The COVID crisis in rural Bihar

The government's focus is on urban areas, so rural areas are neglected and the frightening COVID situation in Bihar's villages -- whether it is the positive cases or the deaths -- are not reported, notes M I Khan.

Guddu Khan, a resident of Muslimabad village in Bihar's Aurangabad district, had all the symptoms of COVID -- breathlessness and uneasiness after days of cough, fever and weakness.

His family rushed him to a government-run hospital where his condition deteriorated, so they shifted him to a private hospital in the nearby town of Arwal.

The Khans were shocked when the doctors treating Guddu there said his oxygen saturation level had dropped to 35.

He was kept on oxygen for nearly 24 hours, then on a mini ventilator as his oxygen level did not improve.

After battling for three days, Guddu -- a man in his early forties and father of three young children -- died on the evening of May 15.

Guddu used to work as a construction contractor and was the only breadwinner for a family of six.

He was not tested for COVID. The government-run referral hospital at Haspura does not -- like in most of rural Bihar -- have the facility to test or treat COVID patients.

According to his relative, Mazhar Khan, Guddu was being treated by a local medical practitioner who prescribed antibiotics and medicines for cough and fever. But Guddu's condition continued to worsen and he was unable to breathe easily.

"The local doctor treating him didn't measure his oxygen level as he does not have an oxymeter. Over 100 people, suffering from cough, fever, weakness and breathlessness from dozens of villages in THE neighbourhood, are visiting him for treatment," another relative Haider Khan said.

"No COVID RT-PCR or Rapid Antigen Test was conducted till Guddu died because there is no testing facility in rural areas," Haider Khan added.

Similar tragedies are playing across different villages in Haspura over the last 20-25 days. Over three dozen people -- all displaying COVID symptoms -- have died without being tested.

In Raghunathpur village alone, half a dozen people died after displaying COVID-like symptoms. Similar deaths were reported from Bantara, Piroo and Dekund villages.

Take the case of Munna Barnwal from Saraun village in Jamui district who developed breathlessness after suffering from high fever and cough for days. His son Shipum said, "When we reached the COVID dedicated centre in Jamui, the doctors declared my father dead."

"Barnwal's condition deteriorated as he was unable to breathe. He died due to lack of oxygen," said a fellow villager, Subhash Kumar, who added that more than a dozen people are suffering from fever, cough and weakness in Saraun. A school teacher, Rohit Rai, also died due to lack of timely treatment.

There is no COVID care centre in the Chakai block to which 600 villages, including Saraun, and 23 panchayats, belong.

All suspected COVID patients are sent to Jamui, about 65 km from Saraun. "Like Barnwal, several people with breathlessness died in our village and in the neighbourhood as it was difficult to take them to Jamui after their condition deteriorated," says a villager.

Saraun's primary health centre has been locked since last month and villagers displaying COVID-like symptoms are forced to consult local doctors.

The Out Patients Department at the referral hospital in Chakai was closed on May 5 after 10 staff members and a doctor tested positive.

Primary health centres in much of rural Bihar are shut for weeks or months; rarely does a doctor visit even if it is open. Referral hospitals have no facility to treat COVID positive cases.

At Malhipur village, 20 villagers, mostly elderly, died in the last three weeks after suffering from fever, cough and breathlessness.

"The health department has neglected us. No COVID test has been conducted despite so many deaths," said Malhipur panchayat Mukhiya Mitra Devi. The COVID vaccination drive is also very slow in her panchayat, she added. Till date, only 200 of the total population of 14,500 people were vaccinated.

The community health centre where COVID tests are conducted is about 7 km from Malhipur, which comes under the Chenari block in Rohtas district.

Similarly, in Nachap village under the Chaugai block in Buxar district, nearly a dozen villagers have died due to suspected COVID infection in the last 20 days. This has created panic in the village.

After these deaths, 18 villagers -- including family members and those in close contact with the deceased -- were diagnosed as COVID positive when a team of health officials tested them at a camp.

Nandlal Yadav died within a week due to lack of treatment and oxygen in Nachap after showing COVID-like symptoms. As did Ramdayal Yadav and Bhola Mahto.

"We are living in fear after the numbers of deaths in our village. The deceased showed COVID symptoms. We never expected the spread of COVID, but this now our reality," Umesh Yadav, a villager said in a phone conversation.

Rahul Kumar Singh said a group of youngsters from his village have collected funds from each household and have been using the money to sanitise Nachap and distribute masks to control spread of COVID.

A health department official admitted that COVID has spread in the state's rural areas. "We have received information that 10-20 people in each village are showing symptoms of COVID. It is an alarming situation."

Reports reaching Patna say thousands of people are sick in the villages across Bihar; many are being treated by local doctors, mostly non-MBBS. Some patients have developed serious health complications caused by low oxygen levels, breathlessness, chest congestion and pneumonia due to lack of proper medical treatment.

The state government's focus is on urban areas, so rural areas are neglected and the frightening COVID situation in Bihar's villages -- whether it is the positive cases or the deaths -- are not reported.

This makes the situation even more dangerous as, under normal circumstances, rural Bihar's notoriously poor health infrastructure has resulted in deaths in large numbers of women and children from various diseases.

Due to the lack of testing facilities and basic health infrastructure in rural areas, most people with clear symptoms of COVID-19 (high fever, cough, weakness and breathlessness) have been diagnosed suffering from typhoid or viral flu in village after village by local self-claimed doctors.

When their condition deteriorates and they are rushed to hospitals in Patna or nearby district headquarters, their oxygen saturation level are at below 70 or 60.

Except for a few reported cases, rural Bihar was largely untouched by the first COVID wave. This time, the increasing number of deaths from COVID-like symptoms and the lack of tests and treatment has left the state's villages fear-stricken.

Even in urban areas, including the state's capital, Patna, the lack of oxygen and beds crisis continues. The families of critical patients rush from one place to another, looking for treatment that will hopefully help their loved ones survive.

According to health officials, RT-PCR facilities in district headquarters are limited; at several places, it's not functional.

At present, 60-70 per cent rapid antigen tests and 25-30 per cent RT-PCR tests have been conducted in Bihar.

At a time when COVID-19 cases are rising, and spreading in rural areas, the state government has not initiated special measures to deal with the thousands of migrant workers returning to their native villages.

The state government has officially claimed that, since last week, Bihar has been witnessing a decline in COVID positive cases.

A day after reporting 5,920 COVID positive cases, the lowest daily figure since a month, Bihar reported 6,286 cases on May 18 from a record 1,35,130 samples that were tested. It also recorded the highest single-day COVID deaths on May 18, taking state's overall death toll to 4,039 so far.

Opposition leaders allege repeatedly that the government has been increasing the testing rate by using rapid antigen tests instead of RT-PCR tests.

However, senior health official Manoj Kumar said the number of active positive cases has declined; on May 16, there were 69,697 cases compared to 115,000 last month as a result of the lockdown imposed in the state in the first week of May.

In a tweet on May 17, Bihar Health Minister Mangal Pandey said the state recovery rate has increased to 88.81 per cent from 77 per cent last month. He also said the positivity rate had declined to 5.7 per cent from 14 per cent early this month.

But, in the last 24 hours, 96 patients lost their lives to COVID-19, indicating a surge in the death rate when COVID positive cases are declining day by day. About 89 people died on May 16, 73 on May 15 and 77 on May 14.

With reports of COVID spreading quickly in rural Bihar and the rising cases of deaths, the state government today has decided to take measures to curb the spread.

State health department officials said all 1,541 additional primary health centres will be activated to provide proper treatment at the village level itself. The state has also decided to open at least one community kitchen centre in each block for COVID patients.

• THE WAR AGAINST CORONAVIRUS