COVID-19 India: More than a million migrant workers have been housed in around 31,000 relief camps.
In the villages of Uttar Pradesh, even some family members returning home from the cities aren't allowed in.
State officials have told village councils to keep returning laborers from entering the town or meeting people due to fears they may be infected with the coronavirus. Instead, they're forced to stay in schools or farms outside the village, where local authorities and doctors make regular visits and police make sure lockdown orders are followed.
Migrant workers and their families walk along a road on March 28.
"People are very afraid here. There might be a lot of misinformation also spreading," said Malkhan Singh, head of Daipur village, some 450 kilometers (280 miles) southeast of Delhi. "We are not sure but we are not even letting our relatives stay with us."
Similar stories are playing out in small towns and villages across India's hinterland -- home to two-thirds of its 1.3 billion people -- where broken state hospital systems fear getting swamped as local infections rise. They now anticipate the worst as hundreds of thousands of migrant workers reach their homes amid the country's 21-day lockdown that wiped out their jobs.
Front line health workers are gripped with anxiety as they operate with some of the world's worst medical infrastructure in the face of the pandemic.
"Government hospitals will run out of beds in rural India even if only 0.03% of the rural population is hit by the virus," said Steve Hanke, professor of applied economics at Johns Hopkins University and the Founder and Co-Director of the Johns Hopkins Institute for Applied Economics, Global Health, and the Study of Business Enterprise. "Nine million people travel back and forth from cities to villages each year -- they will be carrying the virus from cities back to villages where the health infrastructure is even worse."
Interviews with nearly two dozen people in rural areas-- including doctors, hospital workers, village governing body heads, government officials and citizens -- revealed a state of despair and panic. Medical supplies face critical shortages, testing is insufficient and authorities banking on the success of the heavy-handed police-enforced lockdown to avoid a surge in cases.
Fear Looms
Protective gear for doctors and other staff was abysmally low when the lockdown began, according to a person with information about hospital stock positions in Bihar who is not authorized to speak to the media. Almost 60% of government hospitals had 100 or fewer PPEs, some of them had none. Some hospitals didn't even have aprons in stock.
On Thursday the federal health ministry said India had placed orders for more than 17 million PPEs and 49,000 ventilators. In the meantime, medical professionals in small-town public hospitals continue to work at great personal risk.
The low testing rates over the last two months have added to the uncertainty. India had tested 144,910 samples as of April 9, according to data from the Indian Council for Medical Research. Data for testing in Uttar Pradesh and Bihar was not immediately available. The country has so far reported 7,600 infections and 249 deaths due to the virus, according to data from Johns Hopkins University.
Uttar Pradesh, which has a population equivalent to Brazil, has only 11 testing facilities as of April 10, according to the ICMR. Noida, one of the identified hotspots, has only one private testing lab.
"We have four testing centers in Bihar," said N.R. Biswas, a doctor and the director of Indira Gandhi Institute of Medical Sciences in Bihar's Patna. "The number should have been 40 but the capacity can't be increased overnight."
The mass exodus of hundreds of thousands of poor, migrant workers heading homeward, packed in crowded trains and buses or on foot over hundreds of miles, has only increased the pressure.
While many did make it back home, more than a million migrant workers have been housed in around 31,000 relief camps set up by state governments and voluntary organizations across the country to ensure they do not complete their journey, according to a government filing in the top court earlier this week. If they did reach their villages, the federal government said, the pandemic would become "unmanageable to contain."
These detainment centers will become host spots of infection, said Sundararaman T., New Delhi-based global coordinator of the People's Health Movement, an organization which brings together local activists, academics and civil society groups working on public health.
"It's only the district hospitals that are really functional, and the district hospitals tend to be overcrowded, with 110%, 150% bed occupancy, a lot of patients sleeping on the floor. This is the situation before Covid-19," said Sundararaman. "The moment that Covid-19 comes into the picture, plus the pressure of migration and the illnesses it brings with it, you could have a serious crisis out there."
Migrant workers and their families board buses during a lockdown imposed due to the coronavirus in New Delhi, India on March 28.
Hospital's Panic
When Lalita Devi died of a respiratory illness at one of the best equipped hospitals in Bihar, it highlighted the fears of doctors across the country who are ill-equipped at the best of times and are now looking at fighting a pandemic without adequate safety gear.
The 75-year-old's relatives told local newspapers last week she died of Covid-19 after being denied hospital treatment. Biswas, the hospital's director, said Devi, who ultimately tested negative for the virus after her death, did receive treatment but acknowledged that doctors were afraid.
"We have to keep our doctors also alive," Biswas said. "Who will treat patients in case there is a serious outbreak?"
Staff and patients at the largest hospital of Gorakhpur in Uttar Pradesh were isolated after test results for a 25-year-old patient, who had been treated in its general ward and later died, showed he had the virus. He had not disclosed that he had returned to his village from Mumbai, NDTV reported and a doctor in the hospital who asked not be be identified citing rules confirmed.
Authorities have since isolated all doctors and hospital employees who might have come in contact with him and are still tracing relatives and neighbors, including those who took his dead body and attended the funeral.
"When the serious cases start appearing there I don't think their hospital systems are really built to cope," said Sundararaman of the hospitals in states like Uttar Pradesh and Bihar. "They don't have even one or two functioning ventilators and now we're talking about hundreds."