Rural India’s Hidden Pandemic: COVID-19 Spreads Unchecked, Cases and Deaths Under-Reported
COVID-19 has spread to rural India where many are dying of COVID-like symptoms. Experts are certain India’s already high official numbers do not reflect the true extent of the spread of the virus.

PUNE: India’s second wave is devastating the country’s rural areas where health infrastructure is rickety and a lack of trained healthcare workers, government support and access to healthcare is likely to worsen the spread of the COVID-19 pandemic.

Health experts believe the number of new COVID-19 cases and deaths are vastly underreported and that strict lockdown regulations and amping up vaccinations will be the key to help curb a possible third wave.

Rabeena Manral, a young mother of two boys who lives in the Champawat region of the picturesque Himalayan state of Uttarakhand, is certain that she was infected with the virus this year, but due to a lack of testing in her village, could not confirm her status. 

While the COVID-19 surge last year left her hilly village of roughly 200 people untouched, this time around there are dozens of known cases and three confirmed COVID deaths so far. 

To get tested Manral will have to hire a private vehicle and travel 15 to 20 km away – a distance too expensive to cover. Public buses are no longer plying as the state is currently under a lockdown to stop the spread of the virus. 

For weeks Indians have been turning to social media with pleas for help and finding help from fellow citizens, instead of the government, as Health Policy Watch reported earlier. Those living in rural areas like Manral are not on Twitter. Even if they were, there is no nearby hospital a sick patient can be taken to in an emergency. 

India has been consistently recording over 3,50,000 new daily cases and over 4,000 deaths for around two weeks now. Experts like Ashish K Jha, dean of the Brown University School of Public Health, believes that both the number of new cases, and the deaths are vastly underreported in India’s vast rural areas. 

Doctors working in rural areas confirm this assumption. Yogesh Jain, a physician and founding member of the Jan Swasthya Sahyog, a health non-profit that runs low-cost health programs in the central Indian state of Chhattisgarh, said that during the first wave of COVID-19 in 2020 he saw only a handful of cases and no deaths in the villages of the state. “It is now 50-50 (urban-rural case spread). There have been several, several deaths. The disease is well spread everywhere.”

Jain worries that the situation will worsen in the coming weeks and that the problem might neither be documented, nor acknowledged.

Indian government has consistently downplayed the toll the pandemic has taken on the country. The government has also pushed the task of procuring the vaccines on to the states, who are now trying desperately to arrange vaccines for their residents and failing.

In rural India people are simply dropping dead without access to tests or treatment. “There was a time most people in my village were sick and had symptoms like fever and cough, including me. None of us got tested,” Manral said speaking over the phone. Some tests were done sometime in April following a death in the village after a wedding party and so Manral knows that dozens are currently positive.

In Rabeena Manral’s rural Himalayan village there are dozens of COVID-19 cases. She suspects she herself might have had the virus but without access to tests there is no sure way to know.

But weddings have continued. Manral says there were a dozen or so in the past month, but now instead of hundreds of attendees only a handful family members are present. 

Jha has consistently communicated that large gatherings like weddings and election rallies are out of the question but Uttarakhand was one of the states that allowed thousands of devotees to gather for Kumbh, a religious event where devotees pray at the banks of the river Ganges that is considered sacred by the Hindus. The event ended up being a super spreader.

In recent days dozens of dead bodies of suspected COVID patients have washed ashore in villages downstream. Petitioners have approached India’s Supreme Court seeking its intervention in the deteriorating health and administrative situation. 

India’s High Positivity Rate

India is reporting a high positivity rate, leading experts to believe that a large number of cases are unreported.

Currently of every five samples tested for COVID in India, one comes back positive. 

The World Health Organization (WHO) recommends that this rate be below 5% for at least two weeks before countries consider easing their restrictions. At 20% test positivity rate, India is likely missing many COVID-19 cases.

Women have been hit particularly hard. Husbands who work as migrant workers outside are back home and without incomes. Anecdotal evidence suggests a rise in cases of domestic violence and stress for the women.  

“The burden on women has increased tremendously,” said Arvind Malik, CEO of Udyogini, an NGO that works with women enterprises across five states in central and northern India. “All these areas we work with are remote. The economy is run by migrant workers. All that has been disrupted. Many households are on the verge of not having food.”

Vaccinations Will be the Key in India

Along with restrictions that many states in India are now resorting to, ramping up vaccinations will be the key, according to experts. In Manral’s village all those above the age of 45 have received vaccinations.

Overall, around 2.5% of Indians are currently fully vaccinated against COVID and a tenth of the population has received at least one dose. If India has to avoid a third wave this number will have to be scaled up quickly. 

As authorities come under fire for not doing enough to pre-empt and handle the second wave, they are pointing out that India’s large size makes vaccinating its roughly 1,391,716,282 population a challenge. India’s health ministry has said that more indigenous vaccines could be available in the market in the coming months, a claim experts in India have called misleading and exaggerated. 

With the situation in urban India dire, those in rural areas are not receiving any media or aid attention this time around, according to Malik. The large digital divide has affected every aspect of life in rural India as children lose learning hours in the absence of mobile and internet connectivity.

Jain points to some urgent measures that need to be taken. “We should stop counting infected people now,” he said, adding that the focus now ought to be on mitigation. “Have a clinical diagnostic criteria. Those who can be managed at home should get high-quality home care and the health workers need to be given adequate protective gear. Those who require hospitalization, the government has to ensure transportation and have a helpline to tell people where to go. Everyone should be able to reach a hospital within one hour.”

Disha Shetty is an independent journalist based in Pune, India

Image Credits: Udyogini, Rabeena Manral.

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