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Corona in India: A billion people are extremely poorly prepared for the virus

An ailing health system, many previous illnesses, 1.3 billion people: the coronavirus could have devastating effects in India. Experts are very worried.

After the outbreak of the Sars-CoV-2 virus in India, a high number of victims is threatened in the country with a population of 1.3 billion. "In absolute terms, we have to reckon with a terrible number of deaths," says Thiagarajan Sundararaman, a former director of the state's National Health Systems Resource Center. Not only the sheer size of the country is a reason for the high toll that the corona virus could take. "The Indian health system is so ailing that it cannot cope with an epidemic," says Sundararaman. Even without the virus that is currently circulating, the public hospitals in India are at their limit. "Public health care has been neglected for years, and now it's going to take revenge."

India spends around two percent of its gross national product on public health; in Switzerland it is around twelve percent. Because of the desperate conditions in India's public hospitals, most Indians turn to private institutions when they are ill - even if it costs them their last shirt. A good two thirds of Indian health care is in private hands. According to the Ministry of Health, seven percent of Indian households slide into poverty every year because of the high cost of health care.

Covid-19 is also a particularly strong threat to India because the Indian population has a high rate of previous illnesses, says Rajib Dasgupta, a professor of public health at Jawaharlal Nehru University in Delhi. Around 77 million Indians suffer from diabetes, and kidney diseases are also widespread. The extreme air pollution has also led to a significant increase in lung diseases in recent years. Many children and adults suffer from malnutrition, especially in rural India and the slums.

The Prime Minister avoids the crowds

Experts hope that the virus will spread more slowly in India than elsewhere, as the poor in particular travel less. "Hopefully that will give us a few weeks or months to prepare for the height of the crisis," says Sundararaman. There are nowhere near enough ventilators or intensive care beds available to care for tens of thousands of critically ill people. Neither the underfunded public sector nor private hospitals could cope with the onslaught.

The government has announced that it will convert one hospital for every half a million inhabitants into an emergency center. India's Prime Minister Narendra Modi warned on Tuesday on Twitter not to panic. "We work together, take small but important measures to protect ourselves," he wrote.

As of Sunday, the virus had been found in only 39 people in India. However, experts assume that there is a high number of unreported cases. "It is very possible that the number of cases in India is much higher than established," says Arunkumar G., director of the Manipal Institute of Virology. On Wednesday, Modi canceled his participation in next week's Holi festival celebrations. "Experts around the world have advised mass gatherings to be reduced to avoid the spread," Modi wrote on Twitter. That's why he decided not to take part.

India stops exporting medicines

It remains to be seen whether many Indians will follow their prime minister's example and avoid crowds. According to experts, it will be extremely difficult to curb the spread of the virus in India with government intervention in public and private life. Coercive measures like those taken in China or Japan are unthinkable in India, says Vivekanand Jha from the George Institute for Public Health in Delhi.

The virus was apparently brought to India by tourists. Among other things, sixteen out of twenty members of an Italian tour group were identified as porters. The group had been traveling in the state of Rajasthan since mid-February. There is great concern that tourists may have infected many local residents. Covid-19 has an incubation period of up to two weeks, so that many infected people may not have any symptoms yet.

At India's airports, all passengers arriving from abroad are now being examined for fever and other signs of infection with Covid-19. Those wishing to travel from Italy, China, South Korea, Japan and Iran are currently not receiving an entry permit for India because of the many coronavirus cases in their home country.

The virus outbreak has led India to restrict exports of 26 pharmaceutical ingredients and the drugs and vitamins made from them. This also includes paracetamol, various antibiotics and substances that are needed for the production of birth control pills. India is one of the world's largest manufacturers and exporters of pharmaceuticals. A delivery stop could lead to bottlenecks in Europe.