Why India's Lockdown failed to control Covid-19?
India will extend Covid-19 Lockdown with some relaxations. But India's Covid-19 response to control the virus has largely failed. India comprises of almost 20% population of the world and perceived as world's largest Democracy. The impact of Covid-19 spreading uncontrollably in India will mean tremendous economic and human loss.
ICMR, Health Ministry, News media and many experts talk about "Flattening of Curve" regarding Coronavirus situation. Its unsurprising that most Politicians as well as news media are unaware of technicalities of Covid-19 curve so they make all kind of wrong statements and assertions. But unfortunately, even experts of ICMR and AIIMS also make illogical statements about Covid-19 in India.
Flawed and Erroneous Covid-19 Model of Niti Aayog predicted new cases falling to zero by May 16
Image - Indian Express
Understanding general Covid-19 curve - Concept of Flattening of Curve
Lets understand some facts on Coronavirus and its curve. Its believed that Coronavirus spreads exponentially with time if no containment measures are enforced. There is a technical term called R0 (Reproduction number) which defines the rate of spread of infection. The strategy of lockdowns, mitigation, social distancing & crowd control measures are adopted to bring down this R0 number and hence slow down the spread of infection. The estimation of R0 number is a tedious process which requires complex modelling taking into account the population dynamics, medical intervention, mitigation measures and many other factors.
Covid-19 cases vs Time Plot. Dotted line in 2nd Plot shows comparison of Healthcare Capacity of Country like India compared to Developed countries. India's Capacity much lower than US or EU states.
Plotting Covid-19 curve with time. X Axis is Time and Y Axis is number of cases on exponential scale, we can plot the Cases vs Time graph like above. The growth of cases depend upon social control measures and cases grow at rapid rate without any control measures. Most of Covid-19 cases do not require medical intervention as infected people are either asymptomatic or only have mild symptoms. But as much as 5% of infected patients may develop serious conditions which require critical medical care like respiratory support and other interventions. The "flattening of curve" is a strategy of curtailing the growth of Covid-19 infections so as to keep the number of critically ill infected patients under the limit of Hospital capacity of healthcare system. The peak of Covid-19 cases is delayed, kept under the limit of health care capacity and gradient of curve is reduced to spread and flatten the curve on a larger timeline. Hospital Capacity to handle critically ill patients depend upon many factors in healthcare system - Doctor to population ratio, Hospital Beds & ICU Beds per thousand people, healthcare outreach specially in rural areas and in general the advancement of healthcare system which very much depend upon government investment in healthcare sector.
It should be noted that this Covid-19 response strategy has to be formulated, reviewed and implemented by a highly technocratic set of people - Economists, Scientists, Epidemiologists, Doctors & other domain experts. Also for planning and execution of any Covid-19 response strategy, the Data and information gathering and continuous monitoring is a top priority.
Strategy of flattening the curve has two dimensions - curtailing the growth of infections and maximizing the healthcare system to accommodate & treat infected people.
1. Large scale testing, identification, isolation, quarantine & treatment of infected people.
2. Lockdown measures to enforce Social distancing, shutting down of economy, businesses, workplaces, transport system and public places to minimize social contacts.
3. Public awareness campaign to inform and educate people about health guidelines and importance of Social distancing.
4. Building new temporary Hospitals and Quarantine zones to increase healthcare capacity.
5. Massive investment in manufacturing and procurement of medical supplies and equipment like Testing kits, Masks, PPEs, Ventilators, Drugs, Sanitizers etc to deal with upsurge in medical emergencies and protection of Doctors, Nurses and other front line workers.
Flattening of the Covid-19 curve in Italy
Image - worldometers.info
While countries like Spain, Italy, South Korea etc have managed to Control Covid-19 in various Lockdown measures, India is moving to relax Lockdown measures even when new Covid-19 cases continue to spike. Why India could not control Covid-19 despite harsh Lockdown measures? Its because Lockdown is just one aspect of Covid-19 response strategy which has to be supplemented with many other things - Large scale testing, isolation & treatment of infected people, building up healthcare capacity to deal with massive surge of patients, economic relief measures to people to support them for an effective Stay-at-home strategy etc.
India's Covid-19 cases continue to rise
Image - worldometers.info
Structural Problems in India - Social Distancing is not feasible - High Population Density is becoming a Nightmare - Healthcare system will implode
1. India's public healthcare system is weak and understaffed with acute shortage of Doctors, Nurses and other resources. India's healthcare spending is among the lowest in the world. Doctor to population ratios is very low and even lower in rural India. Healthcare outreach in rural areas is almost non existent. Many posts in Govt healthcare sector like Doctors, Nurses, Professors, Epidemiologists etc in States remain vacant as Govt in most parts of the country never gave priority to public health. Much of the country's healthcare system is under private sector which works purely on profit incentive. Since most of population is poor, they don't have access to private health system.
India's Doctor to Population Ratio - Doctors per thousand people - Comparison with rest of the world
Photo - BMJ
Hospital Beds per 1000 people - India's comparison with other countries
Source - OECD
Hospital Bed Density in Indian States - Southern States are relatively better
2. India's economic system is fragile, imbalanced and unstable. India's economic growth is concentrated in urban cities while economic development and job opportunities are low to non existent in rural India and villages. There is huge economic disparity among states and workers in unorganized sectors travel from poorer states to other states with relatively better avenues for employment. Most of the economy is unorganized and most of workforce earns and eat hand to mouth on daily wages. Most of the population doesn't have food security, income security, access to healthcare, housing and other basic amenities.
3. India's population dynamics and socioeconomic conditions has major impact on public health. The sheer size of population of India being the second most populous country in the world is itself a huge risk factor in Covid-19 spread. High population density in cities is one of the greatest problems in tackling Covid-19 crisis in India. Most of the population lives in villages, slums, urban clusters, illegal colonies, temporary shelters etc where basic amenities like running water supply, sewer system, electricity, cooking gas etc are not available. Sanitary conditions are very bad which lead to frequent outbreaks of Cholera, Malaria, Dengue, Tuberculosis and other diseases.
A map of India by Population comparison of states with other foreign countries
4. Social distancing cannot be reasonably implemented in country like India due to obvious socioeconomic reasons. Most of the Indians living in slums and illegal colonies live in highly congested localities with Population of as much as 50,000 per square mile. Many families and co-workers migrants share same rooms and toilets. Many depend upon public toilets which is shared by hundreds of people everyday. As most people depend on state ration, they have to visit Govt ration depots and stand in long queues. The public transport system is overloaded by high population and its almost impossible to implement Social distancing in Railways, Metros, Buses and other modes of transportation system.
5. Lack of public awareness and literacy among population is a big problem in India specially Hindi heartland. The government does try to spread health awareness among public through variety of outreach programs but its very difficult to do when a lot of population has no formal education.
Early mistakes - Mismanagement and lack of planning - Failure to take the crisis seriously - Lack of Transparency
1. Govt didn't realize the seriousness of crisis. January, February and most part of March were wasted by the Govt when preparations for Covid-19 outbreak would have been done as a top national priority.
2. As India had major structural problems in healthcare system and economy, the early containment strategy was the best & only effective strategy to stop Covid-19 crisis in India. It was clear that WHO was not giving accurate information on nature of Pandemic. So it was responsibility of Govt to enforce full international travel ban and sealing of borders in February.
3. As the Covid-19 crisis hit India in March, India was caught completely unprepared. The success story of Covid-19 response in South Korea and Taiwan shows that early response is the most critical step in Covid-19 crisis. Large scale testing, identification, isolation & treatment should be a key priority. But without medical supplies, testing kits, PPEs & Quarantine facilities, India could not mount an effective initial containment strategy.
Covid-19 Tests per thousand - Comparison of India with rest of the world
Source - ourworldindata.org
4. Virus can be seen in 5 stages of transmission - Direct transmission due to foreign travel history, Local transmission from contact with people with foreign travel history, Limited and localized community transmission, wide spread community transmission and Finally full blown epidemic. India with all the weaknesses and structural problems can mount an effective defense strategy only to deal with first two stages. As its evident from recent experience that despite harsh lockdown measures, the Covid-19 continues to transmit at great pace in country and specially metropolitan cities and high density population areas like Mumbai and Delhi.
5. Due to lack of testing kits, Govt is resorting to general screening by visiting homes and inquiring about presence of Covid symptoms. Screening cannot be a substitution for testing as most infected people are asymptomatic/pre symptomatic. People either do not show any symptoms at all or they show symptoms several days after infection while they remain spreaders of infections without showing any symptoms.
To prepare any response strategy, Data and information gathering is critical. Without sufficient number of testing kits, there was much expectation from random Antibody screening tests specially in cities and hotspots that could give some idea about level of infection spread in country. Unfortunately, half of million serology testing kits imported from China turned out to be defective. So India which lacked RT PCR kits also failed to roll out antibody testing for general surveillance.
6. Lack of Lockdown planning was clearly visible. Lockdown was announced with only few hours notice but Govt did not do any preparation for economic and healthcare management for this national emergency. The situation with mass exodus of migrants was one of the biggest failure of Govt. As Govt failed to provide food & income security to Millions of migrant workers, they started going back to their native villages. Social distancing norms were thrown out of the window and massive humanitarian tragedy unfolded where millions of people started walking on national highways,
Migrant workers at Delhi UP Border
Photo - Hindustan Times
7. Another extremely important aspect of India's Covid-19 response is lack of transparency by the Govt. Govt has not made a serious effort to clearly put forward its response in terms of healthcare as well as economic policy. Public is mostly kept uninformed and clueless about Govt action plan and perhaps for a good reason - there is no action plan. What is the Epidemiological model of India's response strategy to Covid-19? How will India add to its healthcare capacity with new Hospitals, ICU Beds and medical supplies? How will India have mass testing in coming months (some estimates suggest India may need hundreds of millions of tests)? Can people afford Rs 4500 testing charges in Private Hospitals? Answers to these questions remain elusive. Even the basic things have not been done. Like building a centralized portal to inform people about availability of beds in Hospitals, regulations & guidelines for private hospitals for Covid-19 treatment, pricing caps and fixation of treatment charges in private hospitals. Central Government has not notified any clear guidelines.
Prime Minister comes on National TV every few weeks and talk about things with no head or tail. All important issues like collapse of our healthcare system and economy, Migrant crisis & mass exodus of people from cities, Food insecurity of poor people, Lack of PPEs Masks & Medical supplies for front line workers - Prime Minister never talks on these issues. He talks about Make in India (repackaged into Atmanirbhar Bharat), Opportunity of India becoming world leader and National pride of India.
On other side, some junior level Health Ministry officials give Press briefings and updates about Covid-19 situation in India. But those briefings also lack any real information.
A Case Study of Urban Slums - Dharavi in Mumbai
1. Dharavi has Population of 700,000 - 1 Million living in less than one square mile of slum cluster. Presently there are around 1000 detected Covid-19 cases and 40 confirmed deaths.
2. A lot of the population depend upon roughly 400 Community and public toilets in Dharavi. That means hundreds of people are sharing same toilets. State Govt is now sanitizing and disinfecting these toilets daily. Most of the people don't have a running water supply in their home so personal hygiene, washing of hands etc is not possible.
Narrow lanes of Mumbai Slums
Photo - Reuters
3. Social distancing is not possible as these slums are extremely crowded. Narrow lanes of Dharavi are only few feet wide with houses crammed up in space without any proper ventilation. People of Dharavi stand in long queues to get daily meals and rations.
4. The State Government does not have RT PCR kits or Antibody testing kits to roll out on large scale so they are trying to health screen Dharavi population based on Door to Door surveys to identify symptomatic patients. This screening will miss majority of infected people as they are Asymptomatic or pre-symptomatic.
5. Quarantining and sealing off such a large population cluster is challenging. Providing relief efforts like food distribution and medical screening is very difficult. Many people are leaving Dharavi and migrating to other areas thus likely spreading of disease in other parts of city.
6. State & Local Govt are providing HCQ as preventive measure though its now known that HCQ doesn't have medical benefit in curing Covid-19.
Conclusion
India's Political leadership failed to grasp the seriousness of Covid-19 emergency early on and this was later compounded by Structural problems in our poor healthcare and economic system. Lockdown was like a hammer which was swung relentlessly to stop the Covid-19. But a more scientific, sensible and technocratic approach was needed in addition to lockdown measures which this Govt could not deliver. Management of healthcare and economic system is an extraordinary challenge during this pandemic emergency and Indian Govt, specially the political leadership, is no match for this crisis. The impact of uncontrolled explosion of Covid-19 infection in India will be tremendous. India like other backward 3rd world countries has significant part of population in deprivation - lack of food, income & job security, lack of access to healthcare, lack of basic amenities etc. A large part of population has many vulnerabilities like Malnutrition, diagnosed and untreated medical conditions, rampant presence of other diseases Cholera, Tuberculosis including Drug resistant TB, Malaria, Dengue etc. The healthcare system which is already in very poor condition will simply implode and collapse as being seen witnessed already in cities like Mumbai.
The economy will breakdown to a large degree as the inability to control underlying health crisis of country will make any recovery impossible for quite some time. Brutal Herd immunity will become a natural course of defense in coming time. Without a vaccine or effective therapeutic against Covid-19, many people will die and country will face a challenging time for next 1-2 years. I don't think that exact number of deaths, disabilities, economic losses, bankruptcies, job losses etc will be quantified with any accuracy in a country like India where public records and information is hardly given any significance. Also judging by the track record of this government, they will try to suppress these statistics and numbers as much as they can.
ICMR, Health Ministry, News media and many experts talk about "Flattening of Curve" regarding Coronavirus situation. Its unsurprising that most Politicians as well as news media are unaware of technicalities of Covid-19 curve so they make all kind of wrong statements and assertions. But unfortunately, even experts of ICMR and AIIMS also make illogical statements about Covid-19 in India.
Flawed and Erroneous Covid-19 Model of Niti Aayog predicted new cases falling to zero by May 16
Image - Indian Express
Understanding general Covid-19 curve - Concept of Flattening of Curve
Lets understand some facts on Coronavirus and its curve. Its believed that Coronavirus spreads exponentially with time if no containment measures are enforced. There is a technical term called R0 (Reproduction number) which defines the rate of spread of infection. The strategy of lockdowns, mitigation, social distancing & crowd control measures are adopted to bring down this R0 number and hence slow down the spread of infection. The estimation of R0 number is a tedious process which requires complex modelling taking into account the population dynamics, medical intervention, mitigation measures and many other factors.
Covid-19 cases vs Time Plot. Dotted line in 2nd Plot shows comparison of Healthcare Capacity of Country like India compared to Developed countries. India's Capacity much lower than US or EU states.
Plotting Covid-19 curve with time. X Axis is Time and Y Axis is number of cases on exponential scale, we can plot the Cases vs Time graph like above. The growth of cases depend upon social control measures and cases grow at rapid rate without any control measures. Most of Covid-19 cases do not require medical intervention as infected people are either asymptomatic or only have mild symptoms. But as much as 5% of infected patients may develop serious conditions which require critical medical care like respiratory support and other interventions. The "flattening of curve" is a strategy of curtailing the growth of Covid-19 infections so as to keep the number of critically ill infected patients under the limit of Hospital capacity of healthcare system. The peak of Covid-19 cases is delayed, kept under the limit of health care capacity and gradient of curve is reduced to spread and flatten the curve on a larger timeline. Hospital Capacity to handle critically ill patients depend upon many factors in healthcare system - Doctor to population ratio, Hospital Beds & ICU Beds per thousand people, healthcare outreach specially in rural areas and in general the advancement of healthcare system which very much depend upon government investment in healthcare sector.
It should be noted that this Covid-19 response strategy has to be formulated, reviewed and implemented by a highly technocratic set of people - Economists, Scientists, Epidemiologists, Doctors & other domain experts. Also for planning and execution of any Covid-19 response strategy, the Data and information gathering and continuous monitoring is a top priority.
Strategy of flattening the curve has two dimensions - curtailing the growth of infections and maximizing the healthcare system to accommodate & treat infected people.
1. Large scale testing, identification, isolation, quarantine & treatment of infected people.
2. Lockdown measures to enforce Social distancing, shutting down of economy, businesses, workplaces, transport system and public places to minimize social contacts.
3. Public awareness campaign to inform and educate people about health guidelines and importance of Social distancing.
4. Building new temporary Hospitals and Quarantine zones to increase healthcare capacity.
5. Massive investment in manufacturing and procurement of medical supplies and equipment like Testing kits, Masks, PPEs, Ventilators, Drugs, Sanitizers etc to deal with upsurge in medical emergencies and protection of Doctors, Nurses and other front line workers.
Image - worldometers.info
While countries like Spain, Italy, South Korea etc have managed to Control Covid-19 in various Lockdown measures, India is moving to relax Lockdown measures even when new Covid-19 cases continue to spike. Why India could not control Covid-19 despite harsh Lockdown measures? Its because Lockdown is just one aspect of Covid-19 response strategy which has to be supplemented with many other things - Large scale testing, isolation & treatment of infected people, building up healthcare capacity to deal with massive surge of patients, economic relief measures to people to support them for an effective Stay-at-home strategy etc.
Image - worldometers.info
Structural Problems in India - Social Distancing is not feasible - High Population Density is becoming a Nightmare - Healthcare system will implode
1. India's public healthcare system is weak and understaffed with acute shortage of Doctors, Nurses and other resources. India's healthcare spending is among the lowest in the world. Doctor to population ratios is very low and even lower in rural India. Healthcare outreach in rural areas is almost non existent. Many posts in Govt healthcare sector like Doctors, Nurses, Professors, Epidemiologists etc in States remain vacant as Govt in most parts of the country never gave priority to public health. Much of the country's healthcare system is under private sector which works purely on profit incentive. Since most of population is poor, they don't have access to private health system.
India's Doctor to Population Ratio - Doctors per thousand people - Comparison with rest of the world
Photo - BMJ
Source - OECD
2. India's economic system is fragile, imbalanced and unstable. India's economic growth is concentrated in urban cities while economic development and job opportunities are low to non existent in rural India and villages. There is huge economic disparity among states and workers in unorganized sectors travel from poorer states to other states with relatively better avenues for employment. Most of the economy is unorganized and most of workforce earns and eat hand to mouth on daily wages. Most of the population doesn't have food security, income security, access to healthcare, housing and other basic amenities.
3. India's population dynamics and socioeconomic conditions has major impact on public health. The sheer size of population of India being the second most populous country in the world is itself a huge risk factor in Covid-19 spread. High population density in cities is one of the greatest problems in tackling Covid-19 crisis in India. Most of the population lives in villages, slums, urban clusters, illegal colonies, temporary shelters etc where basic amenities like running water supply, sewer system, electricity, cooking gas etc are not available. Sanitary conditions are very bad which lead to frequent outbreaks of Cholera, Malaria, Dengue, Tuberculosis and other diseases.
A map of India by Population comparison of states with other foreign countries
4. Social distancing cannot be reasonably implemented in country like India due to obvious socioeconomic reasons. Most of the Indians living in slums and illegal colonies live in highly congested localities with Population of as much as 50,000 per square mile. Many families and co-workers migrants share same rooms and toilets. Many depend upon public toilets which is shared by hundreds of people everyday. As most people depend on state ration, they have to visit Govt ration depots and stand in long queues. The public transport system is overloaded by high population and its almost impossible to implement Social distancing in Railways, Metros, Buses and other modes of transportation system.
5. Lack of public awareness and literacy among population is a big problem in India specially Hindi heartland. The government does try to spread health awareness among public through variety of outreach programs but its very difficult to do when a lot of population has no formal education.
Early mistakes - Mismanagement and lack of planning - Failure to take the crisis seriously - Lack of Transparency
1. Govt didn't realize the seriousness of crisis. January, February and most part of March were wasted by the Govt when preparations for Covid-19 outbreak would have been done as a top national priority.
Namaste Trump event in India on Feb 24, in the early days of Pandemic (Photo - qz.com)
3. As the Covid-19 crisis hit India in March, India was caught completely unprepared. The success story of Covid-19 response in South Korea and Taiwan shows that early response is the most critical step in Covid-19 crisis. Large scale testing, identification, isolation & treatment should be a key priority. But without medical supplies, testing kits, PPEs & Quarantine facilities, India could not mount an effective initial containment strategy.
Source - ourworldindata.org
4. Virus can be seen in 5 stages of transmission - Direct transmission due to foreign travel history, Local transmission from contact with people with foreign travel history, Limited and localized community transmission, wide spread community transmission and Finally full blown epidemic. India with all the weaknesses and structural problems can mount an effective defense strategy only to deal with first two stages. As its evident from recent experience that despite harsh lockdown measures, the Covid-19 continues to transmit at great pace in country and specially metropolitan cities and high density population areas like Mumbai and Delhi.
5. Due to lack of testing kits, Govt is resorting to general screening by visiting homes and inquiring about presence of Covid symptoms. Screening cannot be a substitution for testing as most infected people are asymptomatic/pre symptomatic. People either do not show any symptoms at all or they show symptoms several days after infection while they remain spreaders of infections without showing any symptoms.
To prepare any response strategy, Data and information gathering is critical. Without sufficient number of testing kits, there was much expectation from random Antibody screening tests specially in cities and hotspots that could give some idea about level of infection spread in country. Unfortunately, half of million serology testing kits imported from China turned out to be defective. So India which lacked RT PCR kits also failed to roll out antibody testing for general surveillance.
6. Lack of Lockdown planning was clearly visible. Lockdown was announced with only few hours notice but Govt did not do any preparation for economic and healthcare management for this national emergency. The situation with mass exodus of migrants was one of the biggest failure of Govt. As Govt failed to provide food & income security to Millions of migrant workers, they started going back to their native villages. Social distancing norms were thrown out of the window and massive humanitarian tragedy unfolded where millions of people started walking on national highways,
Migrant workers at Delhi UP Border
Photo - Hindustan Times
7. Another extremely important aspect of India's Covid-19 response is lack of transparency by the Govt. Govt has not made a serious effort to clearly put forward its response in terms of healthcare as well as economic policy. Public is mostly kept uninformed and clueless about Govt action plan and perhaps for a good reason - there is no action plan. What is the Epidemiological model of India's response strategy to Covid-19? How will India add to its healthcare capacity with new Hospitals, ICU Beds and medical supplies? How will India have mass testing in coming months (some estimates suggest India may need hundreds of millions of tests)? Can people afford Rs 4500 testing charges in Private Hospitals? Answers to these questions remain elusive. Even the basic things have not been done. Like building a centralized portal to inform people about availability of beds in Hospitals, regulations & guidelines for private hospitals for Covid-19 treatment, pricing caps and fixation of treatment charges in private hospitals. Central Government has not notified any clear guidelines.
Prime Minister comes on National TV every few weeks and talk about things with no head or tail. All important issues like collapse of our healthcare system and economy, Migrant crisis & mass exodus of people from cities, Food insecurity of poor people, Lack of PPEs Masks & Medical supplies for front line workers - Prime Minister never talks on these issues. He talks about Make in India (repackaged into Atmanirbhar Bharat), Opportunity of India becoming world leader and National pride of India.
On other side, some junior level Health Ministry officials give Press briefings and updates about Covid-19 situation in India. But those briefings also lack any real information.
A Case Study of Urban Slums - Dharavi in Mumbai
1. Dharavi has Population of 700,000 - 1 Million living in less than one square mile of slum cluster. Presently there are around 1000 detected Covid-19 cases and 40 confirmed deaths.
2. A lot of the population depend upon roughly 400 Community and public toilets in Dharavi. That means hundreds of people are sharing same toilets. State Govt is now sanitizing and disinfecting these toilets daily. Most of the people don't have a running water supply in their home so personal hygiene, washing of hands etc is not possible.
Narrow lanes of Mumbai Slums
Photo - Reuters
3. Social distancing is not possible as these slums are extremely crowded. Narrow lanes of Dharavi are only few feet wide with houses crammed up in space without any proper ventilation. People of Dharavi stand in long queues to get daily meals and rations.
4. The State Government does not have RT PCR kits or Antibody testing kits to roll out on large scale so they are trying to health screen Dharavi population based on Door to Door surveys to identify symptomatic patients. This screening will miss majority of infected people as they are Asymptomatic or pre-symptomatic.
5. Quarantining and sealing off such a large population cluster is challenging. Providing relief efforts like food distribution and medical screening is very difficult. Many people are leaving Dharavi and migrating to other areas thus likely spreading of disease in other parts of city.
6. State & Local Govt are providing HCQ as preventive measure though its now known that HCQ doesn't have medical benefit in curing Covid-19.
Conclusion
India's Political leadership failed to grasp the seriousness of Covid-19 emergency early on and this was later compounded by Structural problems in our poor healthcare and economic system. Lockdown was like a hammer which was swung relentlessly to stop the Covid-19. But a more scientific, sensible and technocratic approach was needed in addition to lockdown measures which this Govt could not deliver. Management of healthcare and economic system is an extraordinary challenge during this pandemic emergency and Indian Govt, specially the political leadership, is no match for this crisis. The impact of uncontrolled explosion of Covid-19 infection in India will be tremendous. India like other backward 3rd world countries has significant part of population in deprivation - lack of food, income & job security, lack of access to healthcare, lack of basic amenities etc. A large part of population has many vulnerabilities like Malnutrition, diagnosed and untreated medical conditions, rampant presence of other diseases Cholera, Tuberculosis including Drug resistant TB, Malaria, Dengue etc. The healthcare system which is already in very poor condition will simply implode and collapse as being seen witnessed already in cities like Mumbai.
The economy will breakdown to a large degree as the inability to control underlying health crisis of country will make any recovery impossible for quite some time. Brutal Herd immunity will become a natural course of defense in coming time. Without a vaccine or effective therapeutic against Covid-19, many people will die and country will face a challenging time for next 1-2 years. I don't think that exact number of deaths, disabilities, economic losses, bankruptcies, job losses etc will be quantified with any accuracy in a country like India where public records and information is hardly given any significance. Also judging by the track record of this government, they will try to suppress these statistics and numbers as much as they can.
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