**Abstract**

The COVID-19 pandemic is an ongoing global crisis that poses enormous and multifarious challenges to humanity since the end of 2019. The pandemic has severely devastated public health systems and universally affected socio-economic development. India is among the worst-hit nations owing to its massive population of 1.35 billion, and more significant socio-economic challenges than most other countries. Despite the current issues and challenges surrounding the COVID-19 pandemic, India has been making targeted efforts towards the fight against the spread of coronavirus, including medical, treatment, vaccination, community prevention and control strategies. The chapter examines the implications of the pandemic on Indian population which have certain unique challenges than other parts of the world. It delves on the gradual progression of the challenges among people especially the vulnerable and the disadvantaged in the existing public health systems. This chapter encompasses a wide array of human suffering and efforts for its mitigation. It highlights and brings to forefront the unique experiences of diverse populations who have faced a crisis within a crisis and its psychosocial ramifications, as well as the psychosocial adversities and public health challenges.

**Keywords:** Covid-19, Psychosocial effect, Public Health, India, Origin, Societal Impact, At-risk Population, Prevention and Control

## **1. Introduction**

The COVID-19 pandemic is an ongoing global crisis that poses enormous multifarious challenges and threatening all of humanity since the end of 2019. The infectious disease COVID-19 (SARS-CoV-2) spread swiftly throughout the world and the outbreak placed most nations on a high public health alert. The pandemic has severely devastated public health systems and universally affected socio-economic development. India is among the worst-hit nations owing to its massive population of 1.35 billion, and more significant socio-economic challenges than most other countries.

By September 2020, the nation witnessed a considerable drop in new and active cases' and declining infection rates. However, during the second wave in April 2021, the virus started to spread faster than ever before. The country witnessed over 3 lakh new cases of COVID-19 daily while death rates surged to new peaks. Despite the current issues and challenges surrounding the COVID-19 pandemic, India has

been making targeted efforts towards the fight against the spread of coronavirus, including community prevention and control strategies, COVID-19 RT-PCR tests, strengthening public health systems, immunization initiatives, nationwide lockdown, phased relaxation of restrictions, night curfews, doubled fines for not wearing masks and crowding, etc. However, the second wave of the pandemic in April 2021 had been enormous with very grim outcomes whereby oxygen, hospital beds and treatment facilities are in extremely short supply.

This chapter examines and discusses the range of societal challenges and public health burden that resulted from the COVID-19 pandemic in India. We examine the impact of the pandemic that has shaken the fundamental essence of social development and the response of public health systems. This chapter encompasses a wide array of human suffering and efforts for its mitigation. The findings are presented and several thematic psychosocial and public health areas which emerged are discussed, primarily the genesis and spread of the virus and its management, the physical impact of the disease and its psychosocial ramifications, as well as the psychosocial adversities and public health challenges.

More specifically, we describe the individualized experiences of varied high-risk groups in a densely populated country that posed unique challenges in the social and economic sphere. This rich learning may serve a significate value in the area of community prevention strategies. The authors further elucidate lessons learned about advancements and strategies of prevention, treatment and control of the pandemic in the country. The chapter concludes with a number of potentially fruitful research themes and directions.

## **2. Origin and progression of the pandemic**

At the initial stage, on 31 December 2020, Chinese national authorities reported unspecified cases of pneumonia to the World Health Organization (WHO). Such cases of unknown etiology were identified in Wuhan city of Hubei province, China and within a mere 3 days, 44 patients were reported with such cases without any known causal agent [1]. Wang et al. [2] reported most common clinical symptoms among the hospitalized patients included fever (98.6 percent), fatigue (69.6 percentage) and dry cough (59.4 percent). Originally, the patients had a history of exposure to the Huanan Seafood Market - a live animal and seafood market in Jianghan District, Wuhan, Hubei, China [1]. On 30 January 2020, the World Health Organization [3] declared the pandemic a Public Health Emergency of International Concern and pandemic on 11 March 2020 [4]. At that point the agency also recommended that all countries should be ready with control strategies such as screening, early detection, containment, case management, contact tracing and prevention of further spread of COVID-19 infection and data sharing with WHO.

As per the available global data on 14 June 2021 there are total 91,451 confirmed COVID-19 cases in China with 86,344 recovered cases which indicates 94 percent recovery rate and 4,636 cases of deaths. Further, worldwide there have been 175,686,814 confirmed cases of COVID-19, including 3,803,592 deaths, reported to WHO [5]. To date, the pandemic rapidly spread across almost 222 countries and territories around the world. The top 10 most-affected countries include: United States of America, India, Brazil, France, Turkey, Russian Federation, the United Kingdom, Italy, Argentina and Spain. The infection levels, which continue to fight against the pandemic, are presented below (**Table 1**).

India reported a total 28,996,473 confirmed COVID-19 cases. The total number of patients who succumbed to the viral disease has reached 351,309 and thereby comprises 17 percent of the global share of case burden [4, 6].


*Psychosocial Effects and Public Health Challenges of COVID-19 Pandemic in India DOI: http://dx.doi.org/10.5772/intechopen.99093*

#### **Table 1.**

*Top 10 countries with Most-affected by COVID-19 pandemic as on 9 June 2021.*

The first case of Coronavirus was reported on 30th January, 2020 and today the country has the second highest number of confirmed cases in the world after the USA. The first death due to COVID-19 was reported on 12 March 2020 from Kalburgi in Karnataka state in India [7].

During the first wave of the Coronavirus pandemic in September 2020, India witnessed the highest peak on 16th September 2021 with a total number of 97,894 infected persons. Again, after six months the country had a sharp upsurge from the first week of March indicating the second wave of the pandemic with the highest number of 4,14,188 infected cases on 6th May 2021. Fortunately, the national pandemic situation is steadily and rapidly improving with a decline in cases. Recent data recorded 100,636 new cases on 6th June 2021. Additionally, death rates and hospitalizations are also dropping [8].

### **3. Societal impact of COVID-19 in India**

Amidst the unprecedented and devastating Coronavirus pandemic, particularly during the second wave, numerous issues related to crumbling public health infrastructures, increasing number of death tolls, psychosocial, economic, political, educational, agricultural effects and many more ramifications have created devastating impact on the lives of people across all states. For example, the social reality of human beings in the modern world revolves around unlimited social interaction.

This interaction came to a sudden halt with the advent of worldwide lockdowns and restrictions on social movement as a result of the coronavirus. Feelings of loneliness and boredom in the population ensued and had varied impacts on people's mental health (see ref. [9]). While this pandemic wreaked havoc in health systems across the world, the social aspects of the disease complicated the recovery process. The contagious character of the pandemic, along with its unpredictable nature of progression on various individuals, has resulted in catastrophic socioeconomic disruption caused by the coronavirus. It is estimated that there were nearly 690 million people globally undernourished in 2019, and by the end of 2021, an additional 132 million are expected to go hungry. Also in this short timeframe, it is anticipated that tens of millions of individuals will be further pushed into risk of extreme poverty [10].

India is not exempt from this prediction. The Covid-19 crisis has amplified the situation of poverty in the country, and left a large number of citizens grappling with inadequate access to clean water and nutritious food, insufficient access to livelihoods or employment, poor education and lack of infrastructure. There is strong underlying evidence between poverty and psychological health [11]. Additionally, studies also indicate that poverty leads to developmental and mental health problems that in turn prevent people from escaping the poverty trap; creating an intergenerational and causal nexus of poverty and ill-health [12]. A study conducted by Mukhtar [13] highlighted the psychological impact of COVID-19 making it a secondary health concern, which requires attention. "Globally implementing preventive and controlling measures, and cultivating coping and resilience are challenging factors; modified lifestyle (lockdown curfew, self-isolation, social distancing and quarantine); conspiracy theories, misinformation and disinformation about the origin, scale, signs, symptoms, transmission, prevention and treatment; global socioeconomic crisis; travel restrictions; workplace hazard control; postponement and cancellation of religious, sports, cultural and entertainment events; panic buying and hoarding; incidents of racism, xenophobia, discrimination, stigma, psychological pressure of productivity, marginalization and violence; overwhelmed medical centers and health organizations, and general impact on education, politics, socioeconomic, culture, environment and climate" ([13], p. 512) are the causative factors arousing challenge and concern.

These factors have diverse impact on people belonging to various strata of society. Demographics such as whether people reside in urban or rural communities and whether they are young or elderly contribute to their vulnerability. Further, hailing from different geographical locations with varying access to social networks, healthcare facilities and personal economic status also contribute to people's exposure to risk. Everyone struggled at his or her individual level with the double burden of the disease and its accompanying factors. In a cross-sectional study by Karmakar et al. [14], they reported that extensive sociodemographic risk factors such as socioeconomic position, family composition, environmental factors and racial/ethnic marginal status were all significantly linked with COVID-19 prevalence and mortality.

Regardless of the socioeconomic risk factors, the microorganism invaded every aspect of social life; individual, family, community and nation. The home environment changed into stressful office rooms and online schools. The personal space was compromised immediately and leaving no alternative. Children were confined to homes and their energy was bottled up causing frustration and loneliness. In some homes, other stressors (such as loss of jobs or ailing people) further dampened the spirit and caused anxiety about the future. While the sanitization rituals by individuals helped disease prevention, it is reported that rigorous hygiene routine to combat COVID-19 resulted in a rise in cases of

obsessive–compulsive disorder [15]. There were countless stories of social isolation and its impact from around the nation and the world, each pointing towards the need to address this unsaid challenge.
