UP: Poor Health Infrastructure Leads to Growing COVID-19 Cases in Rural Areas

Lucknow: A sense of fear is growing in Uttar Pradesh over the rapid spread of COVID-19, as reports of COVID-19 cases and related deaths are pouring in, day after day. What is alarming however, is that cases are now being reported from rural areas, which had been untouched till recently.

There has been a rapid surge in COVID-19 cases in districts which had few cases until now. For example, Sonbhadra reported 52 new COVID-19 cases in the 24 hours prior to July 17, Hardoi had 58 cases, and Sultanpur had 42 cases in the same period. The eastern district of Ballia added 67 more cases, while Meerut, a big hotspot in the west, added 63 more.

The rise in the number of cases in the two holy towns of Varanasi and Prayagraj has also caught the eye of the government. On a day when the two cities reported considerable spikes in the number of cases— Varanasi with 78 new cases and two deaths, Prayagraj had 56 new cases and three deaths (as of July 17)— Chief Minister Yogi Adityanath expressed concern about the situation in five districts and told officials that there was a need for alertness in Jhansi, Varanasi, Lucknow, Kanpur city and Prayagraj.

To contain the spread of COVID-19, the Uttar Pradesh government had announced that there will be a complete lockdown in the state from every Friday at 10 p.m. to 5 a.m. on Monday, till further orders. The decision come amid a spike in the number of cases, which is at 47,036 on July 18. A month ago, on June 18, the total number of cases in the state was 14,598. It means that COVID-19 cases have increased by nearly 200% in one month.

Poor Health Infrastructure

According to health experts, the rise in the number of cases is largely due to poor health infrastructure in the state. Another reason is the returning migrant workers, many of whom did not undergo medical screening or were asymptomatic.

Dr. C.S. Verma, President of the public health outfit, Jan Swasthya Abhiyan (JSA), Uttar Pradesh, said there were three reasons behind the sudden spike in COVID-19 cases in rural areas, with migration having happened to Maharashtra, Gujarat, Delhi and Bangalore. When the workers started returning, the number of cases increased, he said.

"We can not deny that community transmission of COVID-19 began in our country long ago, and the largest wave of internal migration is from the poorest districts of eastern Uttar Pradesh. Ever since they returned to their hometowns, COVID-19 cases have increased. However, this is not the sole reason behind increasing cases in rural areas. To be honest, when you do more testing, you find more cases. This is still not the peak," said Dr. Verma, adding that the virus’ peak effect will be seen in September.

"Asha workers have assisted in contact tracing and community level surveillance. They not only identified persons with symptoms, but also regularly followed up on their health status. They have facilitated sample collection from returnees who were found to be COVID-19 positive and were referred to COVID health care services. This way, Asha workers also got infected and started spreading the virus," he added.

Many state health department officials, who had been consistently highlighting the lack of basic public health infrastructure in the state, particularly in the rural areas, cited these alarming figures to emphasise on how this debilitating weakness was corruption-ridden. “As is evident, it is not possible to build up good infrastructure in a short period, especially when you are confronting a pandemic of this scale,” said Dr. Verma. He went on to add that the public health machinery in the State was also corruption-ridden. “We have been getting reports that several private hospitals in different parts of the state have been supplying fake COVID-19 negative reports to people for a price,” he said.

Sunita Sahyog, a member of the Sahyog and Health Watch Forum based in Lucknow, told NewsClick: "Our work is mainly in rural areas of Uttar Pradesh. According to what I see on the ground that all the markets have opened and at some places in big cities, people are not following the guidelines issued by the Centre to contain the spread of the virus. They are not wearing masks and are flouting social distancing norms. The key reason behind spike in cases in rural areas is that people from other cities are commuting easily and there are no quarantine facilities like earlier; people who feel COVID-like symptoms are not discussing it with anyone as villagers start boycotting them," Suniya said, adding that front-line workers in rural areas were risking their lives and working without proper security gear.

She said that all primary schools in rural areas, which were turned into quarantine centres, are now open without being sanitised. “Isn't it negligence on the part of the authority. If the virus spreads from a primary school, who will be responsible?" asked Sunita.

Areas with new cases of the infection are Gorakhpur, Varanasi and Prayagraj. Dr. Mridul Singh, district in-charge of contact tracing said: “The number of COVID-19 cases in rural areas of the district has showing an increasing trend. The number of new cases till date has almost equalled the corresponding number from June," she added. When asked why the virus is spreading to rural areas, Singh said that the “virus needs a new body” and that the movement of people due to easing of restrictions after the lockdown helped it.