Indias coronavirus crisis spreads to its villages, where health care is hard to find

Vipin Kumar, a farmer in his 40s, was one of them. Last week, a feverish Kumar lay in pain on a cot in the courtyard of his family's modest home, which abuts a maize field.

On the fifth day, his breathing became labored, and the family was advised by a local doctor to rush him to a big city 25 miles away - a formidable task the family could not manage, according to his son, Devendra. That evening, on May 10, his body began to shake violently and he died soon after.

More than 20 people with coronavirus symptoms have died in the village over the past two weeks, according to locals, a significant increase over the three or four deaths per month the village saw before the pandemic. Most of them, like Kumar, were never tested.

"Not a day goes by when there are no deaths," said Hariom Raghav, a farmer and businessman who had just returned from a cremation. "If things continue like this, the village will empty out soon."

The story of Banail has been playing out in villages across India as the virus continues its deadly surge: Rural areas, where over 65 percent of India's 1.3 billion people live, had been spared in the first wave of the pandemic but are now facing devastating numbers of infections. Three quarters of all districts in India are reporting a positivity rate of more than 10 percent, a health official said Tuesday, an indication of how widely the virus had spread.

With more than 23 million reported cases, India is the global epicenter of the coronavirus pandemic. The country is recording more than 4,000 deaths a day, which experts say is an undercount. This week the World Health Organization classified the variant first found in India as a variant of "concern" and said initial studies suggested it spreads more easily.

Health-care infrastructure in villages - deficient at best or missing altogether before the pandemic - is ill-equipped to service the current needs. India's rural health-care system has far fewer specialist doctors than needed. Low levels of awareness among villagers about coronavirus prevention and a slow rollout of vaccines has added to worries.

At the center of this crisis in the hinterland is the state of Uttar Pradesh - home to 230 million people, more than the population of Brazil. It is also one of the poorest and least-developed states. In April, local elections were held in villages across the state, which officials say led to the surge in rural areas. According to a teachers' organization, more than 700 government teachers who were assigned to poll duty died after the elections, many after testing positive for the coronavirus. At the start of the month, the state was recording just over 2,500 cases. By the end of the month, as the elections wrapped up, cases surged to nearly 35,000.

This week, dozens of bodies suspected to be coronavirus patients have been found floating in India's holy Ganges river in areas of Uttar Pradesh and its adjoining state, raising fears that corpses are being cast into the river because crematoriums are overwhelmed.

Activist and farmer leader Yogendra Yadav wrote that "sheer political callousness" has made the state the epicenter of "one of the worst" disasters in 21st century India. Recently, legislators from the ruling Bharatiya Janata Party wrote to the state chief minister to raise an alarm over the situation in rural areas.

In Banail, the village seeing a spurt of deaths, the primary health center is a rundown pink building with broken windows and a motorbike parked in one of the treatment rooms. The doctor had been away for more than a month - first for a government training program, and then in quarantine after working in a covid hospital in the district. A pharmacist on duty said he told villagers to call covid helpline numbers for assistance.

"The government has made no arrangements. They have left us at the mercy of God," said Rakesh Sisodiya, a villager. "Where should people go?"

Manpal Singh, a local doctor, said nearly 10 people turn up at his clinic every day with flu-like symptoms. He advises those who complain of breathlessness to get tested.

On a recent afternoon, a government team arrived in the village to conduct screening and testing. Outside a temple guesthouse, under the shade of a neem tree, the team checked the temperature and oxygen level of the villagers who gathered. The team had brought 25 rapid antigen test kits for a village with more than 10,000 people.

About three miles away in a nearby town is a larger government health center. Just before 2 p.m., Hemendra Kumar, the solo technician conducting tests, had run out of kits and began to turn people away. He said the district authorities send 100-120 rapid antigen kits and 50 RT-PCR kits each day that are used quickly. RT-PCR results can take up to five days because they are sent to a city hospital 40 miles away.

At district headquarters in Bulandshahr, Ravindra Kumar, a high-ranking official, said he works late into the night these days. "You have visited one village out of 951," he said. "We are sending teams in villages for screening, testing and with medicine kits. The situation is completely under control."

Unlike earlier, he said, a majority of the cases in the past weeks have been reported from rural areas.

In Ghazipur district, at the other end of the state, the situation is just as grim. In the village of Sauram, the village head recently wrote to officials about 17 covid-like deaths in the past two weeks, prompting them to organize screening camps. Most died at home without ever making it to a health-care facility. The closest center is 12 miles from the village; for advanced care, villagers must travel 60 miles to the city of Varanasi. G.C. Maurya, a local health official, denied these were deaths from the coronavirus.

The neighboring state of Bihar is also hard-hit. In Siwan, Vishnu Shankar Tiwari, a 34-year-old worker at an eye clinic, spent three days trying to find a hospital bed with access to oxygen for his mother, whose saturation levels were dropping quickly. She died on way to a hospital.

"In last two weeks at least 12 people I knew have died," Tiwari said. "Most of them died without even reaching a hospital, like my mother."

Amjad Khan, a doctor in the area, runs a covid WhatsApp group offering consultation to people across the state that he said helped him keep tabs on the situation in far-flung places.

"It is impossible to know the real magnitude of covid-related deaths in rural Bihar," Khan said. "Most of the people don't even know that it was [covid] that killed their loved ones."

For the family of Kumar, the farmer from Banail village, the shock of his death was compounded by the ordeal that followed. Villagers were unwilling to help carry the body to the cremation ground, as is the norm. Ultimately, Kumar's sons, including a 12-year-old, picked up the cot on which he died and carried it the two miles to the cremation site.

"He would have been alive if there had been medical facilities here," said Bimla Devi, Kumar's sister breaking into tears. "This was not his age to die."