How Indian states are gearing up to tackle the coronavirus pandemic

The novel coronavirus has enveloped the world in a pall of fear and panic. In India, the first case of the virus, also known as COVID-19, was reported on January 30. Over the next three days, two more cases came to light. The three patients, all from Kerala, had returned from Wuhan in China, the epicentre of what has become a global pandemic.

In the month that followed, no fresh cases were reported in the country. However, on March 3, two more patients from Delhi and Hyderabad tested positive. Since then, new cases have been routinely recorded in different places, bringing the spectre of COVID-19 to India.

According to the Ministry of Health and Family Welfare’s data, at 12 pm on March 18, the number of confirmed cases in the country stood at 147. In all, 16 states and Union Territories have reported coronavirus infections. Three people have died so far, one each in Karnataka, Delhi, and Maharashtra.

On March 11, the central government announced that all states and Union Territories should invoke Section 2 of the Epidemic Diseases Act, 1897 so as to be able to enforce all advisories periodically issued by the central health ministry and state authorities.

Three days later, the Centre declared the disease a “notified disaster” under the Disaster Management Act of 2005. This has allowed states to spend a larger chunk of resources under the State Disaster Response Funds to fight COVID-19.

State governments can use the SDRF funds to provide temporary accommodation, food, clothing, and medical care for people quarantined in camps and at home, or for cluster containment operations. Additionally, as the Ministry of Home Affairs said, “Cost of setting up additional labs, cost of personal protective equipment for healthcare, municipal, police and fire authorities and cost of thermal scanners, ventilators, air purifiers and consumables for government hospitals can also be covered.”

Yet, there are certain caps. For example, the cost for quarantine shouldn’t exceed 25 percent of the State Disaster Response Fund’s allocation for the year. Also, the expenditure on equipment for laboratories and equipment should not exceed 10 percent of the total allocation.

Maharashtra is the worst affected of India’s states with 41 reported cases so far. Kerala has 27 cases, and both Haryana and Uttar Pradesh have 16 each. The figures for all other states are, so far, below 10.

As social distancing holds the key to halt the infection spread, a common response by state governments has been to shut down places where large gatherings occur. Over a dozen states and Union Territories have ordered the closure of education institutions, shopping malls, swimming pools, movie theatres, and gyms till the end of March.

The World Health Organization has urged all the affected countries, numbering over 150 now, to widen their testing drives and cover as many people as possible to fight the pandemic. But Indian authorities so far have adopted narrow criteria. The country has only been testing those with a recent travel history from affected countries or those who have come in contact with a confirmed case and shown symptoms after two weeks of quarantine. On March 17, however, it added to the list the healthcare workers with symptoms who have been treating patients with severe respiratory illnesses.

Balaram Bharghava, who heads the Indian Council of Medical Research, India's top body for medical research, has termed the WHO guidance "premature" for India because community transmission is yet to be detected in the country.

"Therefore it creates more fear, more paranoia and more hype," he said.

In addition to the Centre’s efforts, states have individually prepared to contain the spread of COVID-19. Here are some major steps taken by states with at least five cases of coronavirus infection to contain the threat to public health.

Maharashtra

Maharashtra has deemed the coronavirus an “epidemic”. On March 17, the state government enforced in Nagpur and Nashik Section 144 of the Criminal Procedure Code prohibiting the assembly of four or more people at a place. A day before, the government had also decided to mandatorily “stamp” all those who had been sent to 100 percent home quarantine in view of the outbreak. Accordingly, Mumbai’s municipal corporation directed hospitals and airport authorities to stamp the left palm of whoever is sent to quarantine. The stamp, which includes dates of isolation, is in indelible ink that lasts at least 14 days — an attempt to easily identify those sent to quarantine if they mingle with the general public.

In addition, the municipal corporation has brought three private hotels and a Public Works Department guest house on board to provide pay-and-use quarantine facilities to travellers flying in from abroad. The corporation has ensured that the hotel rooms are available at lower rates for interested patients to get quarantined. Others can avail government facilities.

It has asked private organisations in the city to function at below 50 percent attendance and allow the rest of their employees to work from home. Offices involved in “essential services”, like medical facilities, are exempted from the order.

The divisional commissioners in Konkan and Pune regions were granted Rs 10 crore each by the government. Rs 5 crore each was sanctioned to the divisional commissioners in Nagpur, Amravati, Aurangabad and Nashik.

All state government offices have been ordered to remain shut until March 24. Shrines and religious sites, including temples, mosques and churches, were asked by the government to avoid large gatherings and ceremonial prayers until further orders.

The Maharashtra government has instructed its ministers to enter their offices with a group of less than 10 people. The general public has been prohibited from entering Mantralaya, the state government’s headquarters.

Under Section 144, the Mumbai police has banned group tours in the city until March 31. On March 14, the state government announced that all shopping malls, swimming pools, movie theatres, and gyms across the state would remain shut till March 31 as a precautionary measure. All school and university examinations, except for Classes 10 and 12, have been postponed. All scheduled elections have been postponed for three months as well.

On March 17, Chief Minister Uddhav Thackeray assured the public that local trains and buses would continue to operate normally in Mumbai for now. Advising people to avoid “non-essential” travel, he said his government would otherwise be compelled to shut public transport services to prevent mass spread of COVID-19.

Kerala

Given millions of its people work abroad, Kerala jumped into action much earlier than other states. Kochi airport was one of seven airports — the others being New Delhi, Mumbai, Bengaluru, Chennai, Hyderabad and Kolkata — in the country that began the process of thermal screening of some international passengers on January 23. Two days later, Chief Minister Pinarayi Vijayan directed his health minister, KK Shailaja, to assess the threat and formulate an action plan.

The health department decided to follow the WHO protocols. It set up isolation wards in all medical colleges and district and general hospitals. It also began training medical support teams and issued treatment protocols.

On March 10, the state government announced the cancellation of mass gatherings in the state until the end of the month. This included examinations, festivals, cinema screenings, and public functions. Classes till Grade 7 were suspended and their examinations were put on hold.

Considering the large number of religious institutions in the state, the government asked their managements to avoid large gatherings and restrict the activities to “core rituals”. On March 10, Vijayan urged the devotees not to visit the Sabarimala temple for the six-day monthly puja, but clarified that “the rituals in the temple will be allowed to continue”. In response, the Travancore Devaswom Board, which runs the temple, urged the public to keep away, according to Manorama.

However, Attukal Pongala, a temple festival which sees a large all-woman congregation, took place on March 9 near Thiruvananthapuram. Afterwards, though, guidelines were introduced to monitor the situation.

Vijayan has also urged the people to “avoid holding large festivities and marriages”. “At least, they should be reduced to mere rituals and limit the people in attendance,” he said on March 10, following a special cabinet meeting.

The government has taken a number of other steps as well. The quarantine period in Kerala is 28 days as against the Centre’s 14 days. To regularly update and assure the people about the outbreak, the chief minister and the health minister are holding a press conference every evening. Shailja has personally visited patients in isolated wards. Also, the government has opened multiple call centres to help and cheer up those who are quarantined at home.

Police teams have been deployed to screen public and private transport at all entry points to the state. On March 13, the government released a smartphone app to publish authentic information about Covid-19. The app, named “GoK Direct”, aims to flag false information about the virus and create awareness about medical do's and don'ts.

Haryana

With more than a dozen reported cases, the Haryana government on March 12 declared coronavirus an “epidemic”. Health minister Anil Vij asked people to avoid large gatherings. The next day, it shut down all universities and colleges until March 31.

The government also decided to close schools in five districts — Gurugram, Sonepat, Rohtak, Jhajjar and Faridabad — till March 31, officials said. "The students will attend the school only to take the board exams, annual exams and assessment exams, March 2020 as per the previous schedule. However, all the teaching and non-teaching staff members will attend the school as usual," an order from the Haryana school education department stated.

On March 17 evening, the Gurugram district administration asked all private companies in the city to allow their employees to work from home until March 31.

Uttar Pradesh

On March 13, Chief Minister Adityanath announced that all schools and colleges, where examinations are not being held, would remain closed until March 22. On March 17, the restrictions were extended to cinema halls and tourist places and ordered to stay in place until April 2. No exception has been made for competitive and other examinations.

The Adityanath government has set up isolation wards in all the 75 districts of the state and medical staff of doctors, paramedics and nurses have been provided training to deal with the virus outbreak. It has said employees of all private companies should be allowed to work from home. The same should be allowed for government employees wherever possible.

The state government has said coronavirus patients will get free treatment. An appeal has been made to religious leaders to ensure there are no large gatherings in temples, mosques, gurdwaras, and churches.

However, these regulations don’t seem to apply to the nine-day Ram Navami Mela in Ayodhya, scheduled to take place between March 25 and April 2. An estimated 10 lakh pilgrims are expected to attend.

Delhi

Delhi too has declared coronavirus an “epidemic”. On March 5, the government closed all primary schools until March 31. Following a spike in cases, Chief Minister Arvind Kejriwal announced on March 12 that the order would extend to all schools, colleges, universities, and cinema halls. Scheduled exams would, however, continue in schools and colleges, he added.

On March 16, Kejriwal announced the closure of all gyms, night clubs, and spas. Also, except for weddings, gatherings of more than 50 have been prohibited.

Flyers from China, South Korea, Germany, France, Spain, Italy, and Iran are straightaway sent to quarantine centres for observation and examination. The Delhi government has also asked all hotels in Aero City near the airport to keep isolated accommodation ready for travellers asymptomatic to COVID-19.

Karnataka

On March 13, Chief Minister BS Yeddiurappa asked all malls, theatres, pubs, and exhibitions across the state to suspend operations for a week. The order effectively applied to all nightclubs, swimming pools, play areas, music festivals, club events, summer camps, sporting events, weddings, conferences, and parties like birthdays and engagements.

Colleges and universities were also shut for a week, after schools had already been ordered closed. Initially, only examinations for Class 7 onwards were permitted, but the government on March 15 postponed examinations upto class 9 till March 31. Secondary School Leaving Certificate examinations have been allowed to continue, however.

Further, employees of information technology companies have been advised to work from home. Companies have also been asked not to send staff abroad for work. The government said it would review the situation and take a fresh call after a week.

Other states

States and Union Territories with five or less cases of coronavirus infection have similarly closed educational institutions and public spaces. They include Telangana, Odisha, Punjab, Rajasthan, Jammu and Kashmir, Tamil Nadu, Uttarakhand, and Bengal. In most of the states, while exams will be held as scheduled, regular classes and gatherings in public spaces have been suspended until the end of the month.

In Jammu and Kashmir, Section 144 was imposed on March 14 in the districts of Kishtwar, Shopian, Budgam, and Ramban. In Odisha, this same restriction on gatherings has been imposed in the districts of Gajapati, Jagatsinghpur, Kandhamal, Bhadrak and Mayurbhanj.

In Telangana, Chief Minister K Chandrashekhar Rao has sanctioned Rs 500 crore to check the spread of COVID-19. He said the state’s health department has prepared 1,020 beds for isolation of suspected cases, 321 intensive care unit beds, and 240 ventilators. The state government has mobilised 200 employees to screen all passengers at the international airport in Hyderabad.

The Uttarakhand government cancelled the Purnagiri Devi Mela in Champawat to avoid mass gatherings. And directives were issued to restrict public gatherings of more than 50 persons across the state.

Several other states that have not reported positive cases of the coronavirus have stepped up precautionary efforts.

Chhattisgarh, Goa, Gujarat and Himachal Pradesh closed all educational institutions until March end. Exceptions have been made only for board examinations.

Assam recently ordered the shutting down of all wildlife sanctuaries, national parks, and the Guwahati state zoo until March 29. It also announced the suspension of classes in schools, colleges and universities till March 29. The directive applied to movie halls, shopping malls, gyms and swimming pools in the state.

In Manipur, a similar order covering all schools was passed on March 12. In both Assam and Manipur, as in most other states, board examinations have been allowed to continue.

Manipur and Mizoram, two states in the region with international borders, have restricted movements through these corridors. Since the morning of March 10, all the entry and exit points between Myanmar and Manipur remain sealed, with personnel from the Manipur Rifles and the Assam Rifles on constant vigil. Mizoram, likewise, sealed its borders with Myanmar and Bangladesh on March 9. It then banned the entry of any foreigner into the state.

Sikkim, a popular tourist destination in the Northeast, on March 16 announced a ban on the entry of international as well as domestic tourists until April 15. Educational institutions and public spaces have been shut.

While most states are on guard and taking a series of measures, there have been public complaints regarding them. In a number of states, people have brought to light unhygienic conditions of isolation wards. Such cases have been reported in Agra, Mangaluru, Manesar and Mumbai.

Another complaint has been long queues at airports. On March 16, hundreds of passengers, flying in from Paris and Frankfurt, were stranded for up to nine hours at the Delhi airport due to the mandatory thermal testing for coronavirus. Despite waiting for hours, the passengers, including children and the elderly, complained that they weren’t even offered food by the authorities. “There was mismanagement and lack of cooperation from government officials on duty inside,” said one flyer to Newslaundry, who asked not to be identified.

Given that coronavirus infection is spreading in India, state governments will need to ramp up their efforts in the coming days. The country’s huge population means there’s a serious risk of the already overburdened healthcare system being overwhelmed in the event of a massive outbreak, as has happened in Italy and Iran.