Maharashtra’s districts of concern in Covid fight: In Pune, rural areas drove surge
Omkar Tupe, a 24-year-old delivery agent is one of the 1.4 million Pune residents who have recovered from Covid-19 as of July 25. But he almost didn’t make it: he was first detected with the disease caused by the coronavirus on June 4. Within three days, he was admitted to the district-run COEP jumbo facility, because although he did not have any severe symptoms, his tests indicated that the infection had spread widely in his lungs. Tupe stayed at the facility for a month before he was released.
Pune has been the worst-hit district in the state in both waves of the pandemic. In August 2020, Pune district crossed other districts in the country with the highest active caseload; on September 16, it recorded the highest single-day spike of the first wave adding 5,049 fresh positives and taking its active caseload to 82,172. In April 2021, Pune district reported over 100,000 active cases. On April 17, it recorded its highest single-day spike, adding 12,825 new cases. On that day, its active caseload went beyond 120,000.
The thick tail of Maharashtra’s second wave
As cases rose, the city experienced a shortage of oxygen beds, drugs like remdesivir, and RTPCR labs functioned at full capacity and led to delays in providing test results by almost 36 hours. Many witnessed scenes of desperation: relatives of patients approached pharmacies directly for drugs; many incidents of physical scuffles broke out. On April 10, the district collector directed hospitals to procure the drug directly from pharmacies and asked them not to give the task to relatives. Meanwhile, as the virus ravaged entire families at one go, the burden on healthcare facilities also became immense. Between January and April 2021, the district’s oxygen requirement went up from 67.5 metric tons (MT) to 310 MT (a 359% jump). The administration was forced to get oxygen from neighboring districts including Raigad. On April 4 the district positivity rate – which reflects the spread of the infection based on the number of positives reported for every 100 tests -- was 41.2%.
Pune resident Pankaj Desai tested positive for the infection along with his elderly parents and his younger brother in April. Although his symptoms were mild, his parents needed attention. The hospital they were admitted in did not have proper facilities. “On April 7, myself, my younger brother and my parents all tested positive, we remained in home isolation however after a few days my parents’ symptoms worsened and then we had to get them admitted. I had to go out to get them food and medicines as the hospital did not have catering facilities. Despite being infected I had to ignore my health and look for beds because we could not get a single bed in any of the major hospitals in the city,” Desai recalled.
Pune also recorded the largest number of mucormycosis cases in the state. By June end, Pune had 4,086 patients. Nagpur, with the second highest cases in the state, was treating only 553 active cases at the time.
The situation in Pune is certainly not as dire as before. However, July end, Pune district still accounts for 19% of the total active cases in the state.
Understanding the spread
While the number of cases is declining, experts have been unable to pinpoint the exact reason as to why Pune has been a Covid hotspot during both waves. Dr Pradeep Awate, state surveillance officer said that there were multiple factors that could account for Pune’s high infectivity: rural elections held in January saw more than 80% voter turnout, the lack of Covid appropriate behaviour and even population density. Almsot 70% of the district’s one crore population is urbanized with nearly 40% of the population living in either slums or in congested localities. Awate pointed out that Pune’s population density is about 9,400 persons per square kilometre. By comparison, the state average is 603 persons per square kilometre. Even the decadal growth rate is higher than that of the state’s: 36 compared to 16.
Pune, one of the largest cities in the state, is an education and Information Technology hub, and sees much migration of youth. From March 2020 to present, the district has seen two aggressive surges in Covid19 cases with peaks in September 2020 and April 2021.
Starting May, rural Pune began reporting more cases than urban areas of the district (the Pune Municipal Corporation (PMC) and the Pimpri-Chinchwad Municipal Corporation (PCMC)).
While the city saw its peak in April, rural areas were reporting almost twice the number of cases by the following month. On May 13, Pune rural reported 4,363 new cases, while Pune city reported 2,021 new cases and PCMC reported 3,152 new cases. By May-end, rural Pune’s daily positivity rate touched 19.6% which was more than urban Pune’s at 6.5%. At the time both PMC and PCMC reported an average of 400-600 new cases daily, while rural areas reported close to 1,200.
In July, the borders were reconfigured and parts of what earlier constituted rural Pune are now within the PMC, which makes it difficult to provide a similar comparison for this month. The 23 villages which were also the most infected were added to the city’s area limits.
In June Pune administrators decided to put rural parts of the district under Level 4 lockdown, while the city limits of Pune, including the cantonment, and Pimpri Chinchwad were categorised as Level 3. This meant that there were greater restrictions placed in villages to help prevent the spread of the disease. This dual categorization remained in place as of July 30.
However, this has not stopped people from travelling between the rural areas and the city. With rural and urban borders being so close and not so defined, the movement of people from the rural to urban areas continues especially to get access to non-essential services, as non-essential shops that were shut in a level four lockdown could remain open in the city.
Dr Sahilesh Suryavanshi, nodal incharge of Velha taluka in Pune district, said, “The restrictions seem like they are just on paper. In April when the city saw its peak and the economic activities were shut people started to travel back to their villages which meant that the infection also travelled from cities to the villages. And so the following month in May the villages saw its peak.”
In the months of June and July, the rural administration collected 75,589 samples, out of which 31,441 were subjected to RT-PCR tests and 44,148 were tested using Rapid Antigen tests kits. In all, 1,888 samples were found to be positive. This mass testing certainly helps administration understand the prevalence of the disease, but it cannot point to its progression.
Ayush Prasad, Chief Executive Officer, Pune Zilla Parishad said, “We identified a total of 110 hotspot areas and 300 affected villages to conduct a random sampling survey. We collected samples through contact tracing of people who were high risk contacts and low risk contacts and who came in touch with the patients. These samples also include super spreaders including bank employees, employees from the MIDC area, social workers and others.”
With sowing season ongoing farmers travel to cities or main trader hubs within the rural areas to purchase seeds, fertilizers or pesticides or even to sell their stocks. On weekends there is crowding in the weekly market areas, said Suryavanshi. Rural Pune currently has an overall positivity rate of above 6%, which is higher than the state average.
Preparing for third wave
Despite two severe waves of Covid-19 in the district, Covid-appropriate behaviour remains a challenge for the authorities. For instance, between July 15 to 21, more than 10, 000 people were penalized across the district for not wearing a mask and for spitting in public places. Till date, local civic bodies and Pune police have penalized more than 942,200 people, collecting close to ₹43 crore in fine.
Dr Avinash Bhondwe, former chairperson of the Indian Medical Association said that breaking the chain of infection is necessary to prevent the spread of the pandemic. Yet, he said, poor contact tracing in Pune meant that the chain of infection could not be broken. “During the peak it was found that positive patients who got tested at private laboratories remained out of PMC records and so their relatives could not be traced and tested. Testing of senior citizens and those with comorbidities was not prioritized. Even during the peak people living in hot spots with high covid19 cases were freely travelling in and out of the containment zone.”
During the peak of the second wave, Maharashtra’s demand for medical oxygen had reached 1,800 Metric Tonnes (MT). However the state’s daily production capacity was 1,300 MT. In preparation of the third wave, the state has set a target to produce 3,000 MT. Accordingly all the district collectors and municipal chiefs have been advised to step up production and storage capacity.
In Pune district, 50 oxygen generation plants were proposed at hospitals in urban and rural areas, of which 16 have become operational.
No doubt, Tupe’s life was saved because of this as he was admitted in June - long after the peak and oxygen crunch. “Before he was admitted, he had only three days of fever. However his HRCT score was 20 which showed that his lung involvement was too severe. In the second wave we saw a lot of young Covid19 positive patients and many deaths were reported due to the infection in the younger population. Tupe received simple O2 treatment and despite his high HRCT score he did not require a ventilator. It is possible that he contracted the infection much earlier but did not feel any symptoms like it happened in many cases,” said a doctor at the jumbo facility who treated Tupe.