We can’t afford to overlook the pandemic misery of rural India

This week, I am in one of the larger states of the country. Last week, I was in a mid-sized one, and next week I will be in another. I am travelling to these states because we have on-the-ground operations there. Our own and those of partners whom we support financially. In the past 12 months, both these kinds of operations have been the bulwark for our efforts to help tackle the pandemic and its affects.

In the state that I was in last week, I went to multiple villages across three districts, as well to block towns, district headquarters and the state capital. I met village communities, panchayat leaders, self-help-group members, Anganwadi workers, Accredited Social Health Activists (ASHAs), doctors from the public and private health systems, including key health officials like medical directors of hospitals and the civil surgeon, collectors of districts, and the state-level administrative leadership, including the mission director for public health, principal secretary, and the Chief Minister.

In short, I met enough people to get a first-hand sense of the escalating pandemic, and the efforts underway to tackle it. I will share a few vignettes.

In every village we asked a few simple questions. How many people have fever, cough, cold, body ache? Usually in this season, last year, the year before last and before, how many people would have these symptoms? How many have died in the past two weeks in your village and nearby villages, and do you know why? We did not make any reference to covid. Given the tsunami-like the second wave, the state’s capacity for covid testing has been overwhelmed, much like other parts of the country. So, there is little testing at the district headquarters and none in the villages.

The response to the second question was the same across villages: This is not the season for fever, cough, cold, etc., we have rarely had it before. The answer to the first question varied markedly. In one district, about 200km from the state capital, these symptoms were rare. There hadn’t been any noticeable number of deaths either in those parts. In the other districts, a few villages had no one with these symptoms, but many more had. Here are a few examples: 19 of a village of 565 people, 53 of 500, 70 of 400, and in one case, every second house of a population of 700. In these villages and around, there had been deaths in the previous two weeks. Many gasping for breath.

One of the district collectors has moved from his residence to the Circuit House. He has been working 20 hours every day for the past few weeks, exposed continually to the virus. He wants to protect his family. The districts’ only hospital with oxygen-supported beds, arranged over the past few months to prepare for later surges, has a capacity of 40. He has requisitioned the only decent private hospital in that town, taking over its nine beds with oxygen. He is working with the hospital to augment it to 30. None of these is an ICU bed, though the beds are supported with oxygen masks. All this capacity is already overwhelmed. Patients are lying in the corridors. His worst nightmare is unfolding, as the virus rages through the villages and people die without even being counted. He is focused on containing this inferno, by mobilizing the village communities for pre-emptive isolation on the basis of symptoms. He was unhesitant in saying that the actual death count from covid must be 4-5 times the reported number. Just that deaths were not being reported to the system; and that is unsurprising, at a time when people are dying without even the first level of medical support. He is quite clear: “If we have to save lives, we have to do everything we can, but not recognizing the current constraints of capacity will only lead to actions that will lose more lives.”

The mission director in the state capital was juggling three phones and five different sets of people, all together, with patience and good humour. He works no less than the collectors. It was clear from the village visits itself that he and his office are doing everything they can. The affable Chief Minister had many things to say, the most important of which was, “Who will suffer if we hide things? Our people. So, we tell the truth.” I know that he is speaking the truth.

While our cities are already under siege, the virus is spreading through our villages. This is so across the country. If we will not get to know this, it is because there is little or no testing, and woeful capturing of death numbers and their cause. Worse, there is hardly any systematic way of handling the infected in villages, in most states. Cities will somehow return to relative normalcy in a few months, but we will have an invisible pandemic continuing to rip through the lives of our most vulnerable. Covid will continue to rage, and people will keep dying, and we will ignore all this. Because the numbers won’t and don’t reflect reality.

The state I was in is bracing for a peak in June and an inevitable third wave, trying its best with limited resources, including a systematic protocol for pre-emptive isolation at the village-panchayat level and oxygen concentrators at all primary healthcare centres. It is able to do this because administrators are leveraging their most important resource: The courage to confront and tell the truth. Unlike so many others.

Anurag Behar is CEO of Azim Premji Foundation.