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COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has witnessed a total of 2,631,338 infected cases as on April 22, 2020. The first case being recorded in January 2020, followed by more than 20,000 case in a matter of 3 months creating a tremor among the population of India. The United States tops the total number of infected cases in the world with 8,45,822 cases, followed by Spain summing up to 2,08,389 cases. India having 21,370 total infected cases, along with 4370 recoveries and a total death toll of 681, ranks 17th among the other countries. In this study, a detailed summary has been conducted on how India is working together to fight this pandemic. The countrymen, along with following the strict instructions provided by the WHO, have set up new rules to fight this disease. This study includes the various medical procedures adopted by the government of India along with the economic guidelines for its fellow citizens during these hard times; a geospatial approach has also been used to identify the infected regions of the country and their pandemic control methods in the 1-month period (22 March–22 April). To date, being the second most populated developing country in the world, India has managed to control the spread of the virus to a large extent. The WHO has praised India's efforts in monitoring the spread of the virus and has alerted India that a simple lockdown would not stop the spread of the virus. They have recommended India to increase the number of tests to segregate the people showing early/mild symptoms. The outcomes of the precautions taken are also discussed in this study.


Origin and mode of transmission of COVID-19
The possible potential natural source of SARS-CoV-2 or the novel coronavirus is still a matter of debate and has not yet been clarified. However, a study by Zhou et al. from the Wuhan Institute of Virology portrayed the resemblance of the gene sequence of SARS-CoV-2 and bat coronavirus to be 96.2%, implying bats to be the primary source of the virus [2]. However, studies by Ji et al. state snakes to be the primary host of SARS-CoV-2, but future studies found no evidence stating the same. Research by Xu et al. using macro genome sequencing, electron microscopic analysis, and molecular biological detection found pangolin to be the primary host of the virus, with the potential for infecting humans to be 99%; they also observed the particles of the novel coronavirus and found pangolins to be transitional hosts of SARS-CoV-2 [3]. However, research has not fully clarified the potential and the transitional hosts of the virus but evidence states the source to be wildlife. As this virus grows exponentially, at present, the most infectious source of COVID-19 is the patients present in the population.
Limited research is available on the transmission or spread of the SARS-CoV-2 from one person to another. However, close contact with the person already carrying the virus is the most common way of transmission of SARS-CoV-2. Contact with objects having the virus and then touching oneself can also transmit the virus, and coughing or sneezing can also scatter droplets in the air leading to the transmission of SARS-CoV-2. A study by Wang et al. and Xiao et al. states that transmission by aerosols can also be a source of transmission of COVID-19 [4]. Researchers have also identified SARS-CoV-2 in urine, saliva, gastrointestinal tract, and stool samples of patients, indicating digestive tracts to be a possible route of transmission of the virus. A study by Xia et al. has found the presence of SARS-CoV-2 in the sobbing and conjunctival discharge of COVID-19positive patients [5]. According to the National Institutes of Health (NIH), many people have a high risk of getting COVID-19, including 1. young children, 2. people with weak immunity or diabetes/senior citizens aged 65 years or older, 3. pregnant women.
Coronavirus or coronavirus disease 2019 (COVID-19) virus can grow exponentially, thus making it highly contagious. Based on the medical evidence of 1099 COVID-19positive patients the average maturation period was 3 days and the average time from maturation to death was 14 days. The average expectancy of SARS is 4 days, the median time frame from first indications to hospital admission was 3.8 days, and to death was 17.4 days. The maximum dormancy of SARS-CoV-2 is observed to be 24 days, causing a high risk of transmission. It is also observed that people aged 70 years or more have lesser average days from the indication period till death compared with those aged 70 years or less, indicating that elder people are more prone to develop the infection than others, keeping them at a high-risk zone. Therefore it should be underlined that the public should pay more attention to the elderly population who are more susceptible to SARS-CoV-2.

Clinical characteristics of COVID-19
Coronavirus is spherical, single-stranded, enclosed RNA and is shielded by glycoproteins shaped like a club. There are four subtypes of coronaviruses: alpha, beta, gamma, and delta coronavirus. For each of these subtypes of coronaviruses, there are numerous serotypes. A few of them affect humans while others affect animals like birds, mice, cats, pigs, and dogs. Based on the report that was published on January 24, 2020, coronavirus disease-ridden patients have several mutual features, for instance, cough, fever, and fatigue while dyspnea and diarrhea were observed to be unusual features. Most of the patients testified bilateral irregularities. At first, coronavirus was secluded from bronchoalveolar lavage, which is also known as bronchoalveolar washing, in China in the year 2020. Its presence is also detected in samples of blood. Up till now, the presence of coronavirus was not verified in urine and fecal samples of patients [6]. A vast series of clinical illustrations are observed in patients with SARS-CoV-2, ranging from mild to medium, to acute and rapidly progressive, and ultimately leading to fulminant disease. The maximum number of patients suffering from SARS-CoV-2 infection was normal and minor, with mortality rates lower than those observed in SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV) infections. Various types of coronaviruses belong from a subfamily of Coronavirinae. Various kinds of human coronaviruses differ in the severity of the resulting disease and the rate of spreading. Doctors presently identified seven sorts of coronavirus that have the capability of infecting humans. The common types of coronavirus are as follows: 1. 229E (alpha coronavirus) 2. OC43 (beta coronavirus) 3. NL63 (alpha coronavirus) 4. HKU1 (beta coronavirus) Rarer strains causing further severe complications involve SARS-CoV, the virus that is accountable for SARS, and MERS-CoV, which results in MERS. A new strain called the SARS-CoV-2 began circulating in 2019, triggering the disease COVID-19. COVID-19 results in a severe viral infection among humans, with an average incubation period summing up to 3 days, which is more alike to SARS having an incubation duration ranging between 2 and 10 days. The features of COVID-19 that are presented in an infected adult are pronounced. The maximum mutual clinical warning sign of SARS-CoV-2 infection was cough (67.7%), fever (87.9%), and fatigue (38.1%), while vomiting (5.0%) and diarrhea (3.7%) were occasional, which presented similar features to those of other coronaviruses [7]. Maximum number of patients faced some level of dyspnea (difficult or labored breathing) at first, as the time of commencement of warning signs for the advancement of acute respiratory distress syndrome (ARDS) was merely 9 days amid the early patients suffering from COVID-19. Furthermore, severely infected patients are likely to develop a diversity of complications, including ARDS, severe heart injury, and secondary infection. Already there is some evidence that coronavirus can be the source of damage to the tissues and organs instead of the lung. In a study conducted on 214 coronavirus disease-ridden patients, 78 (36.4%) of them possessed neurologic manifestations. Additionally, evidence of ocular surface infection in the patients suffering from COVID-19 is already present, and the SARS-CoV-2 RNA was spotted in secretions from the eyes of patients [8]. Generally, the radiographical characteristics of COVID-19 are very equivalent to those observed in pneumonia acquired from the community, which is triggered by other organisms. A chest computed tomographic (CT) scan is a vital means to diagnose this type of pneumonia. Nonetheless, quite a few distinctive imaging features are commonly detected in COVID-19 pneumonia, together with the principal ground-glass opacity (65%); smooth or irregular interlobular septal thickening, which is technically termed as smooth septal thickening (35%); consolidations (50%); thickening of the adjacent pleura (32%); and air bronchogram (47%), with primary involvement of the peripheral and lower lobes. A current study stated that a maximum number of patients (almost 90%) had bilateral chest CT scan results and the susceptibility of chest CT scan suggested COVID-19 was around 97%. Combining the chest CT scan imaging features with laboratory test results and clinical symptoms could simplify the initial diagnosis of COVID-19 pneumonia. Most patients had standard leukocyte counts, but then again leukopenia was detected in 33.7% of the infected patients. Moreover, many patients established raised levels of lactate dehydrogenase, C-reactive protein, and creatinine kinase. Nevertheless, a marginal number of patients had higher abnormal myocardial enzyme spectrum, transaminase levels, or raised serum creatinine levels. In comparison with bacterial pneumonia, patients suffering from SARS-CoV-2 infection exhibited a lesser oxygenation index [9].

Current scenario of COVID-19 in India
India witnessed its first case of coronavirus on January 30, 2020, in a Kerala district. Among the initiatives taken up by all the countries against the COVID-19 pandemic, India's response is considered to be the most stringent. India has been rated a faultless score of 100 on the "Oxford COVID-19 Government Response Tracker (OxCGRT)," which aims to compare and keep a track of the government initiatives toward the coronavirus outbreak, rigorously and constantly. Along with India, Israel, South Africa, Mauritius, and New Zealand also scored 100 in this tracker. At the initial stage, the Indian government was swift to initiate its health managing system and issue essential travel advisories. All travelers entering India from the affected countries were screened at first, which was initiated on January 2020. Even if a person showed no symptoms of the disease, the government machinery was initiated to keep a regular check on the progress of the person for the next 2 weeks. This was done via phone calls or in-person visits. The Indian government turned out to be very vigilant and came up with taking strict actions for those who did not take the lockdown seriously. In the intervening time, India embarked to confirm that all the stranded citizens, particularly students and workers who were stuck in foreign countries, were flown back home [10]. India deferred all domestic and international travel by March 20, 2020. On the 24th of March, India declared an entire lockdown for 21 days. A well-coordinated plan of action included careful checking at airports, vigorous health laboratories, and the rapid establishment of solitary confinement facilities across the country. The Indian government has stuck to the "Prevention is better than cure" policy to fight against this pandemic.
As of April 22, 2020, the Ministry of Health and Family Welfare (MoHFW) and the Indian Council of Medical Research (ICMR) have confirmed an another-all number of 21,372 cases (subjected to change in due course of time), 4370 recoveries, and 681 deaths. The rate of infection of the coronavirus pandemic in India was testified to be 1.7, which is bizarrely less than that recorded in the countries that are worst affected. This rate is reported to be slowed down, thereby flattening the curve. The outbreak of COVID-19 has been officially declared as an epidemic in almost all states and union territories, where the Epidemic Diseases Act of 1897 has been appealed [11]. All educational institutions and commercial establishments have been ordered to shut down to reduce the spread of the disease. India entirely suspended all tourist visas because the majority of the cases were connected to international travels. On 24th of March the prime minister (PM) of India, Narendra Modi, declared a nation-wide lockdown for 3 weeks to break the chain of spread of this epidemic. This was extended to May 3 for further precautions. The PM urged all the citizens of India to remain indoors for the coming few weeks and if probable work being at home. The establishment of the COVID-19 Economic Response Task Force was publicized at the time of PM's live address to the country. From Fig. 36.2, it can be evaluated that within 1 month (March 22, 2020 to April 22, 2020) the total number of active cases increased from 373 to 16,319 [12]. During this tenure, India was in lockdown to prevent the spread of the virus. From Fig. 36.2, it can also be seen that the western and central parts of India are mostly affected. There is an exponential growth in the number of active cases in India from March 22, 2020, with an average of 560 new cases every day. From Fig. 36.3, it is evident that there is a steep rise in the total number of COVID-19 cases. On the brighter side, the number of recovered patients is also increasing exponentially. Once the number of recovered cases equals the number of newly detected cases, the exponential growth will decrease and the "flattening of the curve" will be achieved. Moreover, from Fig. 36.3, it is evident that the number of deaths by the coronavirus is almost constant. On March 22, 2020, the number of total confirmed cases was 403, the number of active cases was 373, the number of recovered cases was 23, and the total number of deaths due to this pandemic was 7 [13]. Within 1 month, i.e., by April 22, 2020, the total confirmed cases increased to 21,370; the number of active cases was 16,319; the number of recovered cases was 4370; and the total number of deaths due to this pandemic was 681.
On closer inspection, from Fig. 36.4, we can observe that in most of the states that had a high number of active cases on March 22, 2020, the number continued to rise exponentially, with Maharashtra scoring the highest number of active cases both on March 22, 2020 and April 22, 2020, with 72 and 4591 cases, respectively. However, there are states that have been successful in this battle against the virus and serve out as a role model to the entire nation. Kerala, located in the southern part of India, has been able to   stop the exponential growth of the virus spread with 64 active cases on March 22, 2020 and only 127 active cases on April 22, 2020. Ladakh is also one such example. This was only possible because of the strict measures adopted by the government authorities. Fig. 36.5 reveals that the total number of recovered cases was highest in the state of Maharashtra, with 789. However, on the contrary, the total number of recovered cases of Kerala was only 308 but their number of active cases was 127. Thus this state has almost reached the flattening of the curve. The number of recovered cases on March 22, 2020 and April 22, 2020, shows that there has been a steady increase in the recovery state.

Precautions taken in India for controlling COVID-19 spread
On January 17, 2020, the Indian government had issued an advisory to the general public to refrain from traveling to China and avoid contact with anyone with travel history to China since January 15, 2020. For the nonresident Indians (NRIs), it had been mandated to hold a coronavirus-negative certificate from designated hospitals within the countries they are traveling from to avoid nonessential travel abroad. Self-quarantine is remitted to passengers arriving in India from China, Hong Kong, Republic of Korea, Japan, Italy, Thailand, Singapore, Iran, Malaysia, France, Spain, and Germany. Visas are suspended to French, German, and Spanish nationals likewise as foreigners with a travel history to those countries. Visas of foreigners already in India, however, remain valid. The Indian government had earlier issued a travel advisory that it had also temporarily suspended e-visa facility for Chinese passport holders and noted that already issued e-visas are temporarily invalid. Online application for a physical visa from China was also disabled [13]. India's first case of COVID-19 was reported on January 30, 2020, within the state of Kerala, who was a collegian from Wuhan traveling back to the state. On 6th February, The Indian Ministry of Health announced that all 645 evacuees from Wuhan tested negative. Two quarantine centers, one at Manesar, Haryana, managed by the defense force Medical Services and the other at Chawla Camp in New Delhi managed by Indo-Tibetan Border Police (ITBP), had been set up to isolate any passengers showing symptoms of the infection [14]. On 19th February, a total of 406 evacuees quarantined at ITBP center were discharged as safe. Coronavirus screening, testing, and quarantining at Indian airports started from March 4, 2020. As per the increase in coronavirus imports, thermal screening had been installed at 21 airports including those in Delhi, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad, and Cochin. There have been mandates for flights from China, Hong Kong, Singapore, and Thailand, including 12 major seaports and 65 minor seaports. India screened approximately 1.2 million visitors by 14th March [15].
Initially, the National Institute of Virology (NIV) and 52 other laboratories were equipped to check COVID samples under the ICMR Viral Research and Diagnostics Laboratories network. The nodal laboratory for coronavirus testing in India, the NIV lab in Pune, was equipped with facilities for COVID-19 molecular diagnosis and nextgeneration sequencing. The Indian government initiated the method of adding more coronavirus testing laboratories within the country. The Indian government further extended visa cancellations to more countries, with fresh cases reported in Maharashtra, Delhi, and Bangalore.
On 19th March, because the cases rose to 500, the PM of India, Narendra Modi, asked all citizens to watch "Janata Curfew" (people's curfew) on Sunday, 22 March. It was a 14-hour curfew (from 7 a.m. to 9 p.m.) for everybody except people of "essential services" like police, medical services, media, home delivery professionals, and firefighters. The PM also requested the citizens of India to stand in or near their doorways, balconies, or windows and clap their hands or ring their bells at 5 p.m. on that day in appreciation of the professionals delivering these essential services. To enforce the curfew within the country, the National Cadet Corps and service Scheme got the charge [16].
To fight the long battle against COVID-19 the PM addressed the countrymen a second time on March 24, announcing the nationwide lockdown from midnight of that day for 21 days. In the absence of any proven cure to the disease, the sole solution to manage the spread of coronavirus was to interrupt the cycle of transmission through social distancing. He made sure that the lockdown would be enforced more strictly than the Janata Curfew.
The availability of medication was assessed by the Department of Pharmaceuticals within the country, thanks to the rise in the number of cases of coronavirus infection. A report submitted by a committee formed by the department revealed that the present stock of active pharmaceutical ingredients (APIs) is sufficient to manufacture drugs for 2 months to a few months.
Various government organizations including the National Pharmaceutical Pricing Authority and the Drugs Controller General of India are instructed to confirm an adequate supply of APIs and check black-marketing or illegal hoarding. The organizations have also been asked to watch the supply of APIs and medicines.
The Directorate General of Foreign Trade (DFGT) has been instructed to limit the export of 13 APIs and formulations, the bulk of which are made in Hubei, China. The lockdown curriculum was to limit people from stepping out of their homes unless for extreme necessity. All transport servicesdroad, air, and raildwere suspended, except transportation of essential goods, fire, police, and emergency services. Educational institutions, industrial establishments, shopping complexes, theaters, hospitality services, and nonessential commodities were also suspended. Services that were exempted from suspension were food shops, banks and ATMs, petrol pumps, and other essentials and their manufacturing. The strict advisory of the Home Ministry stated that anyone who did not follow the restrictions could approach to a year in jail.
On March 25, the primary day of the lockdown, nearly all services and factories were suspended. In some parts, people were hurrying to stock essentials. The government held meetings with e-commerce websites and vendors to confirm a seamless supply of essential goods across the state during the lockdown period. Several states announced relief funds for the poor and affected people while the central government was finalizing a stimulus package. Arrests across the states were made for violating norms of lockdown, such as venturing out for no emergency, opening businesses, and violating residential quarantine.
On March 26, the minister of finance, Nirmala Sitharaman, announced a 170,000 crore (US$24 billion) stimulus package to assist those plagued by the lockdown. The package was aimed to supply food security measures for poor households through direct cash transfers, free cereal, and cooking gas for 3 months. It also provided a sum of money for medical personnel.
On March 27, the banking company of India announced a slew of measures to assist mitigate the economic impacts of the lockdown. Before the announcement of the nationwide lockdown, on March 22, the government had announced that the Indian Railways would suspend passenger operations through March 31. The national rail network has maintained its freight operations during the lockdown to move essential goods. On March 29, the Indian Railways announced that it might start services for special parcel trains to move essential goods, additionally to the regular freight service. The national rail operator also announced plans to convert coaches into isolation wards for patients of COVID-19. This has been described as the first time in 167 years that India's rail network had been suspended, although there was also a strike in 1974.
On April 5, citizens everywhere in India cheered and showed solidarity with the physicians, police, and every one fighting the disease by switching off electric lights from 9:00 p.m. to 9:09 p.m. for 9 min and lighting diya, a candle, and flashing a torchlight or a mobile flashlight. Fig. 36.7 indicates the hotspots of India as of April 22, 2020. These hotspots have been completely shut down to lessen the spread of the virus.
On April 9, the government of Odisha extended the lockdown within the state till April 30. On April 10, the government of Punjab also extended the lockdown till May 1. On April 11, the government of Maharashtra extended the lockdown within the state till April 30. Karnataka followed suit but with some relaxation. Telangana also extended the lockdown.
On April 14, PM Modi extended the nationwide lockdown till May 3, with a conditional relaxation after April 20 for the regions where the spread had been contained by then. He said that each town, every police headquarters area, and each state would be carefully evaluated to work out if it had contained the spread. The areas that were ready to do so would be released from the lockdown on April 20. If any new cases emerged in those areas, lockdown may well be reimposed.
On April 16, lockdown areas were classified as "red zone", which indicates infection hotspots, "orange zone" denotes some infection, "green zone" indicates a neighborhood with no infections. As the end of the lockdown period approached, state governments and other advisory committees recommended extending the lockdown. The governments of Odisha and Punjab extended the state lockdowns to May 1. Maharashtra, Karnataka province, and Telangana followed suit.
Dr. Harsh Vardhan, the Union Minister of Health & Family Welfare, states that the lockdown has slowed the expansion rate of the pandemic by April 6 to a rate of doubling every 7.8 days, from a rate of doubling every 3 days earlier. According to Dr. Harsh Vardhan, India's response to COVID-19 had been proactive, preemptive, and graded in handling situations. Concerning other first world countries, India was first to retort to COVID-19 due to the dear and sincere services of our "corona warriors." The active surveillance efforts made by the government agencies to watch potential victims or carriers of the disease have made it possible to hold out community surveillance issuance of assorted advisories, cluster containment, and dynamic strategies.
Primarily, India had just one laboratory at the NIV at Pune to perform tests for COVID-19. During the past 3 months, India has scaled up the number of state laboratories to 230 aided by another 87 private laboratories with 16,000 collection centers. A total of 579,957 samples are tested as on April 25, 2020. The MoHFW has planned to extend the numbers of state laboratories to 300 and work up the daily testing capacity of 55,000 to 1 lakh tests per day by May 31, 2020.
The Indian government has ensured preparedness for the top numerous patients in times to return. It's classified COVID treatment facilities supported the severity of the disease and are of three categories, namely, COVID Care Centers for patients with mild symptoms, COVID Health Care Centers for patients with medium symptoms, and Dedicated COVID Hospitals for patients with severe symptoms. These three styles of COVID centers are duly mapped to facilitate the transfer of patients as per the severity of the case. India has 2033 dedicated facilities within the country with 1,90,000 isolation beds, 24,000 ICU beds, and 12,000 ventilators. These facilities are organized within the last 3 months. The ministry has further introduced a mobile application, i.e., "Aarogya Setu" developed by the government of India to attach essential health services with the people of India within the combined fight against COVID-19. It has been downloaded by 7.2 crore people. The app is aimed toward augmenting the initiatives of the government of India in proactively reaching resolute and informing the users of the app regarding risks, best practices, and relevant advisories regarding the containment of COVID-19.
The government of India has announced significant investments to the tune of Rs.15,000 crores for "India COVID-19 Emergency Response and Health System Preparedness Package." The funds sanctioned are utilized for immediate COVID-19 Emergency Response (amount of Rs.7774 crores) and the rest for medium-term support (1e4 years) to be provided under the mission mode approach.
The key objectives of the package include mounting emergency response to slow and limit COVID-19 in India through the event of diagnostics and COVID-19 dedicated treatment facilities, centralized procurement of essential medical equipment and medicines required for treatment of infected patients, strengthen and build resilient national and state health systems to support prevention and preparedness for future disease outbreaks, fitting of laboratories and bolster surveillance activities, biosecurity preparedness, pandemic research and proactively engage communities, and conduct risk communication activities. These interventions and initiatives would be implemented under the umbrella of the MoHFW.
Chapter 36 COVID-19: in the direction of monitoring the pandemic in India 717 The major share of the expenditure is used for mounting robust emergency response, strengthening national and state health systems followed by strengthening pandemic research and multisector national institutions and platforms for One Health, community engagement and risk communication and implementation, management, capacity building, monitoring, and evaluation components. MoHFW is permitted to reappropriate resources among components of the package and the assorted implementation agencies (National Health Mission, Central Procurement, Railways, Dept of Health Research/ICMR, National Centre for Disease Control) as per the evolving emergent situation.
The MoHFW has been playing a lead role in executing the health sector response, with containment and control as key response strategies. As on date, a total of 223 labs comprising a network of 157 government and 66 private laboratories are conducting a rigorous screening process. Furthermore, the MoHFW has already disbursed Rs. 4113 crore to any or all the states and union territories for handling the emergency COVID response [17].
The PM announced the creation of "COVID-19 Economic Response Task Force" under the union minister to accommodate the economic challenges caused by the pandemic. The Task Force will consult stakeholders; take feedback, on the premise of which decisions are going to be taken to fulfill the challenges; and ensure implementation of the selections taken to fulfill these challenges. The PM also urged the community and better income groups to appear after the economic needs of those from lower income groups, from whom they take various services, urging them to not cut their salary on the times they are unable to render the services, thanks to the inability to come back to the workplace. He stressed on the importance of humanity during such times. The following economic decisions were made for smoothing the economic conditions of the citizens.
A series of steps announced this year aim to encourage banks to lend. Measures announced by the depository financial institution of India since early February inject certificate of indebtedness to 3.2% of the country's gross domestic output. Banks do not have to put aside cash reserves for loans given to small businesses between January 31 and July 31 or for credit to assist consumers buy a car or home (announced February 6). Policy lending rated-the repurchase ratedhas been cut by 75 basis points in an exceedingly single move this year. However, the effective deposit rate has been slashed by 90 basis points to discourage lenders from playing safe and parking the cash with the Reserve Bank of India (RBI) (March 27). Cash Reserve Ratio has been reduced to 3% from 4% (March 27). The RBI Governor Shaktikanta Das has stopped the put-down loan repayments amid an unprecedented 3-week lockdown announced by PM Narendra Modi. All lenders can freeze repayments for 3 months on term loans outstanding March 1. Lenders are allowed to suspend interest payments on asset facilities for 3 months; accumulated interest is paid later and also the loans will not be in default.
The steps increase previous measures that permit a one-off restructuring of loans to small businesses that were in default as of January 1 Loans to commercial property projects that are delayed for reasons beyond the control of the developer are allowed to be treated as standard for one more year. Implementation of stricter regulations are delayed.
Rules requiring banks to fund their activities through stable sources has been deferred to October 1 from April 1: Completion of Capital Conservation Buffer pushed to September 30 from March 31. The RBI has been injecting additional liquidity within the industry to stay down bond yields. At its February policy review, the RBI said it will provide Rs. Rs.1 trillion of targeted future funds from the financial organization to banks for investing only in corporate bonds, aimed toward easing cash crunch at firms. TheRBI pledged to inject dollars through dollar-rupee swaps. Two $2 billion swap lines each for March 16 and March 23 provided $2.7 billion. Companies were allowed an additional 45 days for declaring their quarterly and annual results, the date for submission of corporate governance report was extended by a month, and company boards were exempted from a provision of maximum time gap between two meetings (March 19). Trading margin in stocks was increased, and market-wide position was reduced to ease volatility in stocks (March 20). Compliance requirements relaxed for real estate investment trusts (REITs). The deadline for risk management rules for liquid mutual funds extended; timeline for filing debenture and preference share issues extended (March 23). Capital, debt market services exempt from lockdown (March 25). The top 100 listed companies were allowed another month to suit the wants of holding an annual general meeting (March 26).
Shareholders allowed 45 more days to disclose their consolidated shareholding in companies for the fiscal year ending March 31 (March 27). The popularity of default by local credit rating companies was relaxed if a delay in payment of interest or principal is due; foreign portfolio investors were allowed relaxation in document processing (March 30). About 800 million poor people will get 5 kg wheat or rice and 1 kg pulses each month during April to June; 80 million families to urge free cooking gas. About 200 million women with basic bank accounts will get 500 rupees a month until June; 30 million senior citizens, widows, and disabled people to urge 1000 rupees; and 87 million farmers are going to be immediately paid 2000 rupees under an existing program. About 2.2 million doctors fighting COVID-19 will get an insurance cover of Rs.5 million. For people earning about 15,000 rupees a month, the government can pay 24% of their monthly wages that feed into pension and provident fund accounts. Wages under the job guarantee program were increased to produce annual good thing about 2000 rupees to a worker.
Keeping in mind the requirement for having an avid national fund with the primary objective of addressing any emergency or distress situation, like the one posed by the COVID-19 pandemic, and to provide relief to the affected, a trust under the name of "Prime Minister's Citizen Assistance and Relief in Emergency Situations Fund" (PM CARES Fund) has been founded. The PM is the chairman of this trust and its members include the defense minister, home minister, and minister of finance. The PM has always believed and shown in actions that public participation is the best because of mitigating any issue and this can be often yet another example. This fund will enable microdonations as a result of which an oversized number of people will be able to contribute with the smallest of denominations.
On the 26th of March, the Narendra Modi government announced a financial package of Rs. 1.7 lakh crores, which focuses on emergency cash transfers for the poor. The package also includes a 3-month free supply of food grains, pulses, and cooking gas under the Pradhan Mantri Garib Kalyan Yojana to support them from the economic vagaries arising out of the impact of the coronavirus pandemic. On 24th March the PM interacted with the medical fraternityddoctors, nurses, and laboratory technicians. He thanked the medical fraternity for their selfless service to the country in tackling COVID-19 [18].
He said that the government has examined the proposal for greater teleconsultation in medicine.
The PM also assured the medical fraternity that their security is of utmost importance and that the government would take every step to safeguard them. In a shot to stay up the regular supply of medicines and medical equipment, the PM also held a videoconference with the pharma sector representatives on the March 21, 2020. In his interaction, the PM asked the pharma industry to work on the manufacture of RNA testing kits for COVID-19 on a war footing. He assured them that the government is committed to maintaining the supply and manufacture of APIs within the country. He directed them that it is vital to keep up the supply of essential medicines and forestall black-marketing and hoarding.
The PM also interacted with various AYUSH practitioners on March 28, 2020. He said the AYUSH sector importance has increased manifold with the continued efforts to tackle COVID-19. The PM requested them to utilize the sector's network, while working in line with the WHO guidelines, to spread the message of fantastic practices that require to be adopted to control the spread of the virus.
On the 20th of March, the PM interacted with all the chief ministers of the country through a videoconference wherein they discussed tackling the challenge together. The PM employed a relentless vigilance and monitoring of the spread of the virus which center and states must work together to combat the pandemic. The PM reminded the state leaders that the country is in a critical phase of tackling the spread of the virus but assured them that there should be no panic. He suggested that the chief ministers should do a videoconference with trade bodies in their states to forestall black-marketing and undue price rise. He urged them to use soft power of persuasion moreover as legal provisions, wherever necessary.
The Indian PM is the primary leader for a regional consultation and discussion when he took part in a videoconference with the leaders of the SAARC Nations, home to a good portion of the world's population. A gathering of the SAARC leaders under India's leadership was held on March 15, 2020. Mr. Narendra Modi led the way with the spirit of collaboration and proposed creating a COVID-19 Emergency Fund supported by voluntary contributions from all the countries, with India making an initial offer of $10 million for the fund. The fund is often utilized by any of the partner countries to meet the worth of immediate actions.

Problems faced in controlling COVID-19 spread
Being one of the most populated countries in the world, India faces a havoc in controlling the epidemic. Currently, India has over 21,370 cases and 681 people in total have lost their lives. The precise measure of this epidemic will be identified only after testing a large number of people. With such a huge population and space crunch, enforcing the rules of quarantine is not strong enough. India is facing various problems toward the control of COVID-19 spread.
The testing capacities need to be increased to a huge amount, which is significantly difficult due to the huge population and low supply of testing equipment. As most of the people in India lack proper education about the impact of this pandemic, they are reluctant in taking tests and are breaking rules of self-shutdown. Thousands of people, particularly daily wage earners, have been extremely affected. A huge number of migratory workers who were employed on a predetermined basis by the Indian industries have become jobless. Most of the engineering corporations have deferred their actions and have requested the workers to go home. The International Labour Organization evaluates that as many as 25 million people could become unemployed with the loss of workers' income of as much as $3.5 trillion. A large part of the Indian population comprises of slums that when affected by COVID-19 will face huge containment problems [19]. Lack of proper protection for doctors treating patients with COVID-19 and lack of proper equipment for treatment and testing kits have made the detection of COVID-19 very difficult. The WHO has praised India's efforts in monitoring the spread of the virus and has alerted India that a simple lockdown would not stop the spread of the virus. The WHO has recommended India to increase the number of tests to segregate the people showing early/mild symptoms.

Significance and outcomes of the adopted measures
The outbreak of coronavirus is likely to bring forward both challenges and opportunities to the Indian pharmaceutical manufacturers, and in the meanwhile, it is predicted that trade relations with China are predicted to be hit. Initial approximates of the effect of coronavirus outbreak on India's trade are $348 million, but it is possible that it will upsurge, assuming the global spread. China, being under lockdown for a long time, has predicted that India will witness a major influence on exports and imports in numerous industries including electronics, pharmaceuticals, and auto parts and mobile manufacturing units. China is the major exporter to India, trailed by the United Arab Emirates and the United States. In the year 2018, goods valued up to $90.4 billion were exported to India, which accounted for 14.63% of the total exports. Wholesale drugs and drug intermediates accounted for $1.5 billion or 3% of India's total imports from China [20]. Conferring to the Indian Trade Promotion Council, roughly 85% of APIs are imported by Indian companies from China. Reports show that Granules India and Mankind Pharma are airlifting other input materials and APIs for their manufacturing purposes due to restricted land movements and delays in shipment from China, as inventories are running short. This delivers an opportunity to the pharmaceutical manufacturers of India to seize the shares of their Chinese competitors. Indian pharmaceutical companies presently have approximately 2 months' stock of intermediates and APIs. It is to be noted that improving the total capacity utilization of prevailing manufacturing plants of India is an immediate solution to supply disruptions. There is a requirement for guaranteed purchase contracts for the present manufacturing plants from the government. The government of India banned the export of personal protective equipment on 31st January. The export of hydroxychloroquine (HCQ) was also banned by the Indian government on the 25th of March (when the country went under lockdown), which was partially lifted for meeting other country's medical demands because India is a global supplier of HCQ [21].
The nationwide lockdown has overall flattened the infected curve. Citizens have taken the lockdown seriously by staying indoors, leading to a reduction in the spread of coronavirus. All offices and educational institutions are kept closed during the lockdown period. Kerala has reported a drastic rate of improvement in several corona-infected people since the lockdown as compared to other states of India. This change can be seen in Fig. 36.4. Before the commencement of lockdown, Kerala had 64 active cases as of 22nd March, but after 1 month (31 days) of lockdown (on 22nd of April), the number of active cases is reported to be 127. Goa was declared as the first state to be coronavirus-free on the 3rd of April, and it has not reported any positive cases since then. After Goa, Manipur and Tripura have reported being coronavirus free. The lockdown has promoted a decrease in the spread of this pandemic disease [22]. The outbreak of coronavirus has brought a sense of maintaining personal hygiene and the importance of leading a healthy life. As social distancing is the only proven way of decreasing the spread of this pandemic, India has succeeded in controlling the spread.
Due to this lockdown and people living indoors, air pollution has decreased by a considerable amount. The shutting down of industries has significantly reduced the release of pollutants into the air, water, and soil. The total pause on commute has resulted in a significant drop in carbon dioxide levels and other pollutants in the air. By now, the major cities are recording comparatively much lower levels of injurious microscopic particulate matter, also known as PM 2.5, and nitrogen dioxide (NO 2 ), which is the exhaust from power plants and vehicles. PM 2.5 is less than 2.5 mm in diameter. It is considered predominantly hazardous because it is capable of lodging deep into the lungs and advances to other organs via the bloodstream, resulting in serious health risks. The abrupt drop in contaminant levels followed by the blue skies indicate a dramatic alteration in India's air quality [23]. Throughout the initial 3 weeks of March, the average levels of nitrogen dioxide were observed to decline by 40%e50% in cities of Pune, Mumbai, and Ahmedabad as compared with the same period in the earlier 2 years. The reduction of fossil fuel emissions from the transport sector and slowing down of various other emission-related commotion like industries is gradually dropping the air pollutants. The Janata Curfew on the 22nd of March also led to the least 1-day road traffic pollution levels. The shutdown of most industries led to cleaner water of the Ganga River. Rare sightings of fish are observed in the ghats of Varanasi. Fig. 36.8 shows graphs of cities each from north, south, east, and west representing the air quality index for a period of 2 months, i.e., 1 month before and after the commencement of the nation-wide lockdown in India. The graphical representation of air pollution levels of Kolkata, Chennai, Mumbai, and Delhi is depicted in Fig. 36.8. These four cities have been strategically chosen for comparison because of their history of pollution. The graph shows the air quality index of a particular place concerning time from the 19th of February till the 22nd of April. All four cities show a common trait of a decrease in air quality index during the time of lockdown [24]. Kolkata displays the steepest rate of reduction in air quality index followed by Chennai. It is predicted that further lockdown will increase the rate of decrease in air quality index resulting in a decrease in air pollution nationwide.

Future measures
The abovementioned findings show us the rate of mutation of SARS-CoV-2 and the risk it possesses for the upcoming days. Therefore to control the mutation of the virus some measures can be adopted: Hard lockdown and social distancing should be practiced, as the baseline reproductive number as stated by Wu et al. is R 0 2.66, but with the practice of hard lockdown and social isolation, it can be reduced to R 0 1.5 [4]. Preventive measures as stated by the WHO, such as washing hands regularly, maintaining at least 1-m distance between people while coughing or sneezing, seeking immediate help from medical staff if symptoms for COVID-19 appear, respiratory hygiene should be regularly followed. People with symptoms of SARS-CoV-2 infection or respiratory illness should be mandatorily isolated until completely recovered to avoid the spread of the virus. Work from home should be encouraged by companies even after the end of the lockdown period. Triage practices should be adopted for SARS-CoV-2-infected patients before the increase of the infection. Medical infrastructure should be developed so that maximum coverage of the population is possible. Healthcare workers should be provided with better facilities and infrastructure, such as gloves, masks, gowns refining sanitation, and hygiene, in the medical care facility, as they are at the highest risks of receiving and spreading the virus. Alternative lockdown tightening and loosening should be practiced, with restrictions on large social gatherings.
Testing for COVID-19 should be extensively available to the public and should also be encouraged by the government. Strategic planning should be done on the deployment of workers and shifts in offices so that the chances of virus mutation is minimized, with no effects on business growth. Strategic opening of the marketplace to reduce the gathering of people (twice or thrice a week). Implementing strict rules and punishment for people violating the lockdown rules such as not wearing masks outdoors, unnecessary gathering on roads, etc. Extending lockdown until no infected cases are reported for at least 1 week.

Conclusion
From this study, it can be concluded that the decisions and precautions taken by the Indian government have led to the control of the pandemic to some extent. However, more strict norms should be adapted to completely eradicate this pandemic. India has learned from China and Italy on what havoc this virus can cause. Testing for COVID-19 should be extensively available to the public and should also be encouraged by the government. Hard lockdown and social distancing should be practiced, as the baseline reproductive number as stated by Wu et al. is R 0 2.66, but with the practice of hard lockdown and social isolation, it can be reduced to R 0 1.5. The WHO has praised India's efforts in monitoring the spread of the virus and has alerted India that a simple lockdown would not stop the spread of the virus.