Coronavirus started gradually expanding to rural areas soon after India declared the presence of covid-19 in the country in January. The situation has been exacerbated with the reverse migration and a shortfall of healthcare services and doctors in the rural areas.
“They may be carrying corona virus infection inside your nose and throat and they may increase the spread they have travelled through heavily crowded buses, trains or vehicles," said Dr. Jugal Kishore, professor and head in the department of community medicine at Vardhman Mahavir Medical College and Safdarjung hospital.
According to the World Health Organization (WHO), a person infected with corona virus infection does not show any sign or symptom for first two to 14 days after getting infected by corona virus during its incubation period.
“Migrant workers are a link between the rural and the urban India. We have dealt with migrant workers in HIV and polio control programmes. But Covid-19 is different. One option is to screen them when they deboard, and isolate them if they have fever and/or cough," said Lalit Kant, scientist and former head of epidemiology and communicable diseases at the Indian Council of Medical Research (ICMR).
The situation assumes importance given that migrants comprise 48% of residents in India’s six largest metros of Delhi, Mumbai, Kolkata, Chennai, Hyderabad and Bengaluru in 2011, according to the national census.
Concerned over any fallout, the government has been trying to put in place door to door surveillance and mapping the path of all confirmed patients in rural areas.
“During outbreak of a communicable disease or social distancing measures as being undertaken for COVID-19 Pandemic, such populations tend to return back to their homes. In such a scenario, the resultant congregations of migrant workers in bus stations/State borders may make them susceptible to COVID-19 infection. Further such exposed individuals may later become infected and carry this infection to far flung rural localities. Also it would be difficult to track them and their contacts," the union health ministry said in its advisory.
The infected migrants will also put the elderly to risk which may prove difficult to handle.
“Rural populations are relatively older, making them more at risk for falling seriously ill from Covid-19. As they live much further from hospitals than their urban or suburban counterparts, and more of them list access to good doctors as a major community problem," added Himanshu Sikka, chief strategy and diversification officer, health, nutrition and wash, IPE Global, an international health consultancy.
This comes in the backdrop of a shortfall of primary health centres (PHCs) and community health centres by 22% and 30% across India, with the highest shortfall in West Bengal, Uttar Pradesh, Bihar, Jharkhand, Rajasthan and Madhya Pradesh.
“The major areas where enhanced deployment of human resources is required are surveillance activities at grass root level, supervisory management of containment operations, laboratory testing, collection, collation and dissemination of data, risk communication and clinical management," said Arun Singhal, special secretary, union health ministry.
At least 60% of PHCs in India have only one doctor while about 5% have none, according to the Economic Survey 2018-19. More than 10% PHCs in Jharkhand and 20% in Chhattisgarh don’t have any doctors. More than 90% PHCs in Gujarat have only one doctor. The situation is the same in 80% of PHCs in Kerala and Karnataka, and 70% of those in Rajasthan, Uttar Pradesh and Bihar.
Public health experts have said that the containment plan for the rural areas should be robust.
“Normally there is a group of persons from the same village which go to same urban area for employment. So, when these group of people return to their village, people get to know. The peripheral worker at the village level should inform their health counterparts about their arrival. Screening for fever and cough be arranged. And those having symptoms be isolated in Panchyat Ghar. Alternatively, some kind of mark is made on the house where migrant workers live with their families so that they could be monitored for fever and cough. It is important that we take care of these migrant workers as they are critical in putting our economy to tick again," said Kant.
More than 90% of India’s workforce is estimated to in the informal sector which includes both rural and urban. The Economic Survey 2017-2018 had said that 87% firms, representing 21% of total turnover, are purely informal, outside both the tax and social security nets.