India’s aggressive measures to slow the spread of the coronavirus are facing challenges as clusters of infected people are emerging across the nation with thousands of jobless migrant workers fleeing the cities, often by foot, to escape starvation.

At nearly 1,600 confirmed cases, India appears to be on the cusp of community transmission, or stage 3 of the epidemic, when cases increase exponentially and are no longer restricted to people who have travelled abroad or come in contact with them. Officials have vehemently denied it, but their worry lines are starting to show.

“We are focusing on hotspots from where large number of cases are being reported and working in tune with states to implement rigorous contact tracing, community surveillance and other containment strategies to break the chain of transmission," said Lav Agarwal, a joint secretary at the health ministry.

If the nationwide lockdown fails to halt the onset of community transmission, the country will have to deal with a sudden explosion of covid-19 cases that could potentially overwhelm India’s already stretched hospitals, resulting in a large number of avoidable deaths for the lack of treatment, similar to what has happened in Italy and China.

Agarwal said the number of hotspots in India, an area with more than 10 positive cases, has risen to 1,251.

The Indian government’s response so far has been to slow the rate of infections, or flatten the coronavirus curve, as it takes steps to prepare itself for a long battle. Doubling down on the 21-day lockdown announced on 24 March, the central government on Monday ordered states to seal their borders and ordered migrants to stay where they are to limit the spread of infections.

Fears about the number of cases being higher than what is officially reported have also been fuelled by India’s low testing rates. Only around 43,000 people in India have been tested for covid-19 as of Tuesday.

So far, Kerala, Karnataka and Maharashtra with large populations living outside India have been the worst affected, but there are now concerns that a religious gathering Tablighi Jamaat in New Delhi’s Nizamuddin area could turn into India’s ground zero, spreading the virus across the nation from Assam to Tamil Nadu.

On Monday, the Delhi government took action against a Tablighi Jamaat priest for allegedly flouting lockdown protocols, though the religious body has denied having violated the rules. At least 175 people have developed symptoms after attending the event, sparking the largest tracking exercise since the outbreak of the pandemic in the country.

The police have now sealed off part of the Nizamuddin area. The building where the religious gathering happened has been quarantined.

“We can only hope that this has not spread within the basti (slum), but we can only know by the end of the week," said Ratish Nanda, projects director at Aga Khan Trust for Culture, which runs a community health programme in the area.

But the worry does not stop there. Among the hundreds who attended, people have travelled as far away as Assam and Tamil Nadu.

Similar cases are now showing up in other parts of the country as well.

A 35-year-old male pharmaceutical executive from Mysuru district is believed to have infected nine other people after he tested positive for covid-19 on 26 March.

According to the district administration, around 1,000 people from the company and other contacts of this person are under home quarantine to ensure they can contain the spread of the novel coronavirus.

Mysuru recorded 12 cases as on Monday, and 10 of them are part of the same cluster, according to the health department. Almost three quarters of the total contacts are in Nanjangud taluka of the district while the remaining are in Mysuru, officials from the local district administration said.

The pharma executive tested positive despite having no travel history outside India, raising fears that there was a possibility of community transmission.

Kasargod in Kerala, a lush green coastal stretch on the northernmost tip of the state, now tops the list of hotspots with 97 active covid-19 patients.

The district administration and the police see the wide spread of the virus in Kasargod as a direct result of its decades-long emigration history to Gulf countries, which often intertwines with murky gold-smuggling stories.

When officials started making house calls on suspicion that many of the Gulf returnees had escaped proper scrutiny of infection, people withheld information.

Consequently, now there are at least six most-infected villages within the district that are practically ghost towns, as hardly anybody can venture out of their homes under the heavy police clampdown. They are Pallikkara, Udma, Chemnad, Madhur and Mogral.

To ensure stay-at-home orders are not flouted, the police are delivering food and groceries at the doorsteps of all houses in these six locations if they send out a WhatsApp message to a helpline number, said inspector general Vijay Sakhare. Pathanamthitta, the other Kerala district on the hotspot list, is a polar opposite of Kasargod. It is one of the most developed regions in Kerala, with a 50-year long migration history with European as well as American nations. The district has only five active patients now but at one point accounted for the highest number of cases in the state, all linked to foreign travellers. A bulk of these could be traced to a five-member family in the district who returned from Italy, and had travelled widely across the region before they were diagnosed with the infection.

Flagrant violations of the near-curfew like situation seen initially has gradually met with grudging acceptance.

In Maharashtra, despite having one of the highest cases of infections, the disease has been more dispersed despite higher concentration in cities such as Pune.

That changed on Tuesday, with 64 new cases being reported in Mumbai alone, taking the total number of infections in the capital to 151, and that of the state to 302. State officials are now identifying clusters within the city with more than three infections and sealing them to contain the spread.

Neetu Chandra Sharma and Shaswati Das in New Delhi, and Kalpana Pathak in Mumbai contributed to this story.

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