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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 3  |  Issue : 1  |  Page : 6-10

Strength, weakness, opportunities, and threats analysis of India's nationwide lockdown: A desperate effort to tackle the potential impact of severe acute respiratory syndrome coronavirus 2 by the world's largest democracy


1 Department of Urology, St.John's Medical College, Bengaluru, Karnataka, India
2 Department of Community Health, St.John's Medical College, Bengaluru, Karnataka, India

Date of Submission10-Dec-2020
Date of Decision22-Jan-2021
Date of Acceptance23-Jan-2021
Date of Web Publication25-Mar-2022

Correspondence Address:
Dr. Seetharam Bhat Kulthe Ramesh
Department of Urology, St. John's Medical College, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jphpc.jphpc_23_20

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  Abstract 


Objective: To study the impact of nationwide lockdown during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Materials and Methods: We performed a strength, weakness, opportunities, and threats analysis of this measure and its potential impact and the current preparedness of the society. Results: SARS-CoV-2 has led to extreme measures by many countries in the form of nationwide lockdown. India is the world's largest democracy with over 1.3 billion people was put under complete lockdown. This pandemic would test India's public health system, community participation, its capacity to innovative and its potential to overcome various challenges. With a lack of adequate testing, a lockdown is the only tool available. Conclusions: In the existing scenario, a complete lockdown is probably the best measure currently available; however, the post lockdown exit strategy is key to recover from this lockdown.

Keywords: Pandemic, potential impact, severe acute respiratory syndrome coronavirus 2, strength, weakness, opportunities and threats analysis


How to cite this article:
Ramesh SB, Joseph B. Strength, weakness, opportunities, and threats analysis of India's nationwide lockdown: A desperate effort to tackle the potential impact of severe acute respiratory syndrome coronavirus 2 by the world's largest democracy. J Public Health Prim Care 2022;3:6-10

How to cite this URL:
Ramesh SB, Joseph B. Strength, weakness, opportunities, and threats analysis of India's nationwide lockdown: A desperate effort to tackle the potential impact of severe acute respiratory syndrome coronavirus 2 by the world's largest democracy. J Public Health Prim Care [serial online] 2022 [cited 2022 May 27];3:6-10. Available from: http://www.jphpc.com/text.asp?2022/3/1/6/340809




  Introduction Top


The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been nothing less than devastating. With more than 1.3 billion people which is equivalent to 17.7% of the total world population living together, India could potentially serve as a  Petri dish More Details for this highly infective virus.[1] Initially, the Indian Council of Medical Research (ICMR) recommended just port of entry screening and quarantine; however, they thought these measures alone were insufficient. As a response to the SARS-CoV-2 pandemic, the Government of India announced a nationwide lockdown of 21 days to “flatten the curve of the cases” based on experiences in Wuhan and Hubei province in China.[2] We performed a strength, weakness, opportunities, and threats (SWOT) analysis of this nationwide lockdown of 1.3 billion people, its potential impact and the current preparedness of the society (both government and private sector) as a whole to tackle this pandemic [Figure 1].
Figure 1: Summary of strength, weakness, opportunities and threats analysis of nationwide lockdown – India's response to coronavirus pandemic

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  Methods Top


We performed a SWOT analysis of this measure and its potential impact and the current preparedness of the society.


  Results and Discussion Top


Strengths

What does India do well as a country?

Ministry of Health and Family Welfare, the National Centre for Disease Control and the ICMR have been very proactive in doing a risk assessment and issuing various guidelines to tackle the SARS-CoV-2 pandemic. India's basic public health care unit is a three-tiered system consisting of subcentres, primary health centers, and community health centers, that have been successful in various vaccination and health interventional programs.[3] These could serve as the backbone of educating under-served populations like the rural farmers and migrant workers. They have been playing a key role in checking on compliance with quarantine measures through their home visits. They could potentially treat patients with minor symptoms at home, thus reducing their dependence on hospitals. The ICMR has been involved in developing low-cost testing kits, epidemic modeling, and testing for community transmission. At the time of writing this article, based on nation-wide sampling, there was no evidence of community transmission but only localized transmission among travelers and their contacts.[4] The national disaster management authority has been instrumental in the management of this pandemic through the actions of the national disaster relief force (NDRF) that carries out day-to-day field activities. They have been organizing camps for testing centers. Ministry of home affairs along with security agencies like the police, the central reserve police force , and others have been instrumental in maintaining law and order. They have employed innovative advertising campaigns to educate people and have helped provide shelter and food to migrant workers along with the NDRF. All these governmental agencies along with the elected representatives have been constantly in touch with the general public through press, mass media, and social media as well.

Finally, despite many controversial actions in the past, the current Prime Minister of India has enough public support to inspire a large section of the society especially the middle class and he has constantly engaged with the people of India. His calls to clap for health workers and lighting lamps to mark the country's fight against coronavirus has managed to inspire many of his support base.[5],[6] The management of the current crisis will be a real test for this popular leader and only time will tell.

Bhilwara model

This is an exit strategy that has been proposed by the union government of India to tackle this pandemic post lockdown period. This was a validated strategy that was used to control coronavirus at the Bhilwara district in Rajasthan. This strategy involves isolating the district especially by mapping its hotspots, screening door-to-door, tracing the contacts, enforcing quarantine, creating isolation wards, and rural monitoring mechanisms. Based on this strategy the health officials were able to identify 14,000 people with influenza-like symptoms who were put on watch lists in Bhilwara. The health officials followed these cases twice a day for symptoms while they were quarantined. In fact, the entire district was sealed and the buffer areas around the epicenters were turned into a no-movement zone. To reduce human suffering door-to-door supply of essential groceries, fruits, vegetables, and milk. Cooked food was distributed to the homeless and fodder for stray cattle.[7]

What unique resources can India draw on?

Community participation

The median age of the Indian population is 28.4 years.[1] Overall, due to the young age of the population, the mortality rate in India is not expected to be high, unlike other European nations. Community participation has proved to be vital in India's handling of the crisis. In general, the youth have been instrumental in volunteering rescue operation in case of a disaster like in the 2015 flash floods in Chennai, the youth of the city were instrumental in setting up communication networks using social media and worked in synchrony with the government authorities in the rescue operation. They used innovative methods like a Google spreadsheet to create a quick short-term database of area-wise resource availability.[8] However, in the case of SARS-CoV-2, though in the field action is not desirable, they can still effectively wield social media to spread awareness campaigns while at the same time refuting false claims. Various organizations and governments have made coordinated efforts in handling various crises that arose from Government's lockdown. The migrant worker crisis was one of them, where various organizations and the government have come together to offer shelter and food to these workers.[9]

Private sector

Private sector companies especially those that specialize in biotechnology have developed low-cost testing kits, further opening-up this market allowing companies to compete helps in reducing overall cost. Work from home initiatives can help in social distancing at the same time maintaining productivity. Private companies can proactively involve in educating their employees and families.

Mass media

Mass media in India plays a vital role in acting as a bridge between the government and the people. They give live update news and statistics. Indian news channels have great access to all sections of society and to all walks of life. They have played role in displaying the plight of many underserved communities, as well as bringing out various issues to the fore.

Social media and the Internet

Social media has given a voice to ordinary Indian citizens and it has been used as a magnifying force to express one's ideas and concerns. This has been effectively used during these times to educate and inform people. Social media has played a big role in education. The role of celebrities in inspiring people and lead the fight against the epidemic can be harnessed. They could be inspirational in motivating people to follow guidelines published by the authorities. Many government agencies are using social media to communicate directly with people and allay fears of the people. Using online conferencing technology like zoom have been used to conduct online meetings while maintaining social distancing. Online messaging apps like WhatsApp have been proactively used in communication. Innovative online website like quarantine tracker developed by the government of Karnataka helps public aware of the number of people under quarantine in their locality and their source of infections as well.[10]

What do others see as your strengths?

India has a growing private health care sector with major players who have the potential to build hospitals in record time. Furthermore, the pharmaceutical industry in India is robust and has a high manufacturing capacity the cost of conducting clinical trials in India is inexpensive too.[11] India's growing economy could encourage multinational companies (MNCs) to invest in India.

Weaknesses

What could you improve?

Currently with such a massive population and with only a 60% literacy rate, there have been issues with compliance to orders for various social, religious, and economic reasons. Migrant workers feared displacement from home, lack of daily wages, and food traveled by foot to their hometown. This probably was the fault of the administration that did not foresee this problem.[12],[13] Second, many religious congregations took place despite the lockdown. This in part was due to the apathy of the organizers and due to the educational level of the participants.[14] Both these situations could have been overcome by health education. India should improve its testing strategies. Currently, not enough tests are being performed mainly due to a lack of testing kits and cost is a major barrier. Contact tracing and testing have suffered due to deficient resources both in terms of kits and workforce. At times people have not been forthcoming with their contacts. Even when they were identified and were asked to self-quarantine, many did not follow this advice and thus led to the spread of the virus.[15] However, following the lockdown, these quarantine measures and contact tracing have been strictly enforced.

Where do you have fewer resources than others?

Manpower

Despite a structured health system, it often lacks workforce both in terms of the number of and the qualification of personnel. The on-field workers and contract workers may not comply to return to work.

Equipment

The lack of personnel protective equipment (PPE) especially for the frontline workers is an issue. India needs at least 1 million coveralls and goggles, 4 million N-95 masks, 2 million nitrile gloves, 600,000 face shield and 2 million triple-layer surgical masks.[16] In another estimate by Invest India, the country might need 38 million mask–14 million by the state government and rest by the central government and 6.2 million pieces of PPE.[17] A possible solution for this is to ramp up production and maybe reuse one's mask post sterilization. The government is planning to import PPEs.

Testing kits

Though WHO emphasized on the need for frequent testing, India currently lacks in both the numbers and in its ability to pay for the testing kits. Currently, an imported testing kit would cost about Rs. 4500 per kit and locally made kit cost about Rs. 1500.[18] However, the local manufacturing capacity is not adequate to fulfill the needs of the entire population, forcing the government to import more kits.

Hospital beds and ventilators

As per National Health Profile–2019, there are 713,986 beds in India's public health system, amounting to 0.55 beds per 1000 population with 8432 ventilators in the public sector and 40,000 in the private sector.[19],[20] This is a gross deficiency in the estimated number of ventilators needed. It is estimated that India would need 4 million ventilators.

What are others likely to see as weaknesses?

India is a growing economy with an ailing public health infrastructure. Such massive clampdown can potentially lock down the entire economy which can, in turn, have long-term effects on the nation's entire population.

Opportunities

What opportunities are open to you?

Low-cost innovations

Many private start-ups and MNCs have worked on low-cost innovations. Low-cost reverse transcription polymerase chain reaction testing kits costing 1/3rd of many international kits have been developed. However, the key challenge is in the mass production of these kits and making them available to the general public. AgVa is a portable ventilator that is highly subsidized, costing only a fraction of the price of conventional ventilators. Conventional ventilators cost up to $10,000, but this is priced at $2000.[21] The current capacity of the manufacturing of this ventilator is 500 per month, but the company has ramped up its production to up to 20,000 per month. This was possible because of the partnership between the government and Maruti Suzuki, India's largest carmaker. This is an opportunity for the country to shift its priority from importing medical equipment to local manufacturing. This in the long term can prove beneficial to modernize the Indian health care system.

Start-ups like Staqu developed a new thermal camera that can detect people with body temperature more than 37°C within 100 m and is powered by video analytics team JARVIS that examines heat signatures thus identifying suspected patients. Another start-up that has developed shields for cars and two-wheelers that is effective against SARS and similar viruses.[22]

Attention of policymakers

India's health expenditure is about 1.28% of its Gross domestic product as of 2015, while in comparison the USA's health expenditure is about 17.9% in 2017. In contrast, the population of India is 3 times more than in the US.[23],[24] For a long time, the medical community in India has been urging the government to increase spending on public health and health infrastructure spending. This could be a wake-up call for the government to increase its spending on improving health care infrastructure.

National integration

As a consequence of this pandemic, if the national situation is handled deftly, the government inculcates a sense of national integration uniting various sections of the society. Especially when the country is going through these tumultuous times due to much national policy and civil unrest that is prevalent in some regions.

Innovative campaigning

Amid the coronavirus outbreak, it was encouraging to see police taking innovative campaigning methods–from Bengaluru cops using coronavirus helmets and Punjabi cops singing pop songs to Kerala cops dance videos demonstrating handwashing, all of which have gone viral in social media.[25],[26]

What trends could you take advantage of?

It is encouraging to see that most of the population are compliant with government lockdown, except for a few sections of the society. Overall, they were compliant with the quarantine instructions and guidelines of lockdown. Many supermarkets maintained social distancing with a minimum 6 ft distance, only two consumers were let in at a time and all had sanitized their hands before entering the store.[27]

Threats

What threats could harm you?

Compliance issue while handling coronavirus

The current epidemic is caused by a highly contagious strain of coronavirus (COVID-19), that has high infectivity. Most infected people experience mild-to-moderate respiratory illness that is usually self-limiting. The best measure to break the transmission is to be well informed about the virus and taking measures to prevent transmission. Transmission occurs through droplets of saliva or discharge from the nose. Measures like social distancing, handwashing, or alcohol-based rub before touching the face, use of the mask can prevent transmission. This calls for the practice of general respiratory etiquette.[2],[28] The need of the hour is to educate people to generally adopt this a routine, thus preparing people to future outbreaks. Compliance is a major issue in the setting of a country with such a diverse population that encompasses people from all walks of life. It is not practical to handwash frequently or to use sanitizers long term for many people who work as daily laborers or construction workers, and the migrant worker. Overtime, weariness can set in and signs of these have been noticed among different sections of society.

Economic challenges

Economic challenges faced both by individual and country as a whole is huge. Before the coronavirus challenge, the Indian economy was already struggling. After the outbreak, with markets tumbling, small businesses closing down, the strain on the informal industry is obvious. Ninety-four percent of the population of India work in the informal industry contributing 45% of overall output.[29] Apart from loss in business, health care cost is substantial.

Bureaucratic oversight and interference

Indian bureaucracy for long has been criticized for its inefficiency, red-tapism, and excessive oversight. Wide-spread corruption in procuring vital medical equipment, PPEs, and testing kits could potentially affect India's effort in fighting coronavirus pandemic. Reports of siphoning of essential N95 mask to bureaucrats, when there is a deficiency in supply to frontline medical workers is heart-breaking and a real threat to current situation.

What threats do your weaknesses expose to you?

During times like these, the actual weaknesses of the Indian healthcare system are exposed. Our overreliance on imports of medical equipment and kits is detrimental in a crisis like this when there is worldwide demand, and this could lead to practices like price gouging by importers and international MNCs. There have been reports of sanitizers and masks being sold at four times its price.[30]


  Conclusions Top


With India's unique social fabric and with its existing resources and problems, we believe that in the current pandemic, India's nationwide lockdown is probably the only option that minimizes the damage caused by this pandemic. Post pandemic reopening of the country should be calculated and done with care. Meanwhile, India should garner all its resources to tackle this disaster.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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