Rural India is the new covid-19 flashpoint amid migrant influx

Rural areas have emerged as the new flashpoint in India’s fight against the virus, despite a government panel cautioning states about the need to strengthen health systems in villages in anticipation of a surge in caseload.

In a report to the Union health ministry, the government’s Rapid Response Team (RRT) on covid suggested local health authorities focus on rural areas. It was submitted to the health ministry just as an estimated 20-25 million migrants began making their way to villages in trains, buses and on foot.

The now two-month-long lockdown has ruined the livelihoods of millions of migrants, mostly daily wage earners, setting off India’s biggest migration since Independence. Many of them have made that journey—from workplaces in cities to their homes in villages—in packed buses and trains, making a mockery of social distancing norms out of desperation.

The report “strongly recommended a dedicated district epidemiology unit to scrutinize all aspects of occurrence, spread, and source of infection, route of transmissions and identification of susceptible contacts to prevent and contain the spread of the disease", a member of the RRT said on condition of anonymity. The report has been reviewed by Mint.

“As the burden of cases in rural India is increasing, the number of labs in rural areas needs to be enhanced as per existing guidelines. Quarantine facilities in districts should also be enhanced based on projections of expected positive cases," he said.

According to the national census, migrant workers comprised 48% of residents in Delhi, Mumbai, Kolkata, Chennai, Hyderabad and Bengaluru in 2011. Most of them came from Uttar Pradesh, Bihar, Jharkhand and Chhattisgarh.

The Union health ministry on Tuesday said these states have witnessed a surge in cases after an inter-state travel ban was lifted. Health secretary Preeti Sudan told states to assess the available health infrastructure for quarantine centres and strengthen them based on needs over the next two months.

In Rajasthan, 2,045 migrants have tested positive since 1 May and 60% of new cases are migrants, according to the state’s additional chief secretary (medical and health) Rohit Kumar Singh.

Bihar is also recording a surge—the number of cases has increased to 2,870, many from rural areas. The new cases have come from Bhojpur (47), Purnia (45), Madhepura(43), Saran (43), West Champaran (42), Sitamarhi (39), Muzaffarpur(38), Arwal (34), Lakhisarai (32), Kishanganj (31) and Jamui (29).

Similarly, the number of rural hotspots are increasing in neighbouring Uttar Pradesh.

“Around 20% of migrants are testing positive, which is a much higher ratio than local residents. We have 46 cases and about 40% are due to migrants. Till 15 May, we had 15 active cases. That is now 40 due to migrants testing positive," said Akash Tomar, senior superintendent of police, Etawah.

In Kerala, almost 85% out of the 445 active covid-19 patients are those that returned from other states. Kerala chief minister Pinarayi Vijayan said rising infections after the state succeeded in flattening the curve is the result of resumption of inter-state travel.

“Most cases being recorded in Karnataka are also persons who have come from other states," said S.Suresh Kumar, Karnataka’s primary and secondary education minister.

“Estimates show 20-25 million migrants are moving from urban to rural areas. India has 120 confirmed cases per million of its population. If we were to apply the same ratio, only 3,000 of migrants should be infected," said Himanshu Sikka, lead-health, nutrition and wash, IPE Global, a healthcare development consulting firm.

Nidheesh M.K. and Sharan Poovanna contributed to this story.