|
 
 |
| EDITORIAL |
|
| Year : 2020 | Volume
: 1
| Issue : 1 | Page : 2-3 |
|
COVID-19 in India's towns and villages
Prasan Kumar Panda1, UB Mishra2
1 Department of Medicine, Division of Infectious Disease, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Hospital Administration, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| Date of Submission | 04-Jun-2020 |
| Date of Decision | 09-Jun-2020 |
| Date of Acceptance | 12-Jun-2020 |
| Date of Web Publication | 20-Jul-2020 |
Correspondence Address:
Dr. Prasan Kumar Panda
Asst. Professor, Department of Medicine, Sixth Floor, College Block, All India Institute of Medical Sciences (AIIMS), Rishikesh - 249 203, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JME.JME_84_20
How to cite this article:
Panda PK, Mishra U B. COVID-19 in India's towns and villages. J Med Evid 2020;1:2-3 |
The coronavirus disease 2019 (COVID-19) pandemic in India has had an enormous impact on each livelihood in this country. A journey from the first reported case on 30 January, 2020, in Kerala to the present lockdown 5.0 has been difficult for all of us. In spite of the beginning of the containment plan for imported cases till the present ongoing mitigation strategy to curb the local transmission, we have not succeeded in controlling the increased number of positive cases, which was 1000 on 29 March, 10,000 on 13 April, 50,000 on 6 May, 1,00,000 on 19 May and 2,00,000 on 3 June and has reached 3,00,000.[1] Along with the invocation of the Epidemic Diseases Act, 1897, the lockdown started on 24 March 2020 and is still on, affecting the entire 1.3 billion population of India, although some observers have doubted that it has slowed the growth rate of the pandemic. A report by the Oxford COVID-19 Government Response Tracker stated that the Indian Government Response Stringency Index was '75.46' for strictness at this point in time and is better than many developed countries.[2] However, these measures taken have come at a great economic and human cost in a diverse country like India. COVID-19 in our country reached a total of 2,97,535 positive cases, 1,47,195 cured/discharged/migrated and 8498 deaths as of 12 June 2020 (MOHFW). These figures must be alarming when we compare the poor with rich, literate and illiterate, private and public health-care systems, rural and urban areas or towns and villages, however, difficult to get those strata.
India primarily lives in its villages where two-third of its population resides. An interesting observation is that COVID-19 pandemic and resulting lockdown has rarely affected self-sufficient village lives where there is less overcrowding, the houses are ventilated and the daily manual labour is in open fields. Our public programmes and policies have also traditionally been village centric and this has led to a fairly self-sustaining administrative arrangement across sectors such as agriculture in fields where sufficient physical distancing is maintained, child education is in the form of home tuition and there are approachable local roads and transportation without traffic barriers. For health, we have, at least theoretically, an extensive meshwork of primary and secondary health-care services. The district being the focus of decentralised planning under the National Health Mission, there is a provision that sectors act in convergence and with facilitation from Panchayati Raj Institutions.[3] If this self-sufficient village model would have truly been in existence, India might have been able to cope with this disaster. However, modernisation has encroached upon each livelihood and there is no self-sufficiency anymore. To come back to that beautiful India, our Prime Minister recently declared the 'Atma-nirbhar Bharat Abhiyan' (or Self-reliant India Mission).
Education is so poor that there is massive confusion in villages and towns about the meaning of certain government orders. For example, the Prime Minister called for a 9-min blackout at 9 PM on a Sunday and urged people to use candles, diyas and mobile torchlights to demonstrate solidarity at this time of crisis. However, some people observed this as 'Deepawali' festival and fired firecrackers, rockets and even revolver shots instead. Think about personal hygiene among our people. Poor rarely get chance to do hygiene.
Our villagers cannot go into towns to sell their vegetables, fruits or home-made products to earn daily wages, fearing police brutality. On the other hand, people in towns are not getting fresh vegetables or fruits. There is a shortage of labourers to help farmers with harvesting, loading and transport, as most of them come from other states, and because of the lockdown, they are unable to come. Migrants are detained wherever they are with lack of food and hygiene. With no work and transport, many of them have been forced to walk thousands of kilometres, to reach home. Now, they have started moving after a recent government order in a controlled manner to avoid the spread of infection, but it is uncertain how families will survive without any daily income. Simultaneously, they are forming hotspots (red zones) similar to the mass gathering of Muslims at the Tablighi Jamaat.[4] Ultimately, COVID-19 infection has inflicted greater sufferings on the poor.
The infection rate of COVID-19 in India of 1.22, doubling time of 17 days, and death rate of 2.83% are lower than in the worst affected countries.[5] This looks good perhaps because of our relatively younger population who rarely die from COVID and because the majority of our lives are in villages where the disease is still at level 1 transmission. However, a basic level of health in the general population and a good health-care infrastructure are the two key indicators apart from demography to decide the impact of COVID in the long run as has been proved by Germany. On 30 April 2020, COVID-19 became India's most deadly infectious disease, except for tuberculosis according to the National Health Profile statistics. However, the major causes of death are also from other infectious diseases (H1N1 and diarrhoea), non-communicable diseases (diabetes mellitus, hypertension, chronic obstructive airways disease, cardiovascular problems and cancers) and road traffic accidents. These diseases need good hospital care for survival. More than 70% of our population pay out of their own funds for their health-care expenses choosing to go to private doctors rather than an underfunded, overcrowded and inefficient public health system. Due to the lockdown, the majority of private clinics are closed due to the fear and stigma of infection. Village people cannot reach the available government hospitals because they are too far away. During the initial days of the lockdown, there was increased violence against health-care workers (HCWs). COVID-infected patients and their attending HCWs are being socially targeted as 'chhut' similar to lepers.
The worst affected in this time of disaster time is because of our unequally distributed health-care infrastructures including HCWs. There is a severe shortage of infectious disease physicians and nurses, few hospital infection control practices and a shortage of infrastructure like personal protection equipment to prevent hospital-acquired infections. The coexistence of various levels of transmission of COVID-19 within a country is evident from data from the USA and elsewhere.[6] With major towns in our country being at level 2 and possibly level 3 of COVID-19 transmission, and villages likely being at level 1, preventive strategies should now be stratified since we cannot do equal health-care distribution in 1 day.
Learning from previous pandemic models, we can say that by maximising benefits to all equally, prioritising health workers, not allocating on a first-come first-served basis, becoming responsive to evidences, recognising research participations and applying the same principles to all COVID-19 and non-COVID-19 patients, our country can have better leverage than others in the time ahead.[7]
COVID-19 has made us more aware of our current poorly developed health system, unscientific practices, lack of education, sufferings of poor and a disdain for protecting our environment as well as the livelihoods of the poor.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| 7. | Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med 2020;382:2049-55.  |
|
Search Pubmed for