Efficacy of India’s COVID response: Study by Harsh Parikh, Kumar Subham

As historians prepare to add new chapters in history textbooks across the world, different countries will end up on different points on the spectrum - from bad to worse - of how they were impacted by the COVID-19 pandemic. While the spreading of the disease is not a question of ‘if’ but ‘when’, its intensity is often highly correlated to how promptly and actively the governments respond to the crisis. If the infection spreads exponentially fast and overwhelms the healthcare system of a country, then the death toll would also be voluminous. Hence, all efforts across the world are to ‘flatten the curve’ and gain more time and resources in the fight against the pandemic. In this article, we analyze India’s response to the pandemic, and use data to understand the efficacy of the measures taken by the government.

With a billion people, vast and complex geography, varied demography topped with limited healthcare facilities, the challenge is even bigger for India when it comes to containing an outbreak. In the past, the cases of Nipah virus containment and Polio or Smallpox vaccination programs have shown the strategic planning, effectiveness and the reach of the Indian state. As India faces a new threat by COVID-19, all eyes are on the Indian government led by the populist leader Narendra Modi on how he deals with the great health and economic threat faced by the country.

Indian government declared a nationwide lockdown on March 24th, 2020, and the lockdown has since been extended until May 17th, 2020 for now. However, by this time, India had already closed schools, banned public gatherings, and restricted international flights weeks before imposing the lockdown. To track the response of the Indian government and to compare it with other major nations, we use time-series data about non-pharmaceutical interventions implemented by governments of different countries compiled extensively by Blavatnik School of Governance at Oxford University. This data includes 7 indicators of government response - school closures, travel bans, workplace closure, cancellation of public events, stay-at-home order, restriction on gathering size and public transport closure - which are also aggregated as a simple additive score of these seven indicators into the stringency index of non-pharmaceutical interventions (rescaled to vary from 0 to 100) by researchers at Oxford University.

While comparing India’s lockdown measures with other countries, we observed (as shown in Figure 1) that India has implemented nearly the maximum stringency of lockdown possible. It is also to be observed that compared to other major nations, India started closing down things even before the total number of cases reached the century mark, and declared a complete lockdown before thousand confirmed cases were noted. Currently, the media and social media narratives are seemingly divided amongst either 1) being timely and prompt, or 2) too little, too late or 3) too much, too early, with each segment holding on to its guards. Thus, we decided to perform a “what-if” analysis (counterfactual analysis) to estimate the real impact of the interventions.

We perform our analysis using Oxford University BSG and Johns Hopkins University’s CSSE COVID-19 data. We use a compartmental SEIR epidemiological model and estimate the model parameters using the observed data time series. We used the trained SEIR model to forecast future trajectories of confirmed cases under different interventions. This analysis is conditional on confirmed cases and testing rates in India and the actual number of cases will be higher than the confirmed cases.

What if the lockdown was declared a week or two later?

A naive eye might question that even after more than a month of lockdown, the number of cases is still increasing and there are no signs of decrease in active cases in several parts of the country. One can easily question the efficacy of the lockdown but we need a deeper statistical analysis of the situation to comment on the same. Instead of looking at just the temporal trend, a more insightful question to ask is what would have been the growth rate of confirmed cases if the lockdown was declared a few weeks earlier or later than March 24th (the actual starting date of the lockdown). From our counterfactual analysis shown in Figure 2, we observe the following:

Starting date for Lockdown Actual/Estimated number of active cases (1st May)
March 17th (one week early) ~19,000
March 24th (current trajectory) 26,010
March 31st (one week late) ~55,000
April 7th (two weeks late) ~88,000

A macro view of this data is sufficient to portray how the current number of active cases being at 26,000 is not too large compared to the prediction of the number of active cases if lockdown was declared a week earlier but is 50-70% lesser than the predicted number of cases if lockdown was declared a week later than the actual start date.

What if the lockdown ends on May 17th?

The lockdown was partially extended beyond May 3rd until May 17th, which leads to several other what-if questions - what would have happened if on May 17th we - 1) return to business as usual (no restrictions) 2) open up to 50% restrictions till August end, 3) 75% restrictions till August end and 4) continue with lockdown as it is till August end. As of March 23rd, 2020, India’s total hospital bed capacity was approximately 2 million (including private hospitals). We observe (as shown in Figure 3) that if the lockdown is continued till the end of August, the number of active cases would peak up to a million by mid-July which is around 50% of India’s total hospital bed count. On the contrary, even if the lockdown is reduced to 75% of its current levels then the cases would peak up to around 10 million by mid-July which is 5 times as many cases as the pan-India hospital bed count. In an unlikely situation where the country returns to business as usual, the active cases could peak up to approximately 40 million.

The Path Forward

Based on our what-if analysis we assess that the Indian government has been acting promptly and decisively in dealing with the coronavirus pandemic. The decision of calling for a lockdown on March 24th was timely which helped India to flatten the curve and keep the number of cases under check. It is also wise of the union government to extend the lockdown beyond May 3rd till May 17th. We believe that even a further extension till June 3rd or June 17th might be largely beneficial in the country’s fight against Corona Virus to have a lower death toll.

While our current counterfactual analysis was only focused on COVID-19 active case count, the decision to keep a country under lockdown is not a unidimensional problem. For a developing country like India, the economic and socio-psychological cost of being under lockdown is very high. Hence, a perpetual lockdown is not a viable idea. While opening up a dense and vast country like India has a huge risk in a pandemic like this, the government needs to work on strategic sequential action plans on how to start opening up the economy by early to mid-June while parallelly increasing the healthcare capacity of the nation. In our next article, we will talk about how the government can systematically open up a complex society like India keeping the cost-benefit analysis in mind and minimizing the hazard to the lives of its citizens.

 Authors:

  • Harsh Parikh is a Ph.D. Student at Duke University, USA. His research work focuses on causal inference and machine learning. He has done his B.Tech in Computer Science from IIT Delhi. He can be reached at harsh.parikh@duke.edu.
  • Kumar Subham is Director at Vision India Foundation, India. His core interest areas are governance models, decentralization, and technology policy. He has done his B.Tech in Computer Science from IIT Delhi. He can be reached at kumar@alumni.iitd.ac.in and tweets at @subhamize.