India’s Covid-19 Outbreak Spreads By way of Rural Areas

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India's Covid-19 Outbreak Spreads Through Rural Areas

MASLI, India – A team of health workers wearing masks and fresh disinfectant slipped out of the rickshaw and approached one of the muddy houses in Masli, a remote village in northeastern India surrounded by miles of mountainous rainforests.

"Are you Amit Deb?" they asked a slim, shirtless man who was standing in his garden. Mr. Deb nodded cautiously. He had tested positive for the coronavirus five days earlier. Now his family members had to be tested.

They all refused.

"We can't afford to quarantine," explained Deb, a shop owner. If anyone in their family were found positive, everyone would be ordered to stay inside, which would mean there would be more weeks of no work, which would bring the family closer to food leakage.

The medical team moved on to the next house. But they met more and more rejections.

The coronavirus rule violation is mirrored in rural India, driving that nation's viral load to number one in the world. Every corner of this country has infections with 1.3 billion people. The Indian news media call it "The Rural Surge".

In the Indian megacities where the pandemic first emerged, fierce public awareness campaigns have largely kept the population on the alert. But when it comes to government efforts to contain the virus, rural India is resisting.

In many villages nobody wears masks. There is no social distancing. People refuse to be tested and hide their sick people.

Hospitals are tense; In the coronavirus department of a hospital here in Tripura state, insects had to crawl over corpses according to photos taken by a former government official.

In recent trips to more than a dozen rural areas spanning multiple states, from Tamil Nadu in the south to West Bengal in the Far East to Tripura, Bihar and Uttar Pradesh in the north, the response to the pandemic seemed completely different from the big cities like Delhi and Mumbai.

In rural areas, many people behave as if there was no coronavirus. Even many police officers who are authorized to enforce the pandemic rules do not wear masks.

This intransigence has helped India catch up with the United States on overall infections. According to a New York Times database, US cases are nearly 7.6 million compared to 6.8 million in India. But India is surpassing about 30,000 new American cases every day, making it on track to possibly outperform the United States in the coming weeks.

Many people in Indian villages believe their government overestimates the severity of the pandemic and shows no sensitivity to the economic hardship they are suffering from.

Government officials have tried to reassure them that they contain the virus while trying to strike the best possible balance between protecting lives and livelihoods.

Officials say India's case numbers are rising because nearly a million tests are done every day, five times as many as a few months ago. They also indicate India's relatively low death rate, about an eighth or ninth that of the United States, Spain, Brazil, and the United Kingdom.

Scientists say this is mainly due to India's population being younger and leaner, although they warn that most deaths in India are not being investigated for some reason. And India's deaths are rising steadily, by about 1,000 a day, now it's about 105,000.

Prime Minister Narendra Modi has "spoken on all available platforms, underscoring the need and importance of wearing masks and maintaining physical distancing," said Manisha Verma, a spokeswoman for India's health ministry. The government's focus, she said, has been on behavior change rather than enforcement.

As the coronavirus spreads to rural areas, other parts of India are easing containment restrictions to help the battered economy. This month the central government allows cinemas to open. Schools can reopen soon if state governments agree.

Mr Modi put a four-hour notice on the country this spring to free up time for India to ramp up production of masks and other protective equipment and to open treatment centers. But the heavy lockdown resulted in an exodus of millions of migrant workers who could not afford to stay in urban areas. Their movement to rural communities helped spread the virus to almost all parts of India.

"We're still in the first wave," said Rajib Acharya, a New Delhi-based research fellow with the Population Council, a nonprofit that deals with health and development issues.

"I don't see a new strategy for rural areas," he added.

Rural areas are not well positioned to deal with this. Almost two-thirds of all hospital beds in the country are in urban areas, where only a third of the population lives.

Hospitals across the country are struggling to supply enough oxygen to the increasing numbers of patients. Many people, both in cities and in rural areas, have problems finding beds for sick family members.

"Families in India live in fear, grief, sadness, depression, anxiety and food insecurity and are delaying their care because of other health problems," said Bhramar Mukherjee, an epidemiologist at the University of Michigan. "It's a tragic time."

She attributed the spread of the virus to "habituation, desensitization, fatalism, fatigue, denial".

The remote northeastern state of Tripura, heavily forested and largely rural, is a case study of the spread of the virus. Before mid-June, the state had reported fewer than 1,000 infections of around four million people. Now, according to state data, there are 27,545. Many experts believe that this is a fraction of the real number. The state's death rate is also rising steadily from its first reported death in June to more than 300 deaths now.

In the small towns and villages of Tripura, many people are afraid of being tested because of the social stigma. Neighbors yell at people who are believed to be positive for staying inside and not even looking out the window.

While walking through a neighborhood near Chawmanu where many of the local Tripuri people grow rice, tea and vegetables, the villagers pointed to a small house with a rusty tin roof. One person inside was sick, they said.

Aparna Saha, a woman with penetrating eyes, opened the door. She admitted that her 72-year-old father tested positive and had breathing problems.

But she quickly added in a high-pitched voice, "He's absolutely fine."

Health workers had arrived a few days earlier to take Ms. Saha's father to a coronavirus facility in a neighboring city. Ms. Saha blocked them.

"Who knows what they're going to do to him?" Ms. Saha said. "There is no corona."

Even the families who followed the rules and took their loved ones to hospitals say the experience was terrible.

On a muggy September evening, Rupam Bhattacharyajee collapsed outside Govind Ballabh Pant Hospital, Tripura's only intensive care health facility, in the state capital, Agartala.

Mr. Bhattacharyajee's older father was inside, sprawled on a mattress on the floor – there were no spare beds – fighting for his life.

"I am completely helpless," said Mr. Bhattacharyajee.

A local court is investigating Tripura's pandemic response to news of hospital conditions. A photo, believed to have been recently taken at the hospital's coronavirus care center and shared with the New York Times by Sudip Roy Barman, a former health secretary, showed a body with insects crawling on it.

Debashish Roy, the hospital's medical superintendent, declined to comment.

After Mr. Bhattacharyajee saw the conditions in the hospital, he took his father home. He paid over $ 200 for a private ambulance and made the bumpy six-hour journey in the background. He kept changing oxygen cylinders to keep his father breathing.

Mr. Bhattacharyajee said that his recovering father is fortunate to be alive.

"People die one by one," said Bhattacharyajee. "Nobody cares."

Karan Deep Singh reported from Masli, India, and Jeffrey Gettleman from New Delhi. The reporting was contributed by Hari Kumar, Sameer Yasir and Shalini Venugopal from New Delhi and Mrinal Banik from Agartala, India.

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