On Tuesday, the tally of Covid-19 cases in India crossed 5.6 million. Maharashtra’s tally rose to 1.24 million with a third of the infections reported among rural populations. Uttar Pradesh and Bihar have also reported an uptick in cases in rural areas. The states represent a nationwide trend of the pandemic shifting to the rural areas where health systems are weak and human resources are stretched or missing altogether. This leaves the sick with no option but to seek treatment in cities, where the strain on the health care system is beginning to show. Testing is still concentrated in urban and peri-urban areas. Testing in rural areas remains below the national average of 46,440 tests per million, which may lead to undetected and asymptomatic spread in the young, mobile rural demographic, and, in turn, bring the infection back to cities.
Meeting the challenge of containing the spread in rural areas is a monumental task. Of the little over 1.2 million allopathic doctors registered with the Medical Council of India (June 30), around a million are available for active service. This puts the doctor-population ratio at 1:1,343 for a population of 1.35 billion, against the World Health Organization-recommended 1:1,000. With most tertiary care hospitals situated in cities, at least 90% doctors live and work urban areas, home to 40% of the population.
Prime Minister Narendra Modi’s review of the Covid-19 situation with the chief ministers of seven states that account for 63% of the country’s cases focused on scaling up testing and containment in rural India ahead of the last phase of unlocking on September 30. To win the war against the pandemic, battles have to be fought and won on every front.