RE-SURGING STATES
400 320 240
Nagaland 160 80 0 0 200 100 500 400 300
Goa
state. Dr Shiuli Biswas, the medical officer at the block health centre, says they are collecting 60-65 swab samples every day and testing 35-40 using the reverse transcription polymerase chain reaction method. The centre has just two beds and outdoor facilities for treating diarrhoea, snake bites and fever. Conditions at the two PHCs in Ganrapota and Nakful are worse. The Ganrapota PHC is a two-room structure that comes to life only during polio drives or when expectant mothers are given medicine kits. These PHCs serve 18-20 gram panchayats. There is no attempt to ramp up facilities to meet Covid exigencies.
It’s the same story in other states. In Madhya Pradesh, the health department had hoped to provide at least 10 beds with ventilators in each district; only 14 of the 52 districts have ICU beds. And even if the state will make additions to Covidspecific medical infrastructure, it will be in cities. “There isn’t any structural space or medical personnel in rural areas to fight the battle there. Covid patients will have to come to cities for treatment,” says a top state health department official.
Hospital facilities remain woeful in Telangana too, especially in the 30 rural districts outside the Hyderabad agglomeration (Medak, Hyderabad and Ranga
Reddy districts), though they account for two of every three residents in the state. While the Ranga Reddy and MedchalMalkajgiri districts were epicentres of cases initially, rural areas and smaller towns further away now have a higher concentration of cases. “A large number of vacancies of doctors and other staff in government hospitals has affected the healthcare services for the poor in Telangana. The work pressure on the existing staff has also increased,” said Congress legislature party leader Mallu Bhatti Vikramarka on August 31, the fifth day of his party’s tour of government hospitals in the districts. He alleges that in spite of borrowing over Rs 3 lakh crore in the past six years, the Telangana government is unable to provide proper beds in government hospitals or to pay salaries to frontline medical workers and other outsourced staff who have been working in these hospitals for the past five months.
The inadequate health facilities apart, there seems to be no preparation for Covid in rural India. As an ASHA (accredited social health activist) worker affiliated with the PHC in Shalgaon, the nearest facility available to Rajeswadi village in Pune district, says, “We have no PPE kits, we have made our own masks, and when we visit homes, we have to make do with soap and water, which isn’t always available. Assuming we even isolate positive cases, how do we look after them? Who is going to walk into the isolation room without protection? We don’t have any Covid medication here other than Vitamin C and paracetamol.”
Testing remains a major bottleneck. As of June 2020, there were 480 government testing laboratories along with 208 private laboratories across the country to combat Covid-19. Yet, the facilities for such centres in the smaller regions of the country remains grossly inadequate.
To make things worse, in one part of the country, there’s growing resentment and resistance towards testing. To blame is a toxic mix of factors: rumour-mongering, irresponsible politicians, social stigma attached to corona-positive families, poor institutional quarantine and Covid care facilities, expensive private sector care and poor communication. Residents of Jafarpur village in Punjab’s Nawanshahr wrote a letter to district collector Sheena Agarwal on August 21, requesting her not to send the healthcare teams for testing. Four days ago, two residents, including a former sarpanch, had died of Covid. The teams that visited to conduct contact tracing as per Covid protocol faced a hostile reception.
This resistance to testing is a problem peculiar to Punjab. Not just in Jafarpur village, panchayats in other Punjab villages too have passed resolutions, and village gurudwaras have made announcements to not allow healthcare teams to conduct testing, especially of those who are asymptomatic.
Health experts say there is still time to arrest the spread of Covid in small towns and villages. States have two key
options at this juncture—more testing and public awareness programmes. “Covid demands changing people’s attitude towards social interactions. The more people are made aware, the more our chances of defeating the disease,” says Dr Fettle. In UP and Maharashtra, attempts to educate the public about the importance of a Covid test has yielded results, with UP having conducted 5.6 million tests and Maharashtra 4.2 million. In Tamil Nadu and Delhi, ASHA workers were deployed in big numbers in all districts to bridge the gap between official information and public confusion. “Some people were initially sceptical but slowly fell in line. We didn’t just tell them what to do, we also showed them how—from wearing a mask to coughing into your elbow,” says Subhadra Kumari, one such activist in Northeast Delhi, the rural district with the lowest containment clusters as on September 1. It is an example of how quality outreach can build public confidence and how instrumental this kind of support is in the battle against Covid.
In states with fewer Covid cases, plans have been drawn up to transport patients from rural to urban areas. In MP, not only rural areas but Covid positive cases from even small towns and Tier-2 cities are being taken to the bigger urban centres for treatment. For many states, this would be the most reasonable bet given the state of primary and secondary health infrastructure.
How India uses its limited resources to treat any potential surge will be the crux of the battle in its villages. But it is a point nobody wants to reach and it is imperative that the virus be contained before it establishes itself in the hinterland.
The only silver lining is that most infections are still asymptomatic or mildly symptomatic. Chances of such individuals with a low virus load spreading the disease are predicted to be less, though there is no scientific estimation of it yet. Dr V.K. Paul, NITI Aayog member and chairman of the empowered committee on medical emergencies, holds out hope. “By its basic nature, a viral infection spreads,” he says. “We are conducting far more tests now—almost 1 million a day. The country has also prepared to cope with Covid in terms of isolation guidelines, infrastructure and equipment. We are strong on the treatment front. We need to prevent drastically high surges from overwhelming the system.” It’s an advice the country would do well to heed.
—with Anilesh S. Mahajan, Kiran D. Tare, Amarnath K. Menon and Romita Datta