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India braces for more coronavirus cases, but experts fear an epidemic

India is bracing for a potential explosion of coronavirus cases as authorities rush to trace, test and quarantine contacts of 31 people confirmed to have the disease.

It is screening international travelers at 30 airports and has already tested more than 3,500 samples. The Indian army is preparing at least five large-scale quarantine centers.

For weeks, India watched as cases of COVID-19, the disease caused by the virus, multiplied in neighboring China and other countries as its own caseload remained static — three students evacuated from Wuhan, the disease epicenter, who were quarantined and returned to health in the southern state of Kerala.

Prime Minister Narendra Modi’s government said last week that community transmission is now taking place. India has shut schools, stopped exporting key pharmaceutical ingredients and urged state governments to cancel public festivities for Holi, the Hindu springtime holiday in which people douse each other with colored water and paint.

Modi canceled travel plans to Brussels for an India-EU summit amid a rising caseload in Belgium, and tweeted that he would not attend any Holi festivities.

Experts fear these precautions won’t be enough for India’s beleaguered, under-funded and under-staffed health system to stave off an epidemic. Here are their foremost concerns:

As the virus spread globally, India began bolstering its ability to test and detect the virus. While the National Institute of Virology at Pune remains the main testing facility, the government has identified 35 additional labs for testing.

But concerns remain over India’s overstretched health infrastructure — a single state-run hospital for every 55,591 people on average and a single hospital bed for every 1,844 people. India needs about 10 times more doctors to meet the norms prescribed by the World Health Organization, a shortfall of at least 500,000 doctors.

Experts fear that an epidemic would cause other routine health care functions to suffer.

“Everything will become about COVID-19. And other routine services like immunization or taking care of maternal mortality would be affected,” said Anant Bhan, a global health and policy expert.

India’s health performance, an index that includes access to primary care, maternal mortality rates and child health, runs the spectrum, with some states outperforming others by almost 2.5 times, according to the government-run think tank NITI Aayog.

The best performer was Kerala, the small state that found and treated India’s first three cases. The worst was Uttar Pradesh, a state with roughly the population of Brazil that has detected at least six cases. Kerala has a doctor for approximately every 6,000 people, while Uttar Pradesh has one for every 18,000 people. The inequalities are further pronounced between urban and rural areas, with the bulk of the available beds concentrated in India’s cities.

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