Covid quietly ravages rural UP

On the day in late April, when Hindustan Times managed to reach Sanawar Chauhan, 45, over phone, the resident of Khardauni village in Uttar Pradesh’s Meerut district is in the village graveyard, helping oversee the burial of a man he identifies as Sharafat, a 55-year old who died that very morning.

Sharafat, Chauhan claims, was exhibiting Covid-like symptoms. But no one can say for sure whether he had the coronavirus disease. Testing is rare in many of these villages, even in large ones such as Khardauni — it has a population in excess of 10,000. Every day, for the past week, two or three people in the village have died, he said; most complained of fever and breathlessness. But their numbers are not among those recorded by the state — either as cases, or deaths.

Villagers claim to have informed the only frontline health workers with whom they are in touch — the local ANM (auxiliary nurse midwife) and ASHA (accredited social health activist) worker. ASHA workers who played a pivotal role in screening and providing medical services to the people residing in rural areas during the first wave of Covid have been deployed by the state this time too, especially to screen migrant workers returning home from various states, largely to vote in the local polls. A majority of the state’s 154,000 Asha workers complain of poor or no protective gear (but that’s another story).

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Almost 40 km away from Khardauni, in Tatarpur village in Hapur district, at least seven people died in the last week of April. A villager, Manoj Kumar, claimed that at least four of them tested Covid positive. The village has a population of over 7,000 and Kumar said many were suffering from fever. He said the situation is turning grim in the villages without proper treatment and testing.

Chauhan and Kumar’s experience suggests that the virus is stalking rural areas — a worrying detail in a state with a population of 230 million, and where almost three in every four people live in villages.

Jagdish Singh, the pradhan (head) of Chabaria village in Meerut district, is convinced the coronavirus has spread in the state’s villages. Most villages, he added, still have a casual approach towards fever. “Therefore, the infection becomes severe in few days without adequate diagnosis and treatment.”

And when people die, he said, their deaths find no place in government records because they are cremated at farms in the villages.

And that’s possibly the only time residents show fear of the disease.

On April 28, Rajwanta, 55, wife of the late Ram Sharan of Ugapur village of Kunda in Pratapgarh, died. She lived alone. No one wanted to dispose the body. Hours later, residents of the village used an earthmover to dig a pit in front of the house and dumped her body in it. The video of the incident has since gone viral on social media platforms.

“Fearing that her death was because of the pandemic, the neighbours were also not ready to lend their shoulders to her body. In front of her house, a hole was dug using a JCB machine and the body wrapped in a piece of cloth was hurriedly thrown into the pit from above and covered,” said Akash Singh, the son of the village chief. He added that the bodies of two other men, one 35, another 32, who died after contracting fever, were cremated as hurriedly, and without any last rites being performed.

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The district official, Tehsildar, of Kaunda, Ramjanam Yadav confirmed the incident and dubbed it extremely unfortunate and inhuman. “Fear of Covid-19 is so set in the minds of the locals that they are even reluctant to ensure proper last rites for the dead,” he said.

Patchy Covid testing in western UP villages

West UP is considered more prosperous than the eastern part of the state. The region has better medical facilities. But like the rest of UP, testing there has been patchy. Most people get infected, fall ill, and some even die — all without being tested.

At least 10 people died in the Sadharanpur Khurd village of Inchauli area in Meerut district since April 25. Their family members claimed they died after consuming liquor distributed by two candidates in the panchayat elections. But superintendent of police (rural) Keshav Mishra, claimed that many exhibited Covid-like symptoms.

Chief medical officer (Meerut) Dr Akhilesh Mohan said instructions have been given to health staff to conduct tests in the villages if they come across reports of “corona- like symptoms”. But the villages are safe, he stressed. “I have not received any specific report of Covid-19 spread in the villages.”

That’s a common view among health officials. Chief medical officer (Pratapgarh) Dr Arvind Srivastava said free of cost Covid-19 testing facilities, as well as vaccination, were available at all 17 community health centres (CHCs) and three primary health centres (PHC) located in the rural areas of the district. “We also have surveillance teams that are active in the rural areas to detect Covid cases on a day- to-day basis,” he added. The CMO said that a CHC is located just one kilometre from where the woman was allegedly buried in a grave outside her house at Pratapgarh’s Ugapur village

Additional chief medical officer (Varanasi) Dr SS Kanaujia said, “Five teams were deployed for tracking and testing in Ramna village that comes under the Kashi Vidhyapeeth block. In addition, a team each has been deployed for tracking and Covid-19 testing in the villages that are part of seven developmental blocks in Varanasi district.”

Yet, villagers have a different story to tell. “In the village, they were not tested for Covid-19”, said Amit Patel, husband of Arti Patel, the head of Ramna village in Varanasi. And there is no ambulance to transport to the patients to the district headquarters, he added.

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Some experts agree that there been far less testing than required. The medical lab at Lala Lajpat Rai Memorial Medical College in Meerut, for instance, currently tests 7,000 to 8,000 samples from Meerut, Baghpat, Bulandshahr and Shamli, not adequate for a region with a population of 7-8 million. The experts add that people are still scared of getting elderly family members tested because they don’t want them to undergo the ordeal of treatment at government hospitals.

Dr Ankur Tyagi is in-charge of the community health centre (CHC) in Hastinapur, which serves 91 villages. He has no hesitation in admitting that the virus has penetrated the villages. Dr Tyagi explained that if 100 people test positive in an urban CHC (community health centre) then 20 to 50 are testing positive in rural CHCs.

What led to the surge

Most experts believe the triggering factors were panchayat polls, the marriage season, the return of migrants and ongoing harvests.

Dr Kausar Usman, head of the department of geriatric medicine at King George’s Medical University (KGMU), said elections in the villages made voters travel back home from faraway places, often carrying the virus with them. “During the first wave, we could quickly identify new cases and isolate them as there was lockdown and hence movement was restricted”.

Dr Rajendra Tyagi at Rehdra village in Meerut district agrees that the panchayat elections were responsible for some of the spread of Covid-19 in the villages. He also said that many ill persons were sent to polling centres for performing their duties, and ended up infecting others. Tyagi claimed that comprehensive testing could reveal the truth of Covid-19 in the villages. Now, added Dr Samir Mishra, senior faculty, trauma surgery at KGMU, it’s too late to worry about that: “It’s time to focus on treatment in rural areas as the infection has spread. The need is to make oxygen and medicines, particularly steroids, available at primary and community health centres so that those having symptoms can be tested and treated immediately.”

Then, there is connectivity.

Dr Tanuraj Sirohi, former president of the district unit of IMA in Meerut, believes that districts of western UP are well connected with metro cities such as Mumbai and Delhi as people frequently travel to them for work. Any outbreak in these cities affects the districts of western UP, he explained. And both Delhi and Mumbai have been ravaged by the second wave.

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With 1,273,035 and 668,085 confirmed cases of Covid-19, and 18,398 and 13,580 deaths due to the disease till Thursday, Delhi and Mumbai are among the worst hit cities in India. Less than two weeks ago, Delhi was reporting an average of 25,294 new cases every day, the highest rate for any city ever recorded in the country. In Mumbai, the average rate of daily cases touched a high of 9,862 for the week ending April 10.

Dr Sirohi added that deploying teachers on election duty was the wrong decision. The state teachers union has claimed around 700 government teaching staff died on account of this, a claim refuted by state education minister Satish Chand Dwivedi.

The fact that April is the traditional harvest season for the winter crop did not help. Wheat procurement began from April 1. Besides harvesting, people are busy managing transportation of the crop to procurement centres. There are 6,000 procurement centres where 11.31 lakh metric tonnes of what has been procured. The government claimed in a statement that there are strict instructions for following Covid-19 protocols in the centres .

Then there were returning migrant workers

Like Suraj Yadav, 38, who left his village Deogaon in Azamgarh district in east Uttar Pradesh for Mumbai in October last year after the decline in the Covid-19 cases and the relaxation in the nationwide lockdown announced by the central government a few mothers earlier.

On April 21, when the Maharashtra government announced strict curbs to fight the surge in Covid cases, Yadav returned home. On April 25, he complained of fever and breathing problem. His family members gave him a drug prescribed by the local doctor. Nevertheless, his condition deteriorated and he died. The family members cremated him in a field on the outskirts of the village.

“The villagers go to quacks in the rural areas for treatment. Only when their condition deteriorates, are they are rushed to hospitals,” said a state health department officer who did not wish to be named.

“Along with the migrants, a large number of pilgrims who visited the Haridwar Kumbh also returned home and several of the pilgrims tested positive,” he added.

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Additional chief secretary (health and family welfare) Amit Mohan Prasad said the state government has ordered the migrant workers returning to Uttar Pradesh to remain in quarantine facilities in various districts. The migrants who are asymptomatic will have to stay in home quarantine for 14 days. Village-level surveillance committees have been activated to monitor the health condition of the migrants in the villages, he said.

Gorakhpur district magistrate K Vijyendra Pandian said a large number of migrants returned home during Holi (late March) and stayed back after the festival. After announcement of lockdowns by Maharashtra, Delhi and other states, several other migrants started returning home.

Together, these factors have contributed to a rise in numbers.

In East UP, Gorakhpur reported 257 active cases on April 1 and 9473 active cases on April 28. Ballia reported 107 active cases on April 1 and 4,072 on April 28. Jaunpur reported 85 active cases on April 1 and 5,012 on April 28. Chandauli reported 68 active cases on April 1 and 3,572 active cases on April 25. The other districts in eastern UP — Deoria, Azamgarh, Maharajganj, Kushinagar, Siddharth Nagar, Basti, Sant Kabir Nagar and Ghazipur — also witnessed a big surge in Covid-19 cases within 28 days.

But beyond the numbers, are the tragedies. Stories such as those of Surendra Singh Gaur, AGE, a prominent traders’ leader of Hardoi, died in Lucknow on the night of April 29.

The only cremation site that the Hardoi Nagar Palika runs in Hardoi town was handling 25 bodies on average each day in late April.

“To my knowledge, hardly two or three bodies were cremated in a week at this site,” said Padam Singh Yadav, former district president of the Samajwadi Party.

Three ghats in Kannauj are also seeing a massive surge in cremations, about 60 a day in late April, up from eight to 10 a week previously.

Since the cremation sites in Hardoi and nearby Kannauj, where most of cremations from Hardoi take place at three ghats close to the Ganga were full, Gaur’s family decided to consign his mortal remains to flames at a field in his village Jogipur.