Rural COVID-19 caseload spurt is a big healthcare challenge

By Express News Service

If metros and big cities bore the brunt of the first wave of Covid-19 last year, the second wave seems to be choking rural India in a way not seen before. According to a recent SBI report, the share of rural districts in new cases has been steadily increasing – from 36.8% in March to 45.5% in April and 48.5% in May. Alarmingly, the fatality rate in interior regions is also high owing to lack of easy access to medical care, shortage of life-saving drugs, and lack of awareness, among other reasons. 

In Punjab, for example, 46% of the active coronavirus cases are from rural areas. Data show that interior regions account for 55% of the overall Covid deaths in the state. During May 1-15, as many as 55,411 cases were reported from Punjab’s 16 rural districts while the total infections in the state were 1,20,723. Out of 2,618 deaths in Punjab during the period, 1,434 were from rural areas. 

Likewise, 43% of Haryana’s Covid cases were from rural areas in the first two weeks of May. Also, 62% of the Covid deaths were from the 15 predominantly rural districts of the state. During May 1-15, as many as 84,242 cases were reported from these districts, while the total cases across the state stood at 1,97,334. In terms of deaths, the figure is 1,456 from rural areas out of the state’s total of 2,330. 

Bihar has a peculiar problem. Nearly 89% of the state’s 13.12 crore population live in its 45,103 villages. In the second Covid wave, 76% of the total cases in the state are from rural areas. According to sources, at least 50% of the population in remote districts like Jamui, Aurangabad, Muzaffarpur, etc could be infected. “The actual degree of rural spread could be much higher, as access and willingness for testing is limited,” said Dr Vikash R Keshri, a health policy expert.

Covid-19 is surging ahead in rural Bengal, too, with health department officials conceding that the situation in at least 18 districts is grim. For example, West Midnapore recorded 268 cases on May 1. The count went up to 653 on May 7 and 829 on May 15. Similarly, 74 new cases were recorded on May 1 in Jhargram. It jumped to 124 on May 8 and to 178 on May 15. 

In Andhra, while rural areas have been reporting more Covid-19 cases than urban regions, interior areas seem to have a slightly lesser fatality rate. According to data for April, the case load was higher in rural areas compared to urban. Of the 1.46 lakh cases reported, 56% of them, accounting for 81,365 cases, were in rural areas while the urban areas accounted for 44%. Explaining the reason, Principal Secretary (Health) Anil Kumar Singhal said the enforcement of partial curfew or restrictions would be more effective in urban areas and cities but not so in hinterlands. 

Rural areas of Telangana resisting Covid tests

In Telangana, the highest caseload in the last one month was reported from Greater Hyderabad Municipal Corporation, Rangareddy, and Medchal districts. These three districts, with infections over 10,000 each, have the highest urban population in the state. However, the situation in districts with tier-2 cities and small towns remained a matter of concern. “There is staunch resistance to even get a Covid-19 test done due to stigma and fear of eventuality,” said Sreeharsha Thanneru of Rythu Swarajya Vedika, which is working extensively to provide relief to rural pockets of the state.

He observed that in many villages and small towns the vaccine acceptance was also poor. In Karnataka, while Bengaluru and other urban centres are showing some signs of improvement in Covid-19 situation, rural areas continue to suffer. Although there is no shocking increase in the number of fresh cases yet in the rural areas, experts say inter-district travellers moving to their native places in the rural areas may be carrying the infection and spreading it there.

In Kerala, where the rural-urban divide is not so well defined, the Covid-19 spread has been more or less uniform across the state with areas with higher population density reporting higher number of cases. “In Kerala, cities where most people reside like Ernakulam, Kozhikode and Thiruvananthapuram have more Covid cases as compared to the interior parts of the districts,” said Dr Praveen G S, an epidemiologist. According to Rijo M John, a health economist, the state has a good network of primary health centres across the rural areas, which has been doing testing and providing primary care to Covid patients. The infection spread in rural Odisha is fast and furious.

Hundreds of miles away from the urban localities, the virus has reached the particularly vulnerable tribal groups – Bondas and Dongria Kondhs who were relatively untouched in the first wave. Health department sources said overall 58% Covid infections in the state are from the rural hinterlands. In Madhya Pradesh, the situation in some rural districts especially those bordering Uttar Pradesh is alarming with daily spike staying in three digits.

In Chhattisgarh, on any given day in May, the number of new cases in urban regions was less than half of what was reported from rural areas. On May 1, rural positive cases were 10,204 while urban areas reported 5,695. On May 15, the figure decreased to 5,506 in rural and 2,158 in urban zones.