impact of covid in india essay

PERSPECTIVE article

The rise and impact of covid-19 in india.

• 1 School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
• 2 VIT-BS, Vellore Institute of Technology, Vellore, India

The coronavirus disease (COVID-19) pandemic, which originated in the city of Wuhan, China, has quickly spread to various countries, with many cases having been reported worldwide. As of May 8th, 2020, in India, 56,342 positive cases have been reported. India, with a population of more than 1.34 billion—the second largest population in the world—will have difficulty in controlling the transmission of severe acute respiratory syndrome coronavirus 2 among its population. Multiple strategies would be highly necessary to handle the current outbreak; these include computational modeling, statistical tools, and quantitative analyses to control the spread as well as the rapid development of a new treatment. The Ministry of Health and Family Welfare of India has raised awareness about the recent outbreak and has taken necessary actions to control the spread of COVID-19. The central and state governments are taking several measures and formulating several wartime protocols to achieve this goal. Moreover, the Indian government implemented a 55-days lockdown throughout the country that started on March 25th, 2020, to reduce the transmission of the virus. This outbreak is inextricably linked to the economy of the nation, as it has dramatically impeded industrial sectors because people worldwide are currently cautious about engaging in business in the affected regions.

Current Scenario in India

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), was first identified in December 2019 in Wuhan city, China, and later spread to many provinces in China. As of May 8th, 2020, the World Health Organization (WHO) had documented 3,759,967 positive COVID-19 cases, and the death toll attributed to COVID-19 had reached 259,474 worldwide ( 1 ). So far, more than 212 countries and territories have confirmed cases of SARS-CoV-2 infection. On January 30th, 2020, the WHO declared COVID-19 a Public Health Emergency of International Concern ( 2 ). The first SARS-CoV-2 positive case in India was reported in the state of Kerala on January 30th, 2020. Subsequently, the number of cases drastically rose. According to the press release by the Indian Council of Medical Research (ICMR) on May 8th, 2020, a total of 14,37,788 suspected samples had been sent to the National Institute of Virology (NIV), Pune, and a related testing laboratory ( 3 ). Among them, 56,342 cases tested positive for SARS-CoV-2 ( 4 ). A state-wise distribution of positive cases until May 8th, 2020, is listed in Table 1 , and the cases have been depicted on an Indian map ( Figure 1 ). Nearly 197,192 Indians have recently been repatriated from affected regions, and more than 1,393,301 passengers have been screened for SARS-CoV-2 at Indian airports ( 5 ), with 111 positive cases observed among foreign nationals ( 4 , 5 ). As of May 8th, 2020, Maharashtra, Delhi, and Gujarat states were reported to be hotspots for COVID-19 with 17,974, 5,980, and 7,012 confirmed cases, respectively. To date, 16,540 patients have recovered, and 1,886 deaths have been reported in India ( 5 ). To impose social distancing, the “Janata curfew” (14-h lockdown) was ordered on March 22nd, 2020. A further lockdown was initiated for 21 days, starting on March 25th, 2020, and the same was extended until May 3rd, 2020, but, owing to an increasing number of positive cases, the lockdown has been extended for the third time until May 17th, 2020 ( 6 ). Currently, out of 32 states and eight union territories in India, 26 states and six union territories have reported COVID-19 cases. Additionally, the health ministry has identified 130 districts as hotspot zones or red zones, 284 as orange zones (with few SARS-CoV-2 infections), and 319 as green zones (no SARS-CoV-2 infection) as of May 4th, 2020. These hotspot districts have been identified to report more than 80% of the cases across the nation. Nineteen districts in Uttar Pradesh are identified as hotspot districts, and this was followed by 14 and 12 districts in Maharashtra and Tamil Nadu, respectively ( 7 ). The complete lockdown was implemented in these containment zones to stop/limit community transmission ( 5 ). As of May 8th, 2020, 310 government laboratories and 111 private laboratories across the country were involved in SARS-CoV-2 testing. As per ICMR report, 14,37,788 samples were tested till date, which is 1.04 per thousand people ( 3 ).

Table 1 . Current status of reported positive coronavirus disease cases in India (State-wise).

Figure 1 . State-wise distribution of positive coronavirus disease cases displayed on an Indian geographical map.

COVID-19 and Previous Coronavirus Outbreaks

The recent outbreak of COVID-19 in several countries is similar to the previous outbreaks of SARS and Middle East respiratory syndrome (MERS) that emerged in 2003 and 2012 in China and Saudi Arabia, respectively ( 8 – 10 ). Coronavirus is responsible for both SARS and COVID-19 diseases; they affect the respiratory tract and cause major disease outbreaks worldwide. SARS is caused by SARS-CoV, whereas SARS-CoV-2 causes COVID-19. So far, there is no particular treatment available to treat SARS or COVID-19. In the current search for a COVID-19 cure, there is some evidence that point to SARS-CoV-2 being similar to human coronavirus HKU1 and 229E strains ( 11 , 12 ) even though they are new coronavirus family members. These reports suggest that humans do not have immunity to this virus, allowing its easy and rapid spread among human populations through contact with an infected person. SARS-CoV-2 is more transmissible than SARS-CoV. The two possible reasons could be (i) the viral load (quantity of virus) tends to be relatively higher in COVID-19-positive patients, especially in the nose and throat immediately after they develop symptoms, and (ii) the binding affinity of SARS-CoV-2 to host cell receptors is higher than that of SARS-CoV ( 13 , 14 ). The other comparisons between SARS and COVID-19 are tabulated in Table 2 , and references for the same are provided here ( 1 , 15 , 16 ).

Table 2 . Differences between coronavirus disease and severe acute respiratory syndrome.

Impact of COVID-19 in India and the Global Economy

As per the official government guidelines, India is making preparations against the COVID-19 outbreak, and avoiding specific crisis actions or not understating its importance will have extremely severe implications. All the neighboring countries of India have reported positive COVID-19 cases. To protect against the deadly virus, the Indian government have taken necessary and strict measures, including establishing health check posts between the national borders to test whether people entering the country have the virus ( 17 ). Different countries have introduced rescue efforts and surveillance measures for citizens wishing to return from China. The lesson learned from the SARS outbreak was first that the lack of clarity and information about SARS weakened China's global standing and hampered its economic growth ( 10 , 18 – 20 ). The outbreak of SARS in China was catastrophic and has led to changes in health care and medical systems ( 18 , 20 ). Compared with China, the ability of India to counter a pandemic seems to be much lower. A recent study reported that affected family members had not visit the Wuhan market in China, suggesting that SARS-CoV-2 may spread without manifesting symptoms ( 21 ). Researchers believe that this phenomenon is normal for many viruses. India, with a population of more than 1.34 billion—the second largest population in the world—will have difficulty treating severe COVID-19 cases because the country has only 49,000 ventilators, which is a minimal amount. If the number of COVID-19 cases increases in the nation, it would be a catastrophe for India ( 22 ). It would be difficult to identify sources of infection and those who come in contact with them. This would necessitate multiple strategies to handle the outbreak, including computational modeling as well as statistical and quantitative analyses, to rapidly develop new vaccines and drug treatments. With such a vast population, India's medical system is grossly inadequate. A study has shown that, owing to inadequate medical care systems, nearly 1 million people die every year in India ( 23 ). India is also engaged in trading with its nearby countries, such as Bangladesh, Bhutan, Pakistan, Myanmar, China, and Nepal. During the financial year 2017–18 (FY2017–18), Indian regional trade amounted to nearly $12 billion, accounting for only 1.56% of its total global trade value of $769 billion. The outbreak of such viruses and their transmission would significantly affect the Indian economy. The outbreak in China could profoundly affect the Indian economy, especially in the sectors of electronics, pharmaceuticals, and logistics operations, as trade ports with China are currently closed. This was further supported by the statement by Suyash Choudhary, Head—Fixed Income, IDFC AMC, stating that GDP might decrease owing to COVID-19 ( 24 ).

Economists assume that the impact of COVID-19 on the economy will be high and negative when compared with the SARS impact during 2003. For instance, it has been estimated that the number of tourists arriving in China was much higher than that of tourists who traveled during the season when SARS emerged in 2003. This shows that COVID-19 has an effect on the tourism industry. It has been estimated that, for SARS, there was a 57 and 45% decline in yearly rail passenger and road passenger traffic, respectively ( 25 ). Moreover, when compared with the world economy 15 years ago, world economies are currently much more inter-related. It has been estimated that COVID-19 will hurt emerging market currencies and also impact oil prices ( 26 – 28 ). From the retail industry's perspective, consumer savings seem to be high. This might have an adverse effect on consumption rates, as all supply chains are likely to be affected, which in turn would have its impact on supply when compared with the demand of various necessary product items ( 29 ). This clearly proves that, based on the estimated losses due to the effect of SARS on tourism (retail sales lost around USD 12–18 billion and USD 30–100 billion was lost at a global macroeconomic level), we cannot estimate the impact of COVID-19 at this point. This will be possible only when the spread of COVID-19 is fully controlled. Until that time, any estimates will be rather ambiguous and imprecise ( 19 ). The OECD Interim economic assessment has provided briefing reports highlighting the role of China in the global supply chain and commodity markets. Japan, South Korea, and Australia are the countries that are most susceptible to adverse effects, as they have close ties with China. It has been estimated that there has been a 20% decline in car sales, which was 10% of the monthly decline in China during January 2020. This shows that even industrial production has been affected by COVID-19. So far, several factors have thus been identified as having a major economic impact: labor mobility, lack of working hours, interruptions in the global supply chain, less consumption, and tourism, and less demand in the commodity market at a global level ( 30 ), which in turn need to be adequately analyzed by industry type. Corporate leaders need to prioritize the supply chain and product line economy trends via demand from the consumer end. Amidst several debates on sustainable economy before the COVID-19 impact, it has now been estimated that India's GDP by the International Monetary Fund has been cut down to 1.9% from 5.8% for the FY21. The financial crisis that has emerged owing to the worldwide lockdown reflects its adverse effect on several industries and the global supply chain, which has resulted in the GDP dropping to 4.2% for FY20, which was previously estimated at 4.8%. Nevertheless, it has been roughly estimated that India and China will be experiencing considerable positive growth among other major economies ( 31 ).

Preparations and Preventive Measures in India

An easy way to decrease SARS-CoV-2 infection rates is to avoid virus exposure. People from India should avoid traveling to countries highly affected with the virus, practice proper hygiene, and avoid consuming food that is not home cooked. Necessary preventive measures, such as wearing a mask, regular hand washing, and avoiding direct contact with infected persons, should also be practiced. The Ministry of Health and Family Welfare (MOHFW), India, has raised awareness about the recent outbreak and taken necessary action to control COVID-19. Besides, the MOHFW has created a 24 h/7 days-a-week disease alert helpline (+91-11-23978046 and 1800-180-1104) and policy guidelines on surveillance, clinical management, infection prevention and control, sample collection, transportation, and discharging suspected or confirmed cases ( 3 , 5 ). Those who traveled from China, or other countries, and exhibited symptoms, including fever, difficulty in breathing, sore throat, cough, and breathlessness, were asked to visit the nearest hospital for a health check-up. Officials from seven different airports, including Chennai, Cochin, New Delhi, Kolkata, Hyderabad, and Bengaluru, have been ordered to screen and monitor Indian travelers from China and other affected countries. In addition, a travel advisory was released to request the cessation of travel to affected countries, and anyone with a travel history that has included China since January 15th, 2020, would be quarantined. A centralized control room has been set up by the Delhi government at the Directorate General of Health Services, and 11 other districts have done the same. India has implemented COVID-19 travel advisory for intra- and inter-passenger aircraft restrictions. More information on additional travel advisory can be accessed with the provided link ( https://www.mohfw.gov.in/pdf/Traveladvisory.pdf ).

India is known for its traditional medicines in the form of AYUSH (Ayurvedic, Yoga and Naturopathy, Unani, Siddha, and Homeopathy). The polyherbal powder NilavembuKudineer showed promising effects against dengue and chikungunya fevers in the past ( 32 ). With the outbreak of COVID-19, the ministry of AYUSH has released a press note “Advisory for Coronavirus,” mentioning useful medications to improve the immunity of the individuals ( 33 ). Currently, according to the ICMR guidelines, doctors prescribe a combination of Lopinavir and Ritonavir for severe COVID-19 cases and hydroxychloroquine for prophylaxis of SARS-CoV-2 infection ( 34 , 35 ). In collaboration with the WHO, ICMR will conduct a therapeutic trial for COVID-19 in India ( 3 ). The ICMR recommends using the US-FDA-approved closed real-time RT-PCR systems, such as GeneXpert and Roche COBAS-6800/8800, which are used to diagnose chronic myeloid leukemia and melanoma, respectively ( 36 ). In addition, the TruenatTM beta CoV test on the TruelabTM workstation validated by the ICMR is recommended as a screening test. All positive results obtained on this platform need to be confirmed by confirmatory assays for SARS-CoV-2. All negative results do not require further testing. Antibody-based rapid tests were validated at NIV, Pune, and found to be satisfactory; the rapid test kits are as follows: (i) SARS-CoV-2 Antibody test (Lateral flow method): Guangzhou Wondfo Biotech, Mylan Laboratories Limited (CE-IVD); (ii) COVID-19 IgM&IgG Rapid Test: BioMedomics (CE-IVD); (iii) COVID-19 IgM/IgG Antibody Rapid Test: Zhuhai Livzon Diagnostics (CEIVD); (iv) New coronavirus (COVID-19) IgG/IgM Rapid Test: Voxtur Bio Ltd, India; (v) COVID-19 IgM/IgG antibody detection card test: VANGUARD Diagnostics, India; (vi) MakesureCOVID-19 Rapid test: HLL Lifecare Limited, India; and (vii) YHLO SARS-CoV-2 IgM and IgG detection kit (additional equipment required): CPC, Diagnostics. As a step further, on the technological aspect, the Union Health Ministry has launched a mobile application called “AarogyaSetu” that works both on android and iOS mobile phones. This application constructs a user database for establishing an awareness network that can alert people and governments about possible COVID-19 victims ( 37 ).

Future Perspectives

Infections caused by these viruses are an enormous global health threat. They are a major cause of death and have adverse socio-economic effects that are continually exacerbated. Therefore, potential treatment initiatives and approaches need to be developed. First, India is taking necessary preventive measures to reduce viral transmission. Second, ICMR and the Ministry of AYUSH provided guidelines to use conventional preventive and treatment strategies to increase immunity against COVID-19 ( 3 , 38 ). These guidelines could help reduce the severity of the viral infection in elderly patients and increase life expectancy ( 39 ). The recent report from the director of ICMR mentioned that India would undergo randomized controlled trials using convalescent plasma of completely recovered COVID-19 patients. Convalescent plasma therapy is highly recommended, as it has provided moderate success with SARS and MERS ( 40 ); this has been rolled out in 20 health centers and will be increased this month (May 2020) ( 3 ). India has expertise in specialized medical/pharmaceutical industries with production facilities, and the government has established fast-tracking research to develop rapid diagnostic test kits and vaccines at low cost ( 41 ). In addition, the Serum Institute of India started developing a vaccine against SARS-CoV-2 infection ( 42 ). Until we obtain an appropriate vaccine, it is highly recommended that we screen the red zoned areas to stop further transmission of the virus. Medical college doctors in Kerala, India, implemented the low-cost WISK (Walk-in Sample Kiosk) to collect samples without direct exposure or contact ( 43 , 44 ). After Kerala, The Defense Research and Development Organization (DRDO) developed walk-in kiosks to collect COVID-19 samples and named these as COVID-19 Sample Collection Kiosk (COVSACK) ( 45 ). After the swab collection, the testing of SARS-CoV-2 can be achieved with the existing diagnostic facility in India. This facility can be used for massive screening or at least in the red zoned areas without the need for personal protective equipment kits ( 43 , 45 ). India has attempted to broaden its research facilities and shift toward testing the mass population, as recommended by medical experts in India and worldwide ( 46 ).

Data Availability Statement

Publicly available datasets were analyzed in this study. This data can be found here: https://www.mohfw.gov.in/ and https://www.icmr.gov.in/ .

Author Contributions

SK, DK, and CD were involved in the design of the study and the acquisition, analysis, interpretation of the data, and drafting the manuscript. BC was involved in the interpretation of the data. CD supervised the entire study. The manuscript was reviewed and approved by all the authors.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We acknowledge The Ministry of Health and Family Welfare (MoHFW) and Indian Council of Medical Research (ICMR) for publicly providing the details of COVID-19. The authors would like to use this opportunity to thank the management of VIT for providing the necessary facilities and encouragement to carry out this work.

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Keywords: COVID-19, SARS-CoV-2, India, economy, safety measures

Citation: Kumar SU, Kumar DT, Christopher BP and Doss CGP (2020) The Rise and Impact of COVID-19 in India. Front. Med. 7:250. doi: 10.3389/fmed.2020.00250

Received: 19 March 2020; Accepted: 11 May 2020; Published: 22 May 2020.

Reviewed by:

Copyright © 2020 Kumar, Kumar, Christopher and Doss. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: C. George Priya Doss, georgepriyadoss@vit.ac.in

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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How has Covid-19 affected India’s economy?

India has been hit hard by the pandemic, particularly during the second wave of the virus in the spring of 2021. the sharp drop in gdp is the largest in the country’s history, but this may still underestimate the economic damage experienced by the poorest households..

From April to June 2020, India’s GDP dropped by a massive 24.4%. According to the latest national income estimates , in the second quarter of the 2020/21 financial year (July to September 2020), the economy contracted by a further 7.4%. The recovery in the third and fourth quarters (October 2020 to March 2021) was still weak, with GDP rising 0.5% and 1.6%, respectively. This means that the overall rate of contraction in India was (in real terms) 7.3% for the whole 2020/21 financial year.

In the post-independence period, India's national income has declined only four times before 2020 – in 1958, 1966, 1973 and 1980 – with the largest drop being in 1980 (5.2%). This means that 2020/21 is the worst year in terms of economic contraction in the country’s history, and much worse than the overall contraction in the world (Figure 1).

The decline is solely responsible for reversing the trend in global inequality, which had been falling but has now started to rise again after three decades ( Deaton, 2021 ; Ferreira, 2021 ).

Figure 1: Economic contraction in India and the world during Covid-19

Source: world economic outlook, international monetary fund, april 2021. note: the gross domestic product (gdp) per capita, constant prices is measured at purchase power parity; 2017 international dollars. the gdp per capita of each series is normalised to 100 in 2011. we use population-weighted average as the aggregation method., what do the main macroeconomic indicators tell us about india’s economy during the pandemic.

While economies worldwide have been hit hard, India has suffered one of the largest contractions. During the 2020/21 financial year, the rates of decline in GDP for the world were 3.3% and 2.2% for emerging market and developing economies. Table 1 summarises macroeconomic indicators for India, along with a reference group of comparable countries and the world. The fact that India’s growth rate in 2019 was among the highest makes the drop due to Covid-19 even more noticeable.

Comparing national unemployment rates in 2020, India’s rate of 7.1% indicates that it has performed relatively poorly – both in terms of the world average and compared with a set of reference group economies with similar per capita incomes. Unemployment rates were more muted within the reference group economies and were also kept low by generous labour market policies to keep people in work.

Despite the scale of the pandemic, additional budgetary allocation to various social safety measures has been relatively low in India compared with other countries. Although the country might look comparable to the reference group in non-health sector measures, the additional health sector fiscal measures are less than half those in the reference group. More worryingly, the Indian government's announced allocation in the 2021 budget for such measures does not show an increase, once inflation is taken into account.

Table 1: Summary of key macroeconomic indicators

Source: data on gross domestic product, constant prices (percentage change) is obtained from the world economic outlook database april 2021, international monetary fund . note: india’s gdp contraction is 8%, according to the international monetary fund (imf) and 7.3% from recent national estimates. unemployment rates (for youth, adults: 15+) are ilo-modelled estimates as of november 2021 and are obtained from ilostat, international labour organization (ilo) and world bank . fiscal measures are obtained from fiscal monitor database of country fiscal measures in response to the covid-19 pandemic as of april 2021, international monetary fund . the ‘reference group’ refers to the closest peer group statistic under which india falls. the reference group for gdp per capita is the emerging market and developing economies (emdes) classification by the imf. the reference group for the unemployment rate is the low- and middle-income countries (lmics) classification by the world bank. the reference group for the fiscal measures is the emdes classification by the imf. see ghatak and raghavan (forthcoming) for a comparison of india’s economic and health performance against the reference group., how has covid-19 changed income, consumption, poverty and unemployment in india.

While the macroeconomic statistics provide a snapshot of India’s economic position, they hide the large and unequal effects on households and workers within the country.

Both wealth and income inequality has been on the rise in India ( Ghatak, 2021 ). Estimates suggest that in 2020, the top 1% of the population held 42.5% of the total wealth, while the bottom 50% had only 2.5% of the total wealth ( Oxfam, 2020 ). Post-pandemic, the number of poor in India is projected to have more than doubled and the number of people in the middle class to have fallen by a third ( Kochhar, 2021 ).

During India’s first stringent national lockdown between April and May 2020, individual income dropped by approximately 40%. The bottom decile of households lost three months’ worth of income ( Azim Premji University, 2021 ; Beyer et al, 2021 ).

Microdata from the largest private survey in India, CMIE’s ‘Consumer Pyramids Household Survey’ (CPHS), show that per capita consumption spending dropped by more than GDP, and did not return to pre-lockdown levels during periods of reduced social distancing. Average per capita consumption spending continued to be over 20% lower after the first lockdown (in August 2020 compared with August 2019), and remained 15% lower year-on-year by the end of 2020.

Official poverty data are unavailable, and the CPHS data come with a caveat of ‘top’ and ‘bottom exclusions’. For example, official statistics show a rural headcount ratio of 35% in 2017/18 ( Subramanian, 2019 ). But the CPHS data estimate it at 25%, which suggests exclusions at the lower end of the consumption distribution ( Dreze and Somanchi, 2021 ).

Despite these statistical concerns, the CPHS does provide consumption numbers for a large sample of individuals, which can provide insights into changes in consumption levels arising from the pandemic.

Table 2 reports the percentage of people who have monthly consumption expenditure below different cut-off values. The different cut-offs encompass the official poverty lines (which, in any case, have been considered too low by some commentators). The current rural poverty line is set at 1,600 rupees (£15.50) per month or over, and the urban poverty line is 2,400 rupees per month (£23.37) or over.

Based on the latest CPHS data, rural poverty increased by 9.3 percentage points and urban poverty by over 11.7 percentage year-on-year from December 2019 to December 2020. Earlier months of the CPHS show that rural poverty increased by 14.2 percentage points and urban poverty by 18.1 percentage points. Yet the actual increase in poverty due to Covid-19 is likely to be higher than what the CPHS data suggest, as indicated by other surveys .

Table 2: Percentage of individuals by monthly consumption expenditure

Source: consumer pyramids household survey (cphs) for december 2019 and december 2020, and for august 2019 and august 2020. notes: estimates for consumption are calculated by dividing household adjusted total expenditure by household size and weighted using member level country weights. adjusted total expenditure is the sum total of all consumption goods and services purchased by the household during a month, adjusted using weekly records. real values are adjusted for inflation using the mospi cpi (iw) for urban workers and cpi (al) for rural workers (base 2012=100). headcount ratio is the percentage of individuals who are below the poverty line in urban and rural areas in each year. poverty line is the inflation-adjusted poverty line in rural areas (rs 972 in 2011-12 prices) and urban areas (rs 1410 in 2011-12 prices), which are adjusted to 2012 prices with the rbi cpi(al) and cpi(iw) for 2011/12-2012/13 respectively. all figures are in december 2019 values and observations with missing regions are dropped. despite a much larger sample in urban areas, the cphs also underestimates mean per capita consumption in urban areas, which is likely to reflect their inability to survey high-income urban households. from the draft national sample survey organisation (nsso) report on household consumer expenditure for 2017-18, the cphs estimate of mean per capita consumption in urban areas was 0.8 of the nsso level for 2017-18. for rural areas, the cphs estimate is 1.1 of the nsso level..

Taking into account the general trend of reduction in poverty, an estimated 230 million people in India have fallen into poverty as a result of the first wave of the pandemic ( Azim Premji University, 2021 ).

Table 3 shows that households in the middle of the pre-Covid-19 CPHS consumption distribution saw large drops in spending after the first wave of the pandemic, helping to create a new set of people entering poverty.

The percentage of poor people in the second lowest quintile of pre-Covid-19 consumption jumped from 32% to 60% within a year. This was driven largely by rural areas, where the headcount ratio for the second quintile almost doubled.

In urban areas, the poverty line is set higher due to greater living costs and 72% of people in the second quintile of the urban income distribution were below this poverty line before the pandemic. Within a year, they were joined in urban poverty by many who had higher incomes before. Half of people in the third quintile and 29% of people in the fourth quintile fell below the poverty line after the pandemic.

This sharp rise in poverty after the first lockdown is consistent with a variety of surveys that highlighted the depth of the crisis ( Azim Premji University, 2021 ). Year-on-year urban unemployment rate jumped from 8.8% in April to June 2019 to a staggering 20.8% in April to June 2020 ( Government of India National Statistical Office, 2020 ).

Table 3: Percentage of individuals who are below the poverty line in middle quintiles of pre-Covid-19 consumption expenditure, August 2019 to August 2020

Source: consumer pyramids household survey (cphs) for august 2019 and august 2020. notes: quintiles are based on 2019 mean per capita consumption levels for each region type. consumption levels are calculated by dividing household adjusted total expenditure by household size and weighted using member level country weights. adjusted total expenditure is the sum total of all consumption goods and services purchased by the household during a month, adjusted using weekly records. real values are adjusted for inflation using the mospi cpi (iw) for urban workers and cpi (al) for rural workers (base 2012=100). all figures are in december 2019 values and observations with missing regions are dropped..

The pandemic has brought severe economic hardship, especially to young individuals who are over-represented in informal work. India has a large share of young people in its workforce and the pandemic has put them at heightened risk of long-term unemployment. This has negative impacts on lifelong earnings and employment prospects ( Machin and Manning, 1999 ).

A study by the Centre for Economic Performance (CEP at the London School of Economics) analyses the depth of continuing joblessness among younger workers in the low-income states of Bihar, Jharkhand and Uttar Pradesh (see Table 4, Dhingra and Kondirolli, 2021 ).

The first round of the survey randomly sampled urban workers aged 18-40 during the first lockdown quarter, finding that a majority of them who had work before the pandemic were left with no work or no pay. After the first lockdown in April to June 2020, 20% of those sampled were out of work, another 9% were employed but had zero hours of work and 81% had no work or pay at all.

Ten months on from the first lockdown quarter, 8% of the sample continued to be out of work, another 8% were working zero hours, and 40% had no work or no pay. The rate of no work or no pay was higher (at 47%) among the youngest low-income individuals (those aged 18-25 who had below median pre-Covid-19 earnings).

Table 4: Crisis labour force status of individuals who were employed pre-Covid-19: recontact sample of individuals interviewed during the first lockdown (April to June 2020) and before the second wave (January to March 2021)

Source: cep-lse survey 2020 and 2021. note: out of work last week and zero hours last week are indicators for individuals who were unemployed in the week preceding the survey and employed but working zero hours in the week before the survey respectively. not paid is an indicator for individuals who received no pay in april 2020 in the column of april to june 2020 and those who received no pay during january to march 2021 in all other columns. median earnings are constructed using average earnings in january and february 2020. 18-25 refers to individuals who are between 18 to 25 years of age at the time of the first survey..

The recovery after the first wave was too muted to get many young Indian workers back into employment. For example, rural migrants continued to be reluctant to return to work in urban areas even before the second wave hit ( Imbert, 2021 ). And the second wave, which started in mid-February and appears to be flattening out in June 2021, heightened these risks of long-term unemployment by increasing the spells of economic inactivity.

What do public health indicators reveal about the impact of Covid-19 on India’s economy?

To avoid another livelihood crisis, India turned to local lockdowns during the second wave of the pandemic. Before the second wave, India’s public health performance (in terms of confirmed cases and confirmed deaths), while not the best, was ahead of several reference group countries. But the second wave has made India’s position significantly worse. The total confirmed cases per million now are comparable to those in the rest the world and the rate of vaccination is lower in India.

While death rates seem lower in India, there is massive underreporting. After accounting for the underreporting within official statistics, India’s total confirmed cases and deaths might exceed that of the rest of the world by a large margin (Gamio and Glanz, 2021).

In the conservative scenario, the total confirmed cases per million are about 13 times larger than in the rest of the world, and the total confirmed deaths per million are about 85% of that in the rest of the world. In the worst-case scenario, India is far behind the rest of the world.

There is an important caveat: while the focus of this article is on India, underreporting of Covid-19 cases and deaths is prevalent globally ( Institute for Health Metrics and Evaluation, University of Washington, 2021 ).

How has India fared so far?

More than a year has passed since India’s first national lockdown was announced. There was talk of a trade-off between lives and livelihoods when the Covid-19 crisis erupted last year. As India struggles in the second wave, it is clear that the country did poorly in both dimensions.

While India’s policy response was strong in terms of some aspects of lockdown stringency, it was ineffective in dealing with both the public health and economic aspects of the crisis. What’s more, it failed to limit the damaging impact of the crisis on the most vulnerable sections of the population.

Where can I find out more?

• State of working in India 2021 : Report from Azim Premji University’s Centre for Sustainable Employment on the effects of Covid-19 on jobs, incomes, inequality and poverty.
• City of dreams no more – The impact of Covid-19 on urban workers in India: Briefings from the Centre for Economic Performance.
• India needs a second wave of relief measures : Jean Drèze discusses the humanitarian and economic case for further support.
• Covid-19 articles from Debraj Ray .
• India COVID-19 chartbook : A series of charts on the effects of the pandemic in India from HSBC Global Research.
• India’s already-stressed rural economy is getting battered by the second wave of Covid-19 : Rohit Inani examines the crisis in India and calls for urgent relief measures.

Who are experts on this question?

• Amit Basole , Azim Premji University
• Swati Dhingra , LSE
• Maitreesh Ghatak , LSE
• Debraj Ray , New York University
• S. Subramanian , Independent Researcher
• Sanchari Roy , King's College London

Authors: Swati Dhingra and Maitreesh Ghatak

Swati thanks the erc for starting grant 760037. the authors would like to thank ramya raghavan and fjolla kondirolli for research assistance, photo by shubhangee vyas on unsplash.

• Swati Dhingra LSE View Profile
• Maitreesh Ghatak LSE View Profile
• News Ideas for the UK: election economics international week
• Prices & interest rates What are the future prospects for UK inflation?
• Trade & supply chains How is India’s trade landscape shaping up for the future?

Home — Essay Samples — Economics — Indian Economy — Impact Of Covid-19 On The Indian Economy

Impact of Covid-19 on The Indian Economy

• Categories: Covid 19 India Indian Economy

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Published: Feb 8, 2022

Words: 1417 | Pages: 3 | 8 min read

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Introduction.

• https://en.wikipedia.org/wiki/Economy_of_India
• https://www.researchgate.net/publication/341266520_Effect_of_COVID-19_on_the_Indian_Economy_and_Supply_Chain
• https://etinsights.et-edge.com/wp-content/uploads/2020/04/KPMG-REPORT-compressed.pdf

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The Rise and Impact of COVID-19 in India

Affiliations.

• 1 School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India.
• 2 VIT-BS, Vellore Institute of Technology, Vellore, India.
• PMID: 32574338
• PMCID: PMC7256162
• DOI: 10.3389/fmed.2020.00250

The coronavirus disease (COVID-19) pandemic, which originated in the city of Wuhan, China, has quickly spread to various countries, with many cases having been reported worldwide. As of May 8th, 2020, in India, 56,342 positive cases have been reported. India, with a population of more than 1.34 billion-the second largest population in the world-will have difficulty in controlling the transmission of severe acute respiratory syndrome coronavirus 2 among its population. Multiple strategies would be highly necessary to handle the current outbreak; these include computational modeling, statistical tools, and quantitative analyses to control the spread as well as the rapid development of a new treatment. The Ministry of Health and Family Welfare of India has raised awareness about the recent outbreak and has taken necessary actions to control the spread of COVID-19. The central and state governments are taking several measures and formulating several wartime protocols to achieve this goal. Moreover, the Indian government implemented a 55-days lockdown throughout the country that started on March 25th, 2020, to reduce the transmission of the virus. This outbreak is inextricably linked to the economy of the nation, as it has dramatically impeded industrial sectors because people worldwide are currently cautious about engaging in business in the affected regions.

Keywords: COVID-19; India; SARS-CoV-2; economy; safety measures.

Copyright © 2020 Kumar, Kumar, Christopher and Doss.

India’s policy response to the COVID-19 pandemic: Lessons for a post-COVID society

• Perspective
• Open access
• Published: 07 March 2024
• Volume 2 , article number  16 , ( 2024 )

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• Prakash Chand Kandpal 1  

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The COVID-19 pandemic has left an indelible mark on societies worldwide, challenging governments to respond swiftly and effectively to mitigate its impact. India, with its vast population and complex healthcare landscape, faced unique challenges in formulating and implementing a pandemic response strategy. The article examines India's policy response to the COVID-19 pandemic and explores the valuable lessons it offers for shaping a more resilient and prepared society in a post-COVID world. It provides a comprehensive analysis of India's multifaceted approach to managing the pandemic, highlighting key elements such as lockdowns, testing and contact tracing, healthcare infrastructure, vaccination drives, and economic relief measures. By delving into both the successes and shortcomings of these policies, it seeks to extract valuable insights for policymakers and public health officials globally. As the world transitions into a post-COVID era, the lessons learned from India's experience offer a roadmap for building stronger healthcare systems, improving disaster preparedness, and enhancing social safety nets. The article underscores the importance of proactive governance, community engagement, data-driven decision-making, and international collaboration in the face of global health crises. The paper demonstrates that India's journey through the pandemic provides a wealth of knowledge that can inform policy development, foster greater resilience, and help societies better navigate the uncertainties of a post-COVID world. By reflecting on the successes and challenges of India's response, this article offers actionable insights for shaping a more equitable, sustainable, and prepared society in the wake of the COVID-19 pandemic.

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1 Introduction

India, a large country of about 1.3 billion people, witnessed its first Coronavirus case on 30th January 2020, in Kerala, in a student returning from Wuhan [ 1 ]. It was on the same day that the World Health Organization declared the COVID-19 outbreak as a Public Health Emergency of International Concern [ 2 ]. However, it was not until March 2020 that the country realized the intensity of the virus. The government took notice of how the virus became a global concern in no time, so much so that it was declared to be a pandemic on March 11, 2020, in just little over three months when the first human case was identified in Wuhan, People’s Republic of China. The Indian Ministry of Health and Family Welfare acknowledged the respiratory disorder that originated in China as highly dangerous and immediately called the Joint Monitoring Group to keep a close eye on further developments. Taking swift action on the issue, the Government of India constituted 11 Empowered Groups on 29 March to investigate the different aspects of COVID-19 management and to assess the risk, review the preparedness and response mechanisms, finalize technical guidelines, and make informed decisions in time on them. Like the rest of the world, India followed suit and announced a complete lockdown on March 24, 2020. By 12th March 2020, India had reported more than 500 cases across various states such as Delhi, Rajasthan, and Telangana, and the initial death count was 10 [ 3 ].

1.1 Impact of Covid pandemic

COVID-19 affected the everyday life of humans and hindered the worldwide economy. The pandemic also impacted a social life of people all over the world. The infection spread all over the globe, almost in 213 countries as per WHO reports, and has shown severe implications for countries' economic and health systems [ 4 , 5 ]. The pandemic shook the roots of world systems and states at almost all levels. The “abnormal” way of life became “normal,” and people were compelled to survive amidst a nationwide lockdown. At times like these, it was the spirit of mankind that helped people fight all odds and go through tough times. The worldwide outbreak of Coronavirus buckled the public health system. Countries across the world struggled to contain the fast spread of the virus as it continued to have a devastating impact on the lives of the people.

The economic devastation caused by the pandemic was very prevalent and easy to monitor. However, it was the ‘disguised disruption’ of structural units that caused the real damage. From shops to schools and offices to public places, a shutdown of everything caused people to directly bear the socio-economic and emotional costs of the pandemic. This caused a massive migrant and labor crisis, with everyone desperately searching for asylum. The 454 million internal migrants felt desperate to return to the safe havens of their homes, also because the means of their livelihood at their place of work was now shut down due to the pandemic [ 6 ].

With the closure of educational institutions to contain the spread of the contagious virus, the burden shifted to the students who were enrolled in schools and colleges or coaching classes. The fee, when coupled with the cut down on family income, caused a heavy dropout, especially for the girl child, who is always the easiest target and the most burnt bearer of a tragedy [ 7 ]. The share of the unorganized sector, which was most hit by the closure and the lockdown, in employment is around 83%. This was going to have a long-term impact on the Indian economy—as while the organised sector switched to continue its business as usual through online mode, work-from-home structure, and technological support; the unorganized sector came to a virtual standstill. The state's healthcare sector, too, shifted the entire “guns and butter” equation to just one unit, and the other regular check-ups, immunization programs, and any other aspect of healthcare program or concern took a back seat—putting the elderly and the diseased at great risk. Put together, the pandemic was a mammoth challenge for everyone, from people to institutions, societies to states. However, it was the collective will, timely-made policies, India’s social capital, and quick responses that helped the country sail through the adversaries.

1.2 Response of the Indian State

As a global response to the pandemic and to contain the spread of the virus, various Public and Private institutions switched to online modes of functioning, such as schools, colleges, and even the Judiciary. But this facility was not available to all sectors and institutions as many other organizations continued to work on the ground, such as those serving essential commodities, medical industries, agricultural sector, transport industry, and the civil society actors—who together came forward towards smooth functioning of the society and economy during the crisis period. In India, various policy reform measures were adopted across various sectors, such as education, health, economy, agriculture, and health, to keep the life of the country functional and the economy afloat. The following section deals with this aspect in detail.

1.3 Education sector

Education has long been a crucial component in assessing development trends throughout time and across countries. It has proved instrumental in numerous ways, from reducing poverty and inequality to preparing the path for long-term economic prosperity. Higher pay, social mobility, practical life skills, increased discipline, and a readiness to change have all been advantages of education.

Due to the COVID-19 pandemic, India’s poor educational records have been exacerbated, with schools being closed since March 2020. Schools in India had to be closed for the largest number of weeks. Since the March 2020 lockdown, 1.5 million schools have been closed, and 247 million primary and secondary pupils have been dropped out of school [ 8 ]. Schools have been attempting to replace in-person classes with online learning since most primary school students have not attended school in over a year. Teachers and institutions have experimented with using e-platforms like WhatsApp groups, group tutoring, Zoom, and Skype to reach out to their students. Other creative approaches to reaching them include using loudspeaker tutorials for those without an internet connection. The internet connectivity and the digital divide in Indian society were laid clear, with people even climbing over trees and buildings to get signals.

These online lessons, however, have had a mixed response. While many children in metropolitan regions have accessed online classes, many preferred lectures "in a classroom," where they would not be forced to "do everything on WhatsApp—i.e., submit assignments, talk to friends, ask questions." Many students take online classes for more than four lessons every day, including core subjects like English and Science, as well as extracurricular activities like dance or taekwondo [ 9 ]. As a result, students started spending a significant amount of time on their laptops or mobile devices. Parents who disliked technology and digital exposure, on the other hand, objected to online classes because "they complained about their children's increased screen time." Due to the extended lockout and the necessity to do other domestic duties, some parents found it difficult to assist their children with the online learning paradigm [ 10 ]. Teachers also expressed dissatisfaction with their inability to establish "rapport with the youngsters," as they did in school. They believed that because teachers got little chance to interact online, they were unable to monitor "body language in class," and "their connection with peers” was affected. As a result, many teachers claimed that remote learning made it harder to engage students [ 11 ].

However, due to poor connectivity and lack of access to digital devices, many students, particularly in rural regions, face many problems in accessing online learning material. According to a report on India's Key Indicators of Household Social Consumption on Education, only 15% of rural families had access to the Internet, compared to 42% of urban households [ 12 ]. Many students struggled because they lacked personal gadgets or one designated for studies, had poor internet connections, or simply couldn't afford an internet connection. The schools, too, failed to provide the necessary infrastructure to the teachers and the students to take up the task of online education. A sudden shift was destined to have problems on both ends as teachers were not trained on how to teach in an online mode, and the students couldn't grasp what was being taught. This made them helpless.

Many families experienced financial hardship as a result of the pandemic, which was going to have an impact on other aspects of their livelihood. During school closures, some of the poorest families couldn’t even afford a digital gadget to avail their children of access to education or other skill training. This created a learning divide, which shall have an impact in the long run. The lengthy closure of schools had been a burden, and over 90% of low-income parents wanted schools to return as soon as feasible [ 13 ]. The reopening of schools, on the other hand, had ebbed and flowed. The Union government allowed schools to begin on October 15, 2020, but gave the respective state education boards to decide the course of action, which was to be based on the incidence of COVID-19 infections in the area and the regular COVID guidelines issued by the Health ministry. The reopening program that was suggested contained options of alternate day schooling, two-day schooling, and continuous use of online learning, as well as two school shifts per day, staggered timetables, and outdoor sessions [ 14 ]. The elderly and the children were the most vulnerable, and the government could not have afforded a fresh spread of the virus, especially when signs of its mutations were evident. The experiences from other countries also helped India to learn the way out.

After the announcement in October 2020, certain states, like Himachal Pradesh, Andhra Pradesh, and Uttarakhand, reopened their schools but had to close them because numerous people (students, teachers, and school staff) got infected. Due to the forthcoming board exams, schools in Himachal Pradesh, Punjab, Haryana, Uttar Pradesh, Gujarat, Maharashtra, Odisha, and Karnataka were to reopen in February 2021, notably for those in grades 9–12 [ 14 ]. However, with India's second wave of COVID-19 infections in March 2021, the number of cases increased once more. As a result, Himachal Pradesh, Punjab, Delhi, Rajasthan, Uttar Pradesh, Bihar, Madhya Pradesh, Chhattisgarh, Maharashtra, Gujarat, Karnataka, and Tamil Nadu chose to close primary schools. The second wave was the most fatal and pushed state healthcare machinery to its maximum, and the number of infected people, along with those who died due to it, broke all records. India overnight became a global hotspot of COVID-19 [ 15 ]. However, several schools across India began to reopen at the beginning of September 2021 after being closed for 18 months. Many cautious precautions were implemented for this reopening, including "stay-at-home" advice, "50 percent capacity, thermal screening, physically distanced seating arrangements, among others." Many schools also improved their infrastructure, such as ventilation, water supply, and restrooms, to support efforts of containment of the virus and restrict its spread. However, the long-term effects of the school shutdown still need more assessment.

The lack of communication between different stakeholders also created confusion sometimes regarding the guidelines, but the teaching–learning experience was sure to have taken a long-term hit with the uncertainty over the upcoming times as the virus was not mutating and taking different forms, resisting the effect of the vaccine. The effect of this can be largely felt in the rural areas. A prolonged disconnect from the studies pushed them way back from where they were. They were unable to recall vernacular scripts and lessons that they had been taught thus far. Thus taking it all to square one or even more primordial. The 18-month school shutdown stunted the development of educational faculties. In addition to the lost knowledge and know-how, the distress could be seen in the rate of dropouts. In rural areas or families with low income, education is seen as a trade-off. It is seen as if the family is compromising on an earning hand by sending their child to school based on a promise of a brighter future. With the onset of the pandemic, people lost their jobs, and this directly compelled them to let go of the education their child was attaining at different levels. These large chunks of dropouts put together would change the dynamics of an entire generation if left unattended at this crucial juncture.

Furthermore, these dropouts would reinforce gender stereotypes and widen the gap [ 16 ]. Girls were an obvious choice to cut resources in times of crisis, and they would be then married off at an early age to reduce their dependency on the family. Therefore, this would strengthen the gender education gap and give rise to child marriages and child labor, both of which are heinous crimes but extremely prevalent in India, particularly amongst the rural poor. In the urban setups, though the girls are not forced to drop out of school, their education remains burdensome. They were expected to fit in the “gender roles'' and help with household chores, which adds to the overall workload. This, in turn, caused them to neglect their studies and overall well-being [ 17 ].

Apart from the gender gap troubles and related adversaries, the shutdown of schools has had an even deeper impact on the overall well-being and health structure of the country. The Midday Meal Scheme was a win–win policy that the government had in place, as it hit two birds with a single stone. On the one hand, it was able to increase the attendance rate and provide education to a good sum of people, while on the other hand, it was able to provide nutritious food to the children that would help forestall stunting, early deaths, and mal-nutrition amongst other food-related illnesses. The meal provided children with daily bodily requirements of proteins and nutrition. However, a shutdown came haunting their health at a time when they should have the best of it to maintain their immunity against the virus [ 18 ].

The nutrition intake scheme was not a yearly process or a short-term goal. It was to help a child develop into a healthy adult while making use of its potential and capabilities. However, a cut on this has risked their future stakes of becoming a healthy, productive, and sound individual who would have the freedom to explore the best of his/her capabilities and contribute to the progress of society. This prominent aspect of human capital formation faced serious risk and, if not corrected within the given time frame, would affect the health of the younger lot, which would define the coming generation and, therefore, the state’s capabilities in the long run [ 14 ]. Moreover, malnutrition in children makes them susceptible to regular diseases and weakness, which makes them skip school, and if left untreated, they could become chronic in nature. All of this led to an increase in the pressure on the state's healthcare system. The state’s increased spending on healthcare came from a cut down on spending on developmental projects. Therefore, both the state and society suffered and started drifting on the path of regression and not progress [ 19 ].

To tackle the situation, the Central government and many state governments ordered Anganwadis and schools to supply midday meals either in raw form or cooked form to all the students. Moreover, some states attempted to regulate this supply using ration cards or cash transfers to the families. Nevertheless, due to the structural factors and loopholes in the systems clubbed with red-tapism and corruption, not everyone could receive these packages or help [ 20 ]. The Midday Meal Scheme might be the same, but the way it has been implemented during the lockdown differed at the state level. While states like Haryana and Chhattisgarh preferred giving dry rations, Telangana provided hot cooked food, while in Bihar, cash transfer was preferred. These implementation level differences were reflected in the results, and the benefits could not reach all [ 21 ].

In addition to this, the shutdown had layers of intersecting factors of caste, class, and religion to it. The upward mobility was snapped for people belonging to lower caste and class. People from Schedule Castes and Tribes who were making a living out of their traditional skills in the city had to move back to the more primitive and highly stereotyped societies, i.e., to their villages, and had to suffer the discrimination which they had earlier fled from. This made the situation far worse [ 22 ]. The tragedy of suffering did not end here. The pandemic affected the mental well-being of poor families who were running on a hand-to-mouth basis, and this sudden economic jolt added to their grievances. Studies establish that the decline in economic status triggered mental ill health problems during the pandemic situation. It has been observed that, although most people had adjusted to COVID-19, levels of anxiety, depression, and stress remained high for respondents who experienced a deterioration in income. The studies also confirm that anxiety, depression, and stress levels were high for economically vulnerable sections of the population [ 23 , 24 ] particularly in developing countries [ 25 , 26 , 27 ].

The mental health of the children suffered a lot. There were many news of them committing suicide following despair or pressure of not being able to do something. In urban households, loneliness caused stress and anxiety in the children, and the lack of communication in the modern family added to the distress. Children who were not able to get therapy or communicate their emotions got caught in a sea of endless thoughts. This attack on their mental health has been overlooked in the state policies. Suicide was the leading cause for over 300 “non-coronavirus deaths” reported in India due to distress triggered by the nationwide lockdown, revealed a new set of data compiled by a group of researchers. The group, comprising public interest technologist Thejesh GN, activist Kanika Sharma, and assistant professor of legal practice at Jindal Global School of Law Aman, said 338 deaths have occurred from March 19 till May 2 and they are related to lockdown. According to the data, 80 people killed themselves due to loneliness and fear of being tested positive for the virus. The suicides are followed by migrants dying in accidents on their way back home (51), deaths associated with withdrawal symptoms (45), and those related to starvation and financial distress (36) [ 28 ].

A lot of things could work because of the strong civil society presence that India has had. Non-governmental organizations, foundations, unions, and individuals from all walks of life came together in these tough times to address the needs of children in their personal capacities. Schools and colleges quickly moved online to keep things going as “usual” to create a psychological impression of normal times. Furthermore, organizations helped deliver books, mobiles, and internet connection facilities in rural areas to keep everyone connected. On the academic front, teachers and professors volunteered to teach their peers in the virtual mode of learning and teaching. This helped develop a community where everyone was keen to learn the new ways of teaching and provide lectures. This bandwagon was joined by coaching institutes and tutors who dispatched tabs in remote areas to facilitate the learning mechanism. A blessing in disguise was the language. Since India has a fairly good amount of English Speakers or people who can read and write in English, or at least know the bare minimum of it, they were able to adapt to the online mode quickly. Even the technology was quick to adapt to people’s needs, and many major tech providers introduced regional languages in their applications to help users connect in a dire situation like the Pandemic. This two-front war and timely action and support from all ends helped the boat from sinking up to a great extent. However, there still lies plenty of scope for improvement and accommodation. The government has been trying to make ends meet and bring children back to school, but it would need to work closely on all the related aspects to make things “normal.”

1.4 Health sector

India’s healthcare system has never been up to the mark despite the fact that India has a sound number of doctors, health experts, and medical facilities. A primary reason for this distress has been the lack of attention it has received from the government. The budget allocation for the Health sector never reflects the population ratio and always falls short. Moreover, the lack of functional and quality-driven government hospitals and affordable health care affects people. But, this rotten system was exposed due to a Pandemic. No government in the world expected an outbreak so severe and was not even distantly prepared to tackle it. There were few hospitals, limited staff, and counted resources. However, the pandemic demanded the healthcare system run at its maximum capacity, which, towards the end, almost collapsed it. Thousands died due to oxygen cylinder shortages, not being able to find a hospital bed on time, or not being able to get vaccines or lifesaving drugs on time. This shortage caused millions of people to lose their lives, especially during the second wave of Covid 19. This wave broke the back of the health care system and compelled governments across the country to be on their toes, import supplies of oxygen and medicines, run on makeshift hospital beds, and work on 24/7 emergencies. In the past, the Modi Government announced a health insurance cover of up to 6021 USD, a scheme dubbed “Modicare,” replicating “Obamacare,” a similar healthcare program launched by President Obama in the United States. However, this bluntly overlooked the need for more aid from the government's end for the public healthcare system. The need for establishing more quality hospitals with better equipment, qualified staff, and affordable prices was never realized. All these shortcomings were perfectly visible and incredibly hurting during the outbreak of the pandemic.

Healthcare infrastructure cannot be built overnight. Therefore, initially, the government relied heavily on the services of private hospitals, along with hotels that were converted into isolation centers. However, the troubles were amplified when the country started running short on medical supplies and not infrastructure. The pandemic exposed how the healthcare cost in the country has almost tripled while people’s income has not matched up. This has created a huge gap and kept a mammoth amount of people out of health coverage. The people who struggled during COVID-19 didn’t have any health insurance, and as the situation became gruesome with fewer and fewer resources for the public to avail, the prices of healthcare shot up. People had to go up to the extent of selling their property to meet the expenses during the COVID crisis. India’s dream of being a superpower can’t be realized until it strengthens its healthcare system, which is the backbone of any country.

Albeit, during the pandemic, the government released guidelines and regulations for private hospitals and warned them against profiteering, but all of it fell on deaf ears. These measures were not implemented in the best of manners, and private hospitals maneuvered in full swing and charged as high as 1lac per day from COVID-19 patients. The worst affected, like always, were the rural people and the poor. They didn’t have any health insurance, connections, and money to buy the facilities. They were solely dependent on the state, which was already running short on supplies. Many states in the north, like Uttar Pradesh, Bihar had no proper infrastructure in place. Lands that were allotted to be hospitals were used for other purposes, and government hospitals in place were in an extremely awful condition. There was no staff, infrastructure, machines, medicines, and oxygen cylinders. It replicated a war-torn camp in some distant part of the world that is dying for human aid [ 29 ].

As the nation crawled out of the second wave somehow, some new challenges awaited it. The vaccine enrolment plans and ensuring that everyone gets both doses timely in a thickly populated country is a tall order. In a country where a huge chunk of the population lives in poverty and is uneducated, it is important to dispense vaccines in a transparent, affordable, and accessible manner. The Indian government and medical experts approved two vaccines, namely Covishield and Covaxin while keeping an eye on all the vaccine development in the world. Later, Sputnik developed in Russia was also included in the list.

There were challenges from the end of workers as well. They were underpaid or were not duly compensated. Many were working overtime or temporarily. Many doctors and medical staff lost their lives while serving the nation in tough times. The government, both on the state and central level, was quick to realize and respond and announced several schemes and packages keeping in mind the families of such workers. The amount of this relief fund as insurance to the frontline workers was as high as 10 million. Along with this, the government announced compensation and policies for the patients who lost their lives in the fight against COVID. The Delhi government declared that children who lost their parents would get free education, along with monetary compensation. People who lost their livelihood or means of income would be helped by providing capital grants and loans. These measures would help heal the economic loss that the people have suffered and will, in turn, also help the state’s economy get back on track. However, a larger challenge was to bring things back to normal and restore lives after such a depressing period that the entire world was witnessing as a whole.

Although the vaccines were there, they faced many challenges. The rollout faced difficulties because states had limited amounts of the doses with them. This caused shortages, and it was alleged that private players were hoarding vaccines only to dispense them at a good price later. The dual policy that the state had given citizens both options, getting vaccines free of cost from the government centers or through private players with a price ceiling. However, there were difficulties obtaining free vaccines provided directly by the government. Moreover, the booking was to be done online; hence, a clear lot of people, especially in the rural areas deprived of technical know-how, were unable to make use of these facilities. The state government stepped in and tried to reach the outskirts and make teams that would help illiterate people avail of services. However, the government could not brush aside the biases people had regarding vaccines. There were plenty of hysteria and false narrations that were doing the rounds with respect to vaccines. People in the rural areas were hesitant to take vaccines as they believed this would either make them impotent, cut short their life cycle, or have side effects in the years to come. This kind of narration created an aversion to vaccines. To address this issue, many TV commercials, serials, and e-modes, along with door-to-door counseling, were done from the government's end to eradicate this issue of ignorance.

India’s over-sized population has been a big challenge, and to get vaccines double doses for such a huge population was even more challenging. However, India managed to vaccinate 100 crore people, a feat in itself. The Indian rural healthcare system, which runs on three levels consisting of Sub-Centres, Primary Health Centres, and Community Health Centres, was involved in making vaccines available at the rural levels. Although the workforce levels were way below the recommended and needed units of WHO, they played a crucial role during the crisis. The number of people who were getting vaccinated was on the increase, but a simultaneous threat of new variants that might spark another wave of COVID has been a matter of serious concern. To ensure a safe environment, it has become important that the government take timely and strict measures. Make RTPCR test mandatory along with ensuring that all people aged above 18 years get vaccinated. Moreover, COVID guidelines and precautions need to be followed religiously to avoid adversaries of all kinds. The fight against COVID is not individual-centric; rather, it needs collective action and determined persistent efforts.

1.5 Fiscal policy response

India’s fiscal policy response to the pandemic was strategized with a step-by-step approach due to the unprecedented nature of the crisis and massive uncertainty. Fiscal spending in India initially focused on providing support in cash and in-kind to vulnerable households. The initial measures in April 2020 included cash transfers to poor households, distribution of free food grains, and medical insurance to health workers. More comprehensive measures were announced under the various tranches of the Atmanirbhar Bharat package in May and November 2020. Policies were announced to aid the micro, small, and medium enterprise (MSME) sector by increasing the coverage, providing collateral-free loans, a corpus to fund equity, etc. Several schemes were announced to provide support to farmers and promote the production of high-value primary products [ 30 ].

In the first phase of the pandemic, the spending measures focused mainly on healthcare and social protection, such as in-kind (meals; cooking gas) and cash transfers to low-income households (1.2% of GDP); employment and wage support provision to the low-wage workers (0.5% of GDP); healthcare insurance coverage; and health care infrastructure (0.1% of GDP). Additional public investment (about 0.2% of GDP) and support for the schemes targeting specific sectors were announced at later dates in October and November 2020.

The latter measures included a Production Linked Incentive scheme that is estimated to cost approximately 0.8 percent of GDP over five years, a higher fertilizer subsidy allocation benefiting agriculture (0.3 percent of GDP), and support for the urban housing construction (0.1% of GDP). Multiple measures to simplify the tax compliance burden across a variety of industries had also been announced, along with the postponement of some tax filing and other compliance deadlines, as well as a decrease in the penalty interest rate for late Goods and Services Tax (GST) filings. In light of the resurge in infections, similar measures to ease the burden of tax compliance were reintroduced somewhat during the months of April and May 2021.

The agricultural sector is primarily supported by infrastructure development. The central government's budget for FY 2021/22 focused on increasing spending on health and well-being, including funding for the nation's COVID-19 vaccination campaign (350 billion Rs). It was tabled in the parliament on February 1, 2021. In response to the surge in infections, the central government announced in April 2021 that free food grains would be provided to 800 million people in May and June (at the cost of approximately 260 billion rupees), comparable to the additional food rations provided in 2020.

The central government had also extended the scheme for giving interest-free loans to states for the capital expenditure for FY 2021/22 (150 billion rupees) and accelerated the distribution of the Disaster Response Fund to the state governments from June to May 2020. Lastly, different taxes and customs duties on vaccines, oxygen, and oxygen-related equipment have been waived to increase their availability. Under the Pradhan Mantri Garib Kalyan Yojana, the Central government announced a 1.7 lakh rupees crore relief package. The package, which was disclosed by the Finance Minister of India on March 26, 2020, included: 60237.35 USD in insurance coverage for each health worker battling Covid-19, for the next three months, 800 million poor citizens will receive free food—5 kg of rice or wheat and 1 kg of preferred pulses, 6.02 USD per month for the next three months for 200 million Jan-Dhan account holders who are women, raising MNREGA wages from Rs 182 to Rs 202 per day, ex-gratia payments of 12.05 USD to 30 million poor senior citizens, widows, and disabled people and Pradhan Mantri Kisan Yojana will provide 24.09 USD to 87 million farmers.

The Mahatma Gandhi National Rural Employment Program (MGNREGA) and the provision of subsidized food grains served as useful buffers, keeping unemployment low and social stability high. In May 2020, 36 million people were looking for work (25 million in May 2019). In June 2020, this figure was increased to 40 million (the mean of 23.6 million in the 2013–2019 periods) [ 31 ]. The government increased its budgetary allocation to the highest level in the history of the program, totalling one trillion rupees. Similarly, in addition to heavily subsidized rice and wheat supplies, a special arrangement of a free supply of 5 kg of wheat or rice per individual for three months was launched and has since been extended by the other three months for 800 million people. There had also been arrangements made for cash transfers to farmers and women to the tune of 500-billion-rupee.

However, if we see the other side of the coin, we witness that MGNREGA, though an ideal program during the pandemic, has a cap of 100 days of guaranteed employment and does not comprise urban areas. The agriculture sector in India failed to absorb the additional labor due to huge underlying disguised unemployment. According to a post-pandemic survey, the Ministry of Micro, Small and Medium Enterprises (MSME) sector expected their earnings to fall by up to 50% that year in 2020. Small and micro enterprises, having limited access to formal credit, account for 30% of the GDP and employ more than 110 million people in India. This was also one of the hardest hit sectors, despite several structural and economic arrangements being made for their survival and growth, especially during and right after the pandemic started waning out. The challenge was twin fold as both the demand and the supply side of the economy had got derailed.

1.6 Monetary policy response

The Reserve Bank of India (RBI) has been on the frontlines of providing policy support, deploying the full range of instruments to ensure the orderly functioning of financial markets, and maintaining financial stability. In terms of monetary policy, the RBI declared a significant loosening of policy. It cut the policy repo rate (the interest rate where the banks borrow money from the RBI) by 75 basis points to 4.4 percent and the reverse repo rate (the interest rate on which banks lend money to the RBI) by 90 basis points to 4.0 percent [ 30 ]. The RBI's overarching goal was to ensure ‘normal market functioning, nurture growth impulses, and preserve financial stability’—all three priority actions.

The Reserve Bank of India's Monetary Policy Committee reduced the policy repo rate by 115 basis points and declared an accommodative monetary policy stance. In addition, the central bank declared several liquidity steps to combat the negative effects of COVID-19, including 3-month cessation on debt-servicing of all time loans outstanding, including working capital loans, and increased the short-term loan limit for states from 30 to 60 percent (declared on 1 April 2020), giving states an alternative source to receive money from the RBI rather than relying on supplemental market borrowings. In a nutshell, the RBI's actions are reasonable. The effective money cost in the system will be smaller as interest rates are cut and inflation rates fall. Despite the minor ambiguity surrounding the home loan repayment EMIs, this is also an all-in response. Table 1 shows India's overall monetary and fiscal support since March 2020.

From Table  1 , it can be seen that the government of India has taken various fiscal and monetary policy measures to cope with the current aftermath of the COVID-19 pandemic. The ending of the disease is in a quagmire to date. The measures shown in the table are those that helped in increasing consumption as well as capital expenditures in both the private and public sectors. The RBI has played a crucial role during the pandemic, attempting to reinforce the policies of the government to cushion the fallout from the pandemic and place the economy on the path to recovery [ 30 ].

2 Concluding observations

While India has struggled to survive the serious implications of the global crisis, proactive policy reforms in various sectors have enabled the social, political, and economic system to sustain itself. There are evident efforts on the part of the state to step up its policy reform measures towards the health and education sector and to create and preserve the livelihoods of the disadvantaged sections through various schemes. In the longer run, there is a need to focus more on employment-intensive investments and cover the social protection gaps vis-à-vis women, migrants, and marginalized segments. Not only this, there is an urgent need to train more health worker staff and promote skilled employment. The crisis demands us to take this as an opportunity to revamp the drawbacks and better prepare for uncalled future adversaries.

To conclude, India's policy response to the COVID-19 pandemic serves as a microcosm of the challenges and triumphs experienced by nations across the globe. While the journey has been arduous, it has also been illuminating, offering valuable insights that can guide the way forward for a post-COVID society. The multifaceted approach India undertook, from implementing lockdowns to expanding healthcare infrastructure and launching an ambitious vaccination campaign, demonstrates the importance of adaptability and innovation in the face of an evolving crisis. These experiences underscore the need for governments and international organizations to remain vigilant, flexible, and prepared for future health emergencies. Moreover, the emphasis on proactive governance, data-driven decision-making, and community engagement highlights the pivotal role of public participation and transparent communication in building trust and promoting cooperation. These principles should remain at the forefront of policymaking, reinforcing the importance of people-centered responses.

As we move into a post-COVID era, the lessons gleaned from India's journey must not only be acknowledged but integrated into global strategies for health and well-being. The way forward requires investments in healthcare infrastructure, robust disaster preparedness, and equitable access to healthcare services. These steps are essential not only to mitigate future crises but also to address existing healthcare disparities. In a post-COVID society, international collaboration must become the norm, as pandemics know no borders. Sharing knowledge, expertise, and resources on a global scale is vital for a coordinated response to any health emergency. India's response to the COVID-19 pandemic offers a roadmap for building a more resilient, equitable, and prepared society. By learning from the experiences of this diverse and complex nation, we can collectively strive for a world that is better equipped to navigate the uncertainties of the future, ensuring the health and well-being of all its inhabitants.

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Kugler M, Sinha S. The impact of COVID-19 and the policy response in India. 2020. https://www.brookings.edu/blog/future-development/2020/07/13/the-impact-of-covid-19-and-the-policy-response-in-india/ . Accessed 25 Feb 2024.

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This article is based on the findings of a research project by the author titled ‘Covid-19 crisis and the challenges of reverse migration’ sponsored by the Indian Council of Social Science Research (ICSSR). 2021-22, New Delhi.

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Kandpal, P.C. India’s policy response to the COVID-19 pandemic: Lessons for a post-COVID society. Discov glob soc 2 , 16 (2024). https://doi.org/10.1007/s44282-024-00043-x

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Getting ahead of coronavirus: Saving lives and livelihoods in India

The COVID-19 pandemic is the defining global health crisis of our time and the greatest global humanitarian challenge the world has faced since World War II. The virus has spread widely, and the number of cases is rising daily as governments work to slow its spread. India has moved quickly, implementing a proactive, nationwide, 21-day lockdown, with the goal of flattening the curve and using the time to plan and resource responses adequately.

Along with an unprecedented human toll, COVID-19 has triggered a deep economic crisis. The global economic impact could be broader than any that we have seen since the Great Depression. 1 In the full briefing materials accompanying Matt Craven, Linda Liu, Mihir Mysore, Shubham Singhal, Sven Smit, and Matt Wilson, “ COVID-19: Implications for business ,” March 2020, McKinsey’s estimates of the global economic impact of COVID-19 suggest that global GDP in 2020 could contract at 1.8 percent and 5.7 percent in scenarios A3 and A1, respectively. This means that India will face a corresponding shrinkage in global demand for its exports in addition to its domestic-production and -consumption challenges. To understand the probable economic outcomes and possible interventions, McKinsey spoke with more than 600 leaders, including senior economists, financial-market experts, and policy makers, in 100 companies across multiple sectors. Based on these inputs, we modeled estimates for three economic scenarios in India (Exhibit 1). 2 The economic scenarios for India are broadly based on McKinsey’s global scenarios in “ COVID-19: Implications for business ,” March 2020, tailored to the Indian situation. All estimates are directional rather than accurate projections or forecasts, and they will evolve over time with new data, inputs, and analysis.

In scenario 1, the economy could contract by about 10 percent in the first quarter of fiscal year 2021, with GDP growth of 1 to 2 percent in fiscal year 2021. In this scenario, the lockdown would be relaxed after April 15, 2020 (when the 21-day deadline is due to expire), with appropriate protocols put in place for the movement of goods and people after that. Our economic modeling suggests that even in this scenario of relatively quick rebound, the livelihoods of eight million workers, including many who are in the informal workforce, could be affected. In other words, eight million people could have their ability to subsist and afford basic necessities, such as food, housing, and clothing, put at severe risk. And with corporate and micro-, small-, and medium-size-enterprise (MSME) failure, nonperforming loans (NPLs) in the financial system could rise by three to four percentage points of loans. The amount of government spending required to protect and revive households, companies, and lenders could therefore be in the region of 6 lakh crore Indian rupees (around $79 billion), or 3 percent of GDP.

In scenario 2, the economy could contract sharply by around 20 percent in the first quarter of fiscal year 2021, with –2 to –3 percent growth for fiscal year 2021. Here, the lockdown would continue in roughly its current form until mid-May 2020, followed by a very gradual restarting of supply chains. This could put 32 million livelihoods at risk and swell NPLs by seven percentage points. The cost of stabilizing and protecting households, companies, and lenders could exceed 10 lakh crore Indian rupees (exceeding $130 billion), or more than 5 percent of GDP.

Scenario 3 could mean an even deeper economic contraction of around 8 to 10 percent for fiscal year 2021. This could occur if the virus flares up a few times over the rest of the year, necessitating more lockdowns, causing even greater reluctance among migrants to resume work, and ensuring a much slower rate of recovery.

Robust measures to stabilize and support households, businesses, and the financial system

Assuming scenario 2 plays out, the potential economic loss in India would vary by sector, with current-quarter output drops that are large in sectors such as aviation and lower in sectors such as IT-enabled services and pharmaceuticals (Exhibit 2). Current-quarter consumption could drop by more than 30 percent in discretionary categories, such as clothing and furnishings, and by up to 10 percent in areas such as food and utilities. Strained debt- service-coverage ratios would be anticipated in the travel, transport, and logistics; textiles; power; and hotel and entertainment sectors.

There could be solvency risk within the Indian financial system, as almost 25 percent of MSME and small- and medium-size-enterprise (SME) loans could slip into default, compared with 6 percent in the corporate sector (although the rate could be much higher in aviation, textiles, power, and construction) and 3 percent in the retail segment (mainly in personal loans for self-employed workers and small businesses). Liquidity risk would also need urgent attention as payments begin freezing in the corporate and SME supply chains. Attention will need to be given to the liquidity needs of banks and nonbanks with stretched liquidity-coverage ratios to ensure depositor confidence.

Given the magnitude of potential unemployment, business failure, and financial-system risk, a comprehensive package of fiscal and monetary interventions may need to be planned, keeping scenario 2 in mind. This might be triggered progressively as situations evolve and as actions are taken to move to the more favorable scenario 1 through effective public-health measures and graded lockdowns.

Further fiscal-, monetary-, and structural-measure possibilities

Several measures have already been announced to provide liquidity, limit the immediate NPL impact, and ease personal distress for needy households in India. These amount to around 0.8 percent of GDP. Additional measures could be considered to the tune of 10 lakh crore Indian rupees, or more than 5 percent of GDP in fiscal year 2021. All the estimated requirements may not necessarily be reflected in the fiscal deficit of the current year—for example, some support may be structured as contingent liabilities that only get reflected when they devolve. However, a package of this order of magnitude may be essential in supporting those dealing with the possible steep declines in aggregate demand and in protecting the financial system from the possible solvency and liquidity risks arising from stressed companies if scenario 2 or scenario 3 plays out.

Household demand could then be boosted beyond the support provided to needy households that the Indian government has already announced. Consideration could be given to an income-support program in which the government both pays for a share of the payroll for the 60 million informal contractual and permanent workers linked to companies and provides direct income support for the 135 million informal workers who are not on any form of company payroll. India’s foundational digital-identity infrastructure, Aadhaar, enables effective mechanisms for direct support, including through the Pradhan Mantri Jan-Dhan Yojana (PMJDY) and Pradhan Mantri Kisan Samman Nidhi (PM-KISAN) programs and to landless Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) beneficiaries. Concessions for home buyers, such as tax rebates for a time-bound period, could stimulate the housing market and unlock the job multiplier.

For bankruptcy protection and liquidity support, MSMEs could receive liquidity lines from their banks, refinanced by the Reserve Bank of India and a loan program for first-time borrowers could be administered through SIDBI. 3 Small Industries Development Bank of India. Substantial credit backstops from the government could be instituted for likely new NPLs Timely payments to MSMEs by large companies and governments could be encouraged by promoting bill discounting on existing platforms.

For large corporations, banks could be allowed to restructure the debt on their balance sheets, and procedural requirements for raising capital could be made less onerous. The Indian government could consider infusing capital through a temporary Troubled Asset Relief (TARP)-type program (such as through preferred equity) in a few distressed sectors (such as travel, logistics, auto, textiles, construction, and power), with appropriate conditions to safeguard workers and MSMEs in their value chains. Banks and nonbanks may also require similar measures to help strengthen their capital, along with measures to step up their liquidity and the liquidity in corporate-bond and government-securities markets.

To manage the macroeconomic consequences of a large stabilization package, the government would also need to consider clearly communicating to the markets and population that these measures are deep but temporary. Given that India’s fiscal resources are constrained, the Reserve Bank of India may need to finance a portion of such incremental government spending. The spending could be tracked as a COVID-19 portion of the budget to boost transparency. The inflationary effects may be low, as lockdowns severely constrict demand and the fiscal support provided would be a substitute for expenditure rather than additional stimulus. Price increases could, however, occur in some sectors, such as food, so appropriate steps would be needed to maintain harvests and keep the food supply chain operating smoothly.

Overall, devising a credible, systemwide, stabilization package would benefit from being executed in a timely fashion so it can influence the pace of recovery and help avoid severe damage to livelihoods, the economy, the financial sector, and society. Many global economies are also facing these issues and having to put in place their own stabilization packages, with similar intent.

Following the first wave of stabilization measures, attention could shift to implementing the structural reforms needed to increase investment and productivity, create jobs quickly, and improve fiscal health. This could mean introducing further reforms in infrastructure and construction and accelerating investments in health, affordable housing, and other urban infrastructure. States could accelerate spending, and institutions such as NIIF 4 National Investment and Infrastructure Fund. could deploy domestic and long-term foreign capital faster. Such reforms could also enable Make in India sectors to become globally competitive and boost exports (such as electronics, textiles, electric vehicles, and food processing), strengthen the financial sector, deepen household financial savings and capital markets, and accelerate asset monetization and privatization to raise resources.

Emergence from lockdown, safeguarding both lives and livelihoods

Countries that are experiencing COVID-19 have adopted different approaches to slow the spread of the virus. Some have tested extensively, carried out contact tracing, limited travel and large gatherings, encouraged physical distancing, and quarantined citizens. Others have implemented full lockdowns in cities with high infection rates and partial lockdowns in other regions, with strict protocols in place to prevent infections.

The pace and scale of opening up from lockdown for India may depend on the availability of the crucial testing capabilities that will be required to get a better handle on the spread of the virus, granular data and technology to track and trace infections, and the build-up of healthcare facilities to treat patients (such as hospital beds by district). In parallel, protection protocols, cocreated with industry, could be designed for different settings (such as mandis [rural markets], construction sites, factories, business-process-outsourcing [BPO] companies, urban transit, and rural–urban labor movement). As an example, industrial areas (such as Baddi, Vapi, and Tirupur) could be ring-fenced and made safe, with local dormitories set up for the labor force and minimal, controlled movement in and out of the site allowed. There could be on-site testing at factories and staggered shifts for workers. While the principles may be the same for construction sites and BPO companies, the specifics would differ.

A geographic lens could be overlaid to determine how quickly the lockdown could be lifted when new protection protocols are in place. Red, yellow, and green zones could be earmarked based on unambiguous criteria, with clear rules for economic activity, entry, and exit. The classification of areas could be updated frequently as the situation evolves. The definition of a “zone” would need to be granular (such as by ward, colony, and building cluster) to allow as much economic activity as is safely possible while targeting infection as accurately as possible. Since there is a very real possibility of the virus lingering on through the year, this microtargeting approach could help decelerate its spread while keeping livelihoods going.

The alternative approach of opening up select industry chains would be less feasible, given that sectors are tightly intertwined. A textile-export factory, for instance, would require chemicals for processing, paper and plastic for packaging, spare parts for its sewing machines, and consumables such as thread. Segregating industrial establishments by size would also be difficult, since smaller suppliers are often bound to the larger manufacturers.

Actions would need to be implemented locally, with different approaches for districts based on their characteristics (such as rural versus urban, industrial versus service oriented, strong versus weak healthcare infrastructure, and heavily infected versus not infected yet). India could consider using the last week of the current lockdown to gear up for local execution, equipping more than 700 of the most appropriate government officers with insights gained from across the world and from ongoing efforts in cities such as Mumbai and states such as Kerala, which are currently fighting the pandemic.

As part of a set of options to consider, based on prior lessons learned in India from repurposing and redeployment of needed skills and expertise for nationwide efforts, such as after floods and natural calamities, these officers could potentially be deputed to work with the district magistrates (DMs) in each district. They could cooperate in dynamically developing and helping execute locally tailored healthcare-expansion efforts, local- or state-level lockdown timetables, and back-to-work protocols. The DMs and deputized officers in districts could potentially be supported by cross-functional centers of excellence (COEs) in states or at the center. These COEs would have medical, administrative, social, economic, and business experts using their considerable knowledge to collect best practices, conduct rapid analysis, and provide valuable suggestions and recommendations to the districts to ensure high-quality implementation.

It is imperative that society preserve both lives and livelihoods. To do so, India can consider a concerted set of fiscal, monetary, and structural measures and explore ways to return from the lockdown that reflect its situation and respect that most important of tenets: the sanctity of human life.

Rajat Gupta is a senior partner and Anu Madgavkar is a partner in McKinsey’s Mumbai office.

The authors wish to thank the leaders of McKinsey India, particularly Kanmani Chockalingam, Vikram Kapur, Alok Kshirsagar, Akash Lal, Renny Thomas, and Hanish Yadav, for their contributions to this article. They also wish to thank Rakesh Mohan—a senior fellow at Yale University’s Jackson Institute for Global Affairs, external adviser to McKinsey Global Institute, and former deputy governor of the Reserve Bank of India—for his contributions to this article.

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Impact of COVID-19 on healthcare system in India: A systematic review

Megha kapoor, karuna nidhi kaur, shazina saeed, mohd shannawaz, amrish chandra.

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Shazina Saeed, Amity Institute of Public Health, Amity University, Noida, Uttar Pradesh 201303, India. Email: [email protected]

Received 2022 Nov 24; Accepted 2023 Jun 17; Collection date 2023 Jul.

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/ ) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage ).

Despite an extensive healthcare system in India, the COVID-19 Pandemic created havoc upon the existing Indian healthcare system by disrupting the supply of essential healthcare services to patients. It has also highlighted the significant-quality discrepancies of healthcare facilities between the rural-urban areas and between public and private healthcare providers. The not so advanced healthcare system of India was exposed through the lack of oxygen and essential drugs required for the treatment of COVID-19. Additionally, during the pandemic period there was a drastic decline in seeking non-COVID-19 disease related healthcare services. The objective of this systematic review is to determine whether COVID-19 has impacted the healthcare system in India.

Keywords: COVID-19, healthcare, India

Introduction

India, the second most populous country in the world has been severely impacted by the ongoing COVID-19 pandemic since it’s emergence. COVID-19 has impacted every sector in the country including healthcare. Indian healthcare system crumbled under the massive burden of the global pandemic highlighting the gaps and challenges in the existing health delivery system.

COVID-19 or Coronavirus is an upper respiratory tract infection of high virulence. It was formerly known as ‘2019-nCoV’ and is caused by the SARS-CoV-2 virus. 1 It first originated from Wuhan city, Central Hubei province of China in December 2019. Several clusters of patients with viral pneumonia of unknown origin were reported to be epidemiologically associated with the Hunan seafood market, Wuhan, China. 2 Soon, cases of pneumonia were reported in other parts of the world as it spread rapidly crossing the borders of China. A massive number of people started losing their lives in China and following its spread to other countries; it was declared a public health emergency of international concern on 30th January 2020 by World Health Organization (WHO). After more than 118,000 cases in 114 countries, and 4291 people lost their lives, COVID-19 was declared as a pandemic by World Health Organization (WHO) on 11th march 2020. 3 As the countries continued to struggle with a lack of resources and capacity the viral outbreak spread rapidly worldwide, infecting millions of people all across the globe including India.

Those infected with Coronavirus disease (COVID-19) exhibit a varying range of symptoms ranging from mild to moderate. It affects people of all ages; however, the risk of serious infection increases with advancing age. Patients infected with coronavirus disease and presenting with pre-existing co-morbidities such as diabetes, asthma and cardiovascular diseases (CVDs) are more vulnerable to experiencing unfavourable outcomes or experiencing death.

A healthy individual can acquire COVID-19 infection directly by coming in close contact with an infected individual through the droplets emitted during sneezing or coughing. It can also be transmitted indirectly after coming in contact with contaminated surfaces such as door knobs. It affects every individual differently with cough, fever, sore throat, tiredness and lethargy being the most common symptoms of the illness. Individuals can also develop few lesser common symptoms such as loss of taste, diarrhoea, irritation of the eyes and rash on the skin among others. An individual can develop shortness of breath or experience difficulty in breathing and requires urgent medical attention. These symptoms may take 4–5 days to appear after coming in contact with a virus or as long as 14 days and can also be asymptomatic.

The first wave

In India, the first case of COVID-19 infection was reported on 27TH January 2020, when a 20 year old female with a travel history of China presented with a sore throat and dry cough in the emergency department of General Hospital, Thrissur, Kerala. 4 Since then, COVID-19 has taken a serious toll in India and worldwide. To prevent the spread of COVID-19 infection, the Government of India announced a nationwide lockdown for 21 days on 24 March 2020, which was further extended. It was not until 30th May, that the government uplifted the restrictions in an ‘unlock’ phase-wise manner. Throughout, national advisories were generated and the norm of ‘social distancing’ and ‘work from home was introduced. People were advised to practise social distancing, wear masks and avoid going out unnecessarily and only people of ‘essential services such as doctors, nurses, police and home services were exempted. These preventive measures allowed the Indian Healthcare delivery system to prepare for the pandemic. These measures stopped the further spread of COVID-19 infection and the efforts of the Indian Government to contain the viral spread were applauded internationally. India has experienced three COVID-19 pandemic waves till now with a massive surge during the second wave in March 2021. 5

The second wave and Indian healthcare system

The first wave had a low infectivity rate since the lockdown was imposed and individuals practised social distancing. Therefore, it largely affected the economy and livelihoods of Indians without any serious implications on the healthcare system. However, during march 2021, the country witnessed the most dangerous second wave that created havoc as individuals started taking preventive measures more casually due to ‘pandemic fatigue’. This was characterized by an increasing number of cases between 25 and 50 years of age, a shortage of essential medicine and equipment, and medical professionals. 6 Indian healthcare system failed to meet daily oxygen demand, Intensive Care Units (ICU) beds and oxygen beds due to which many hospitals had to turn the patients away, resulting in higher mortality rates. This lead to the disruption of routine immunization procedures, and treatment of Non-communicable and communicable diseases. 7 This revealed the overstretched and overburdened existing Indian Healthcare system. This also highlighted the failing healthcare management system and lacking public health system and efficient healthcare models in India. The Indian government failed to respond to the second wave effectively unlike the first wave.

The third wave of COVID-19 in India

With the emergence of the new Omicron variant of SARS-CoV2, the cases increased in January 2022. 8 The majority of the cases were asymptomatic or mildly symptomatic. With increased administration of the COVID-19 vaccine, the patients admitted in ICU were mostly unvaccinated or with pre-existing co-morbidities. The demand for hospital beds, oxygen beds and ventilators were low and mostly remained unoccupied.

The third wave was different from the first two waves due to various factors such as low virulence of the omicron variant despite high transmissibility and administration of either single or both doses of COVID—19 vaccine to the adult population, authenticating the effectiveness of the vaccine.

Therefore, the COVID-19 pandemic has significantly disrupted the healthcare systems in India. Hence, this review aims to describe the impact of COVID-19 on the healthcare system concerning the patient visit and reception of treatment, diagnostic tests done and referral services in India. It is necessary to conduct this review as it will aid in developing new healthcare models in order to manage the COVID-19 pandemic at present and prevent any further waves from arising in the future.

Health care system in India

A sound and effective healthcare system enable the country to respond to a pandemic efficiently by overcoming the challenges and barriers encountered in providing healthcare.

The Indian healthcare system is a mixed framework, including both public and private healthcare service providers. However, a large proportion of private healthcare providers are present in urban India, providing, secondary and tertiary healthcare services. 9

The objective of this systematic review is to determine the impact of the COVID-19 pandemic on the healthcare system in India.

Rationale: The rationale for this study is to investigate the impact of the COVID-19 pandemic on the healthcare system in India, considering the challenges, gaps and disruptions experienced during this global health crisis.

Material and methods

Study design.

This systematic review was conducted on the available online published studies in high-quality journals related to COVID-19 impact on healthcare services in India.

Search strategy

A thorough extensive literature search was conducted between 14 February 2022 and 20 February 2022 on the electronic database ‘PubMed’ for quality studies published between time period 2019 and 2022 using the search strategy (impact) AND (COVID-19) AND (healthcare system) OR (Primary Health centre)) OR (secondary health centre)) OR (community health centre)) OR (tertiary health centre))) OR (hospital)) OR (government)) OR (private)) AND (India).

The following keywords and Medical Subject Headings (MeSH) entries were used:

COVID-19, healthcare system, India.

Studies that met the eligibility criteria were selected based on the inclusion and exclusion criteria after screening the database for this systematic review.

Inclusion and exclusion criteria

This systematic review included the studies conducted in the English language during the COVID-19 Pandemic assessing the healthcare system in India. Studies involving outpatient clinics visit, hospital admissions, diagnostic tests done, minor and major surgeries and case referrals were also included.

Studies which were conducted in private clinics & not involving government, primary, secondary and tertiary centres, along with the studies conducted on the physical & mental health status of healthcare providers through surveys were excluded as shown in Table 1 .

Summary of excluded studies.

Data extraction

After completion of the initial screening process, a total of seven articles were selected to be included in this systematic review. The study selection process is illustrated in Figure 1 , representing the PRISMA (Preferred reporting items for systematic reviews and meta-analysis) flow diagram for this systematic review.

PRISMA flow diagram of the systematic search.

From the selected articles following data was extracted by preparing an MS Excel spreadsheet: title of the study, study objectives, study methodology and conclusion.

Table 2 shows the summary of all the included articles in this systematic review.

Summary of included studies.

According to the objective of this systematic review the results described based upon the Impact of the COVID-19 Pandemic on the health care system in India on various parameters – number of outpatients, number of inpatients, number of patients undergoing minor and major surgeries, emergency trauma cases, patients undergoing nonurgent elective procedures.

Impact of COVID-19 on cancer care in India

From the seven included articles in this review, two articles described the disrupted oncology services in India by comparing these before and during the pandemic. A cohort study to describe the impact of COVID-19 on cancer care in India compared the oncology services provisions by cancer patients between 01 March 2020 and 01 March 2020 with similar duration for 2019 and concluded that there was a 54% reduction in new patient registration, 46% reduction in patient follow-up visit, 36% reduction in hospital admissions, 37% reduction in outpatient chemotherapy, 49% reduction in number of major surgeries, 52% reduction in minor surgeries, 23% reduction in patients accessing radiotherapy, 38% reduction in pathological diagnostic testing, 43% reduction in radiological diagnostic tests and 29% reduction in palliative care referrals. It also found that there was more reduction of oncology services for larger metro cities than smaller cities. 10 Another study, A retrospective analysis from western India determining the impact of the COVID-19 lockdown on Cancer care stated reduced patient visits and number of treatments received during the lockdown with chemotherapy being the most common treatment received. 11

Impact of COVID-19 on nephrology services in India

Only one study out of the seven included studies described the impact of the COVID-19 pandemic on nephrology and transplant services at a tertiary care centre, in Ahmedabad, India. The study concluded that there was significant reduction in a number of outpatients and inpatients between April 2020 and June 2020 when compared with a similar duration in 2019 almost by 50%. There was also a reduction in donor transplants, haemodialysis and nonelective procedures such as renal biopsies and arteriovenous fistulas during March 2020. 12

Impact of COVID-19 on ophthalmic care in India

Three out of seven included studies reported the impact of COVID-19 on ophthalmic care in India. A study conducted at a tertiary care ophthalmic institute in India reported a decrease of 97.14% in the routine patient visit, a decline of 35.25% in emergency outpatient visits, a decrease in routine and emergency ward admissions by 95.18% and 61.66% respectively, a reduction of elective surgeries by 98.18%, decrease of 58.81% in emergency surgeries, reduction of 99.61% in the number of donor corneas collected between 25 March 2020 and 15 July 2020 with comparison on previous year data of the same duration. 13 A study conducted in rural eye centres of Southern India reported that between 23 March 2020 and 19 April 2020, the total number of patients reduced during the lockdown-I period versus pre-lockdown. Only essential procedures were performed and most of the patients were treated for conjunctivitis. 14 A third study, which was conducted in a tertiary eye care Institute reported that there was a reduction in the number of patients presenting with ocular trauma in their emergency department during the lockdown as compared to the previous year. 15

Impact of the COVID-19 pandemic on the clinical practice of trauma and orthopaedics

A single epidemiology study out of seven studies included in this article, which was conducted at a tertiary care centre in New Delhi, explained various outcomes of the COVID-19 pandemic on the practice of orthopaedics and trauma through comparison between the pandemic period and pre-lockdown. It stated a reduction by 71.93% in outpatient attendance, a reduction of 59.35% in inpatient admissions, 55.78% reduction in surgical procedures including arthroplasty surgery, trauma and arthroscopic surgery during the pandemic period. 16

This study is being conducted to investigate the impact of the COVID-19 pandemic on the health care system in India by a systematic review approach based upon the eligibility criteria, seven articles related to the purpose of the study were screened after inclusion and the final analysis was prepared. The included studies defined various parameters – number of outpatients, number of inpatients, number of patients undergoing minor and major surgeries, emergency trauma cases, patients undergoing nonurgent elective procedures, follow-up visits for assessment of the impact of the COVID-19 pandemic on overstretched and overburdened health care system Of India. The studies included in this article reported that the COVID-19 pandemic has sharply affected the health care services in India including cancer care, nephrology services, ophthalmic care, trauma practice and orthopaedics care.

The COVID-19 Pandemic has led to a disrupted healthcare system which has subsequently impacted non-COVID disease conditions. The observed reduction in the number of new patient registrations, hospital registrations, major and minor surgeries, and transplant procedures as summarized in various studies during March 2020–April 2020 could be due to fear of infection among patients. The patients residing in rural parts of India found it difficult to access health services in metro cities due to travel restrictions during the lockdown period and this has led to delays in early screening, correct diagnosis and appropriate treatment which is of grave concern. These patients may present with advanced stages of the disease and create a backlog of patients by overloading the healthcare system.

Hospitals faced certain challenges that inhibited them from providing appropriate care to the patient such as- many hospitals being converted to COVID-19 dedicated treatment facilities and as result, they faced a widespread shortage of Personal Protective Equipment (PPE) supplies. Hospitals reported a shortage of adequate staff as they were themselves exposed to the virus. Various hospitals reported lack of necessary medical equipments such as ICU beds and Ventilators which was a major threat.

Despite the lockdown and various challenges encountered, hospitals realized the need of improving the accessibility of healthcare through teleconsultation along with in-person visits during these challenging times. In the absence of direct consultations to the patients, telemedicine was conducted to address the concerns of outpatients and therefore, reduce their need to visit the hospital.

In general, the COVID-19 Pandemic has posed a serious threat to all aspects of the healthcare system in India by affecting the activities of hospitals that provide treatment services to patients for non-COVID-19 diseases.

The results of this study show that Indian Healthcare System during the COVID-19 pandemic has suffered serious challenges, which can be a wake-up call because due to delayed diagnosis, a large number of patients will present with advanced stages of the non- covid-19 disease such as cancers, which may require emergency treatment. Strengthening of the Indian healthcare system is required so that it does not crumble under future pandemics if any. Need of the hour is a robust healthcare model and effective healthcare policies with regular updates to manage the current pandemic along with more emphasis on telemedicine as this is not the last pandemic that India will face. In conclusion, the COVID-19 pandemic has significantly impacted the healthcare system in India.

Limitations of the study: This study has limitation regarding language inclusion, as the researchers’ proficiency was limited to English, resulting in the exclusion of articles written in other languages. Another major limitation is the bias as the he papers relies on available online published studies in high-quality journals, which may introduce a bias towards studies that have been published and accessible. There may be relevant studies that have not been included in the review, potentially leading to a skewed representation of the impact of COVID-19 on the healthcare system in India.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical statement: No Ethical approval is needed.

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