said he was overcome with anxiety at not being able to earn money for at least three weeks, if not more. “I have to pay for my room, pay rent for my rickshaw, and I have family back home who are waiting for me to send money, but I don’t know how I will do that and also survive. We are already just boiling rice and salt for lunch.”
Yadav also said that physical distancing was simply not an option in his crowded living quarters.
Experts widely agree that locking down is the most sensible plan of action for India, where healthcare is already lacking and overstretched. The country has only 40,000 ventilators, one doctor per 11,600 people, one hospital bed per 1,826 people and one isolation bed per 84,000 people. The number of coronavirus cases is still low compared with Europe and the US, with just over 500 people infected and 10 deaths, but testing is also markedly behind other countries. Only about 17,000 tests have been carried out.
“India can not take any chances now,” said Bhramar Mukherjee, a professor of epidemiology at the University of Michigan School of Public Health who leads a team studying the spread of the coronavirus around the world. “Even with the projected best-case scenarios, the already overstretched healthcare system will definitely collapse. There will be fatalities and deaths.
“We need to increase testing, think of pragmatic surveillance strategies. We need to brace ourselves and prepare for a long haul.”
But in a densely populated country where personal space is a luxury, the edict from the prime minister, Narendra Modi, calling for physical distancing and people to “forget what going out means” seemed like an almost impossible and unenforceable demand. Communal spaces form the basis of Indian society, three generations of a family tend to live together or next door, millions gather together in temples, mosques and gurdwaras on a daily basis and 64 million people live in overcrowded and insanitary slums.
There are signs that India is already buckling under the weight of the increasing coronavirus caseload. A junior doctor in Kolkata who works in a state hospital where infected patients are being treated, and spoke to the Guardian on condition of anonymity, said the four doctors in his hospital had been forced to work without the special personal protection equipment kits recommended by the World Health Organization because the authorities had not ordered them.
“Like many other doctor and paramedic colleagues and friends I worry that there is a high chance that I have already been infected and perhaps remained asymptomatic,” he said. “This is extremely stressful for me while I am still working as a doctor among the patients.
“After working directly among the corona suspects I am sure of one thing, that unless the authorities bring more population under test we will not be able to curb or stop the spread of the infection. Lots of people who are potential carriers are not being tested even after they turned up at hospitals with some symptoms. Many others are not even reporting to the hospitals.”
It was a similarly chaotic picture in the state of Bihar, which is dealing with around 50 coronavirus cases. Bihar also reported its first death at the weekend, a man who had recently returned from Qatar. Dr Ajay Kumar Bharti, the chief medical officer at Sadar hospital, where the man died, said they were ill-equipped to treat coronavirus patients safely. “We don’t have surgical masks available right now and hence have ordered a local tailor shop to stitch 5,000 masks made of clothes and make them available soon,” he said.
Before lockdown was imposed, state borders began to close and India’s railways, which usually carry 23 million passengers a day, shut down, tens of thousands of migrant workers returned to their villages from states such as Kerala and Maharashtra, the current centres of India’s outbreak, raising fears of an already uncontrollable spread.
“The available bed facility at government hospitals is not inadequate,” said the prominent Indian health expert Dr Rajiv Rajan. “The situation will turn alarming if we move into stage three and the patients start flooding the hospitals.”
For the people of Jammu and Kashmir however, Modi’s announcement on Tuesday evening was met with a familiar dread and panic. Lockdowns have long been part of their way of life and since Modi revoked the state’s special status last October and split it in two, they have endured a six-month crackdown which has crippled many essential services, including healthcare.
As a result, Kashmir’s healthcare system does not have enough manpower or machinery to deal with the outbreak. The state’s doctor-patient ratio is the lowest in India, it is severe short of nurses and has only about 100 ventilators for a population of more than 12 million.
“What we are doing are preventive measures just to control and isolate the virus,” said a doctor at a major trauma care hospital in Srinagar. “God forbid if we get a lot of cases or seriously sick patients. We will saturate in a matter of hours.
“We have a few ventilators, only at maximum 50 to 100, and they are already occupied. It could be a nightmare.”
Shaikh Azizur Rahman contributed reporting from Kolkata, Manoj Chaurasia from Patna and a reporter from Srinagar