India has overtaken Brazil to become the second country in the world, after the United States of America, with the most infections of the novel coronavirus disease (COVID-19). The total number of COVID-19 positive cases in the country, as of September 11, has surged to 4,562,414 with 943,480 active cases and 76,271 deaths. Meanwhile, All India Institute of Medical Sciences (AIIMS) director Randeep Guleria has confirmed the presence of the second wave of COVID-19 infections in certain parts of the country.
In a news interview, Guleria predicted a rise in such cases and hoped for some stability in the infection numbers by 2021. Speaking about why the pandemic showed no signs of abating, Guleria admitted that it had spread across the country and to small towns and rural areas. However, he clarified that because “our population is high, even though we have more cases, there are less cases than average per 10 lakh cases”.
Increased testing
Elaborating on the second wave of COVID-19 in many states, Guleria attributed it to several reasons, the first being the rapid increase in testing capacity. More than a million tests are conducted every day in India, and areas with increased testing show more cases.
A total of 96,551 COVID-19 cases were reported in the country on a single day, September 11. The numbers have hovered above 75,000 a day for a week now. COVID-19 cases are the highest in the US with 6,304,181 cases, nearly two million more than India. Brazil has 4,197,889 cases as of September 10.
The Indian government claims the number of COVID-19 recoveries has been satisfactory. So far, the number of recovered patients is nearing 3.3 million. The recovery rate is pegged at 77.44 per cent, while the fatality rate has dropped to 1.68 per cent.
The threat to rural India
A recent report of the State Bank of India’s (SBI) economic research department confirmed that the country’s economy had received a severe blow due to the COVID-19 lockdown, but also pointed out that cases in rural India were rapidly rising and this would have an adverse effect on the rural economy. The setback, if it happened, would deeply upset the country’s economic recovery, it feared.
According to the SBI report, 26 rural districts of Andhra Pradesh, Uttar Pradesh, Maharashtra and Karnataka had witnessed rampant spread of COVID-19 in August 2020 and continued to reel badly under its onslaught.
Of the active cases, more than 60 per cent were in Maharashtra, Andhra Pradesh, Karnataka, Uttar Pradesh and Tamil Nadu. Similarly, 70 per cent of the total deaths due to COVID-19 were from Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu and Delhi.
Lack of health facilities in rural India
As per the Census 2011, about 69 per cent of the population of the country lived in rural areas but the condition of health facilities in rural India was far from satisfactory. The status of India’s rural health services can be better understood with the Government of India’s report National Health Profile 2019.
As per this report, there are 21,403 government hospitals (primary, community and sub-district/block) in rural India with a total capacity of 265,275 beds. Contrast this to the 4,375 city hospitals equipped with 448,711 beds. There may be a bed for every 1,700 patients in the country, but in rural India that figure is one bed for 3,100 patients.
In fact, a report based on the National Health Profile 2019, found that rural government hospitals would run out of beds even if just 0.03 per cent of the rural population was infected by the virus.
Bihar fares the poorest among states as per the 2011 Census — with a total population of 100 million, rural Bihar had 1,032 hospitals offering a mere 5,510 beds. This translates into one bed for about 18,000 villagers.
In Uttar Pradesh, the largest state in the country, 77 per cent of the population (more than 150 million) is rural, and they have access to 4,442 hospitals and 39,104 beds. This means there is one bed for about 3,900 people. Tamil Nadu fares the best on this count with a total of 40,179 beds and 690 government hospitals in rural areas. This means that there is one bed for every 800 people.
The availability of doctors is also a major challenge in rural India. As per The National Health Profile 2019, there is only one allopathic doctor for a population of 10,926 in rural areas, as opposed to the World Health Organization (WHO) stipulating one doctor for every 1,000 people. Overall, India has about seven doctors for 10,000 people, or one every 1,428 people.
In comparison, China has more than 17 doctors per 10,000 people, the United States of America more than 25 and Italy about 37 doctors per 10,000 people.
In terms of availability of doctors, the situation in West Bengal is the worst among all Indian states. According to the National Health Profile 2019 report, there are a total of 881 doctors in rural areas of West Bengal for a rural population of 62 million. This means there is just one doctor for about 70,000 people. The condition of Jharkhand and Bihar is also deplorable with only one doctor for 50,000 rural people.
In such a situation, a second COVID-19 wave that spreads to rural India could prove to be a crisis hard to recover from. Lack of beds and hospitals and lesser number of doctors could prove a deadly cocktail at a time when every resource has to be at peak readiness to fight COVID-19.
