The impact of COVID-19 and the policy response in India

Subscribe to global connection, maurice kugler and maurice kugler professor of public policy, schar school of policy and government - george mason university @kugler_maurice shakti sinha shakti sinha senior fellow - world resources international (wri india).

July 13, 2020

Much has been written about how COVID-19 is affecting people in rich countries but less has been reported on what is happening in poor countries. Paradoxically, the first images of COVID-19 that India associates with are not ventilators or medical professionals in ICUs but of migrant laborers trudging back to their villages hundreds of miles away, lugging their belongings. With most of the economy shut down, the fragility of India’s labor market was patent. It is estimated that in the first wave, almost 10 million people returned to their villages, half a million of them walking or bicycling. After the economic stoppage, the International Labor Organization has projected that 400 million people in India risk falling into poverty .

Agriculture is the largest employer, at 42 percent of the workforce, but produces just 18 percent of GDP. Over 86 percent of all agricultural holdings have inefficient scale (below 2 hectares). Suppressed incomes due to low agricultural productivity prompt rural-urban migration. Migration is circular, as workers return for some seasons, such as harvesting.

Evidence of Indian labor market segmentation is widely available—with a small percentage of workers being employed formally, while the lion’s share of households relies on income from self-employment or precarious jobs without recourse to rights stipulated by labor regulations. Only about 10 percent of the workforce is formal with safe working conditions and social security. Perversely, modern-sector employment is becoming “informalized,” through outsourcing or hiring without direct contracts. The share of formal employment in the modern sector fell from 52 percent in 2005 to 45 percent in 2012. During this period, formal employment went up from 33.41 million to 38.56 million (about 15 percent), while nonagricultural informal employment increased from 160.83 million to 204.03 million (about 25 percent) .

Most informal workers labor for micro, small, and medium-sized enterprises (MSMEs) that emerged as intermediate inputs and services suppliers to the modern sector. However, workers struggle to get paid, which the government identifies as great challenge. Payroll and other taxes, as well as limited access to subsidized credit for large firms, are disincentives to MSME growth. Although over half of India has smartphone access, relatively few can telework. Retail and manufacturing jobs require physical presence involving direct client interaction. Indeed, income for families unable to telework has fallen faster.

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The government’s crisis response has mitigated damage, with a fiscal stimulus of 20 trillion rupees , almost 10 percent of GDP. Also, the Reserve Bank of India enacted decisive expansionary monetary policy . Yet, banks accessed only 520 billion rupees out of the emergency guaranteed credit window of 3 trillion rupees. In fact, corporate credit in June is lower than June last year by a wide margin after bank lending’s fall. S&P has estimated the nonperforming loans would increase by 14 percent this fiscal year . Corporations have deleveraged retiring old debts and hoarding cash, as have households. Recovery through investment and consumption has stalled . These trends are exacerbated due to the pandemic. The manufacturing Purchasing Managers Index (PMI) recovered 50 percent since May but at 47.2 it remains in negative territory. Services contribute over half of GDP but its PMI, even after bouncing back , remains low at 33.7 in June. Consumption of electricity, petrol, and diesel have regained from the lockdown lows but are still 10-18 percent below June 2019 levels . Agriculture has been the bright spot, with 50 percent higher monsoon crop sowing and fertilizer consumption up 100 percent. Unemployment levels had spiked to 23.5 percent but with a mid-June recovery to 8.5 percent—and then crept up again marginally.

The National Rural Employment Guarantee Scheme (MNREGA) and supply of subsidized food grains have acted as useful buffers keeping unemployment down and ensuring social stability. Thirty-six million people sought work in May 2020 (25 million in May 2019). This went up to 40 million in June 2020 (average of 23.6 million during 2013-2019 period). The government has ramped up allocation to the highest level ever, totaling 1 trillion rupees. Similarly, in addition to a heavily subsidized supply of rice and wheat, a special scheme of free supply of 5 kilograms of wheat/rice per person for three months was started and since extended by another three months, covering 800 million people. There have also been cash transfers of 500 billion rupees to women and farmers .

However, MNREGA has an upper bound of 100 days guaranteed employment and it also does not cover urban areas. Agriculture cannot absorb more labor, with massive underlying disguised unemployment. A post-pandemic survey shows that the MSME sector expects earnings to fall up to 50 percent this year. Critically, the larger firms are perceived healthier. However, small and micro enterprises, who have minimal access to formal credit, constitute 99.2 percent of all MSMEs . These are the largest source of employment outside agriculture. Their inability to bounce back could see India face further economic and also social tensions. The economy is withstanding both supply and demand shocks, with the wholesale prices index declining sharply .

We identified labor market pressures toward increased poverty, both in the extensive margin (headcount) and intensive margin (deprivation depth). India needs to ramp up MNREGA, introduce a guaranteed urban employment scheme, and boost further cash transfers to poor households. Government efforts have been enormous in macroeconomic policy (fiscal stimulus and monetary loosening) to mitigate adversity but fiscal space is narrowing, requiring the World Bank and other international financial institutions to step up and help avert even greater hardship. Also, ongoing advances towards structural economic policy reforms have to continue.

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  • 1 School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
  • 2 VIT-BS, Vellore Institute of Technology, Vellore, India

The coronavirus disease (COVID-19) pandemic, which originated in the city of Wuhan, China, has quickly spread to various countries, with many cases having been reported worldwide. As of May 8th, 2020, in India, 56,342 positive cases have been reported. India, with a population of more than 1.34 billion—the second largest population in the world—will have difficulty in controlling the transmission of severe acute respiratory syndrome coronavirus 2 among its population. Multiple strategies would be highly necessary to handle the current outbreak; these include computational modeling, statistical tools, and quantitative analyses to control the spread as well as the rapid development of a new treatment. The Ministry of Health and Family Welfare of India has raised awareness about the recent outbreak and has taken necessary actions to control the spread of COVID-19. The central and state governments are taking several measures and formulating several wartime protocols to achieve this goal. Moreover, the Indian government implemented a 55-days lockdown throughout the country that started on March 25th, 2020, to reduce the transmission of the virus. This outbreak is inextricably linked to the economy of the nation, as it has dramatically impeded industrial sectors because people worldwide are currently cautious about engaging in business in the affected regions.

Current Scenario in India

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), was first identified in December 2019 in Wuhan city, China, and later spread to many provinces in China. As of May 8th, 2020, the World Health Organization (WHO) had documented 3,759,967 positive COVID-19 cases, and the death toll attributed to COVID-19 had reached 259,474 worldwide ( 1 ). So far, more than 212 countries and territories have confirmed cases of SARS-CoV-2 infection. On January 30th, 2020, the WHO declared COVID-19 a Public Health Emergency of International Concern ( 2 ). The first SARS-CoV-2 positive case in India was reported in the state of Kerala on January 30th, 2020. Subsequently, the number of cases drastically rose. According to the press release by the Indian Council of Medical Research (ICMR) on May 8th, 2020, a total of 14,37,788 suspected samples had been sent to the National Institute of Virology (NIV), Pune, and a related testing laboratory ( 3 ). Among them, 56,342 cases tested positive for SARS-CoV-2 ( 4 ). A state-wise distribution of positive cases until May 8th, 2020, is listed in Table 1 , and the cases have been depicted on an Indian map ( Figure 1 ). Nearly 197,192 Indians have recently been repatriated from affected regions, and more than 1,393,301 passengers have been screened for SARS-CoV-2 at Indian airports ( 5 ), with 111 positive cases observed among foreign nationals ( 4 , 5 ). As of May 8th, 2020, Maharashtra, Delhi, and Gujarat states were reported to be hotspots for COVID-19 with 17,974, 5,980, and 7,012 confirmed cases, respectively. To date, 16,540 patients have recovered, and 1,886 deaths have been reported in India ( 5 ). To impose social distancing, the “Janata curfew” (14-h lockdown) was ordered on March 22nd, 2020. A further lockdown was initiated for 21 days, starting on March 25th, 2020, and the same was extended until May 3rd, 2020, but, owing to an increasing number of positive cases, the lockdown has been extended for the third time until May 17th, 2020 ( 6 ). Currently, out of 32 states and eight union territories in India, 26 states and six union territories have reported COVID-19 cases. Additionally, the health ministry has identified 130 districts as hotspot zones or red zones, 284 as orange zones (with few SARS-CoV-2 infections), and 319 as green zones (no SARS-CoV-2 infection) as of May 4th, 2020. These hotspot districts have been identified to report more than 80% of the cases across the nation. Nineteen districts in Uttar Pradesh are identified as hotspot districts, and this was followed by 14 and 12 districts in Maharashtra and Tamil Nadu, respectively ( 7 ). The complete lockdown was implemented in these containment zones to stop/limit community transmission ( 5 ). As of May 8th, 2020, 310 government laboratories and 111 private laboratories across the country were involved in SARS-CoV-2 testing. As per ICMR report, 14,37,788 samples were tested till date, which is 1.04 per thousand people ( 3 ).

Table 1 . Current status of reported positive coronavirus disease cases in India (State-wise).

Figure 1 . State-wise distribution of positive coronavirus disease cases displayed on an Indian geographical map.

COVID-19 and Previous Coronavirus Outbreaks

The recent outbreak of COVID-19 in several countries is similar to the previous outbreaks of SARS and Middle East respiratory syndrome (MERS) that emerged in 2003 and 2012 in China and Saudi Arabia, respectively ( 8 – 10 ). Coronavirus is responsible for both SARS and COVID-19 diseases; they affect the respiratory tract and cause major disease outbreaks worldwide. SARS is caused by SARS-CoV, whereas SARS-CoV-2 causes COVID-19. So far, there is no particular treatment available to treat SARS or COVID-19. In the current search for a COVID-19 cure, there is some evidence that point to SARS-CoV-2 being similar to human coronavirus HKU1 and 229E strains ( 11 , 12 ) even though they are new coronavirus family members. These reports suggest that humans do not have immunity to this virus, allowing its easy and rapid spread among human populations through contact with an infected person. SARS-CoV-2 is more transmissible than SARS-CoV. The two possible reasons could be (i) the viral load (quantity of virus) tends to be relatively higher in COVID-19-positive patients, especially in the nose and throat immediately after they develop symptoms, and (ii) the binding affinity of SARS-CoV-2 to host cell receptors is higher than that of SARS-CoV ( 13 , 14 ). The other comparisons between SARS and COVID-19 are tabulated in Table 2 , and references for the same are provided here ( 1 , 15 , 16 ).

Table 2 . Differences between coronavirus disease and severe acute respiratory syndrome.

Impact of COVID-19 in India and the Global Economy

As per the official government guidelines, India is making preparations against the COVID-19 outbreak, and avoiding specific crisis actions or not understating its importance will have extremely severe implications. All the neighboring countries of India have reported positive COVID-19 cases. To protect against the deadly virus, the Indian government have taken necessary and strict measures, including establishing health check posts between the national borders to test whether people entering the country have the virus ( 17 ). Different countries have introduced rescue efforts and surveillance measures for citizens wishing to return from China. The lesson learned from the SARS outbreak was first that the lack of clarity and information about SARS weakened China's global standing and hampered its economic growth ( 10 , 18 – 20 ). The outbreak of SARS in China was catastrophic and has led to changes in health care and medical systems ( 18 , 20 ). Compared with China, the ability of India to counter a pandemic seems to be much lower. A recent study reported that affected family members had not visit the Wuhan market in China, suggesting that SARS-CoV-2 may spread without manifesting symptoms ( 21 ). Researchers believe that this phenomenon is normal for many viruses. India, with a population of more than 1.34 billion—the second largest population in the world—will have difficulty treating severe COVID-19 cases because the country has only 49,000 ventilators, which is a minimal amount. If the number of COVID-19 cases increases in the nation, it would be a catastrophe for India ( 22 ). It would be difficult to identify sources of infection and those who come in contact with them. This would necessitate multiple strategies to handle the outbreak, including computational modeling as well as statistical and quantitative analyses, to rapidly develop new vaccines and drug treatments. With such a vast population, India's medical system is grossly inadequate. A study has shown that, owing to inadequate medical care systems, nearly 1 million people die every year in India ( 23 ). India is also engaged in trading with its nearby countries, such as Bangladesh, Bhutan, Pakistan, Myanmar, China, and Nepal. During the financial year 2017–18 (FY2017–18), Indian regional trade amounted to nearly $12 billion, accounting for only 1.56% of its total global trade value of $769 billion. The outbreak of such viruses and their transmission would significantly affect the Indian economy. The outbreak in China could profoundly affect the Indian economy, especially in the sectors of electronics, pharmaceuticals, and logistics operations, as trade ports with China are currently closed. This was further supported by the statement by Suyash Choudhary, Head—Fixed Income, IDFC AMC, stating that GDP might decrease owing to COVID-19 ( 24 ).

Economists assume that the impact of COVID-19 on the economy will be high and negative when compared with the SARS impact during 2003. For instance, it has been estimated that the number of tourists arriving in China was much higher than that of tourists who traveled during the season when SARS emerged in 2003. This shows that COVID-19 has an effect on the tourism industry. It has been estimated that, for SARS, there was a 57 and 45% decline in yearly rail passenger and road passenger traffic, respectively ( 25 ). Moreover, when compared with the world economy 15 years ago, world economies are currently much more inter-related. It has been estimated that COVID-19 will hurt emerging market currencies and also impact oil prices ( 26 – 28 ). From the retail industry's perspective, consumer savings seem to be high. This might have an adverse effect on consumption rates, as all supply chains are likely to be affected, which in turn would have its impact on supply when compared with the demand of various necessary product items ( 29 ). This clearly proves that, based on the estimated losses due to the effect of SARS on tourism (retail sales lost around USD 12–18 billion and USD 30–100 billion was lost at a global macroeconomic level), we cannot estimate the impact of COVID-19 at this point. This will be possible only when the spread of COVID-19 is fully controlled. Until that time, any estimates will be rather ambiguous and imprecise ( 19 ). The OECD Interim economic assessment has provided briefing reports highlighting the role of China in the global supply chain and commodity markets. Japan, South Korea, and Australia are the countries that are most susceptible to adverse effects, as they have close ties with China. It has been estimated that there has been a 20% decline in car sales, which was 10% of the monthly decline in China during January 2020. This shows that even industrial production has been affected by COVID-19. So far, several factors have thus been identified as having a major economic impact: labor mobility, lack of working hours, interruptions in the global supply chain, less consumption, and tourism, and less demand in the commodity market at a global level ( 30 ), which in turn need to be adequately analyzed by industry type. Corporate leaders need to prioritize the supply chain and product line economy trends via demand from the consumer end. Amidst several debates on sustainable economy before the COVID-19 impact, it has now been estimated that India's GDP by the International Monetary Fund has been cut down to 1.9% from 5.8% for the FY21. The financial crisis that has emerged owing to the worldwide lockdown reflects its adverse effect on several industries and the global supply chain, which has resulted in the GDP dropping to 4.2% for FY20, which was previously estimated at 4.8%. Nevertheless, it has been roughly estimated that India and China will be experiencing considerable positive growth among other major economies ( 31 ).

Preparations and Preventive Measures in India

An easy way to decrease SARS-CoV-2 infection rates is to avoid virus exposure. People from India should avoid traveling to countries highly affected with the virus, practice proper hygiene, and avoid consuming food that is not home cooked. Necessary preventive measures, such as wearing a mask, regular hand washing, and avoiding direct contact with infected persons, should also be practiced. The Ministry of Health and Family Welfare (MOHFW), India, has raised awareness about the recent outbreak and taken necessary action to control COVID-19. Besides, the MOHFW has created a 24 h/7 days-a-week disease alert helpline (+91-11-23978046 and 1800-180-1104) and policy guidelines on surveillance, clinical management, infection prevention and control, sample collection, transportation, and discharging suspected or confirmed cases ( 3 , 5 ). Those who traveled from China, or other countries, and exhibited symptoms, including fever, difficulty in breathing, sore throat, cough, and breathlessness, were asked to visit the nearest hospital for a health check-up. Officials from seven different airports, including Chennai, Cochin, New Delhi, Kolkata, Hyderabad, and Bengaluru, have been ordered to screen and monitor Indian travelers from China and other affected countries. In addition, a travel advisory was released to request the cessation of travel to affected countries, and anyone with a travel history that has included China since January 15th, 2020, would be quarantined. A centralized control room has been set up by the Delhi government at the Directorate General of Health Services, and 11 other districts have done the same. India has implemented COVID-19 travel advisory for intra- and inter-passenger aircraft restrictions. More information on additional travel advisory can be accessed with the provided link ( ).

India is known for its traditional medicines in the form of AYUSH (Ayurvedic, Yoga and Naturopathy, Unani, Siddha, and Homeopathy). The polyherbal powder NilavembuKudineer showed promising effects against dengue and chikungunya fevers in the past ( 32 ). With the outbreak of COVID-19, the ministry of AYUSH has released a press note “Advisory for Coronavirus,” mentioning useful medications to improve the immunity of the individuals ( 33 ). Currently, according to the ICMR guidelines, doctors prescribe a combination of Lopinavir and Ritonavir for severe COVID-19 cases and hydroxychloroquine for prophylaxis of SARS-CoV-2 infection ( 34 , 35 ). In collaboration with the WHO, ICMR will conduct a therapeutic trial for COVID-19 in India ( 3 ). The ICMR recommends using the US-FDA-approved closed real-time RT-PCR systems, such as GeneXpert and Roche COBAS-6800/8800, which are used to diagnose chronic myeloid leukemia and melanoma, respectively ( 36 ). In addition, the TruenatTM beta CoV test on the TruelabTM workstation validated by the ICMR is recommended as a screening test. All positive results obtained on this platform need to be confirmed by confirmatory assays for SARS-CoV-2. All negative results do not require further testing. Antibody-based rapid tests were validated at NIV, Pune, and found to be satisfactory; the rapid test kits are as follows: (i) SARS-CoV-2 Antibody test (Lateral flow method): Guangzhou Wondfo Biotech, Mylan Laboratories Limited (CE-IVD); (ii) COVID-19 IgM&IgG Rapid Test: BioMedomics (CE-IVD); (iii) COVID-19 IgM/IgG Antibody Rapid Test: Zhuhai Livzon Diagnostics (CEIVD); (iv) New coronavirus (COVID-19) IgG/IgM Rapid Test: Voxtur Bio Ltd, India; (v) COVID-19 IgM/IgG antibody detection card test: VANGUARD Diagnostics, India; (vi) MakesureCOVID-19 Rapid test: HLL Lifecare Limited, India; and (vii) YHLO SARS-CoV-2 IgM and IgG detection kit (additional equipment required): CPC, Diagnostics. As a step further, on the technological aspect, the Union Health Ministry has launched a mobile application called “AarogyaSetu” that works both on android and iOS mobile phones. This application constructs a user database for establishing an awareness network that can alert people and governments about possible COVID-19 victims ( 37 ).

Future Perspectives

Infections caused by these viruses are an enormous global health threat. They are a major cause of death and have adverse socio-economic effects that are continually exacerbated. Therefore, potential treatment initiatives and approaches need to be developed. First, India is taking necessary preventive measures to reduce viral transmission. Second, ICMR and the Ministry of AYUSH provided guidelines to use conventional preventive and treatment strategies to increase immunity against COVID-19 ( 3 , 38 ). These guidelines could help reduce the severity of the viral infection in elderly patients and increase life expectancy ( 39 ). The recent report from the director of ICMR mentioned that India would undergo randomized controlled trials using convalescent plasma of completely recovered COVID-19 patients. Convalescent plasma therapy is highly recommended, as it has provided moderate success with SARS and MERS ( 40 ); this has been rolled out in 20 health centers and will be increased this month (May 2020) ( 3 ). India has expertise in specialized medical/pharmaceutical industries with production facilities, and the government has established fast-tracking research to develop rapid diagnostic test kits and vaccines at low cost ( 41 ). In addition, the Serum Institute of India started developing a vaccine against SARS-CoV-2 infection ( 42 ). Until we obtain an appropriate vaccine, it is highly recommended that we screen the red zoned areas to stop further transmission of the virus. Medical college doctors in Kerala, India, implemented the low-cost WISK (Walk-in Sample Kiosk) to collect samples without direct exposure or contact ( 43 , 44 ). After Kerala, The Defense Research and Development Organization (DRDO) developed walk-in kiosks to collect COVID-19 samples and named these as COVID-19 Sample Collection Kiosk (COVSACK) ( 45 ). After the swab collection, the testing of SARS-CoV-2 can be achieved with the existing diagnostic facility in India. This facility can be used for massive screening or at least in the red zoned areas without the need for personal protective equipment kits ( 43 , 45 ). India has attempted to broaden its research facilities and shift toward testing the mass population, as recommended by medical experts in India and worldwide ( 46 ).

Data Availability Statement

Publicly available datasets were analyzed in this study. This data can be found here: and .

Author Contributions

SK, DK, and CD were involved in the design of the study and the acquisition, analysis, interpretation of the data, and drafting the manuscript. BC was involved in the interpretation of the data. CD supervised the entire study. The manuscript was reviewed and approved by all the authors.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


We acknowledge The Ministry of Health and Family Welfare (MoHFW) and Indian Council of Medical Research (ICMR) for publicly providing the details of COVID-19. The authors would like to use this opportunity to thank the management of VIT for providing the necessary facilities and encouragement to carry out this work.

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45. DRDO. Covid-19 Sample Collection Kiosk (COVSACK) . Defence Research and Development Organisation - DRDO|GoI (2020). Available online at: (accessed May 09, 2020).

46. Vaidyanathan G. People power: how India is attempting to slow the coronavirus. Nature. (2020) 580:442. doi: 10.1038/d41586-020-01058-5

Keywords: COVID-19, SARS-CoV-2, India, economy, safety measures

Citation: Kumar SU, Kumar DT, Christopher BP and Doss CGP (2020) The Rise and Impact of COVID-19 in India. Front. Med. 7:250. doi: 10.3389/fmed.2020.00250

Received: 19 March 2020; Accepted: 11 May 2020; Published: 22 May 2020.

Reviewed by:

Copyright © 2020 Kumar, Kumar, Christopher and Doss. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: C. George Priya Doss,

This article is part of the Research Topic

Coronavirus Disease (COVID-19): Pathophysiology, Epidemiology, Clinical Management and Public Health Response

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Pandemic lessons from India

Read our latest coverage of the coronavirus pandemic.

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  • ksrinath.reddy{at}

Lesson one: don’t declare success too early

In January 2021, global observers marvelled at India’s smooth passage through the first wave of the covid-19 pandemic. 1 By the end of April this sentiment was replaced by alarm at a surging second wave that threatened to spill over into other countries, along with variants of SARS-CoV-2. 2 This dramatic and distressing reversal offers valuable lessons on the consequences of prematurely declaring control of covid-19.

In late March 2020, India began a long nationwide lockdown lasting over two months. Incidence of covid-19 was low when the lockdown began. Though cases rose after the lockdown eased, they were successfully contained from around mid-September onwards. By early January 2021, daily cases, deaths, and test positivity rates had plummeted and victory was declared. 3 Some opinion makers urged caution, concerned about a possible second wave, 4 but others claimed that India had attained herd immunity. 5

India then turned its back on the virus, but the virus did not turn its back on India. As local and state elections, large religious gatherings, unrestricted travel, and unmasked people offered the virus a fast track to a large and susceptible population, cases spiked and then surged across the country. Variants arrived through travellers (B.1.1.7) or emerged in India (B.1.617 and B.1.618) to add speed and scale to the surge. 6 As daily cases hit record numbers, the world closed its doors to travellers from India, fearing contagion, particularly with new variants.

The health system was overwhelmed, but not uniformly. Southern states that had invested in robust health systems, such as Kerala and Tamil Nadu, could withstand the pressure with competence and confidence while states in other regions were challenged beyond their capacity. Even the capital, Delhi, ran short of hospital beds and oxygen. Long queues of bereaved families waited outside crematoriums, unable to provide a dignified departure for their loved ones. By early May, vaccines had been administered to 12% of the country’s population—only 2% had received both doses. 7

Be prepared

Even as India strives to contain transmission, with several states implementing complete or partial lockdowns, the world can learn several lessons from the country’s recent experience. The most obvious is not to take control of this virus for granted by neglecting production of oxygen and vaccines, closing temporary hospitals, and permitting super spreader events.

In the longer term, countries cannot generate a strong and swift response to a public health emergency if they have not previously invested in building an efficient and equitable health system. Chronic underfunding has weakened health systems in many regions of India. Public financing of health hovers around 1% of gross domestic product (GDP), and about 7% of the population every year face being pitchforked into poverty by high out-of-pocket expenditure on healthcare. 8

While large cities boast of world class hospitals vying for global medical tourists, primary and secondary care facilities remain weak even in urban areas. The size of the healthcare workforce falls far short of global norms 9 and is unevenly distributed across the country. It is challenging for such health systems to deal simultaneously with detection and care of covid-19, routine and covid-19 vaccinations, and a high burden of non-covid conditions.

Although distressed hospitals attract most attention, primary care systems are vital for effective pandemic responses. Primary care is central to case detection, timely testing of suspected cases and traced contacts, home care, triage, referral, post-covid care, vaccination, and surveillance for reinfections or vaccine escape, in addition to the usual detection and management of pre-existing health conditions that influence severity of covid-19 and prognosis. India’s experience teaches that states which value primary care fare better.

Several states have now imposed complete or near complete lockdown. Others are restricting crowded events, with partial success. Masks are mandated by central and state governments but not universally worn in rural areas. Courts are monitoring and mandating the supply of resources to needy states. 10 Temporary hospitals, dismantled recently, have been resurrected. Oxygen concentrators and generation plants are being imported, along with vaccines. Retired doctors have been recalled. Final year medical and nursing students have been inducted for clinical care. 11 Non-governmental organisations have been invited to provide points of contact and social support for affected communities. Home care, for mild cases, is being promoted. Testing rates and genomic analyses of positive samples are being scaled up.

Absence of a national health service means that care is not standardised in public and private hospitals across India. Though some states have assured free vaccinations and free care for patients with covid-19, this is not uniform across the country. 12 India’s mixed health system, which evolved by default rather than design, is being put to severe tests of coverage and quality.

Even as India struggles to quell the virus and the world rallies to its cause, the pandemic has turned teacher to sternly remind us that strong health systems are vital for sustainable, stable, and secure development. That lesson must enter the DNA of future societies, even after this RNA virus ceases to be a threat.

Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: Commissioned; not externally peer reviewed.

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

  • ↵ Biswas S. Coronavirus: is the epidemic finally coming to an end in India? India Today 2021 Feb 15.
  • ↵ Shrivastava B, Gretler C, Pradhan B. There’s a new virus variant in India. How worried should we be? Bloomberg Quint 2021 Apr 16.
  • ↵ PM Modi at Davos: despite doomsday predictions, India defeated covid and helped 150 other countries. India Today 2021 Jan 28.
  • ↵ Ray K. Covid-19 vaccine is here, but this is no time for complacency or carelessness: Deccan Herald 2021 Jan 12.
  • ↵ Kapur M. Has the Covid-19 pandemic effectively ended in India? Quartz India 2021 Feb 18.
  • ↵ Basu M, Sen S. B.1.117 to B.1.618, India has many Covid variants causing infections. Here are the dominant ones. The Print 2021 Apr 23.
  • ↵ India coronavirus: Over-18s vaccination drive hit by shortages. BBC News 2021 May 1.
  • ↵ Ravi S, Ahluwalia R, Bergkvist S. Health and morbidity in India (2004-2014). Brookings India Research Paper No 092016. 2016.
  • Negandhi H ,
  • ↵ Tripathi A. Supply 700 MT oxygen to Delhi daily, don't make us go firm: SC tells centre. Deccan Herald 2021 May 7.
  • ↵ Malavika PM. Govt to rope in medical interns, final yr MBBS students to fight new Covid wave. Hindustan Times 2021 May 3.
  • ↵ Free covid-19 care in all Aarogyasri hospitals: Jagan. Deccan Chronicle 2021 May 7.

covid pandemic in india essay

Relatives perform the last rites for COVID-19 victims during their funeral at a cremation ground in New Delhi

COVID in India: the deep-rooted issues behind the current crisis

covid pandemic in india essay

NIHR Academic Clinical Fellow in Public Health Medicine, UCL

Disclosure statement

Vageesh Jain does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

University College London provides funding as a founding partner of The Conversation UK.

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India finds itself in the throes of a humanitarian disaster. Until March 2021, case numbers were low in most parts of the country, leading many to think that the worst was over. Much like in Brazil though, jingoism, overconfidence and false reassurance from the political elite negated hard-won progress.

Mass gatherings have acted as state-sanctioned super-spreader events. More infectious variants and a sluggish uptake of vaccines are also fuelling the current surge . These are the triggers, but there are more deep-rooted issues at the heart of the current crisis.

India is an inherently high-risk country for an epidemic. The country holds 1.4 billion people , living in crowded areas with extensive community networks and limited facilities for sanitation, isolation and healthcare.

Most do not have the luxury of isolating at home for prolonged periods. Over 90% of workers are self-employed with no social safety net. The vast majority rely on daily earnings to put food on the table. Many predicted that because of all of this, the initial wave of COVID in 2020 would have a devastating impact .

The fact that it did not led some to believe that the Indian population was innately less vulnerable to COVID. An old theory, the hygiene hypothesis , was dusted off in an attempt to explain the low number of cases. The idea is that poor hygiene trains people’s immune defences, so when people are exposed to the coronavirus, their bodies are well-equiped to deal with it.

But this theory largely relied on population studies that failed to account for various factors involved in disease severity at an individual level. Even with higher quality research, correlation does not imply causation, especially with the threat of new variants on the horizon. And yet this theory settled comfortably into the national psyche of a traditionally patriotic country.

Complacency gave the coronavirus an opportunity to spread. Unlike in the first wave though, proportionally more cases have progressed into deaths this time around because the health system was overwhelmed. Supplies of oxygen, ventilators, health workers and beds are critically low in hotspots like Delhi. But the fact that so many require medical care in the first place, is a symptom of longstanding structural deficiencies in the Indian health system.

Indian people wait to fill their oxygen cylinders at an oxygen vendor shop in New Delhi.

Age is the single biggest risk factor for severe disease and death with COVID. India has an exceptionally young population, with only 6% aged 65 and over . Even with a slightly more deadly virus, one would expect most to recover at home without the need for hospital care. But a relatively unhealthy middle-aged population in part offsets this advantage.

Air pollution is closely associated with lung and heart disease. A whopping 17.8% of all deaths in India were due to pollution in 2019, and Delhi, currently flooded with COVID patients seeking oxygen, is the most polluted capital in the world.

Obesity is also a growing concern in India, with high rates in urban areas where COVID outbreaks have been most concentrated. The prevalence of diabetes in those aged 50-69 years is over 30% , much higher than in other Asian countries. One in five women of reproductive age has undiagnosed high blood pressure.

All of these are significant risk factors for death from COVID . Having an unhealthy population also leads to excess deaths because non-COVID health services are suspended during such emergencies.

Despite these health needs, total health expenditure in India represents only 3.9% of GDP , well below the 5% minimum recommended to achieve universal health coverage. The nation remains starved of the resources needed for a robust, resilient and well-equipped health system.

What money is spent goes into an expensive hospital-based system predominantly delivered through the private sector. Most people do not have insurance and pay for care out of their own pockets . This can lead to unnecessary costs and delays in seeking care or getting tested, which is critical to controlling epidemics in the early stages.

No incentive to prevent disease

Private institutions operating in this way rely on people becoming unwell to generate revenue . There is no incentive to prevent disease. A largely commercialised and profit-driven system centred on treating disease has skewed investment away from essential public health functions. It is this market failure that is in part responsible for India’s ailments, and many avoidable deaths during this epidemic.

Despite a recent expansion of primary care centres and a large health insurance scheme for the poor, infrastructure remains poorly aligned with need. As a result, capacities for infectious disease control like surveillance, testing, contact tracing, guidance and research were limited at the start of the pandemic . Efforts to prevent and control chronic diseases have also been traditionally neglected despite their escalating burden and early onset in the Indian population.

India is a high-risk setting for an epidemic, but the current situation was not inevitable. As more are infected, the pool of susceptible people will shrink, the virus will relent, and the country will rebuild. There will be a chance to reflect on the fundamental goals of the health system. For future epidemics, bolstering hospital capacity will be necessary but not sufficient. Death must be averted not just by treating disease, but by preventing it altogether.

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Effects of the COVID-19 pandemic in India: An analysis of policy and technological interventions


  • 1 Economics Indian Institute of Technology, New Delhi, India.
  • 2 Indian Institute of Technology, New Delhi, India.
  • PMID: 33520638
  • PMCID: PMC7837304
  • DOI: 10.1016/j.hlpt.2020.12.001

Objectives: Following a surge in cases of coronavirus disease 2019 (COVID-19) in June 2020, India became the third-worst affected country worldwide. This study aims to analyse the underlying epidemiological situation in India and explain possible impacts of policy and technological changes.

Methods: Secondary data were utilized, including recently published literature from government sources, the COVID-19 India website and local media reports. These data were analysed, with a focus on the impact of policy and technological interventions.

Results: The spread of COVID-19 in India was initially characterized by fewer cases and lower case fatality rates compared with numbers in many developed countries, primarily due to a stringent lockdown and a demographic dividend. However, economic constraints forced a staggered lockdown exit strategy, resulting in a spike in COVID-19 cases. This factor, coupled with low spending on health as a percentage of gross domestic product (GDP), created mayhem because of inadequate numbers of hospital beds and ventilators and a lack of medical personnel, especially in the public health sector. Nevertheless, technological advances, supported by a strong research base, helped contain the damage resulting from the pandemic.

Conclusions: Following nationwide lockdown, the Indian economy was hit hard by unemployment and a steep decline in growth. The early implementation of lockdown initially decreased the doubling rate of cases and allowed time to upscale critical medical infrastructure. Measures such as asymptomatic testing, public-private partnerships, and technological advances will be essential until a vaccine can be developed and deployed in India.

Public interest summary: The spread of COVID-19 in India was initially characterized by lower case numbers and fewer deaths compared with numbers in many developed countries. This was mainly due to a stringent lockdown and demographic factors. However, economic constraints forced a staggered lockdown exit strategy, resulting in a spike in COVID-19 cases in June 2020. Subsequently, India became the third-worst affected country worldwide. Low spending on health as a percentage of gross domestic product (GDP) meant there was a shortage of hospital beds and ventilators and a lack of medical personnel, especially in the public health sector. Nevertheless, technological advances, supported by a strong research base, helped contain the health and economic damage resulting from the pandemic. In the future, measures such as asymptomatic testing, public-private partnerships, and technological advances will be essential until a vaccine against COVID-19 can be developed and rolled-out in India.

Keywords: Health; India; Pandemic; Policy.

© 2021 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.

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Covid 19 Essay in English

Essay on Covid -19: In a very short amount of time, coronavirus has spread globally. It has had an enormous impact on people's lives, economy, and societies all around the world, affecting every country. Governments have had to take severe measures to try and contain the pandemic. The virus has altered our way of life in many ways, including its effects on our health and our economy. Here are a few sample essays on ‘CoronaVirus’.

100 Words Essay on Covid 19

200 words essay on covid 19, 500 words essay on covid 19.

Covid 19 Essay in English

COVID-19 or Corona Virus is a novel coronavirus that was first identified in 2019. It is similar to other coronaviruses, such as SARS-CoV and MERS-CoV, but it is more contagious and has caused more severe respiratory illness in people who have been infected. The novel coronavirus became a global pandemic in a very short period of time. It has affected lives, economies and societies across the world, leaving no country untouched. The virus has caused governments to take drastic measures to try and contain it. From health implications to economic and social ramifications, COVID-19 impacted every part of our lives. It has been more than 2 years since the pandemic hit and the world is still recovering from its effects.

Since the outbreak of COVID-19, the world has been impacted in a number of ways. For one, the global economy has taken a hit as businesses have been forced to close their doors. This has led to widespread job losses and an increase in poverty levels around the world. Additionally, countries have had to impose strict travel restrictions in an attempt to contain the virus, which has resulted in a decrease in tourism and international trade. Furthermore, the pandemic has put immense pressure on healthcare systems globally, as hospitals have been overwhelmed with patients suffering from the virus. Lastly, the outbreak has led to a general feeling of anxiety and uncertainty, as people are fearful of contracting the disease.

My Experience of COVID-19

I still remember how abruptly colleges and schools shut down in March 2020. I was a college student at that time and I was under the impression that everything would go back to normal in a few weeks. I could not have been more wrong. The situation only got worse every week and the government had to impose a lockdown. There were so many restrictions in place. For example, we had to wear face masks whenever we left the house, and we could only go out for essential errands. Restaurants and shops were only allowed to operate at take-out capacity, and many businesses were shut down.

In the current scenario, coronavirus is dominating all aspects of our lives. The coronavirus pandemic has wreaked havoc upon people’s lives, altering the way we live and work in a very short amount of time. It has revolutionised how we think about health care, education, and even social interaction. This virus has had long-term implications on our society, including its impact on mental health, economic stability, and global politics. But we as individuals can help to mitigate these effects by taking personal responsibility to protect themselves and those around them from infection.

Effects of CoronaVirus on Education

The outbreak of coronavirus has had a significant impact on education systems around the world. In China, where the virus originated, all schools and universities were closed for several weeks in an effort to contain the spread of the disease. Many other countries have followed suit, either closing schools altogether or suspending classes for a period of time.

This has resulted in a major disruption to the education of millions of students. Some have been able to continue their studies online, but many have not had access to the internet or have not been able to afford the costs associated with it. This has led to a widening of the digital divide between those who can afford to continue their education online and those who cannot.

The closure of schools has also had a negative impact on the mental health of many students. With no face-to-face contact with friends and teachers, some students have felt isolated and anxious. This has been compounded by the worry and uncertainty surrounding the virus itself.

The situation with coronavirus has improved and schools have been reopened but students are still catching up with the gap of 2 years that the pandemic created. In the meantime, governments and educational institutions are working together to find ways to support students and ensure that they are able to continue their education despite these difficult circumstances.

Effects of CoronaVirus on Economy

The outbreak of the coronavirus has had a significant impact on the global economy. The virus, which originated in China, has spread to over two hundred countries, resulting in widespread panic and a decrease in global trade. As a result of the outbreak, many businesses have been forced to close their doors, leading to a rise in unemployment. In addition, the stock market has taken a severe hit.

Effects of CoronaVirus on Health

The effects that coronavirus has on one's health are still being studied and researched as the virus continues to spread throughout the world. However, some of the potential effects on health that have been observed thus far include respiratory problems, fever, and coughing. In severe cases, pneumonia, kidney failure, and death can occur. It is important for people who think they may have been exposed to the virus to seek medical attention immediately so that they can be treated properly and avoid any serious complications. There is no specific cure or treatment for coronavirus at this time, but there are ways to help ease symptoms and prevent the virus from spreading.

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There’s a New Covid Variant. What Will That Mean for Spring and Summer?

Experts are closely watching KP.2, now the leading variant.

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A man wearing a mask coughs into his hand on a subway train.

By Dani Blum

For most of this year, the JN.1 variant of the coronavirus accounted for an overwhelming majority of Covid cases . But now, an offshoot variant called KP.2 is taking off. The variant, which made up just one percent of cases in the United States in mid-March, now makes up over a quarter.

KP.2 belongs to a subset of Covid variants that scientists have cheekily nicknamed “FLiRT,” drawn from the letters in the names of their mutations. They are descendants of JN.1, and KP.2 is “very, very close” to JN.1, said Dr. David Ho, a virologist at Columbia University. But Dr. Ho has conducted early lab tests in cells that suggest that slight differences in KP.2’s spike protein might make it better at evading our immune defenses and slightly more infectious than JN.1.

While cases currently don’t appear to be on the rise, researchers and physicians are closely watching whether the variant will drive a summer surge.

“I don’t think anybody’s expecting things to change abruptly, necessarily,” said Dr. Marc Sala, co-director of the Northwestern Medicine Comprehensive Covid-19 Center in Chicago. But KP.2 will most likely “be our new norm,’” he said. Here’s what to know.

The current spread of Covid

Experts said it would take several weeks to see whether KP.2 might lead to a rise in Covid cases, and noted that we have only a limited understanding of how the virus is spreading. Since the public health emergency ended , there is less robust data available on cases, and doctors said fewer people were using Covid tests.

But what we do know is reassuring: Despite the shift in variants, data from the C.D.C. suggests there are only “minimal ” levels of the virus circulating in wastewater nationally, and emergency department visits and hospitalizations fell between early March and late April.

“I don’t want to say that we already know everything about KP.2,” said Dr. Ziyad Al-Aly, the chief of research and development at the Veterans Affairs St. Louis Healthcare System. “But at this time, I’m not seeing any major indications of anything ominous.”

Protection from vaccines and past infections

Experts said that even if you had JN.1, you may still get reinfected with KP.2 — particularly if it’s been several months or longer since your last bout of Covid.

KP.2 could infect even people who got the most updated vaccine, Dr. Ho said, since that shot targets XBB.1.5, a variant that is notably different from JN.1 and its descendants. An early version of a paper released in April by researchers in Japan suggested that KP.2 might be more adept than JN.1 at infecting people who received the most recent Covid vaccine. (The research has not yet been peer-reviewed or published.) A spokesperson for the C.D.C. said the agency was continuing to monitor how vaccines perform against KP.2.

Still, the shot does provide some protection, especially against severe disease, doctors said, as do previous infections. At this point, there isn’t reason to believe that KP.2 would cause more severe illness than other strains, the C.D.C. spokesperson said. But people who are 65 and older, pregnant or immunocompromised remain at higher risk of serious complications from Covid.

Those groups, in particular, may want to get the updated vaccine if they haven’t yet, said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco. The C.D.C. has recommended t hat people 65 and older who already received one dose of the updated vaccine get an additional shot at least four months later.

“Even though it’s the lowest level of deaths and hospitalizations we’ve seen, I’m still taking care of sick people with Covid,” he said. “And they all have one unifying theme, which is that they’re older and they didn’t get the latest shot.”

The latest on symptoms and long Covid

Doctors said that the symptoms of both KP.2 and JN.1 — which now makes up around 16 percent of cases — are most likely similar to those seen with other variants . These include sore throat, runny nose, coughing, head and body aches, fever, congestion, fatigue and in severe cases, shortness of breath. Fewer people lose their sense of taste and smell now than did at the start of the pandemic, but some people will still experience those symptoms.

Dr. Chin-Hong said that patients were often surprised that diarrhea, nausea and vomiting could be Covid symptoms as well, and that they sometimes confused those issues as signs that they had norovirus .

For many people who’ve already had Covid, a reinfection is often as mild or milder than their first case. While new cases of long Covid are less common now than they were at the start of the pandemic, repeat infections do raise the risk of developing long Covid, said Fikadu Tafesse, a virologist at Oregon Health & Science University. But researchers are still trying to determine by how much — one of many issues scientists are trying to untangle as the pandemic continues to evolve.

“That’s the nature of the virus,” Dr. Tafesse said. “It keeps mutating.”

Dani Blum is a health reporter for The Times. More about Dani Blum

3 Things to Know About FLiRT, the New Coronavirus Strains


illustration of FLiRT coronavirus strain

Note: Information in this article was accurate at the time of original publication. Because information about COVID-19 changes rapidly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the latest information.

The good news is that in the early spring of 2024, COVID-19 cases were down, with far fewer infections and hospitalizations than were seen in the previous winter. But SARS-CoV-2, the coronavirus that causes COVID, is still mutating. In April, a group of new virus strains known as the FLiRT variants (based on the technical names of their two mutations) emerged.

The FLiRT strains are subvariants of Omicron . One of them, KP.2, accounted for 28.2% of COVID infections in the United States by the third week of May, making it the dominant coronavirus variant in the country; another, KP.1.1, made up 7.1% of cases.

Some experts have suggested that the new variants could cause a summer surge in COVID cases. But the Centers for Disease Control and Prevention (CDC) also reports that COVID viral activity in wastewater (water containing waste from residential, commercial, and industrial processes) in the U.S. has been dropping since January and is currently “minimal.”

“Viruses mutate all the time, so I’m not surprised to see a new coronavirus variant taking over,” says Yale Medicine infectious diseases specialist Scott Roberts, MD . If anything, he says the new mutations are confirmation that the SARS-CoV-2 virus remains a bit of a wild card, where it’s always difficult to predict what it will do next. “And I’m guessing it will continue to mutate.”

Perhaps the biggest question, Dr. Roberts says, is whether the newly mutated virus will continue to evolve before the winter, when infections and hospitalizations usually rise, and whether the FLiRT strains will be included as a component of a fall COVID vaccine.

Below, Dr. Roberts answers three questions about the FLiRT variants.

1. Where did the FLiRT strains come from?

Nobody knows exactly where the FLiRT variants first emerged. They were first detected in the U.S. in wastewater by the CDC, which tests sewage to detect traces of SARS-CoV-2 circulating in a community, even if people don’t have symptoms. (The data can be used as an early warning that infection levels may be increasing or decreasing in a community.) The FLiRT strains have since been identified in several other countries, including Canada and the United Kingdom.

To better understand how the FLiRT strains emerged, it might help to see how the SARS-CoV-2 virus has changed over time, with new variants forming as mutations emerged in its genetic code. Omicron was a variant of SARS-CoV-2 that took hold in the U.S. in 2021 and began to spawn subvariants of its own. One of those was JN.1, which was identified in September 2023 and spread through the country during the winter months, leading to a spike in COVID hospitalizations. JN.1 also has descendants; the FLiRT subvariants are spinoffs of one called JN.1.11.1.

2. What do we know—and not know—about the FLiRT variants?

We know the FLiRT variants have two mutations on their spike proteins (the spike-shaped protrusions on the surface of the virus) that weren’t seen on JN.1 (the previously dominant strain in the U.S.). Some experts say these mutations could make it easier for the virus to evade people’s immunity—from the vaccine or a previous bout of COVID.

But, the fact that the FLiRT variants are otherwise genetically similar to JN.1 should be reassuring, Dr. Roberts says. "While JN.1 occurred during the winter months, when people gather indoors and the virus is more likely to spread, its symptoms were milder than those caused by variants in the early years of the pandemic," he says.

There is no news yet about whether a COVID illness will be more severe with the FLiRT variants or how symptoms might change. Because everyone is different, a person’s symptoms and the severity of their COVID disease usually depend less on which variant they are infected with and more on their immunity and overall health, the CDC says.

3. How can people protect themselves against the FLiRT strains?

Vaccination is still a key strategy, says Dr. Roberts, adding that everyone eligible for COVID vaccination should make sure they are up to date with the latest COVID vaccines. While vaccination may not prevent infection, it significantly lowers a person’s risk of severe illness, hospitalization, and death from COVID.

“We know that the updated monovalent vaccine, which was designed for the XBB.1.5 variant, worked against JN.1, and I strongly suspect it will have some degree of activity against the FLiRT mutations as well,” Dr. Roberts says.

“I would especially recommend anyone who qualifies for the vaccine because of advanced age get it if they haven’t already,” Dr. Roberts adds. “The reason is that the biggest risk factor for a bad outcome from COVID is advanced age.” Anyone over age 65 is eligible for both the first updated vaccine offered in the fall of 2023, and a second shot four months later.

He also says COVID tests should be able to detect the FLiRT strains, and antiviral treatments should remain effective against them. Paxlovid , the primary treatment for most people with COVID, acts on a “nonspiked part of the virus,” he says. “It's relatively variant-proof, so it should really act against many future COVID iterations.”

Other preventive efforts can help. You can avoid getting too close to people who are sick, mask strategically , wash hands properly , improve ventilation , and stay aware of COVID transmission levels where you live and work. Additional strategies are available on the CDC website.

Information provided in Yale Medicine articles is for general informational purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider with any questions you have regarding a medical condition.

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Mental health implications of COVID-19 pandemic and its response in India

1 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Arvind Kumar Singh

Shree mishra.

2 Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Aravinda Chinnadurai

3 Independent Researcher, Bhubaneswar, Odisha, India

Ojaswini Bakshi

4 Independent Researcher, Kalyani, West Bengal, India


Mental health concerns and treatment usually take a backseat when the limited resources are geared for pandemic containment. In this global humanitarian crisis of the COVID-19 pandemic, mental health issues have been reported from all over the world.


In this study, we attempt to review the prevailing mental health issues during the COVID-19 pandemic through global experiences, and reactive strategies established in mental health care with special reference to the Indian context. By performing a rapid synthesis of available evidence, we aim to propose a conceptual and recommendation framework for mental health issues during the COVID-19 pandemic.

A search of the PubMed electronic database and google scholar were undertaken using the search terms ‘novel coronavirus’, ‘COVID-19’, ‘nCoV’, SARS-CoV-2, ‘mental health’, ‘psychiatry’, ‘psychology’, ‘anxiety’, ‘depression’ and ‘stress’ in various permutations and combinations. Published journals, magazines and newspaper articles, official webpages and independent websites of various institutions and non-government organizations, verified social media portals were compiled.

The major mental health issues reported were stress, anxiety, depression, insomnia, denial, anger and fear. Children and older people, frontline workers, people with existing mental health illnesses were among the vulnerable in this context. COVID-19 related suicides have also been increasingly common. Globally, measures have been taken to address mental health issues through the use of guidelines and intervention strategies. The role of social media has also been immense in this context. State-specific intervention strategies, telepsychiatry consultations, toll free number specific for psychological and behavioral issues have been issued by the Government of India.


Keeping a positive approach, developing vulnerable-group-specific need-based interventions with proper risk communication strategies and keeping at par with the evolving epidemiology of COVID-19 would be instrumental in guiding the planning and prioritization of mental health care resources to serve the most vulnerable.

The World Health Organisation (WHO) declared COVID-19 as a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 ( Coronavirus (COVID-19) events as they happen , 2020 .) COVID-19 Pandemic has reached a level of a humanitarian crisis with over 6 million confirmed cases and 350,000 deaths reported globally to date (Up to 31st May 2020). PHEICs can pose a significant mental health risk to communities ( Davis et al., 2010 ) especially in developing countries, where the risk is further precipitated by suboptimal socio-economic determinants ( COVID-19: impact could cause equivalent of 195 million job losses, says ILO chief | | UN News , 2020 ). The consequences of COVID-19 impacts not only the physical health and wellbeing but also the mental health, which can have a disastrous effect on the health system.

Mental health concerns and treatment usually take a backseat when the limited resources are geared for pandemic containment. History suggests that any infectious disease outbreak or pandemic brings with itself a major setback in the mental health front. In the case of the Ebola outbreak in the year 2014, symptoms of Post-Traumatic Stress Disorder (PTSD) and anxiety-depression were more prevalent even after 1 year of Ebola response ( Jalloh et al., 2018 ). The global HIV pandemic also provides a similar picture. It has been found that the prevalence of mental illnesses in HIV-infected individuals is substantially higher than in the general population. ( World Health Organization, 2008 ) The risk of PTSD in the aftermath of the pandemic can, therefore, be a huge challenge to the mental health system of the country. Since the healthcare system focuses majorly on emergency services, individuals suffering from substance abuse and dependency disorders may see deterioration in their mental health as a result of this pandemic. ( Clay & Parker, 2020 ) The economic fallout and forecasted recession pertaining to ‘The Great Lockdown’ is feared to be the worst global economic crisis after ‘The Great Depression’ ( The Great Lockdown: Worst Economic Downturn Since the Great Depression – IMF Blog, 2020 ). With many sectors seeing pay-outs and job losses across Europe and America, unemployment can rise to a record 14% in the USA which can worsen to 20% post-pandemic in the future. This can lead to increase in suicide rates among the economically vulnerable ( COVID-19: Man commits suicide after being quarantined in Madhya Pradesh | Deccan Herald, 2020 ; COVID-19 suspect jumps to death at quarantine facility in Greater Noida, magisterial inquiry ordered | India News, 2020 ). Reports of stigmatization of front-line workers resulting from the fear of getting 2..32the infection from them have surfaced across the world leading to increased mental health illnesses, like anxiety and depression among them Government, professional organizations, civil society bodies and other relevant stakeholders have come up with various measures in the context of mental health in a short span of time. In this study, we attempt to review the prevailing mental health issues during the COVID-19 pandemic through global experiences, and reactive strategies established in mental health care with special reference to the Indian context. By performing a rapid synthesis of available evidence, we aim to propose a conceptual and recommendation framework for mental health issues during the COVID-19 pandemic.

The current article reviews the existing literature on mental health issues and interventions relevant to the COVID-19 pandemic. A search of the PubMed electronic database and google scholar was undertaken using the search terms ‘novel coronavirus’, ‘COVID-19’, ‘nCoV’, SARS-CoV-2, ‘mental health’, ‘psychiatry’, ‘psychology’, ‘anxiety’, ‘depression’ and ‘stress’ in various permutations and combinations. A thorough search of all published journal articles, newspaper articles, magazine articles, webpages including World health Organisation, Ministry of Health and Family Welfare- Government of India (MOHFW), State governments and independent websites of various institutions) and non-government organizations, and verified social media portals including -Twitter, Youtube, Facebook, Whatsapp, etc., have been compiled after exclusion of fake and unverified updates. The authenticity of the social media updates has been ensured by thorough search and inclusion of only verified institutional/organisational social media pages and central and state government social media portals. Different combinations of keywords including geographical locations, the vulnerable population were also used for the search strategy. Review was limited to search output up to 31st May 2020.

After review, we synthesized the evidence into two broad headings that is, mental health issues during COVID-19 pandemic particularly in the context of some vulnerable groups and possible reasons thereof, interventions recommended so far at a global level and India. Based on the evidence synthesis, we have proposed a conceptual framework for mental health risk during COVID-19 pandemic and a recommendation framework with reference to Low- and Middle-Income Countries (LMIC) like India

Mental health issues during COVID-19 pandemic

The major mental health issues that have been reported to have been associated with the COVID-19 pandemic are stress, anxiety, depressive symptoms, insomnia, denial, anger and fear globally. ( Torales et al., 2020 ) Stress, anxiety and depression go hand in hand with the COVID-19 pandemic, results from studies done globally has shown the increasing prevalence of mental health disorders among various population groups ( Ji et al., 2017 ; Mohindra et al., 2020 ; Xiao et al., 2020b ). Historically, disease pandemics have been associated with grave psychological consequences. A recent article published in JAMA Psychiatry suggests that COVID-19 may lead to increased risk of suicide ( Xiang et al., 2020 ). A recent study done in China reported 16.5% moderate to severe depressive symptoms; 28.8% moderate to severe anxiety symptoms; 8.1% moderate to severe stress due to COVID -19 ( Wang et al., 2020 ). Similar impacts of COVID-19 on mental health has also been seen in other countries like Japan, Singapore and Iran ( Rajkumar, 2020 ). The grief and depression resulting from loss of a loved one, anxiety and panic due to uncertain future and financial turmoil may lead individuals to resort to these extreme measures. Reports of COVID-19 related suicides have been increasingly common in the world news. India is also not immune to this phenomenon. Cases of COVID-19 related suicide have been reported from Maharashtra, Uttar Pradesh, Assam, Kerala ( Cullen et al., 2020 ; Coronavirus in India: Suspected Covid-19 patient who committed suicide in UP hospital tests negative - India News , 2020 ; Anxiety over COVID-19 leads to Phagwara woman’s suicide : The Tribune India , 2020 ). An Indian newspaper article published in May 2020 revealed that, Suicide was the leading cause for over 300 ‘noncoronavirus deaths’ reported in India due to distress triggered by the nationwide lockdown (‘Suicides due to lockdown: Suicide leading cause for over 300 lockdown deaths in India, says study,’ 2020 ) . Reports of suicide of healthcare workers, migrant labourers and those in quarantine centres have been frequenting in the news and media ever since the pandemic started to change the lives of people. Though some newspaper articles and webpages and researchers have reported deaths during the pandemic apart from the COVID-19 (which includes deaths due to mental health disorders, suicide, starvation, accidents etc.) ( Thejesh, 2020 ; A Different Tragedy Strikes Kerala During COVID-19 Lockdown Due to Non-Availability of Alcohol, 2020 ; Corona scare drives youth to suicide, third in UP, 2020 ; Coronavirus Lockdown: Unable To Care For Family, Uttar Pradesh Man Commits Suicide In Lakhimpur Kheri, Blames Lockdown, 2020 ; Hyderabad tippler commits suicide upset at not getting liquor during lockdown- The New Indian Express, 2020 ; Two Covid-19 patients commit suicide at Chennai hospitals within 24 hours - India News, 2020 ), a huge area of ‘ Non COVID–19’ related deaths remain to be explored.

Strict lockdown laws, social distancing, restrictions in movement could result in increased screen time. Constant misinformation in social media portals may result in a state of panic and anxiety, often resulting in depression eventually. Findings of a study done in Shanghai, China show a high prevalence of mental health problems, which positively associated with frequent social media exposure during the COVID-19 outbreak ( Gao et al., 2020 ).

Summary of studies reporting mental health effects of COVID 19 pandemic and previous pandemics are summarized in Table 1 .

Studies on mental health implications of different outbreaks, epidemics and pandemics globally.

Mental health implications in specific population groups

People with pre-existing mental health illness.

It is known that at the rise of an epidemic, generally, people with pre-existing mental health conditions are among the most affected ( Chatterjee et al., 2020 ). The reasons include social stigmatization, risk of infection, low priority to morbidities of mental health etc. These coupled with cognitive impairment, little awareness of risk and diminished efforts regarding personal protection in patients, as well as confined conditions in psychiatric wards could add to the vulnerability of individuals with presenting mental health illnesses during the COVID-19 pandemic ( Yao et al., 2020 ). Discrimination and fear of social isolation due to social distancing worsened by the effects of strict rules of lockdown could add to the cause of their vulnerability. The resulting emotional responses, leading to triggering, relapse or worsening of pre-existing mental health conditions could be another result of the effects of the COVID-19 pandemic. Wandering mentally ill people are at major risk of contracting illness secondary to compromised immune status. Relapse and exacerbation of severe mental health conditions secondary to lockdown and unavailability of psychotropics in rural pharmacies can also pose a hurdle to the health care system.

Frontline workers

The frontline workers including doctors, nurses, community health workers, sanitation workers, policemen, and other volunteers across the world are in an entirely unprecedented situation, having to make impossible decisions and work under extreme pressures. Working under stressful conditions with scarce resources affect not just their personal and family life, but also place them in a situation of moral injury, causing mental health problems. These symptoms can contribute to the development of mental health difficulties, including depression, post-traumatic stress disorder, and even suicidal ideation ( Cheng et al., 2004 ; Duan & Zhu, 2020 ; Greenberg et al., 2020 ; Litz et al., 2009 ; Williamson et al., 2018 ). Apart from being at high risk of infection, front line healthcare workers including doctors are subject to stigma by community and neighborhoods. Many instances of eviction and harassment from house owners, violence on duties against doctors at the workplace, social isolation, and discrimination have been reported.

Children and older people

The sudden and drastic changes in the day to day routine can be extremely confusing and difficult to cope with the children, geriatric, and quarantined individuals. Closure of schools, recreational outdoor activities, not meeting their peers could take a toll on the mental health of the children. The geriatric population in India has been identified as a vulnerable group to COVID-19. Over 50% of those more than 60 years have at least 1 comorbidity putting them at a much higher risk. The psychological impacts of these populations can include anxiety and feel stressed or angry. Mental health impact can be particularly difficult for older people who are already experiencing cognitive decline, dementia, social isolation, and loneliness. Also, the progression of the disease tends to be more severe in the case of elderlies resulting in higher mortality ( MOHFW, 2020 ).

Probable reasons (both evidence-based and theoretical possibilities) of mental health effects during COVID-19 pandemic among specific vulnerable population groups are summarized in Table 3 .

Probable reasons of mental health issues and recommended intervention strategies for COVID-19 related mental health problems among different vulnerable population groups.

Intervention strategies for mental health issues during COVID-19

Global context.

A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic suggests the following recommendations for future interventions: (a) increased attention needs to be paid to vulnerable groups such as the young, the elderly, women and migrant workers; (b) the availability and accessibility of medical resources and the public health service system should be further strengthened and improved, with lessons from the management of the COVID-19 epidemic; (c) nationwide strategic planning and coordination for psychological first aid during major disasters, potentially delivered through telemedicine, should be established and (d) comprehensive crisis prevention and intervention system should be built including stable surveillance and monitoring systems, screening, referral, and targeted interventions should be built to reduce psychological distress and prevent further mental health problems.

On 27 January 2020, the National Health Commission in Mainland China issued the first comprehensive guidelines on emergency psychological crisis intervention in individuals who were affected by COVID-19; 19 the emphasis was on the delivery of mental health support services to patients and HCW by multidisciplinary teams that consisted of mental health professionals ( Ho, 2020 ). In Singapore, the Ministry of Health, have kept the public abreast of the progress of the outbreak with regular news broadcasts and announcements on social media. Social media channels have also been set up by the state to curb the spread of false information and ‘fake news’ ( Ho, 2020 ). Some interventions used by China, where the pandemic was first reported were, ‘Expert-teacher-coach’ intervention, frequently issuing guidelines for ‘Emergency Psychological Assistance’ by National Health Commission of China, applications like ‘WE-CHAT’ based survey program, online education using ‘WE-CHAT’, ‘WEIBO’ and ‘TIKTOK’. Artificial Intelligence-based ‘Tree hole rescue’ has also been utilized to combat mental health concerns and could be incorporated in other countries including India ( Liu et al., 2020 ).

The Centre for Disease Control (CDC) advises parents to watch for changes in behaviour in their child. Since not all children and teens respond to stress in the same way a thorough and timely lookout for alert signs are important. Some common changes to watch for include the following ( Mental Health and Coping During COVID-19 | CDC , 2020 ): that is, Excessive crying or irritation in younger children, Returning to behaviours they have outgrown (e.g. toileting accidents or bedwetting), Excessive worry or sadness, Unhealthy eating or sleeping habits, Irritability and ‘acting out’ behaviors in teens, Poor school performance or avoiding school, Difficulty with attention and concentration, Avoidance of activities enjoyed in the past, Unexplained headaches or body pain, Use of alcohol, tobacco or other drugs.

In Italy, many independent (mainly online) initiatives have been established to provide psychological and psychiatric support to health professionals and laypeople, such as the ‘NON SEI SOLO’ [‘YOU ARE NOT ALONE’] and ‘Resilienza COVID-19’ [‘Resilience COVID-19’] projects of Rome’s Fondazione Policlinico Universitario Agostino Gemelli (Sa ni et al., 2020 ).

When looking largely at a global scenario, the varied population profile and mental healthcare needs of different countries are different. Therefore the intervention strategies taken up by the other high-income countries may not necessarily be effective in the context of India or similar Low and Middle-Income Countries (LMICs).

Indian context

The mental health issues in the context of the COVID-19 pandemic in India is more complex due to large proportion of socially and economically vulnerable population (children, geriatric, migrant laborers, etc.), high burden of pre-existing mental illness ( Murthy, 2017 ), constrained mental health services infrastructure ( Cullen et al., 2020 ), less penetration of digital mental health solutions, and above all scare created due to tremendous misinformation on social media. Thus, interventions should also be specific and relevant to the circumstances in India. The MOHFW- GOI has issued a tollfree helpline number for ‘Behavioural Health’, The Psycho-Social toll-free helpline-08046110007 can be used by anyone needing mental health assistance during the COVID-19 pandemic. A list of videos, advisories and resource materials on coping stress during COVID, yoga and meditation advice, taking care of the mental health of vulnerable groups, etc. have been provided in the MOHFW-GOI web portal ( MoHFW | Home , 2020 ).

The existing mental health-related initiatives include guidelines detailing about mental health and psychosocial considerations during the COVID-19 outbreak developed by the WHO Department of Mental Health and Substance Use, as a series of messages that can be used in communications to support mental and psychosocial well-being in different target groups during the outbreak ( Mental Health and Psychosocial Considerations During the COVID-19 Outbreak , 2020 ). The Ministry of health and family welfare, Government of India has published IEC materials on mental health care of the elderly and children. It also has materials on understanding the lockdown situation, handling isolation, dealing with mental health issues after recovering from COVID-19 ( MoHFW | Home , 2020 ). Various other portals and institutions like The National Institute of Mental Health and Neuro-Sciences (NIMHANS), All India Institute of Medical Sciences, Indian Psychiatric Society have taken up independent responsibilities to promote and manage mental health issues during the COVID-19 pandemic in the form of online services, telemedicine services, etc.

NIMHANS suggests that a ‘Psychological intervention medical team’ can be formed as a standalone team or be part of the general medical team attending to people affected by the pandemic. The staff should consist of psychiatrists, with clinical psychologists and psychiatric nurses participating and the teams should formulate interventions plans separately for different groups for example: (i) Confirmed cases who are hospitalised with severe symptoms (ii) Suspected cases and close contacts of confirmed cases (iii) People with mild symptoms who are in home quarantine (iv) Health care personnel working with people with COVID-19 (v) General public ( Cullen et al., 2020 ) As it is, mental health alone is a global challenge in itself and the COVID-19 pandemic greatly escalated the mental health burden as well.

Another initiative by the GOI is the Aarogya Setu mobile application which is used to connect essential health services with the people of India in our combined fight against COVID-19. The app is aimed at augmenting the initiatives of the Government of India, particularly the Department of Health, in proactively reaching out to and informing the users of the app regarding risks, best practices, and relevant advisories about the containment of COVID-19.

For the frontline workers fighting against this global crisis, routine support activities should be made available and must efficiently incorporate and include a briefing on moral injuries. It should also focus on raising awareness of other causes of mental ill-health and what to look out for.

Apart from these, mental health interventions have been issued by different states, NGOs and organisational bodies, some of which are listed in Table 2 .

Some specific mental health interventions or initiatives taken by different states and institutional/ organizational bodies.

Previous research has revealed a profound and broad spectrum of psychological impact that outbreaks can inflict on people. We found in this review that stress, anxiety, depressive symptoms, insomnia, denial, anger and fear were the major mental health manifestations of the COVID 19 pandemic. Anecdotal evidences and newspaper report also suggest an increasing trend of suicide in the community, people with COVID 19, and people in quarantine and isolation.

Fear of disease can precipitate new psychiatric symptoms in people without mental illness, aggravate the condition of those with pre-existing mental illness and cause distress to the caregivers of affected individuals. Regardless of exposure, people may experience fear and anxiety regarding falling sick or dying, helplessness, or blame people who are ill, potentially triggering off a mental breakdown ( Ho et al., 2020 ). Anxiety and fear related to an infection can lead to acts of discrimination. For example, People from Wuhan were targeted and blamed for the COVID-19 outbreak by other Chinese people and Chinese people have since been stigmatized internationally, for example, use of the term ‘China virus’ and the use of terms such as ‘Wuhan virus’ and the ‘New Yellow Peril’ by the media ( Usher et al., 2020 ).

The news of a pandemic is no less than a news of death and morbidity. In the case of COVID-19, we have tried to micro conceptualize based on the concept of ‘Breaking bad news’ and how the news of the pandemic was perceived globally could be very well classified according to stages of grief. Figure 1 shows how the stages of the COVID-19 pandemic could be placed into the Kubler-Ross stages of grief ( How to identify the stages of grief in COVID-19 messages - PR Daily , 2020 ). The concept of crisis Communication is therefore what is needed in order to manage the mental health issues in the times of COVID-19 pandemic. With the world having witnessed about 7 pandemics over the last 100 years, the public health professionals across the globe have had the time to assess the impact such diseases have on human behaviour and communication. With no existing form of immunity against the pathogen and no availability of effective drugs or vaccines, behavioural actions (such as physical distancing and frequent handwashing) and risk communication becomes the first line of intervention.

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The stages of COVID-19 pandemic explained according to Kubler-Ross model of stages of grief.

We developed a conceptual framework both on the existing evidence and well as theoretical plausibility of mental health implication of COVID 19 pandemic and its response ( Figure 2 ) While, the disease itself has instilled a sense of fear among front line workers, people with COVID 19 and population at large, this effect has been amplified by the overuse of social media which has led to an Infodemic ( Orso et al., 2020 ; Vaezi & Javanmard, 2019 ). The fear due to disease could affect the population in general whereas it can have a precipitating effect of mental status of people with existing mental health conditions. The response to pandemic has led to a complete or partial restriction of movement in many countries. ‘Lockdown’, closure of educational centers and workplaces can have a significant impact on mental health due to changes in daily routine, social isolation in population, predominantly in children and older people, and people with existing mental health conditions. Abundance evidence is available to suggest that excessive use of social media has a significant impact on mental health ( Ahmad & Murad, 2020 ; Gao et al., 2020 ; Ni et al., 2020 ). COVID 19 pandemic and restrictions imposed because of it had led to a surge in screen time as well as social media exposure. Closure of hospitals for non-essential services, in order to meet the surge capacity and halt the disease transmission, has caused serious disruption in routine health care services in many countries including India ( Banerjee, 2020 ; How covid-19 response disrupted health services in rural India, 2020 ; COVID-19 significantly impacts health services for noncommunicable diseases, 2020 ). Non-provision of essential services may have a serious impact of older people, people with mental health conditions and chronic conditions. Whereas, a change in working pattern and increase perception of risk of disease can lead to anxiety, depression, stress and burnout among health care workers. Health care workers are also at risk of moral injury apart from recognized mental health conditions such as depression or post-traumatic stress disorder. Moral injury has been explained as a term that originated in the military and can be defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code. People with moral injury are likely to experience negative thoughts about themselves or others as well as intense feelings of shame, guilt or disgust. As we have searched multiple portals to gather information and have also compiled results from various research papers available, the paper gives us a detailed overview of the mental health issues during COVID-19 and its responses, however a limitation of this review could be that, the information regarding data availability or sampling frame was not possible to be explored from every source of information, thus there could be a question about its generalizability to the population.

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Conceptual framework of mental health issues during COVID-19 pandemic, its risk factors or causes; and some recommended intervention strategies.

We propose a multi-pronged multi-stakeholder approach based on the experiences and evidence available from India and different countries. International and national organizations, governments, non-governmental organizations, health professionals’ groups and self-help groups are important stakeholders in providing interventions. Multi-pronged approach should comprise of a helpline number for easy access to mental health support, strict control over misinformation in social media, provision of continuum of care services at all level, financial and employment security to vulnerable groups, regulatory and legal provisions against discrimination and stigma of health care workers and other forces involved in pandemic response. We also suggest a framework for interventions and recommendations for specific population groups based on the possible reasons associated with their enhanced risk to mental health problems ( Table 3 ).

While the health system struggles to save millions of lives daily, there is probably a risk of a looming pandemic of hidden mental health issues which has a huge potential of shattering the existing mental health infrastructure. To handle the aftermath of the COVID-19 pandemic, the mental health of the people needs to be handled hand in hand and given equal importance along with other strategies to manage and control the disease and the pandemic at large. There is a definite need for specialized psychological intervention and proper and consistent risk communication and crisis communication. An updated, timely, uncomplicated guidelines should be put forth in order to avoid confusion and anxiety among the people. Hence, keeping a positive approach, effective communication strategies and understanding the problem statement, will help in dealing with the mental health issues faced by the world in this hour of crisis. The recommended intervention strategies should therefore be vulnerable group specific and further cause or risk factor specific also. Developing need-based interventions with proper risk communication strategies and keeping at par with the evolving epidemiology of COVID-19 would be instrumental in guiding the planning and prioritization of mental health care resources so that the mental health of most vulnerable groups is well served.

Author Contributions: All the authors contributed to the manuscript. The conceptualization of the study was done by AS, AR and SM, AR and AS contributed to the methodology of the study, AR, AC, AM, OB were responsible for the writing – original draft preparation. AS, AR, SM and AM contributed to the manuscript review, and editing.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

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