COVID-19 has not “exploded” in India, but the risk of it happening remains as the country moves towards exiting the lockdown that was imposed in March to contain the disease, according to a top WHO expert.

WHO Health Emergencies Programme executive director Michael Ryan said on June 5 the doubling time of cases in India was about three weeks at this stage. So the direction of travel of the epidemic was not exponential but it was still growing, he said.

The impact of the pandemic was different in different parts of India, and varied between urban and rural settings.

“In South Asia, not just in India but in Bangladesh and ... in Pakistan, other countries in South Asia, with large dense populations, the disease has not exploded. But there is always the risk of that happening,” Mr. Ryan said in Geneva.

He stressed that as the disease generated and created a foothold in communities, it could accelerate at any time as had been seen in a number of settings.

Mr. Ryan noted that measures taken in India, like the nationwide lockdown, had helped had an impact in slowing to slow transmission, but the risk of an increase in cases loomed as the country opened up. “The measures taken in India certainly had an impact in dampening transmission and as India, as in other large countries, opens up and as people begin to move again, there’s always a risk of the disease bouncing back up.”

He added that there were specific issues in India regarding the large amount of migration, the dense populations in the urban environment and the fact that many workers had no choice but to go to work every day.

India went past Italy to become the sixth worst-hit nation by the COVID-19 pandemic.

India saw a record single-day jump of 9,887 coronavirus cases and 294 deaths on Saturday, pushing the nationwide infection tally to 2,36,657 and the death toll to 6,642, according to the Health Ministry.

The lockdown in India, was first clamped on March 25 and spanned for 21 days, while the second phase of the curbs began on April 15 and stretched for 19 days till May 3. The third phase of the lockdown was in effect for 14 days and ended on May 17. The fourth phase ended on May 31.

The country had registered 512 coronavirus infection cases till March 24.

The nation-wide lockdown in containment zones will continue till June 30 in India but extensive relaxations in a phased manner from June 8 are listed in the Union Home Ministry’s fresh guidelines on tackling the COVID-19 pandemic issued last week.

WHO Chief Scientist Soumya Swaminathan said the over 2,00,000 current novel coronavirus cases in India, a country of over 1.3 billion people, “look big but for a country of this size, it’s still modest”. She stressed that it was important for India to keep track of the growth rate and the doubling time of the cases and make sure that the number did not get worse.

She said India is a heterogeneous and huge country with very densely populated cities and a much lower density in some rural areas and varying health systems in different States, and these factors posed challenges to the control of COVID-19.

Ms. Swaminathan added that as the lockdown and restrictions were lifted, it must be ensured that people took all precautions. “We’ve been making this point repeatedly that really if you want behaviour change at a large level, people need to understand the rationale for asking them to do certain things [such as] wearing masks,” she said.

In many urban areas, it is impossible to maintain physical distancing, she said, adding that it becomes very important for people to wear face coverings when they are out, at offices, in public transport and educational institutions. “As some States are thinking about opening, every institution, organisation, industry and sector needs to think about what are the measures that need to be put in place before you can allow a functioning and it may never be back to normal.”

She said that in many professions working from home can be encouraged but in several jobs, people have to go to work and in such cases measures must be put in place that allow people to protect themselves and others.

“I think communication and behaviour change is a very large part of this whole exercise,” she said.