India posted another record in daily Covid-19 infections on Friday, adding to pressure on Prime Minister Narendra Modi to impose a nationwide lockdown amid a debate whether restrictions imposed by individual states are enough.
Many medical experts, opposition leaders and some Supreme Court judges suggested lockdown seems to be the only option with the virus raging in cities and towns. Hospitals are forced to turn patients away for lack of space and crematoriums and burial grounds are struggling to handle the dead.
On Friday, India reported a new record of 414,188 confirmed cases in the previous 24 hours. Its tally has risen to more than 21.4 million since the pandemic began with faint hopes of the curve going down quickly. The Health Ministry reported 3,915 additional deaths, bringing the total to 234,083. Experts believe both figures are an undercount.
The official daily death count has stayed above 3,000 for the past 10 days.
Over the past month, nearly a dozen of India's 28 states announced less stringent restrictions than the nationwide lockdown imposed for two months in March last year.
Mr Modi, who consulted with elected leaders and officials of the worst-hit states on Thursday, has so far left the responsibility for fighting the virus to poorly equipped state governments.
Randeep Guleria, a government health expert, said a complete, aggressive lockdown was needed in India just like last year, especially in areas where more than 10 per cent of those tested have contracted Covid-19.
Srinath Reddy, president of the Public Health Foundation of India, a public-private consultancy, acknowledged that states were experiencing different intensities of the epidemic, but said a "co-ordinated countrywide strategy" was still needed.
According to Mr Reddy, decisions need to be based on local conditions but should be closely co-ordinated by the central government.
“Like an orchestra which plays the same sheet music but with different instruments,” he said.
Anthony Fauci, US President Joe Biden's chief medical adviser, suggested that India might need a complete shutdown for two to four weeks to help ease the surge of infections.
“As soon as the cases start coming down, you can vaccinate more people and get ahead of the trajectory of the outbreak of the pandemic,” Dr Fauci said in an interview with the Indian television CNN News18 news channel on Thursday. He did not provide specifics of what a shutdown should entail.
He said it appeared there were at least two types of virus variants circulating in India. He said B117, which is the UK variant, tended to be concentrated in New Delhi and that the 617 variant was concentrated in the worst-hit western Maharashtra state.
“Both of those have increasing capability of transmitting better and more efficiently than the original Wuhan strain a year ago,” Dr Fauci said.
Mr Modi last year imposed a stringent two-month lockdown on four hours' notice. It stranded tens of millions of migrant workers who were left jobless and fled to villages with many dying along the way. Experts say the decision helped contain the virus and bought time for the government.
India's economy contracted by 23 per cent in April-June last year and showed recovery as the restrictions were eased. The International Monetary Fund's projection of 12.5 per cent growth in the 2021-2022 financial year, beginning in April, is expected to suffer again with the surge in infections.
Mr Modi's policy of selected lockdowns is supported by some experts, including Vineeta Bal, a scientist at the National Institute of Immunology. She said states have different needs, and local particularities need to be taken into account for any policy to work.
In most instances, in places where health infrastructure and expertise are good, localised restrictions at the level of a state, or even a district, are a better way to curb the spread of infections, Ms Bal said. "A centrally mandated lockdown will just be inappropriate," she said.
Yogesh Jain Ganiyari of the Peoples Health Support Group, a low-cost public health programme in the central state of Chhattisgarh, said that lockdowns, scientifically, are the most effective way of curbing infections.
"But we don’t live in a lab. We need to take into account the humanitarian aspect,” Dr Ganiyari said. “Those who look at lockdowns just as disease control mechanisms are heartless. You have to think about the people.”