High on hype

O n June 11, in a videoconference with the Chief Secretaries and Health Secretaries of the States, Union Cabinet Secretary Rajiv Gauba warned that five States would face a critical shortfall in ICU beds and ventilators between June and August in the battle against COVID-19. In other words, these States would be found wanting in providing care to those who fell seriously ill with the deadly infection. Uttar Pradesh was one of the States identified by the Cabinet Secretary, along with Maharashtra, Tamil Nadu, Delhi and Gujarat. All these States were marked as having extreme limitations in relation to hospital inventory even as the confirmation rate (percentage of samples tested returning positive) recorded a steady surge. Gauba’s presentation further pointed out that the national Case Fatality Rate (CFR) remained stable. Sixtynine districts spread across 13 States had CFRs around 5 per cent, rated as very high. Of these districts, 11 are in Uttar Pradesh.

Even as the country’s top bureaucrat flagged these concerns and practically asked the five States to buck up and ensure greater focus on combating the pandemic, the Yogi Adityanath-led Bharatiya Janata Party (BJP) government in Uttar Pradesh was relentlessly pursuing its self-congratulatory publicity drives. A day after this warning there was much propaganda in the media and the government publicity machinery on how the Chief Minister had become a messiah of the children of migrant labourers as he had sanctioned a dole of Rs.1,000 to boys and Rs.1,200 to girls. The huge rise in fatalities in the first 10 days of June was explained away as something caused by the people’s casual attitude towards Unlock 1.0. Throughout the first 10 days of June the spurt in new COVID-19 cases was at a steady 5 per cent, as high as in Delhi and Tamil Nadu, rated as the worst affected States.

A number of senior officials in various departments of the State government, including Health and Home Affairs, point out in private that one of the major reasons for the spurt was the colossal lack of basic health infrastructure across the State. But in their public statements, government representatives, including bureaucrats, highlight the casual public reaction to Unlock 1.0.

A case in point is the statement of Dr Ashok Shukla, Chief Medical Officer (CMO) of Kanpur. Talking to the media, he pointed out that while there had been two case peaks in the past for diverse reasons, the surge in early June was basically because of the unrestricted movement of people following the easing of the lockdown. During a stringent lockdown it was easier to trace and track the infection. Now it was becoming extremely difficult. During a lockdown there was limited movement of people and people remembered every single place they had visited and person they had come in contact with. But now they were unable to tell everything. In a recent instance, one person infected as many as 80 people. Officials of Noida and Ghaziabad districts have also blamed the spurt in infection in their districts to the movement of people from Delhi. State Surveillance Officer Vikasendu Agarwal said that in these districts the spillover from Delhi was adding to the case load.

However, there was a silver lining in the COVID-19 data tabulated in early June, in the form of one aspect of new infections. This showed that the share of inter-State migrants in cases reported “since the beginning of June had come down to roughly 26 per cent”. In May, when the reverse migration of labourers from the big cities to rural Uttar Pradesh was at its peak, their contribution to the new cases was above 50 per cent. But another nuance of the June data causes serious concern. Out of the 321 deaths reported in the State between June 1 and 10, approximately 65 per cent—as many as 209—were of people in the 21-60 age group, many of them without known comorbidities. This flies in the face of the widely accepted assessment that healthy youngsters are at lesser risk from COVID-19 than elderly people with long-standing morbidities. Around 31.5 per cent of the deaths, 101, were of persons above the age of 60, while 3.5 per cent, 11, were of persons under 20 years.

According to a senior State Health Ministry official, the exact percentage of the deceased without comorbidities in the age group of 21 to 60 has not been quantified and unless it is done properly it cannot be gauged how far the early June experience of Uttar Pradesh repudiates the generally held view on the connection between COVID-19 and comorbidities. As one who has consistently flagged the long-standing deficiencies in Uttar Pradesh’s public health system, he is not sure whether the current government will take up an evaluation earnestly. “At the moment, there is a huge publicity drive promoting the so-called dynamism with which the the self-purportedly ascetic Chief Minister is battling the COVID-19 crisis even as cases and fatalities keep mounting. After all is said and done, herd immunity will arrive, give or take a few thousand deaths, seems to be the primary attitude of the self-promotion team in the Chief Minister’s Office in Lucknow,” the veteran officer told Frontline .