Ask a simple question to anyone you meet from rural India: How many persons have died in your village in the last 50 days? Don’t bother to ask about the cause of death, just ask for the total number. Also ask: What’s the population of your village? And then do a simple calculation: If the number of deaths, from all possible causes, during this period exceeds 1 per 1,000, you are looking at “excess deaths”. If it is more than 1.5, you can be sure this reflects a significant deviation, a major disease. If it is more than 2, more than double the number of deaths we would normally expect, we are looking at a calamity.
I asked this question to a few friends from Uttar Pradesh and requested them to call their village. I got information from 14 villages spread across the districts of Varanasi, Unnao, Rae Bareli, Pratapgarh, Meerut and Bulandshahr. This is not a scientific random sample, but it not a sample of badly hit villages either. The proportion of deaths was much higher in the poorer and smaller villages of eastern and central UP than in the relatively prosperous areas of the west. Ever since the beginning of the second wave of Covid in the last week of March, these villages have recorded 101 deaths against their combined population of 33,600. That gives a ratio of 3.005 per 1,000 persons during this period, about three times what you would expect normally.
If this ratio is projected for the entire state of Uttar Pradesh with a population of 23.5 crore, about 4.7 lakh excess deaths could have taken place during this period. These excess deaths could be attributed to the second wave of Covid pandemic. Compare that to the official figures of Covid deaths: just 2.5 lakhs for the entire country and merely thousands for UP since the beginning of the pandemic last year.
Even the unofficial projections don’t get the scale of expected deaths. The Institute for Health Metrics and Evaluation (IHME), an independent global health research centre at the University of Washington, estimates that by the end of August, UP may have 1.7 lakh to 2.1 lakh deaths due to Covid.
This looks like a gross underestimate. Even if we take the ratio of deaths per thousand for last 50 days to be a conservative 2.5 (lower than the 3.0 that we found in our crude survey) and project it to just the next 50 days as well, Uttar Pradesh is likely to witness at least 7 lakh additional deaths due to Covid cumulatively in the months of April, May and June. For the entire year, assuming that we don’t have a lethal third wave, the figure could be well over 10 lakh deaths. This is not just a calamity; we are in the midst of a public health catastrophe, one of the worst this century.
Pandemic ravages UP
My colleagues Ravi Chopra, Ankit Tyagi, Rajeev Dhyani, Anmol, and I have also been tracking media reports on how the pandemic is panning out in rural Uttar Pradesh. While we work on a fuller report, our initial impression is that at every stage of response to the Covid-19 epidemic, from testing to cremation, people in UP are facing desperation and defeat.
One thing is clear. Official statistics give you no idea of the devastating pandemic that is raging through rural UP. The state is officially reporting about 20,000 cases per day now. This is a joke. Widespread ignorance, lack of nearby or adequate testing facilities, official and unofficial cap on testing and inordinate delays in test reports have meant that in village after village, virtually no one has been tested, while scores of people complain of a ‘strange fever’. There is callous and deliberate under-reporting of deaths. Then there are the recent reports about a large number of dead bodies washing up along the banks of Ganga.
Media reports suggest that public as well as private health infrastructure in Uttar Pradesh began crumbling by the middle of April, just when the second wave began. Newspapers are full of reports of shortage and black marketing of drugs like remdesivir and equipment like oximeters, even in the big cities.
Ambulances and hearses were hard to find. Hospital beds were already unavailable by the third week of April. And then, like everywhere else, there is the oxygen shortage. Lack of oxygen leading to the death of a hospitalised patient was reported as early as 22 April from an Etawah district hospital (Amar Ujala, Agra edition, 23 April 2021). While the crisis of oxygen in the metros gets attention, the situation in the small towns of UP is infinitely worse. There is rampant black marketing of oxygen and even attempts to loot oxygen cylinders.
What was the response of the government? To be fair, a pandemic like this one is a challenge to any government. The challenge is manifold in a state like Uttar Pradesh with dismal medical infrastructure. Granting all these limitations, it must be said that the response of the UP government has been shocking, arguably the worst response anywhere in the country. For the record, the government announced a slew of measures including steps to augment hospital beds and ICU facilities, oxygen supply, concentrators, availability of medicines and free treatment in private hospitals. Much of this remained on paper. The Allahabad High Court had to step in with strongly worded orders: “We will not tolerate your paper work anymore for tackling the situation. Now you do what we order.”
Instead of managing the situation, Chief Minister Yogi Adityanath is fixated on managing perceptions and images. In a video conference with select journalists on 24 April, he asserted that there was no shortage of oxygen in any Covid-19 hospital and that the real problem was hoarding and black marketing. He reportedly asked officials to take action under the National Security Act and “seize the property” of those who spread “rumours” and propaganda on social media and try to “spoil the atmosphere”. In one of the most brazen cases of Covid denial, the state government forced school teachers to conduct panchayat elections through the state. More than 577 teachers reportedly died in the process. Despite Supreme Court orders not to harass whistleblowers and critics, the UP government went ahead with booking those who drew attention to the gravity of the situation. Barring a few exceptions, the media in UP has limited itself to pointing out local problems and has not questioned the state government and the CM.
The story of Uttar Pradesh is not unique. Now we know that this second wave of Covid has spread deep and fast in rural India across the country. We hear similar stories of collapse of medical infrastructure in many poorer states. Attempts to invisibilise the number of cases and deaths have been reported from many states, including Gujarat and Delhi. And Yogi Adityanath is not the only self-obsessed leader occupying the chair of a CM. Yet a combination of all this – depth of rural penetration of Covid infection, poor quality public health infrastructure, collapse of private health services, lack of planning or response by the government and sheer political callousness – makes rural UP the epicentre of one of the worst and preventable disasters in 21st century India, and perhaps the world.
Saving rural UP from this catastrophe must be a national mission. The time to act was yesterday. But we can still save many lakh lives. We must act NOW.
Yogendra Yadav is the national president of Swaraj India. Views are personal.
(Edited by Neera Majumdar)