India coronavirus cases rise amid fears true figure much higher

Doubt has been cast over India’s claim that it has no community transmission of coronavirus after the country reported its biggest daily rise in number of cases so far, connected to a religious gathering held in Delhi two weeks ago.

India reported a record increase of 386 cases in the past 24 hours, pushing the total number to 1,637, according to the country’s health ministry. The death toll is now 38.

In another worrying development, the first coronavirus case was also confirmed in Mumbai’s Dharavi slum, which is India’s largest and is home to almost one million people living in close, unsanitary quarters. The 56-year-old man was taken to Sion hospital and eight of his family members placed into quarantine.

What is Covid-19?

It is caused by a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals.

What are the symptoms this coronavirus causes?

The virus can cause pneumonia-like symptoms. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties.

In the UK, the National Heath Service has defined the symptoms as:

• a high temperature - you feel hot to touch on your chest or back

• a new continuous cough - this means you've started coughing repeatedly

Should I go to the doctor if I have a cough?

Medical advice varies around the world - with many countries imposing travel bans and lockdowns to try and prevent the spread of the virus. In many place people are being told to stay at home rather than visit a doctor of hospital in person. Check with your local authorities.

In the UK, NHS advice is that anyone with symptoms should stay at home for at least 7 days. If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.

How many people have been affected?

China’s national health commission confirmed human-to-human transmission in January. As of 31 March, more than 780,000 people have been infected in more than 170 countries, according to the Johns Hopkins University Center for Systems Science and Engineering.

There have been over 37,800 deaths globally. Just over 3,200 of those deaths have occurred in mainland China. Italy has been worst affected, with over 11,500 fatalities, and there have been over 7,700 deaths in Spain. The US now has more confirmed cases than any other country - more than 164,000. Many of those who have died had underlying health conditions, which the coronavirus complicated.

More than 166,000 people are recorded as having recovered from the coronavirus.

Yet for a densely populated country of 1.3 billion people, the number of cases is still relatively low compared with Europe and the US, and believed to be linked to both low levels of testing and poor access to an already overstretched healthcare system with people not reporting their symptoms.

India spends only about 1.3% of its GDP on public health, among the lowest in the world. Only 47,951 tests have been done so far and there are just 51 government-approved testing centres across the country.

The jump in number of cases was linked to an annual two-day convention of the Muslim sect Tablighi Jamaat on 13 March, for which about 3,500 people gathered from all over the country and abroad in the south Delhi neighbourhood of Nizamuddin. Almost 2,000 stayed in the area for days afterwards, and the area has become the coronavirus hotspot of India.

The outbreak from the Nizamuddin mosque gathering also inflamed religious tensions in a city still reeling from communal riots last month that took 50 lives, with Hindu mobs rampaging through the streets attacking Muslims in their homes.

Across Indian media and social networks, Muslims were blamed for spreading the virus while “Corona Jihad” began to trend on Twitter.

The gathering also appeared to trigger a spread of the virus across numerous states from Kashmir to West Bengal by those who returned home afterwards. So far, 10 people who attended the event have died while 1,800 people have been sent to nine hospitals and quarantine centres across the country.

However, despite the jump in number of cases this week, the Indian government insists there is still no community transmission and that cases have been either from those who travelled abroad or in localised incidents. Lav Agarwal, the joint secretary in the health ministry, told reporters: “Nowhere have we said that there is a community transmission. We are still in a local transmission in this country.”

Raman R Gangakhedkar, the head of epidemiology and communicable diseases at the Indian Council of Medical Research (ICMR), also insisted there was “no reason to panic at the moment”. Nonetheless, the ICMR conceded last month that community transmission was “inevitable” in India.

“Until we see a significant number of cases to indicate community transmission, let us not over interpret things,” said Gangakhedkar.

Doctors in hospitals across India said the lack of proper protective equipment available for medical staff, including basic masks, meant that patients presenting with coronavirus symptoms were being turned away. Doctors in Kolkata described how they were made to wear plastic raincoats to examine possible coronavirus patients, while a doctor in a Delhi hospital resorted to wearing a motorcycle helmet to cover his face.

One junior doctor working in a Kolkata hospital where coronavirus patients are being treated, described how “for over a week, we came in close contact with suspected corona patients without proper protective gear … We all are left at the mercy of God.”

The doctor also cast aspersions on the claim that the disease was not already spreading within impoverished communities.

“Every day thousands of people gather here, seeking treatment for many infectious diseases. Last week, I noticed, hundreds of people, with many coughing, having fever and breathing problems stood on queue waiting for their turn to be examined by us,” he said.

“They stood in the queue for hours and many of them were coughing and sneezing. I have every reason to believe many were carriers of Covid-19 who spread the infection to people in that same line, who in turn are now spreading it in the community … hundred or thousand times more people should be tested for the infection. Otherwise, the coronavirus situation will turn unmanageable.”

A recent report, jointly published by three American universities and the Delhi School of Economics, claimed that India could have as many as 1.3 million coronavirus infections by mid-May.

Testing capacity may about to increase. Last week, Mylab Discovery, a company based in the city of Pune, became the first Indian firm to get full approval to make and sell testing kits, which have already shipped to labs in Pune, Mumbai, Delhi, Goa and Bangalore. Each Mylab kit can test 100 samples and costs 1,200 rupees.

Private company Practo also announced it has been authorised by the government to conduct private coronavirus tests, which can be booked directly. The facility is available only for Mumbai residents but they say it will soon be widened out to the whole country.