Umesh Rajak had to reportedly spend the night of July 11 on the footpath inside the premises of the All India Institute of Medical Sciences in Patna because the hospital did not have any beds to spare. Rajak, who was a senior bureaucrat in Bihar’s home department, died days later of Covid-19 related complications.

Videos of Rajak lying on the footpath at night, his wife running around and crying for help, became an ominous warning of what possibly lay ahead. If a senior state official could not find a hospital bed, what chance did the common man stand? Several people who could leave for states with better medical facilities did, anticipating the worst.

Even government officials said things could only get worse from there, considering Bihar’s infamously beleaguered health infrastructure. “Every state has a carrying capacity,” a senior state bureaucrat told at the time. “That capacity has been breached in Bihar.”

The worst avoided?

Cut to October: it appears most of the Covid-19 related doomsday predictions for the state did not come true and the panic of July has all but waned. The state has just over 11,000 active cases and its reported case fatality rate of 0.5 % is one of the lowest in the country. According to Ragini Mishra, Bihar’s state epidemiologist, only 10% of the total 56,370 beds earmarked for Covid-19 patients are currently occupied.

Doctors from the state who had also warned in July that things could spiral out of control also said that fewer patients were coming in to the dedicated Covid wards. “That rush is gone now; there are more general patients now,” said Manish Mishra, a doctor at the Patna Medical College and Hospital.

Naysayers have argued that the state is not testing enough, but data shows its testing rate is around the national average, but its positivity rate (number of positive cases per 100 people tested) of 2.2% is significantly less than the national average of 7.8%. This, epidemiologists say, suggests the state is unlikely to be missing out infections at an industrial scale.

What does that mean as the state goes to polls later this month? Will Bihar’s seemingly under-control Covid situation, despite all odds, count as an achievement for the incumbent government led by Nitish Kumar?

Most people spoke to did not seem to think so. As Jitendra Singh, who teaches political science in a college in the state’s Hajipur town, said, “I would attribute this to the grace of god rather than the government’s work.”

He explained, “People in Bihar lead a hard life, always dealing with some adversity or the other as it is, so I suppose us Biharis have some sort of innate immunity that has taken us through this.”

Sunidhi Singh, a 24-year-old freelance content writer from Patna, tended to agree. “I don’t think the government has not done anything exceptional,” she said. “I don’t know how it happened, but people just seem to be recovering on their own. Maybe it is just strong immunity.”

Dr Kumar Gaurav, the top official at Jawahar Lal Nehru Medical College and Hospital in Bihar's Bhagalpur, speaks to a nurse who contracted Covid-19, on July 26. Credit: Danish Siddiqui/Reuters

Bad data?

Still others alleged that the government, on the contrary, had deviated from standard protocol to keep the case-count low. Shakeel, a doctor who is part of the Bihar chapter of Jan Swasthya Abhiyan, pointed out that a bulk of the lakh-odd daily tests that the state conducts were rapid antigen tests as opposed to the gold standard of diagnostics: reverse transcriptase polymerase chain reaction or RT-PCR tests.

“Protocol says that symptomatic people who test negative in the rapid test should be made to undergo an RT-PCR test, but that is not happening,” said Shakeel.

According to Mishra of the health department, the state has the capacity to do 10,000 RT-PCR tests a day – which means almost 90% of Bihar’s daily tests are rapid antigen tests. These tests could yield false negatives in as many as 50% of cases.

“We are a huge state so it is impossible to do so many RT-PCR tests, but all symptomatic patients undergo a confirmatory RT-PCR,” Mishra said.

Home isolation key to success?

Mishra insisted that Bihar’s impressive Covid-19 metrics did indeed reflect the ground reality – and was a result of sustained work by the government. “We switched to a policy of home isolation for asymptomatic and mild cases,” she said. “We have hired a private agency which monitors each patient under home isolation multiple times a day.”

Doctors seemed to agree that the policy of home isolation helped calm down things. “There was chaos in July, but now fewer patients are coming in so that has helped us concentrate on the more serious cases and save lives too,” said Kundan Suman, secretary of the state’s junior doctors’ association which had gone on protests several times during July, alleging mismanagement by the authorities. “And I must concede the overall management has become better since.”

Life goes on

Critics of the government, however, said that people had simply stopped going to hospitals because they could not afford to undergo isolation for two weeks. “People are just popping pills and carrying on with their lives,” said Rupesh, a Patna-based right to food activist. “What choice do they have? They have to feed themselves.”

But surely, if the virus was running riot in the community, infecting and killing significantly more than the official numbers showed, there would be some signs? Instead, the state is witnessing election rallies attended by hordes of people each day.

The disease and deaths caused by it have been normalised, suspected Shakeel. “The state experiences so many maternal deaths and tuberculosis-related deaths – is there any outrage or count?” asked Shakeel. “So, it is simply part of that pattern…people are getting sick and dying of Covid-19 too, but no one is really keeping count.”

Vinay Kumar Trivedi, a PhD scholar at the Indian Institute of Technology, said while things did not indeed appear to be dire, few people would credit the government for that. “Maybe it’s the immunity or maybe it’s something else, but nobody is saying it’s Nitish Kumar’s government,” he said. “Not even Nitish Kumar himself.”

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.