India may be next coronavirus hotspot, experts warn

India could become the next global hotspot for virus cases, with experts warning containment measures that proved successful elsewhere in Asia may not work in the world’s second-most populous country.

The South Asian nation, which has so far reported 152 infections and three deaths, is trying to contain the virus by closing its borders, testing incoming travelers and contact tracing from those who tested positive. On Tuesday, the Indian Council of Medical Research announced it was ramping up the country’s testing capacity to 8,000 samples a day from the current 500. Its director general Balram Bhargava maintained there was “no evidence” of the transmission of the virus in the community.

But some experts in the nation of 1.3 billion people say that won’t be enough to contain the spread. Other measures like widespread testing and social distancing may be infeasible in cities with a high population density and rickety health infrastructure.

Mass Tests Vital to Map Virus Spread in India as Cases Rise

While growth in total numbers has been slow until now, “the number will be 10 times higher” by April 15, said Dr. T. Jacob John, the former head of the Indian Council for Medical Research’s Centre for Advanced Research in Virology, a government-funded institution.

“They are not understanding that this is an avalanche,” said John, who was also chairman of the Indian Government Expert Advisory Group on Polio Eradication and chief of the National HIV/AIDS Reference Centre at the Christian Medical College in Vellore. “As every week passes, the avalanche is growing bigger and bigger.”

Apart from its sheer size, India’s other challenge is the density of its population: 420 people live on each square kilometer (about 0.4 of a square mile), compared with 148 per square kilometer in China. Its cities are crammed with slums and low-income housing clusters where the living conditions are tight.

While South Korea was able to test even asymptomatic people, India’s population “makes it extremely difficult,” said Dr. K. Srinath Reddy, adjunct professor of epidemiology at the T.H. Chan School of Public Health at Harvard University and president of the New Delhi-based health think-tank Public Health Foundation of India.

“Social distancing is something often talked about but only works well for the urban middle class,” he added. “It doesn’t work well for the urban poor or the rural population where its extremely difficult both in terms of compactly packed houses, but also because many of them have to go to work in areas which are not necessarily suitable for social distancing.”