Covid-19: Pay attention to rural India
When Covid-19 first hit India, the biggest fear among both policymakers and public experts was that the pandemic would travel to India’s Hindi heartland — primarily across the rural belt of Uttar Pradesh (UP) and Bihar. Given the size of the two states, the density of population, the abysmal health care infrastructure, and the manner in which the virus could quickly transmit in these regions, this fear was legitimate. And there was palpable relief when the first wave was, in hindsight, relatively less destructive. There was never any scientific and cogent explanation for why this was the case, but this did not deter speculative, and clearly misplaced, theories about the innate immunity of those in rural India to resist the virus.
It is now clear that the biggest fear of 2020 is the everyday reality of 2021. There is, after all, no innate immunity, and Sars-CoV-2 and its variants are sweeping through the villages and small towns of two of India’s most populous states. UP reported 20,000 new cases and over 300 deaths, and Bihar had over 10,000 cases and 72 deaths on Tuesday. But anecdotal reports from local communities, hospitals, emergency wards, crematoriums and graveyards; informal admissions by district and health authorities; pleas for help on social media (even though recourse to Twitter is not the natural default option for many in these areas); and now the tragic sight of bodies floating in the Ganga, confirm that the numbers are much higher. The process of medical management of Covid-19 is under great strain. Testing is hard, hospital admissions of patients with serious symptoms (with or without a test) are harder, there is an acute shortage of medical supplies, contact-tracing is non-existent, bureaucratic red tape has made care even more difficult, and there is little dignity in death.
Given the dense networks that exist between cities and villages, continuous inter-state movement, the return of migrants for Holi and the harvesting season and in response to curbs in bigger cities, the impact of Kumbh, and in the case of UP, untimely panchayat elections, this surge is not unexpected. And the pace of vaccination, the most effective way to fight the disease, is much slower than needed. Away from India’s urban hubs, India’s Covid-19 trajectory will be decided by what happens in Bihar and UP. The state governments, with help from the Centre, must step up.