Capacity issues, absence of political will, and operational feasibility to blame for disadvantaging already vulnerable populations with “hastily prepared” sudden lockdown, said a lancet paper published on Friday.

Pointing out at the recent mass exodus of migrant workers during the lockdown and concerns rising about starvation among people who work in the informal economy, the Lancet said, “The government’s sudden enforcement of the lockdown seemed hastily prepared and immediately disadvantaged already vulnerable populations.

The Lancet highlighted that government’s efforts to provide financial support and a measure of food security to ease these pressures will be insufficient to meet demand, but better planning and communication could have helped avert this crisis. Similarly, non covid-19 health services have been disrupted as India’s public health-care system is chronically underfunded (at just 1·28% of GDP), leaving primary care weak.

The paper has further said that in India rates of testing have been low (0·28 per 1000 people as of April 20). However, efforts to reverse the situation are underway as hundreds of thousands of testing kits have become available, and more testing companies and laboratories have been approved. “Testing needs to be expanded exponentially as well as strategically as a tool to provide epidemiological evidence,” said the Lancet.

Reviewing the public health measures and manpower, the Lancet said, “India’s response has also been constrained by a shortage of health workers, but this should be remedied by new reforms that would mobilise additional healthcare workers from different sources adding that implementing public health measures is also difficult in places with overcrowded living conditions and inadequate hygiene and sanitation.

The Lancet also said that one threat to the covid-19 response in India is the spread of misinformation driven by fear, stigma, and blame. “There have been rising levels of violence against health-care workers and stigmatisation of people with or suspected of having covid-19, which could impede reporting of illness,” adding that the pandemic has also been used to fan anti-Muslim sentiment and violence, after a gathering connected to the group Tablighi Jamaat was identified as being responsible for many cases.

The Lancet said that states deserve much of the credit for India’s covid-19 response and central government should loosen its control and give states more autonomy over their funding and decision making.

Citing examples of the Kerala, and Odhisha, it said that Kerala has drawn on its experience with the Nipah virus in 2018 to use extensive testing, contact tracing, and community mobilisation to contain the virus and maintain a very low mortality rate. It has also set up thousands of temporary shelters for migrant workers. Similarly, the Lancet said that Odisha’s exposure to previous natural disasters meant crisis precautions were already in place and have been repurposed.

It said that Maharashtra has used drones to monitor physical distancing during lockdown and applied a cluster containment strategy: if three or more patients are diagnosed, all houses within 3 km are surveyed to detect further cases, trace contacts, and raise awareness. Whether this strategy will be successful is still unclear. The premise relies on there not being community transmission, and there is danger of stigmatisation and coercion, the paper said.

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