What is really alarming though is that UP is not the only state that risks a devastating rural spread and consequent overwhelmed healthcare.
While a May 16 release of the Union health ministry, on a containment strategy for peri-urban, rural and tribal areas, talks about the need to prepare the public health system for the “gradual ingress” of Covid-19 to these areas, the fact is the share of rural areas in the country’s daily new cases is already over a fifth, having risen from close to a tenth in February-March, as a Business Standard analysis shows.
Indeed, a Bloomberg ground report from a village in Uttar Pradesh shows how the second wave is already ravaging villages but has managed to escape attention with deaths and shortages of key Covid care elements in major cities dominating the headlines. Against such a backdrop, it is hardly surprising the Allahabad High Court observed the “entire medical system” in the state “pertaining to smaller cities and villages” in the state was “Ram bharose” (at the mercy of God).
This, despite the state government having insisted UP is ready to take on a third wave and that the Covid-19 situation in the state is under control. While the Kumbh and recently-concluded panchayat polls are likely to have pushed up the rural-spread in the state, with migrants seeking to return to their villages—UP accounts for a large chunk of the migrant population—the situation could worsen.
What is really alarming though is that UP is not the only state that risks a devastating rural spread and consequent overwhelmed healthcare. The Rural Health Statistics 2019-2020 shows serious gaps in rural public healthcare across the country—of both personnel and infrastructure—with the problem less acute in the southern states. To be sure, healthcare facilities should have improved over the last year with it becoming a focal point for policy, but the states have had limited spending capacity and so the gaps are likely still significant.
Moreover, not much can be expected to get done at the eleventh hour. The Centre, as Dr K Srinath Reddy of the Public Health Foundation of India points out in The Indian Express, will need to relook certain points prescribed to states as the standard operating protocol for containing rural spread.
For instance, the reliance on the Rapid Antigen Test (RAT) for cases labelled suspect by ground-level surveillance could prove problematic, given RAT’s higher rate of false negatives compared to RT-PCR. Dr Reddy recommends increasing reliance on “composite clinical diagnosis” for case management.
Similarly, prescribing “off-label” use of hydroxychloroquine and ivermectin could lead to a false sense of effective management. This needs to be corrected. Other than that, emergency patient transport on stand-by, accelerated vaccine-delivery, etc, need to be put in place. Without a multi-pronged strategy, rural India could see a far more tragic second wave than the cities have.