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Combating the COVID-19 pandemic in a resource-constrained setting: insights from initial response in India
  1. GRID COVID-19 Study Group
    1. Correspondence to GRID COVID-19 Study Group; archismn{at}


    The low-and-middle-income country (LMIC) context is volatile, uncertain and resource-constrained. India, an LMIC, has put up a complex response to the COVID-19 pandemic. Using an analytic approach, we have described India’s response to combat the pandemic during the initial months (from 17 January to 20 April 2020). India issued travel advisories and implemented graded international border controls between January and March 2020. By early March, cases started to surge. States scaled up movement restrictions. On 25 March, India went into a nationwide lockdown to ramp up preparedness. The lockdown uncovered contextual vulnerabilities and stimulated countermeasures. India leveraged existing legal frameworks, institutional mechanisms and administrative provisions to respond to the pandemic. Nevertheless, the cross-sectoral impact of the initial combat was intense and is potentially long-lasting. The country could have further benefited from evidence-based policy and planning attuned to local needs and vulnerabilities. Experience from India offers insights to nations, especially LMICs, on the need to have contextualised pandemic response plans.

    • control strategies
    • health policy
    • health systems
    • prevention strategies
    • public health

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    • Handling editor Seye Abimbola

    • Collaborators GRID COVID-19 Study Group Members: Coordinators: Mohan Bairwa (All India Institute of Medical Sciences, New Delhi, India); Sabyasachi Behera (GRID Council, Bhubaneswar, India); Paragkumar Dhirajlal Chavda (Gujarat Medical Education and Research Society Medical College, Vadodara, Gujarat, India); Praveen Kulkarni (JSS Academy of Higher Education & Research, Mysuru, Karnataka, India); Archisman Mohapatra (GRID Council, Delhi NCR, India); Balaji Ramraj (SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India); Siddharudha Shivalli (London School of Hygiene & Tropical Medicine, London, UK); Arvind Kumar Singh (All India Institute of Medical Sciences, Bhubaneswar, Odisha, India); Manish Kumar Singh (Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India). Members of the nationwide network: Northern India: Ravi Rohilla (Government Medical College & Hospital, Chandigarh); Bharti Chawla, Sumit Chawla (Pt JLN Government Medical College and Hospital, Chamba, Himachal Pradesh); Rabbanie Tariq Wani (Government Medical College, Srinagar, Jammu & Kashmir); Rashmi Agarwalla (Hamdard Institute of Medical Sciences and Research, New Delhi); Pranab Chatterjee (Independent Public Health Consultant, New Delhi); Shubhashri Sudhiendra Jahagirdar (The INCLEN Trust International, New Delhi); Madan Mohan Majhi (Maulana Azad Medical College, New Delhi); Harshal Ramesh Salve, Pallavi Shukla, Kapil Yadav, Ramadass Sathiyamoorthy, Nitika Sharma (All India Institute of Medical Sciences, New Delhi); Kaushik Sarkar (Aceso Global Health Consultants Limited - India, New Delhi); Soumya Swaroop Sahoo, Madhur Verma (All India Institute of Medical Sciences, Bathinda, Punjab); North-Central India: Shamshad Ahmad (All India Institute of Medical Sciences, Patna, Bihar); Dewesh Kumar (Rajendra Institute of Medical Sciences, Ranchi, Jharkhand); Anirban Chatterjee (All India Institute of Medical Sciences, Bhopal, Madhya Pradesh); Gaihemlung Pamei (Government Medical College, Haldwani, Uttarakhand); Hariom Kumar Solanki (Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh); Eastern and North-Eastern India: Shashanka Shekhar Chakraborty (Gauhati Medical College, Guwahati, Assam); Gitismita Naik, M Mohan Kumar (All India Institute of Medical Sciences, Raipur, Chhattisgarh); Chinnadurai Aravinda (All India Institute of Medical Sciences, Bhubaneswar, Odisha); Shilpa Karir, Jasmin Nilima Panda (Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha); Jaya Singh Kshatri (Indian Council of Medical Research-Regional Medical Research Center, Bhubaneswar, Odisha); Smrutiranjan Nayak (Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha); Sithun Kumar Patro (Maharaja Krushna Chandra Gajapati Medical College & Hospital, Brahmapur, Odisha); Shib Sekhar Datta (Tripura Medical College and Dr BR Ambedkar Memorial Teaching Hospital, Agartala, Tripura); Nilanjana Ghosh (North Bengal Medical College & Hospital, Darjeeling, West Bengal); Pritam Roy (Independent Public Health Researcher, Kolkata, West Bengal); Southern India: Shankar Reddy Dudala (Government Medical College, Kadapa, Andhra Pradesh); Rachana R Annadani, Malatesh Undi (Karwar Institute of Medical Sciences, Karwar, Karnataka); Sudhir Prabhu (Father Muller Medical College, Mangalore, Karnataka); Santosh K Yatnatti (Dr Chandramma Dayananda Sagar Institute of Medical Education and Research, Bengaluru, Karnataka); Rakesh N Pillai (GRID Council, Thiruvananthapuram, Kerala); Antony Stanley (Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, Kerala); Satyanarayana G Konda (Mamata Academy of Medical Science, Hyderabad, Telangana); Western India: Kajal Davara (Gujarat Medical Education and Research Society Medical College, Vadodara, Gujarat); Mihir Prafulbhai Rupani (Government Medical College, Bhavnagar, Gujarat); Anuj Mundra (Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra); Akhil Dhanesh Goel, Manoj Kumar Gupta (All India Institute of Medical Sciences, Jodhpur, Rajasthan).

    • Contributors All authors reviewed the drafts, provided critical inputs and agreed on the final version. The coordinators conceptualised and wrote the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer The expressed views and opinions in this paper are of the authors and do not necessarily express the views or policies of their organisations and affiliations.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement There are no data to share. Circulars and documents cited in the manuscript have been archived by the group and can be provided upon request.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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