Why has coronavirus not run rampant in India?

India is preparing to repatriate hundreds of thousands of nationals left stranded abroad as a result of the coronavirus pandemic, in what may become one of the largest emergency evacuations in decades.

The Indian government will begin returning nationals on military ships and chartered flights from Thursday, with almost 15,000 people to be flown home from a total of 12 countries in the first week of the operation alone, reports Chennai-based newspaper The Hindu.

How many of the 17 million Indians currently living abroad will seek repatriation remains to be seen, but “it is estimated that the number could rise to a million”, adds Germany’s Deutsche Welle.

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One factor influencing their decision may be the limited extent of India’s coronavirus outbreak, with the South Asian nation and its neighbours accounting for a quarter of the world’s population but only 2% of global Covid-19 infections.

How many cases has India reported so far?

The past 24 hours have seen a steep rise in infections in India, with latest figures showing 3,852 new cases confirmed since the beginning of Tuesday. However, the country’s overall tally of infections is still startlingly low at just 46,476.

By comparison, the US has almost 1.2 million confirmed cases, in a population about a quarter of the size of that in India.

Why are there so few cases confirmed in India?

One possible explanation for the “puzzle” of India’s low rate of confirmed infections is the country’s poor testing capacity, says Foreign Policy.

As of the end of April, India had conducted only 830,201 tests, or 614 for every million people - among the lowest rates of testing in the world.

However, “if India’s low rate of testing were hiding a massive outbreak, it would show up in other ways”, says the Washington D.C.-based news site. Just 4% of the tests done to date have returned positive, compared with around 17% in the US, “implying that the virus is less widespread in India”.

India’s coronavirus death rate is also very low, at just 1,571 as of Tuesday morning.

Foreign Policy notes that “only one-fifth of deaths in India tend to be medically certified”, but adds that hospital admissions since the beginning of the year have been relatively normal - which again suggests that the infection rate remains low.

Other theories about India’s low reported infection and death rates include the comparative youth of the country’s population, the authorities’ speed and strictness in implementing nationwide lockdowns, and the success of their contact tracing programme.

Some experts and commentators have also suggested that warm weather may hamper the virus, or that certain medications including a widely deployed tuberculosis drug may boost resistance to the infection.

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What next?

India began relaxing its coronavirus lockdown restrictions on Monday, “even as the pace of infection picked up”, reports Associated Press.

Some aspects of the lockdown will be kept in place at least until 18 May, but a “tentative return to normal life, albeit with masks, social distancing and stringent hygiene standards,” is beginning in areas nationwide that are deemed to be low risk, says the New York City-based news agency.

Yet India’s total infection rate has begun to rise significantly, according to the Brookings Institution think tank.

“Active cases now growing at 5.5%, so doubling every 13 days. Not good. Hotspot management (containment and contact tracing and testing) needs to be much better,” tweeted Brookings Institute fellow Professor Shamika Ravi.

The country has also seen its biggest single-day jump in deaths linked to the illness, with 195 Covid-19 patients dying in the last 24 hours, New Delhi Television reports today.

The statistics add weight to growing fears that India’s outbreak “has yet to peak”, says The New York Times.

Rather than bringing the outbreak under control, limited interactions between people may simply have bought the Indian authorities “time to prepare”, says Ramanan Laxminarayan, an epidemiologist and economist at Washington D.C.’s Center for Disease Dynamics, Economics and Policy.