GURUGRAM: The medical surveillance of villages launched by the state government in May, which involved door-to-door screenings and Covid testing camps, did not throw up alarming numbers.
From May 15, when this campaign began, to the 30th, the total number of tests conducted in villages was 1.07 lakh and the number of people who tested positive was 3,362.
The numbers weren’t alarming – in the first week of May, Gurugram alone was reporting as many or more cases on an average daily.
Does this mean there was no rural surge? Or does the progress of the state’s Covid graph in April and May simply show that there was no separate rural surge and cases in villages more or less rose and fell simultaneously with the cities, where testing, health care and headlines were focused? Data suggests the latter.
During the second wave – in the period between April 1 and May 31 – the number of daily infections reported in the state peaked on May 5 (15,786).
The case positivity rate, the percentage of samples tested that are found to be Covid-positive, touched a peak of 32% on April 26 and fluctuated till May 10, hitting 28.6% on April 29, 29.9% on May 5 and 25.3% on May 10, after which it began to fall steadily.
The death toll peaked the same day as the daily new cases (181 on May 5).
Extensive door-to-door rural screenings that chief minister Manohar Lal Khattar ordered after reports of deaths in some villages – one of them was Titoli in Rohtak – because of a “mystery fever” began on May 15.
The increased testing that this led to in rural areas did not alter the shape of the state’s Covid cases graph, which kept steadily sloping downward with only minor aberrations.
After the fortnight-long surveillance, the predominantly rural districts that were found to have recorded most cases were Hisar, Bhiwani, Karnal, Jind, Fatehabad, Rohtak, Sirsa and Ambala.
Data shows the peaks in terms of daily new infections came earlier than May 15 in all these districts, closer to the state peak on May 5 – Hisar (May 8), Karnal (April 30), Bhiwani (May 4), Jind (April 28), Fatehabad (May 6), Rohtak (May 13), Sirsa (May 13) and Ambala (May 4).
The end-April to early-May period saw the highest urban surge too – Gurugram, for example, peaked on April 29 with 5,042 cases.
Reports of mystery fever in villages that triggered alarm had, however, started coming in from the last week of April.
Some were also reported in the first week of May.
Asked if the surge period in rural areas had passed by the time the statewide surveillance was launched, Dr Dhruv Chaudhary, head of pulmonary and critical care medicine at PGIMS Rohtak, said, “In hindsight, we are wiser and probably should have looked into it.
But now, with the experience of the second wave and the hindsight, we are already working so that we don’t face this problem again.” He added that the rural screenings will help the state prepare better for the next wave of the pandemic.
“A majority of villages are around the highway and we are examining how much it has spread into the interiors through the rural screenings.
It will also help us in our sero surveys and in planning vaccinations in rural areas.
The rural screenings will give us better data as well to prepare in terms of how much infrastructure we have and the areas we need to work on,” added Chaudhary, who is also Haryana’s nodal officer for Covid-19.
Dr Namita Jaggi, a Gurugram-based epidemiologist, said public health measures have to match the surge but setting up those measures takes time.
“The surge in the bigger cities started in mid-April and then migrants travelled to villages.
So, the ideal time to start these (rural) screenings would have been the end of April or early May but these concerted public health measures take time and if you do it in a haphazard way, it may not work out efficiently,” said Dr Jaggi.
Health department data shows Hisar was the worst-affected district in terms of rural deaths till May 30, reporting the highest toll at 433, followed by Bhiwani (274) and Karnal (206), Jind (204) and Fatehebad (196).
These districts reported 60%-70% of their total Covid-19 cases in April and May.
For example, Hisar added 35,529 Covid-19 cases from April 1 to May 31, which is 66% of the total cases reported till the end of May.
Similarly, Bhiwani added 15,450 cases, which is 70% of its overall tally, Karnal saw 24,690 cases (62%); Jind 15,085 (72%) and Fatehabad 11,906 (68%).
Spikes reported in April Last year, when the country declared a lockdown in March, many residents of Halwana village in Karnal had come back to their homes.
They usually travel to smaller cities 10 to 11 months a year to sell local products of daily use.
After they came back, the villagers went to the local administration and handed a list of people who had returned so that they could be quarantined.
The vigil helped.
Halwana did not record any Covid case in 2020, said local health department officials.
Things changed this year.
According to records of the primary health centre (PHC) Biana that holds jurisdiction over Halwana, 162 people tested positive from January 1, 2021 to June 5, 2021.
Bhajan Singh, a local resident and social worker, claimed two villagers died mysteriously in mid-April.
They had complained of chest congestion.
“After these two people died, we started going from household-to-household and observed that people have symptoms of Covid.
We approached the local health officer.
The first screening camp was organised on May 22.
A total of 181 samples were taken.
Of these, 38 tested positive.
This raised an alarm,” said Singh.
Dr Anuj Kamboj, medical officer of the Biana PHC, told TOI, “I got a call from the sarpanch that he suspected some cases of Covid in the village, so tests should be conducted.
The village has a population of 5,045.
We tested every day and started getting positive cases.
In the following days, we set up two isolation camps for people who don’t have space at their homes.
Now, the number of cases is showing a downward trend.” Kunjpura, 20km from Halwana, started reporting a spike in Covid cases around April 15.
The health department of Karnal in the first week of May – when the increase had become a steep one – had identified villages where most cases were reported.
Kunjpura was among those.
In May alone, it reported 13 deaths and 623 cases.
The assistant medical officer in Kunjpura, Dr Reena, said most Covid cases in the village were reported between April 15 and May 15.
“While we would receive five to six cases every day earlier, it gradually increased to eight to 10 cases every day and then nearly 25 cases everyday between mid-April and mid-May,” said Dr Reena.
Karnal civil surgeon Dr Yogesh Sharma told TOI, “We covered 433 villages and more than 8,000 rapid antigen tests and 2,000 RT-PCR tests were conducted in these villages.
We also set up isolation centres in the villages with oxygen beds.
We were focusing on around 50 villages, but now, it has come down to around eight villages because the number of cases has come down.
There are certain villages like Halwana that we are closely monitoring.” Mundhal Jhoju, a village in Bhiwani, saw around 70 deaths in the first half of May, claimed outgoing sarpanch Vijaypal.
Many of those ill, according to him, had fever and Covid-like symptoms.
“Around the second week of May, people were unwell in every other household.
There were around 70 deaths.
Our village is on the national highway, but some patients did not even get paracetamol,” said Vijaypal.
There is, however, no data to confirm Vijaypal’s claims.
Sapna Gahlawat, chief medical officer in Bhiwani, told TOI the claims were exaggerated.
“We were regularly monitoring the deaths and some of them were not actually due to Covid.
The number of (Covid) deaths is less than the number reported.” Gahlawat, however, agreed the district’s medical infrastructure was a concern.
Bhiwani reported most deaths after Hisar during the May 15-31 government surveillance.
Krishan Murari, a shopkeeper at Kila Zafargarh in Jind, said people were hesitant about getting tested, which led to the infection spreading despite screenings.
“That is why cases in our village were quite high,” said Murari.
Paleram Kataria, the nodal officer for Covid-19 in Jind, said that was one of the reasons why the number of deaths was on the higher side in Jind.
“Many people in villages did not get tested.
Some patients died within a couple of days of testing positive,” said Kataria, indicating the infection had already turned critical by the time it was detected.
Hesitancy & ‘just season change’ The biggest challenge, said Dr Reena, is that no one wants to wear a mask.
“Our ASHA workers apprise villagers about the importance of social distancing, wearing masks and also advise them to step out of homes only when necessary.
But there isn’t much regard for Covid-appropriate protocol,” said Dr Reena.
At Datta village in Hisar, Sumer Singh Jaglan, its outgoing sarpanch and member of the Roghi khap, simply refused to acknowledge Covid.
Seasonal changes, he said, bring along diseases every year.
“People get fever every year and they recover with home remedies and rest.
Even this year, we did not see anyone die of fever in the village unless they went to hospitals to get treated and were declared Covid-positive,” said Jaglan, adding policemen were “harassing” locals and forcing them to wear masks.
“We cannot work in farms with masks on.
So, we decided to lift the lockdown ourselves and not let the police into the village,” Jaglan told TOI.
Additional chief secretary (health) Rajeev Arora said the rural areas did not witness a surge as reported.
“Even during the peak of the second wave, the positivity rate in the rural areas was much lower than the urban areas.
On May 15, while the cumulative positivity rate was 16%, the positivity rate for rural areas was 3.8%,” Arora pointed out, adding even though the state started the screening process on May 15,around 60% of the rural population was screened by May 25 and the positivity rate came down substantially.
Covid rise and ebb is almost even in Haryana, ‘rural surge’ may be a misnomer
