When the government on March 24 announced a complete lockdown in an attempt to contain the spread of the Covid-19 epidemic, millions of migrant workers were stranded in India’s towns and cities. Tens of thousands of others started walking or cycling hundreds of kilometres to their villages.
Though the lockdown on Friday was extended to May 17, the Ministry of Home Affairs has said that state governments can make necessary arrangements for migrants from their regions to return. However, both state governments and communities fear that the returning migrants could spread infection in rural areas.
In mid-March, the Rajasthan government asked Primary Health Centres around the state to conduct an active surveillance of every household in their catchment area to identify those with influenza-like illnesses and those with suspected Covid-19, based on symptoms and a history of travel back from an area where Covid-19 cases were reported. All those who returned from the city were to be monitored for a period of 14 days for development of these symptoms.
Dungarpur study
The Primary Health Centre in South Rajasthan’s Dungarpur district also participated in this exercise. It run by Basic Health Care Services, for which the authors of this article work, and Aajeevika Bureau as a public-private-partnership with the state government. This centre covers a rural population of about 25,000, 84% of whom belong to tribal communities.
A large number of young men from this area migrate to Ahmedabad, Mumbai and other cities for their livelihood. Most of them are engaged in manual labour, working and living in rough conditions.
When the survey was conducted between March 17 and March 31, the team from the centre identified those who returned from the cities during this period, and through household visits, monitored them for two weeks to see if they had developed symptoms suggestive of Covid-19.
The team conducted a survey of 4,883 households comprising 17,884 family members. The survey revealed that a total of 1,129 migrants had returned to their homes from the cities: 444 came before the lockdown was announced, 663 came during the week after lockdown (between March 24 and March 31) and 22 came after March 31. Most who came back were young with an average age of 25 years. Most (94%) were male.
Most were from Ahmedabad in Gujarat, Mumbai in Maharashtra and Indore in Madhya Pradesh All three cities had been declared hotspots by April 23.
Based on the assessment, a total of 13 people were suspected to have Covid-19. Three of them were migrants (one each from Maharashtra, Gujarat and Madhya Pradesh), and were referred for testing and quarantine at district hospitals. They all tested negative. There were no occurrences of Severe Acute Respiratory Infection in any of them and none of them died.
The results from the study suggest that the risk of Covid-19 infection among migrants returning from cities to their villages is low or negligible. The infection was introduced in the cities by people who were infected overseas, and returned to the cities over the last three months. Most of the migrants work in factories or construction sites where they are largely excluded, and their interaction with residents of the city is minimal, reflecting a kind of enforced “social distancing”. That may be the reason for their negligible risk of getting infected.
Though the study was conducted in only one Primary Health Centre area, it provides a strong indication that the risk of returning migrants spreading the infection is very low considering that more than a thousand returnees were tracked, most of them having returned from a hotspot and that none of them were found to have a confirmed infection, no one developed a severe infection and none died.
Of course, due caution in screening, home isolation and monitoring for development of symptoms would be essential.
Within Rajasthan, such an analysis can be carried out in all Primary Health Centre areas and should be used as a basis for managing the next phase of the epidemic in rural areas. Other states should also use similar analyses to bring back and re-assimilate their migrants.
We should bring back the migrants without fear, with due understanding of the low risk and due caution, and help them rebuild their lives.
Pavitra Mohan, a pediatrician and public health physician, is the co-founder of Basic Health Care Services. He leads health services at Aajeevika Bureau. Arpita Amin is Executive (Research) and Sanjana Brahmawar Mohan is a Director at Basic Health Care Services.