UP: Cases Rise Eight-Fold in One and a Half Months With Poor Healthcare Facilities Coming to the Fore

Lucknow: In the biggest spike in COVID-19 cases recorded in Uttar Pradesh till date, the state saw an eight-fold increase in COVID-19 cases over the past one and a half months with 3,458 new cases in 24 hours.

According to data from the Ministry of Health and Family Welfare, on June 1 – a month and a half ago – Uttar Pradesh had 8,075 confirmed cases of COVID-19. The number rose to 73,951 cases on July 28, with 51,804 new cases over a month.

By June 1, when relaxations were introduced as part of Unlock 1, the country was three months into the pandemic and the state had a total of 8,075 COVID-19 patients. About 20 days later, the number of patients had doubled to 16,602. Just five days later, on June 25, the total number of patients had crossed the 20,000 mark. This figure rose to 23,492 by June 30. On 26 July, the number of patients had increased to 66,988, with a sharp rise seen over the past eight days.

As per government data, Uttar Pradesh reported its highest ever single-day spike of COVID-19 cases on July 19, with 2,211, including 392 cases in Lucknow, 168 in Kanpur, 125 in Noida and 100 in Prayagraj. This was the first time that the number of patients had crossed 2,000 in a single day. After this, on July 20, 1,913 positive patients were traced and then every day the number of patients kept increasing. Between July 21 and July 26, at least 15,828 patients have been detected. During this period, the number of samples being tested is also between 40,000 to 55,000 per day. On July 26, more than 71,000 samples were tested, the highest number of tests in a single day so far.

Dr. Nafis Faizi, Assistant Professor of Community Medicine at Aligarh Muslim University (AMU), said that a key reason behind COVID-19 “spreading like wildfire in Uttar Pradesh” is that patients of are being “unattended” in cities like Lucknow and Kanpur, and the virus has now spread to rural areas with no facilities, “which is a recipe for disaster.” He said that another reason was that “asymptomatic patients and for those with mild symptoms are not allowed to home quarantine."

According to researchers from Stanford University, states like Uttar Pradesh and Bihar are among the worst in India at reporting COVID-19 data while Karnataka tops the national chart. Their study, published in the pre-print repository medRxiv, found a disparity in the quality of COVID-19 data reporting across India.

The researchers mention four key aspects of public health data reporting – availability, accessibility, granularity and privacy. The team used this framework to calculate a 'COVID-19 Data Reporting Score' (CDRS, ranging from 0 to 1) for 29 states. The score was based on the quality of COVID-19 data reporting done by the states between May 19 and June 1.

The findings showed that CDRS varied from 0.61 (good) in Karnataka to 0.0 (poor) in Bihar and Uttar Pradesh, with a median value of 0.26.

Poor Health Infrastructure

Dr. C.S. Verma, President of the public health outfit, Jan Swasthya Abhiyan (JSA), Uttar Pradesh, said that COVID-19 cases in Uttar Pradesh have been on the rise since Unlock 1 kicked off. “Community spread has begun and the situation is pretty bad. There are so many factors but the bottom line is that it is now spreading to rural areas. This is a bad sign. It now shows signs of a community spread," he added.

Highlighting the key factors behind the spike in cases, Verma said that the movement of people from urban to rural areas and vice-versa is a reason. "COVID-19 has infected field workers, ward boys, sanitation workers, security guards, lab attendants, peons, laundry and kitchen staff, among others, which is a matter of concern because we are already facing a shortage of health workers. Another reason is that those health workers that have been found to be positive are being asked to quarantine themselves at home, which is quite dangerous. They do not have adequate facilities at home,” he said, mentioning that the government had initially said that doctors and health workers who tested positive would be accommodated in hotels, but that it was mere lip service.

“Cases have been found in towns and villages where it will be very difficult to control. In Lucknow, the government is able to contain it, but what about the interiors of the state – Ballia, Gorakhpur, Bahraich?” he asked.

When asked if the UP government ramping up COVID-19 tests would help, Dr. Verma said that it was a welcome step, “but what is the government is doing after tracing the cases. They are doing nothing as they do not have beds in hospitals; COVID-19 patients are making a beeline outside hospitals and are still unable to get admission," said Verma, adding that 40% of posts for healthcare staff in Uttar Pradesh is still vacant.

The National Health Profile (NHP), 2019, created by the Central Bureau of Health Intelligence, estimated the total number of doctors in Uttar Pradesh to be around 77,549. There is only one doctor for 19,000 people in the state, while the total number of government hospitals is 4,635, with about 76,260 beds.

Sunita Sahyog, a member of Sahyog and Health Watch Forum, based in Lucknow, said that in several rural areas, “community health centres were turned into COVID-19 wards and they conducted awareness programmes only for COVID-19 positive patients; this resulted in a spike in cases. Even pregnant women landed at the same centre along with family members for delivery. Asymptomatic patients also resorted to it and the virus spread,” she added.

Sahyog mentioned that health workers, including Accredited Social Health Activist (ASHA) and Auxiliary Nurse Midwife (ANM), who are on the front-lines and conducting door-to-door preliminary survey for COVID-19 have been working without PPE kits. “What I have learned is that people in rural areas are shunning ASHA/ANM workers and boycotting them, saying that they are the ones responsible for spreading COVID-19. Some workers also suggested that improper handling of throat swabs and other such objects likely to carry the infection could have also caused it," she added.

She mentioned that the UP government should immediately turn private hospitals, nursing homes, schools, colleges into temporary COVID-19 dedicated hospitals to stop the virus. “The Government should also stop hiding data which shows its failure," she said.

Primary Health Centres in Abysmal Shape

There are several factors which could be reasons for the poor healthcare situation in Uttar Pradesh — shortage of doctors, shortage of Primary Health Centres (PHC) and community health centres, their extremely poor condition and the lack of a political will to improve the system.

According to a reply given by the Union Health Minister Harsh Vardhan in the Lok Sabha in November 2019, Uttar Pradesh’s PHCs have the worst patient to doctor ratio and infrastructure in the country.

According to data, Uttar Pradesh requires 3,621 doctors for its PHCs. The state has a sanctioned strength of 4,509 but has only 1,344 doctors on the job with 3,165 seats vacant; a deficit of 2,277 doctors.

Former Resident Doctors’ Welfare Association (RDWA) KGMU President Neeraj Mishra said: "There is a shortage of doctors not just at the primary level but at every level. There are three layers of healthcare systems beginning with Primary Health Centres (PHC), Community Health Centres (CSC), Sub-District and District Hospitals and medical colleges/institutions. There is a shortage of doctors at every level. UP is facing a critical shortage of doctors while PHCs in UP are almost shut. Due to COVID-19, the maximum doctors from the state have been deputed to medical colleges/institutions,” he added.

"Policy in Uttar Pradesh is working on a hit-and-trial method. The weekend lockdown serves no purpose in the fight against the novel coronavirus as markets are overcrowded on the remaining three days. No social distancing is being followed. How is the weekend lockdown serving its purpose?" asked Mishra.

He added that the doctors and healthcare staff is also tired, having worked for four months, and that their work efficiency would be compromised given the situation they work in. “The number of cases increases everyday and the same doctors are working on rotational shifts," said Mishra, adding that the government should take concrete steps before the system collapses.