India marshals more resources to stop virus, but gaps remain

India is adding more resources to tackle its increase in coronavirus cases by announcing that private hospitals may be requisitioned to help treat virus patients, and turning railway cars and a motor racing circuit into makeshift quarantine facilities.

The steps were taken after a nationwide lockdown announced last week by Prime Minister Narendra Modi led to a mass exodus of migrant workers from cities to their villages, often on foot and without food and water, raising fears that the virus may have reached to the countryside, where health care facilities are limited.

Indian health officials have confirmed more than 1,000 cases of the coronavirus, including 29 deaths.

Experts say that local spreading is inevitable in a country where tens of millions of people live in dense urban areas with irregular access to clean water, and that the exodus of the migrants will burden the already strained health system.

As India’s under-resourced health care system prepares to confront a wave of coronavirus cases, some state governments have asked liquor factories and breweries to produce liquid sanitizer after the initial supply failed to match demand. Designers, nonprofit groups and prisoners in various jails have stepped up to help overcome shortages of masks and other personal protective equipment.

India has less than one medical doctor and three nurses per thousand people, the minimum recommended by the World Health Organization. The dominant share of India’s doctors and beds are in the private health care sector, which the country’s poor often cannot afford.

“India’s big city hospitals are well equipped to deal with the surge in virus cases,” said public health expert T. Sundararaman. “But the same can’t be said about district hospitals in rural areas, barring some exceptions in states that fare well when it comes to health care.”

On Monday, the Indian Council of Medical Research, India’s top medical research body, said the country had conducted 38,442 tests for the virus as of March 29. India has a population of 1.3 billion people.

“We are still at less than 30% of our testing capacity,” said Dr. Raman R. Gangakhedkar, a scientist at the council.

The need for broader support for strong measures to avoid the spread of the virus has continued to mount as opposition leaders, analysts and health experts say the government appears to have been caught off guard.

The governments of the states of Uttarakhand, Chhattisgarh, Rajasthan and Madhya Pradesh have announced in the past few days that intensive care units, ventilators and staff of private hospitals might be requisitioned to treat virus patients.

Joining the fight against the virus, New Delhi’s top hospital, the All India Institute of Medical Sciences, said it is converting its trauma center into a coronavirus hospital, the Press Trust of India news agency reported. The Buddh International Circuit, India’s first Formula One racing track, was being readied for use as a shelter and quarantine facility, officials said.

Indian Railways announced on Saturday that it is converting some of its train coaches into isolation units for rural and remote areas. All passenger train service in the country has been suspended until April 14.

On Sunday, after tens of thousands of migrant workers had already made arduous dayslong journeys home on foot, Modi apologized for the 21-day lockdown he ordered and said he had “no choice.”

On Saturday, state borders were opened as hundreds of buses were sent by the authorities to transport migrant workers who live in squalid housing in congested urban ghettos and earn meager wages, often with no savings to fall back on.

The government’s late response, however, struck a jarring note in comparison to its quick response to the plight of Indian workers stranded abroad, hundreds of whom were brought back home on special flights.

Ram Bhajan Nisar, a migrant worker from the north Indian state of Uttar Pradesh who was working in New Delhi as a painter, set off from the capital last week with his wife and two children. Government buses and hitchhiking took the family part of the way, but the rest of the journey to their village near the border with neighboring Nepal was on foot.

“I walked two days, two nights to reach here, and both the children have blisters on their feet,” said Nisar, who was then sent for quarantine in a government school.

People who have been quarantined in India for suspected exposure to the virus say conditions inside government facilities are unsanitary and could potentially foment the outbreak.

Azad Ahmad Padder, a 40-year-old doctor, was sent to a quarantine facility in northern Jammu city along with his ailing brother on March 24. The two, with no foreign travel history, had expected clean quarantine facilities at the converted university campus.

Instead, they found stained bedding at the facility, with five people in a room, dirty floors and clogged washrooms that were full of bird droppings.

Apart from the squalid living conditions, the facility, Padder said, already housed more than 200 people who rushed through its corridors in groups, risking the spread of the virus.

“The way that they have been treating us is absolutely terrifying,” he said.

Padder’s account of the conditions was corroborated by other people at the facility, along with photographs of washrooms covered with excrement.

Others at the facility lamented the lack of medical facilities, including sanitizers and masks. They said they were not adequately screened for the virus or treated for existing conditions, and that their days passed with continuing concern about possible virus cases around them.

Padder said the situation was particularly worrying for his 60-year-old brother, who is recovering from lung-related ailments and is at risk of getting pneumonia if he catches the coronavirus.

“The conditions here are so filthy that if a person spends a few days here, even if they are healthy, they will get the virus,” he said. “It feels like we are living in a detention center.” ——— Associated Press photographer Manish Swarup contributed to this report.

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