BackMass gatherings amid second covid wave pose risk of virus transmission to rural areas
The potential ‘super spreader events’ may ring alarm bells for the government as it will be difficult to contain the possible spread of virus to rural areas that already lack health infrastructure and diagnostics facilities
PremiumNEW DELHI : NEW DELHI: Even as fresh coronavirus infections are touching record highs nearing 2 lakhs a day, mass gatherings ranging from farmer protests, political rallies to religious gatherings like mahkumbh mela, may trigger further spike in total tally of covid-19 cases.
The potential “super spreader events" may ring alarm bells for the government when the health infrastructure in metropolitan cities is already creaking due to pressure of rising covid-19 patients. And, the threat of infection spreading to rural areas comes in the backdrop of a shortfall in healthcare infrastructure.
According to the rural health infrastructure statistics released by the union health ministry on Wednesday, as on 31 March, 2020, there are 155,404 and 2,517 Sub Centres (SC), 24,918 and 5,895 Primary Health Centres (PHCs) and 5,183 and 466 Community Health Centres (CHCs) respectively which are functioning in rural and urban areas of the country.
According to the report, there is shortfall of 6.8% of allopathic doctors at PHC, out of the total requirement at all India level. Overall, there is a shortfall of 76.1% specialists at the CHCs as compared to the requirement for existing CHCs.
The ongoing Mahakumbh mela in Haridwar is attracting about 1-2 million people on a regular day and about 5-6 million people attending the mela on auspicious day (bathing days). The Central government earlier in March warned the Uttarakhand government of a potential surge in covid-19 cases in the local population in Haridwar after the auspicious Shahi Snan days during the ongoing Kumbh Mela. While over 6 lakh people took a holy dip on Wednesday, around 1000 people have already tested positive for covid-19 in Haridwar in last two days.
The union health ministry warned that mass gathering events, such as this, have the potential to facilitate the transmission of the virus and potentially disrupt the gains made by the country in covid-19 management.
“It is very difficult to change behaviour of the people and in mass gatherings one infected person can infect many. In the mass gatherings where the faith is involved such as kumbh mela it is very difficult to avoid spread of disease," said Professor N K Ganguly, president, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) and former Director General of the Indian Council of Medical Research (ICMR).
During the first wave of covid-19 pandemic in the beginning of lockdown in March 2020, large number of migrant labourers left the cities and metropolis that reduced the population in urban areas. Public health experts hold that the migration could be the reason of lesser spike in urban India especially metropolitan cities than in the second wave.
“The spike is higher because the population is also high since the migrants came back during January and February 2021. But this time virus is also more infective and scaping from inherent immunity in certain group of people. This time, it is spreading to all strata of people and age groups. Major reason for transmission to one another is through closure contact and sharing of close space. This is happening in festival celebration, rallies and kumbh," said Dr Jugal Kishore, professor and head, department of community medicine, Safdarjung Hospital who has also been part of the government’s covid-19 task force.
Kishore notes that the current congregations and hastened human activities are also due to vaccine euphoria believing that they have some solution they can go back to normal. “All commercial activities started and labor came back to major cities like Mumbai, Pune, Indore, Ahmadabad, Chandigarh, etc. Partial lockdown in some cities is repeating same scenario of last year when labor started flocking back to their rural homes," said Kishore.
“This time infective virus will reach to rural areas with all those who have congregated in rallies and kumbh and come in contact to infected person. It is difficult to stop the transmission in rural areas now. Vaccine is not going to stop transmission even if it is given to all those who are going back to their homes," he maintained.
The threat of infection spreading to rural areas 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. 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.
There have been continues rallies in poll bound state of West Bengal attracting huge crowds. April 29h will see the last phase of polling in the state. Similarly states like Madhya Pradesh and Rajasthan are having by elections seeing huge gatherings. Local body elections in Uttar Pradesh too seeing major crowds along with the farmers protests.
Urban India may face shortage of further health infrastructure shortage. The health ministry data also showed as on 31 March 2020, there are a total of 5,895 Urban-PHCs functional in India and there is a shortfall of 38.2% of U-PHCs as per the urban population norms. At U-PHC level shortfall has been observed in all the posts. There is a shortfall of 46.4% auxiliary nurse midwife (ANMs) at PHCs. There is a shortfall of 11.1% of doctors, 30.4% of pharmacists, 32.3% of lab technicians and 13.3% of staff nurses at U-PHCs.
Similarly, there is shortfall of 37.4% of total specialist, 13.5% of general duty medical officers (GDMOs), 41.8% of radiographers, 9.9% of pharmacists, 7.5% of lab technicians and 9.5% of staff nurses at U-CHCs.
“The current situation will require the strategic use of every tried and tested intervention, since no single action will be effective now. Targeted testing of symptomatic cases, with rigorous contact tracing, isolation and quarantine of household members and close contacts, need to be followed- an apparently higher infectivity, is resulting in higher number of household members getting infected," said Dr Preeti Kumar-vice president-Health Systems, Public Health Foundation of India.
“Scaling up vaccination, stepping up the communication strategy especially for younger people who need to be told that they are equally vulnerable. Only a rigorous universal masking up by everyone in public spaces may help," she said.
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