Crowded villages show why coronavirus cases are surging in rural India

A health worker interacts with a resident in the Dharavi slum area in Mumbai, on Aug 7, 2020. PHOTO: AFP

NEW DELHI (BLOOMBERG) - As India passes the grim milestone of two million virus cases and new hot spots emerge in villages, experts are worried that infections will now rise exponentially in the world's second-most populous country, overwhelming its underprepared hinterland.

In the remote Valad village in the southern state of Kerala, 236 people have been found positive in the last two weeks. In Katapali village in eastern Odisha, nearly 200 people were infected and the area locked down for almost 50 days before the outbreak was controlled.

It's still early days for Katapali, where hundreds more risk becoming infected. Many villagers who were mostly asymptomatic were afraid to be tested over concerns that they'd be forced to leave their families to be quarantined in the local Covid-19 care centre.

Living in a strictly-policed containment zone for more than six weeks meant that their fields were neglected and many could not venture out to find work. Although restrictions have lifted in most areas, money remains tight.

The authorities struggled to check the spread of virus in the village, with its overcrowded houses in narrow lanes, said Mr Jyoti Ranjan Pradhan, the main administrative officer of the Bargarh district, where the village is located.

"This village has the characteristics of an urban slum", where it is a challenge to provide support to citizens, Mr Pradhan said.

The disease is now widespread outside metropolitan areas, said Professor Bhramar Mukherjee from the School of Public Health at the University of Michigan.

"We need commitment and collective sacrifice from people of rural India to keep contact diaries, symptom diaries, and to not feel stigmatised if they test positive or have symptoms, so that the disease does not infest villages like an enemy in the dark."

A Ministry of Health spokesman was not immediately available for comment.

Emerging rural hot spots, where healthcare infrastructure is fragile and living conditions are already difficult, pose a challenge to the government of Prime Minister Narendra Modi as it attempts to rein in infections and kick-start the country's ailing economy.

The epidemic in India is now one of the world's fastest growing, with more than 50,000 new cases added each day. It trails only the US and Brazil in the total number of confirmed infections.

The virus has spread to about 711 of 739 districts, including 100 of the country's poorest rural areas.

"Even if people need hospitalisation, they are unlikely to be able to reach a Covid facility in time," said Dr Ramanan Laxminarayan, director of the Centre for Disease Dynamics, Economics & Policy, which has offices in Washington and New Delhi. "It is going to be a tough few months ahead but there is effectively no brake on the virus and I don't expect a decline for quite some time."

Several districts in nine major states - Bihar, Madhya Pradesh, Telangana, Jharkhand, Uttar Pradesh, Maharashtra, West Bengal, Odisha and Gujarat - all of which have sizable rural populations, are highly vulnerable to new infections, according to a Lancet study.

And this vulnerability extends beyond infections to their socio-economic conditions and the ability of the local health system to handle the challenge of surging infections.

"Under-testing may be an even more serious problem in rural areas due to lack of sufficient testing infrastructure," said Mr Rijo M. John, a Kerala-based economist and public health policy analyst who consults for the World Health Organisation. "The increasing presence of undetected cases can potentially lead to superspreader events, which, in turn, can have devastating consequences."

He expects India to report as many as three million infections by the end of the month.

Rural Indians could draw some hope from the success story of Dharavi, Asia's most crowded slum, said Prof Mukherjee.

Located in country's financial capital of Mumbai, citizens and the public health task force worked together to contain the pandemic. Still, she warnsthat the worst is yet to come.

"This is a long and painful crisis till we have a vaccine," said Prof Mukherjee. "I know we are all tired but we cannot surrender."

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