The COVID-19 pandemic is often thought of as an urban phenomenon. This is not the case. Reports indicate that hotspots of the disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or the coronavirus, are springing up in India’s rural communities. This is a concerning trend – especially considering that healthcare infrastructure in rural areas often leaves much to be desired.
The bulk of India’s population reside in rural villages. As of 2018, 66 percent of India’s population are defined as living in rural communities according to the World Bank.
Despite India’s rural population vastly outweighing its urban populace, it is urban India that continues to enjoy the bulk of the country’s healthcare infrastructure. As previously reported by Health Issues India, “rural areas often have such poorly developed healthcare infrastructure in their area that access to such basic medicines as paracetamol or ibuprofen is sporadic at best.”
Outbreaks of COVID-19 in rural India have been reported for some time. Reports at the beginning of June indicated a surge in COVID-19 cases in rural communities, precipitated by the influx 0f approximately forty million migrant workers into their native villages following a mass exodus from the cities. This has grim portents for the health of India’s rural communities during the pandemic.
“High levels of comorbidity, high levels of under-nutrition and a weak health infrastructure, that’s just the recipe for high mortality,” Reuters quoted epidemiologist and physician Dr Naman Shah as saying at the beginning of June. When I interviewed Professor Sarang Deo of the Indian School of Business recently, he told me “I’ve done a lot of research on tuberculosis and other airborne respiratory infections and there are problems in rural areas for patients who are infected.
“Now the counterargument to that is the likelihood of transmission is actually somewhat lower in rural areas because people live in open space. Population density is lower compared to cities. So there is some hope. But I think that the difficulty and the fear is if people are infected to whatever extent the access to healthcare services is going to be much lower.”
The continued emergence of hotspots is affecting impoverished rural communities hard. On April 15th, Niti Aayog data indicated that 34 of the country’s 112 poorest rural districts were hit by COVID-19. The figure is now 98.
The lack of healthcare infrastructure entails greater mortality. “Rural death rates for nearly all infectious conditions are considerably higher than in urban areas,” said Professor Prabhat Jha of the University of Toronto. To address the spread, some rural communities in Goa have gone so far as to enter lockdowns of their own accord.
If the COVID crisis tells us anything, it is that we were not prepared. Chronic neglect of public health infrastructure, especially in rural communities, has exacerbated the crisis. Going forward, it is imperative that meaningful, substantive action is taken to bolster public health infrastructure in rural India – lest the persistent inequities within the country engender a COVID crisis of even greater, and even less manageable, scope.