Since March, a second Covid-19 wave, driven by a more infectious variant of the coronavirus, has led to an unprecedented crisis in India. With over 25 million cases and over 2.78 lakh reported deaths, India’s healthcare infrastructure is proving inadequate. Medical personnel are overworked and overwhelmed, medicines and oxygen cylinders are scarce, crematoriums and cemeteries have been running out of space for funerals.

While urban India struggles, another worrying development has begun to unfold: Covid-19 has now spread in rural areas.

Recent data analysed by the Hindustan Times shows that in March, rural areas contributed a little over a third of all cases (34.3%) in India. In April, this increased to nearly half (44.1%). In May, rural India accounted for 1.39 times more Covid-19 cases than cities.

One region where the disease has spread widely is southern rural Rajasthan, which is largely tribal, backward, characterised by acute poverty, barren land and poor access to welfare. Basic HealthCare Services, a health-based NGO associated with Aajeevika Bureau, the migrants rights organisation for which I work, has been on the frontlines of the response to the crisis. It runs clinics in six underserved regions of South Rajasthan.

Medicine shortage

While official estimates of the extent of the spread in the state are yet to be confirmed, Rajasthan health minister Raghu Sharma in a recent interview said that nearly 50% of all new infections are being found in rural areas. The Barmer Chief Medical Officer said on May 12 that 70% of all new cases were being found in the district’s villages.

The biggest challenge to curtailing the disease lies in the lack of human resources and infrastructure for testing and treatment, said Hyjel D’Souza and Anupriya Saxena, who work as executives with Basic HealthCare Services.

Treatment kits being distributed to frontline workers such as the ASHA and the Auxiliary Nurse Midwives staff are inadequate, they said. Most medicines are in short supply – and in some areas not available at all. In the Gogunda block, some kits received by workers reportedly had chloroquine, a medication used in the prevention and treatment of malaria.

In Udaipur district’s Salumber block, a recent rise in reported cases has prompted the police to put up barricades restricting vehicular movement on roads leading to the government-run Primary Health Centre. Such arbitrary measures are likely to exacerbate the burden of Covid-19 in these areas.

The inoculation campaign in southern Rajasthan also has its share of problems. Only people scheduled to receive second doses are being given their shots. In areas where mobile phone networks are weak or unavailable, registering for vaccinations for those aged between 18 to 44 has been impossible.

D’Souza and Saxena said that there is fear and stigma associated with vaccinations. They said that after the traumas of last year’s lockdown, where little help was forthcoming from the government, there has been a growing mistrust towards the state and its services. As a consequence, several communities are now reluctant to take the vaccine.

“How does one rebuild their trust, how does one convey that vaccines are a life saver for them considering the horrors they have had to endure?” said D’Souza.

Primary Health Centres in the region are not equipped to provide Covid-19 treatment. There is one health centre for every 25,000 to 30,000 people at the block or the panchayat level, while district hospitals remain severely understaffed, said Dr Pavitra Mohan, the co- founder and director of Basic HealthCare Services.

“The government has set up Covid care centres in many districts,” said Mohan. “This is welcome move, but merely beefing oxygen supply and medicines will not be enough. Healthcare requires people – trained and informed medical personnel prepared to handle Covid treatment. We too are actively looking for doctors and medical staff for our centres.”

The other challenge has to do with the current capacities of many frontlines workers dispensing medicines, coordinating vaccination drives and spreading awareness, Mohan said. “They are overworked and without updated information on Covid-19 protocols,” he said. “This needs to be addressed immediately, else this will become a major hurdle in the months to come.”

After the state government started a door-to-door survey across Rajasthan in April, . health department said that 7 lakh people with influenza-like symptoms were detected.

D’Souza and Saxena said that at least one person in every household that they have met with is reporting influenza-like symptoms. Relative to the total number of infections they are hearing about, there have been very few deaths. However, they said, this does not confirm low mortality across the state in any way.

The problem of obtaining accurate data on covid deaths across the country is well known. Tracking and monitoring, and convincing people over treatment and isolation, especially those with mild symptoms, who live in remote areas, who migrate for work, is difficult, D’Souza and Saxena said. Given these challenges, how does one check if Covid-19 has subsided?

To adequately tackle Covid-19 in rural areas, it is imperative for the state government to acknowledge that the problem is not limited to infrastructure alone. It must swiftly allocate resources to test potential patients. It should also collect accurate, timely data on infections and deaths in order to institute effective policy interventions.

If this is left unaddressed, Covid-19 could have devastating consequences on Rajasthan’s poor Adivasi population.

Anhad Imaan works with Aajeevika Bureau, a non-profit that provides support to seasonal migrant labourers in Rajasthan, Gujarat, and Maharashtra.