Shifting hotspots

Apart from this, in every district we have deployed 1,500 of our COVID warriors—including those who have recovered from COVID—AND they are of great help. We have a cord blood bank, which is not there in many parts of Asia…. Many of our doctors, including some who have retired, are touring the districts…. Our health workers, municipality workers and police are going from house to house every day to help people with their problems. We are trying in different ways to ensure that people remain safe and healthy.”

The State has also stepped up its COVID testing, with well over 30,000 samples being tested every day from the second week of August. Until July 31, this number was below 20,000 a day. As of August 18, as many as 13,32,198 samples had been tested, including 35,107 on August 18 alone. The rate of testing in West Bengal stood at 15,358 per million of the population. Around 80 per cent of the tests are the RT-PCR tests, while 20 per cent are rapid antigen tests. Between August 11 and 18 the State added seven more laboratories that test for COVID-19, bringing up the total number of such laboratories to 68.

There are at present 84 COVID hospitals (29 government hospitals and 55 private hospitals requisitioned by the government) in West Bengal, with 11,775 beds. According to the government, the occupancy rate in the COVID beds is a mere 36.82 per cent (as of August 18). Mamata Banerjee claimed that only 5 per cent of those infected were “serious cases that required hospitalisation”, and 89 per cent of the patients were recovering at home. The discharge rate, as of August 18, stood at 75.51 per cent, with 92,677 so far discharged. According to the State government, the mortality rate has come down to 2 per cent from 4.5 per cent.

However, the number of COVID cases has been increasing at an alarming rate, and the number of people dying every day is also very high.

As of August 18, the total number of COVID cases in West Bengal stood at 1,22,753, including 27,668 active cases. On August 18 itself, 3,175 new cases were registered. The total number of deaths due to COVID stood at 2,583 on August 18, including 55 deaths on that day. Moreover, there have been numerous allegations of patients being denied admission and treatment in government hospitals; of treatment being delayed either because of callousness or because of elaborate procedures that patients find confusing; and lack of facilities and poor conditions inside government establishments.

On August 11, a COVID patient under treatment in a government hospital in Howrah managed to send a video message outside, pleading for help. Gasping for breath and in obvious physical distress, she said, “The people in the hospital are not doing anything for us. Please share this video and let the media know what is happening here.” The video went viral, prompting government authorities to finally visit the hospital. The hospital authorities denied any instance of negligence on their part.

More recently, on August 18, the day after the CPMS was officially launched, distraught family members of an 80-year-old COVID patient, who had been admitted in the Calcutta Medical College on July 31, complained that they had no idea about the condition or even whereabouts of the patient. One of them said: “They are not telling us anything. Not even the bed number. We have been going from one department to another from morning till evening. There is absolutely no news of her.”

This was not the first such instance in the State. Commenting on the incident, Archana Majumdar, Senior Chief Medical Officer in eastern and north-eastern India, told Frontline that such incidents made it clear that there was no coordination between the different wings of the hospital and between the hospital authorities and the patients’ families.

The situation in government hospitals has been forcing common people to get admitted in private nursing homes, which is financially unaffordable for poor and most middle-class patients. The State government claims that it is providing “free treatment” for COVID patients in public hospitals and private establishments requisitioned by the government. But Archana Majumdar pointed out that the majority of those who got admission in government-requisitioned hospitals were VIP patients or those with high-placed connections.

“The poor people are helpless and it is the failure of the State government that it has not been able to provide service to them. They continue to be harassed,” she told Frontline. According to reports, private hospitals in Kolkata are charging anywhere between Rs.50,000 and Rs.1 lakh a day. There have been complaints of private hospitals demanding as much as Rs.3 lakh as deposit for admission. Recently, a well-known private hospital in Kolkata reportedly charged a COVID patient Rs.19 lakh.

Amid public outcry over inflated hospital bills, the West Bengal Clinical Establishment Regulatory Commission put a cap on the advance that hospitals could charge. Earlier, the State government had fixed a uniform rate on COVID tests. However, Archana Majumdar feels these steps are not likely to make any difference. “These are just advisories, but no private hospital is actually paying any heed to them,” she said.

HARYANA was among the few States that enforced COVID lockdown measures strictly. Apparently, it even amounted to the harassment of migrant labourers on way

As of August 18, the total number of COVID cases in West Bengal stood at 1,22,753.

to work and health workers moving from place to place.

Inter-state borders were sealed following a large number of cases being reported in districts that formed part of the National Capital Region (NCR), adjoining Delhi, on the grounds that the movement of people to and from Delhi into these districts caused the spike in cases.

For most of April, May and June, Gurugram, Faridabad and Sonipat districts in the NCR, all of which are industrial and employment hubs, accounted for a high concentration of cases. But all these measures do not seem to have had the desired effect. Apart from a sharp rise in the rate of new cases of infections and deaths in these districts, the infection has spread to other districts too.

According to the State COVID-19 bulletin, as on August 18, as many as 557 persons had died (396 males and 161 females) and there were 896 new cases. Of those who died, 397 persons had other illnesses. On August 19, the number of cases went up to 994. As many as 155 patients were on critical care; 136 patients were on oxygen support and 19 were on ventilators.

Haryana was ranked 15 among 35 States and Union Territories in the number of COVID cases. It had more cases, but fewer deaths, than Punjab, Madhya Pradesh and Jammu and Kashmir. Uttar Pradesh, Delhi and Rajasthan were on fifth, sixth and thirteenth positions respectively among States reporting a large number of cases. So the daily spike of more than 800 cases in mid-august in Haryana is worrisome.

Faridabad, Panipat, Gurugram, Rohtak, Panchkula, Karnal, Rewari, Sonipat and Kurukshetra districts account for 58.7 per cent of the cases now. The doubling time overall has been 30 days. That in itself is not worrying, but the fact that the infection rate is growing at 1.9 per cent every day is a cause for concern.

SPREADS TO NEWER AREAS

From the more populated districts in the south of the State the infection has now spread to the less-populated districts in the north and north-west areas. With interstate borders now open and attendance in government offices going up, the centre of infection has also spread accordingly. Yamunanagar, Panchkula, Panipat and Kurukshetra have recorded the sharpest growth in the number of cases in a month. For instance, on July 19, there were only 148 cases in Yamunanagar.

Within a month, this went up to 830. In Panchkula, from 250 confirmed cases on July 19 the number went up to 1,313 in a month’s time. Kurukshetra and Panipat too displayed similar trends.

While almost all districts have reported an increase in the number of cases for most of August, in the districts designated as hotspots in the early phases of the pandemic the numbers seemed to be plateauing. The return of migrant workers is seen as one of the reasons for the spike in the less-populated districts, though to what extent it has contributed is not clear.

Testing in Haryana has also been inadequate compared with neighbouring States. It had done fewer tests than Rajasthan and Delhi, but was on a par with Punjab, Jammu and Kashmir and Telangana.

DISTRICT HOSPITALS IN BAD SHAPE

Frontline spoke to rural health workers who said district hospitals were in bad shape and people were averse to getting themselves tested because of the stigma attached to the disease. Sunita Rani, general secretary of the Accredited Social Health Activist (ASHA) union, told Frontline that health workers had been on a strike for one week as their incentives had been slashed. She said many ASHA workers had contracted the virus, but the government paid scant attention to their health or immunity requirements.

She narrated an example of a worker from Kaithal and her daughter who had contracted the virus. Neither of them received treatment at the Post Graduate Institute of Medical Sciences at Chandigarh, she said, but had to seek help from a hospital in Patiala in Punjab after a relative’s recommendation.

“The government did not help her. Health workers have been helping each other,” Sunita Rani said. She said there were four workers in her knowledge who were battling cancer and one who had a brain hemorrhage. The workers did not have health insurance nor was the government providing any help.

The health workers were also asked to register themselves under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which provides vulnerable sections cashless cover of up to Rs.5 lakh per family per year.

“One worker who had registered under the scheme took her son to an empanelled hospital where the hospital administration said they would cover only Rs.20,000 of the costs. She had to shell out Rs.2.5 lakh from her pocket for the medical expenses,” she said.

Besides, the health workers routinely faced harassment when they went to collect samples for testing. “People are afraid to get tested as they do not trust government facilities. There are a large number of people who are definitely infected but are not seeking treatment,” Sunita Rani said. There were no proper facilities in district hospitals, including ventilators, medicines or medical staff, she said.

The problem was compounded for pregnant women who were unable to get regular check-ups as government hospitals had been converted into COVID centres. They had to get their ultrasound scans done from private facilities.

Just as in most of India, health care in Haryana is dominated by the private sector. Yet most of the critical cases are being treated in government medical facilities located in urban centres. The state of primary and secondary health care centres and that of district hospitals has not inspired confidence among people to report symptoms and seek treatment.

With a high daily average of COVID cases, Haryana cannot afford to remain complacent, especially with the development of new hotspots. m