Maharashtra's rural infrastructure ill-equipped to handle coronavirus; experts say next 15 days critical

Police personnel have been stationed outside homes of 33 residents of Maharashtra’s Yavatmal. And the only job of these policemen is to ensure that all of them remain indoors, minimising contact with other people as they are potential patients of COVID-19, a disease caused by novel coronavirus. In Yavatmal, three people have tested positive for coronavirus so far, taking the state’s tally to 39 – highest in India. The three are currently in the 12-bedded isolation ward in Yavatmal’s district hospital. “They had a history of travel to Dubai,” said M Devendra Singh, Collector of Yavatmal. " [caption id=“attachment_8128911” align=“alignleft” width=“380”] Representational image. PTI[/caption] “As a preventive measure, we came up with a list of 33 people based on who they had come in contact with directly or indirectly. They have been placed under home quarantine. Our police team is monitoring them so they do not leave their homes. And health department teams are in touch with them to get updates on their health,” Singh said. Experts believe the next 15 days are extremely critical for Maharashtra in terms of containing the virus. Otherwise, it could spell doom, considering the state’s public health facilities in rural parts are ill equipped to deal with an outbreak of this volume. Maharashtra’s health minister, Rajesh Tope, tweeted that 16 of the 39 cases are found in Pune, and six are from Mumbai. In an attempt to reassure the public, Chief Minister Uddhav Thackeray, addressing the press, said, “All the positive cases were a result of out-of-country travel or contact with those who traveled out of India.” However, with three cases in Yavatmal, and a case each in Aurangabad, Raigad and Ahmednagar, COVID-19 is no longer limited to the urban centres. If it spills over into the vast swathes of rural Maharashtra, it would spread like forest fire, for the virus’ infectiousness is ominous. Dr Anant Phadke, health expert based in Pune, said the chances of it spreading across rural Maharashtra are less, but it cannot be ruled out. “We need to avoid social contact as much as possible,” he said. “But the tragedy is that not everyone has the privilege of sitting at home. They have to take buses, they have to take trains, especially the ones that depend on daily wages.” Moreover, March onwards is the time when Rabi harvesting is done, and farmers and farm labourers start migrating to urban centres for daily wage work. “The government needs to take that into account and figure out if there is a way in which they can get people to stay home,” said Phadke. “Only an appeal won’t be sufficient. Maybe the government can arrange for their ration or ignore the attendance of MNREGA workers. Otherwise, the risk of community transmission is potent right now.” Community transmission is considered to be stage three, when the number of patients explodes. Local transmission is considered to be stage two, where Maharashtra and India find themselves right now. The state government has closed down malls, theaters, cinema halls as well as schools and imposed Section 144 to avoid getting to stage three. COVID-19 first broke out in China’s Wuhan town, and has ominously spread across the world, with 1.68 lakh positive cases, and more than 7,000 dead, according to World Health Organisation, which has declared COVID-19 a pandemic. 70,000 of those have been treated, and recovered. More than 3000 of these deaths have transpired in China. In India, positive cases are around 130, and three have died so far. The latest death being reported today was in Mumbai. Former health minister and Shiv Sena leader Deepak Sawant believes we can contain COVID-19 at stage two. “We have handled swine flue, which was airborne. This one is droplet infection,” he said. “Plus, there is a possibility that heat stroke could kill the virus.” However, just last week, cases of COVID-19 have seen a spike in countries like Malaysia, Qatar, Bahrain, Indonesia and so on, where the temperature range is between 20 to 30 degrees Celsius. The question, therefore, is whether the proactive measures are adequate. “We have made provisions of isolation wards in every district hospital. Isolation is important to stop the spread,” said Sawant. In Yavatmal, the district administration has taken over a girls’ hostel and converted it into a 100-bedded isolation ward. A health official in Osmanabad, along similar lines, said, “At our level, in Osmanabad, 100 beds have been provisioned, including private and public hospitals, for the isolation wards. We have identified two organisations and turned them into a quarantine centre, should the situation demand it.” Besides, there are attempts being made in the hinterland to educate people about COVID-19. Hoardings are up, and electronic media is being used to disseminate scientific explanations. But the population of Osmanabad is 16 lakhs. The biggest challenge is that the districts are densely populated. “There is only as much we can do with the existing infrastructure,” said the official in Osmanabad. “We have no testing facility. We can only refer potential patients to Pune.” Across Maharashtra, there are only three testing centres : National Institute of Virology, Pune. Kasturba Central Laboratory, Mumbai, and Indira Gandhi Medical College, Nagpur. “We are adding more testing centres,” said Sawant. “KEM hospital in Mumbai would start testing soon. And we are thinking about private labs as well.” However, experts believe countries need to test as much as possible in order to deal with COVID-19, which could lead to a shortage of resources in India considering the population. Health officials, therefore, want to ensure the resources are not wasted on patients that do not need testing. Because the virus did not originate here, Sawant said, they are only testing people with travel history or those who have been in contact with a person with travel history. Phadke said it could be a dangerous strategy, as did WHO, which urged countries to test every suspected case, because it reduces the risk of transmission. “We need to be testing more,” said Phadke. “We need to make the kits available.” South Korea’s example alone explains how crucial testing is. Their testing rate per million people is 3692, which is why their mortality rate is restricted at 0.6 percent. In contrast, Italy is testing 826 people per million. And their mortality rate is almost 10 times that of South Korea. The death toll in Italy has crossed 2,000. India, alarmingly, is among the lowest with the testing rate of only three per million people. Phadke said Italy’s health facilities are exponentially better than ours and yet they are struggling badly. “So our only way out is to contain it now and not let it spread,” he said. “We have 15 days or so.”