Amravati (Maharashtra): India is currently in the grips of the second wave of Covid-19 infections, and like in the first wave, Maharashtra is the worst-hit state. The far-flung Amravati district is the most-affected district in the state, and it is showing a disturbing trend: That the coronavirus is shifting from urban areas of the first wave to rural areas in the second.
The current surge began back in February in Yavatmal and Amravati, both in the northeastern Vidarbha region of the state. And now, rural areas in Amravati have reported a higher number of cases than urban areas for eight out of the 10 days preceding 27 March, according to the district’s health department.
In an interaction with state government officials Saturday, Union Health Secretary Rajesh Bhushan pointed out that 25 of Maharashtra’s 36 districts contributed to 59.8 per cent of the total caseload in India last week.
Shailesh Nawal, District Collector of Amravati, added: “Earlier, in the first (Covid) phase, it covered some parts of slums and the highly congested areas. Now we find that it is mostly infecting the middle-income population and entire households are getting affected.
“This is a recent phenomenon which we have found in the second phase. Also now, the urban, as well as rural, areas contribute to about 50 per cent of the positive load.”
Spreading to the interiors
At a press conference on 17 March, the central government highlighted how the pandemic has also spread to tier-2 and tier-3 cities, and is moving “closer to rural areas”. In February, a team of the National Centre for Disease Control that visited Amravati also noted a rise in cases in rural areas.
According to data from the Amravati health department, on 18 March, urban areas reported 229 cases, while rural areas reported 236 cases.
From then on, urban and rural areas have seen a daily increase of anywhere between 100 and 350 cases. But in eight of the 10 days up to 27 March, rural areas reported more cases.
This, health department officials said, wasn’t a trend that was seen in the first phase.
However, Nawal said even though cases in rural areas are on the rise, 65 per cent of these pockets are yet to be touched by the pandemic.
The case fatality rate of the district currently stands at 1.4 per cent, according to District Civil Surgeon Shyam Sundar Nikam. The figure is, however, far below the mortality rate of 15 per cent in May-June last year, he added.
Block-level officials in the district blame people’s carelessness — not wearing masks — and large gatherings such as weddings and gram panchayat elections, held earlier this year, for the spurt in infections.
The residents, however, accuse the local authorities of not doing enough to contain the outbreak.
Behind rising numbers
Two days before Holi, the main market of Achalpur, a block under Amravati district, was teeming with people and vehicles.
At Sadar Bazar, people were out shopping for Holi and buying vegetables and fruits from scores of vendors. There was a constant stream of vehicles. Pedestrians, many of them without masks, were walking slowly, brushing past each other.
According to local municipal officials, the 131 villages in the block had recorded a total of 1,158 cases as of 26 March.
“Last year, the number of cases was less here, but from 1 February, the number of cases started increasing,” said Kalpana Chithore, a worker at a primary health centre in Kandali village of the block, which has emerged as a hotspot.
“Earlier there was a lockdown because of which people were at home, then the number of people was less. But now, people are not following the same restrictions, they’re continuing as if there’s no corona. They’re not wearing masks, they’re going into the crowd,” she said.
Local authorities also attribute the rise in Covid cases to social gatherings like weddings and gram panchayat elections that concluded in the mid-week of January.
At Surwadi village in Tiosa block of the district, it was a combination of the two — weddings and elections — that led to the recent outbreak.
“When the weddings were allowed, we had one here. In that, the brother of the groom wasn’t well. He was also the one running the election panel in the village, and everyone would go to his place… he turned out to be (Covid) positive,” said Pramod Boralkar, a worker associated with the village-level primary health centre.
Soon afterwards, several of the patient’s contacts tested positive for Covid in February, following which a testing camp was held in which 12 more people from the village were diagnosed with the infection.
‘Lack of awareness among people a challenge’
Dharni block, 145 km from Amravati city, is facing a similar surge in cases as it did around Holi last year.
Located in a tribal belt, the block is one of the remotest and most backward in the district and can only be accessed by the Maharashtra State Highway-6 that traverses through the famous Melghat Tiger Reserve.
The highway, which starts in Amravati city, also connects Dharni to Madhya Pradesh, which is just a few kilometres away from the block.
“The surge happened for the first time after Holi last year. During Holi, there were a lot of crowds here because it is a tribal belt. In the tribal belt, the Holi festival is celebrated more, so corona started at that time,” said Dharni-based journalist Ravi Navlekha.
“Out here, a lot of people like businessmen and workers would also come from the cities (mostly in Madhya Pradesh),” he said.
The same situation is being repeated ahead of Holi this year, Navlekha added, pointing to the bustling market at the Dharni town centre.
So far, according to the local authorities, 62 of the 155 villages in the block have active cases. Last year, about 146 villages were affected.
Dr Rekha Gajaralwar, the superintendent at the sub-district hospital in Dharni, told ThePrint, “I was transferred here from Mumbai in October. There it was very strict, we were following all the rules for Covid prevention. But here, those rules aren’t followed at the moment.”
“Lack of awareness among people is a challenge, they don’t understand the seriousness of this. If a patient is positive, they start fighting that our report is false and claim that we are forcefully trying to send patients to Covid care centres and home quarantine,” she added.
Outside the sub-district hospital, ThePrint spotted several people without masks.
Among them was Suman Uike, who explained, “We don’t feel scared, we are fine. Whatever will happen is in the hands of God.”
‘We blame authorities’
Following the Covid surge, the district administration in Amravati imposed a lockdown from 21 February to 8 March. Testing was also ramped up, especially in rural areas. This led to a fall in the positivity rate in rural areas — from 23.8 per cent on 1 March to 6.8 per cent as on 27 March.
The increased testing might be another possible reason why more cases are being reported from rural areas.
Meanwhile, at the block level, authorities have imposed protocols to ensure better surveillance.
For instance, in Achalpur, the local authorities did away with home isolation for the first seven days after one tests positive. Asymptomatic to moderate cases were sent to either of the two designated Covid care centres or the sub-district hospital. The more severe cases were sent to Amravati for treatment.
Residents, however, blame the authorities for not doing enough to prevent the infections from recurring.
“No action is being taken for Covid,” said a resident of Achalpur’s Kandali village, who didn’t want to be named.
The resident said he and another member of the family had tested positive for the virus in early February.
“Nothing happened, there was no sticker [which the gram panchayat sticks at homes of infected patients]. When my sister was positive, three houses away, they put a sticker,” the resident said.
“On 25-26 February, 11 people came out to be positive in the house next door. They brought a spray pump and sanitised the outside of the house and put a banner 7 days later. But that was it. A child from there who had tested positive was also moving about freely,” he added.
There were no demarcated containment zones across the three blocks.
Another resident in the village said there was limited follow-up from the gram panchayat when her brother tested positive for Covid.
“If we see this spreading in Maharashtra, it is because of these officers. No one wears masks, they should be stopped and something should be said.”
Civil Surgeon Nikam said, “After September, the cases came down, there was some laxity in the people and the administration also wasn’t doing as much because for a year, we had kept people in check… I won’t see there were a lapse but yes the administration had to be a little people-friendly.”
He added: “But after the cases rose, the restrictions were made a little more stringent and after that, we got the results also. Our cases are falling right now.”
(Edited by Debalina Dey)