Punjab: Worrying spread in COVID second wave

Punjab sees COVID reach rural areas, which were largely unaffected by the first wave of the pandemic.

A police officer ties a facemask on a woman on the outskirts of Amritsar on May 3. There is a very little awareness of the disease in rural areas.

Punjab was among the early States to see the second surge of COVID-19 in March this year. More worrying now is the rural spread of the disease in addition to an unprecedented spurt in COVID cases in big cities and towns in the State. Significantly, the villagers were largely unaffected by the first wave of the pandemic. Add to that the frequent complaints of non-functioning ventilators received under the PM CARES Fund, and the dismal picture is complete.

On May 11, the State reported 8,868 new COVID cases, taking the total tally to 4,67,539. Significantly, with 217 deaths on that day the total number of deaths recorded was 11,111. The figure marked a disconcerting high after the peak of 106 deaths registered during the first phase in August last year.

As in the past, the highest number of cases was reported from Ludhiana followed by Bathinda, Jalandhar, Fazilka and Mohali. By May 12, the State had nearly 80,000 active cases. Ludhiana contributed 1,215 cases while Bathinda and Jalandhar reported 874 and 821 cases respectively. Fazilka saw 723 cases and Mohali 713.

Ludhiana recorded 28 deaths while Bathinda and Patiala reported 20 each. Amritsar reported 19 deaths and Sangrur 14. Significantly, Nawanshahr, which had reported the highest number of cases and deaths in January-February this year, quietly slipped out of the list of the worst-performing districts. This is partially because of the greater population density in other areas.

Over the past month, the State has reported 1.83 lakh cases and 3,359 deaths. The five districts of Ludhiana, SAS Nagar, Jalandhar, Patiala and Bathinda contributed 58 per cent of the total cases and 42 per cent of all deaths. Once again, Ludhiana topped the list with 36,357 cases (398 deaths), followed by SAS Nagar with 25,147 cases (237 deaths) and Jalandhar with 16,067 cases (195 deaths). Bathinda saw 15,455 cases in the past month (279 deaths) and Patiala reported 14,435 cases (298 deaths).

Low awareness

What is disturbing this time is the spread of the virus to the rural belt of the State. With significantly low awareness of the disease and lesser access to medical facilities in the hinterland, the spread of the disease to villages can have a snowballing effect. Most rural people are still sceptical about the vaccine and are averse to using a mask or maintaining social distancing.

Worse, most villagers, either because of ignorance or the absence of facilities, prefer to treat an infection at home. Hardly any case is reported to the Health Department, significantly reducing the daily tally by the Health Ministry. Most patients are taken for treatment only when their condition worsens significantly, thereby affecting their chances of survival. It explains why the percentage of deaths is much higher in comparison to positive cases in rural areas. From January to April end, deaths in rural areas were 1,156 (55%) vis-a-vis urban areas 952 (45%). The corresponding number of positive cases are 42,802 (23%) and 1,43,853 (77%) respectively.

Like medical facilities, vaccines too have not reached rural areas. According to Dr Rajesh Bhaskar, State COVID-19 Nodal Officer, “Patients from villages visit hospitals only when their condition deteriorates to an extent that they require ventilator support. The ventilator support is not easy to get, more so in rural areas. Further, self-medication or medicines prescribed by local medical practitioners add to the problems.”

According to an estimate, one-third of the deaths in the State are from rural areas. The case fatality ratio in rural Punjab is 2.86, significantly higher than 1.73 in the urban areas. The difference in figures stems from the fact that almost 84 per cent of the rural patients visited hospitals when their condition deteriorated significantly.

Speaking to news agencies, Health Minister Balbir Singh Sidhu said: “The situation of Punjab is similar to that in the rest of the country. Now the infection has spread to rural areas, and that will increase the problem for the State. That is why we have urged people to stay at home and take all precautions.”

Court’s intervention

Concerned over the spread of the disease in rural areas, the Punjab and Haryana High Court initiated a suo motu hearing on the management of the COVID-19 situation in the two States. The court sought a report from the State governments outlining the steps being taken to combat the virus in the rural belt.

During the hearing, Atul Nanda, Punjab’s Advocate General, said the State was suffering because of many faulty ventilators. He pointed out that 71 of the 82 ventilators the Centre had supplied to Punjab were found to be faulty.

War of words over ventilators

Later, it was found that 237 of the 320 ventilators received through the PM CARES Fund at the three government medical colleges in Punjab were defective. Speaking to the media, Dr Raj Bahadur, adviser to Punjab’s COVID-19 Response and Procurement Committee, said, “The medical college in Patiala received 98 ventilators from the PM CARES Fund. Forty-eight of them were made functional after repair while the other 50 are non-functional.”

Apparently, at Government Medical College, Amritsar, only 12 per cent of the 109 ventilators provided by the Centre were found to be functional. The unusually high number of faulty ventilators under the PM CARES Fund robbed the technicians of confidence in using them for the treatment of critically ill patients. The trust deficit with respect to the new machines has meant that the State has had to rely largely on its own limited resources. According to Dr Bahadur, 90 per cent of the 320 ventilators received by Punjab under the PM CARES Fund were defective.

Predictably, a political war of words has followed. Shiromani Akali Dal president Sukhbir Singh Badal urged Prime Minister Narendra Modi to conduct an inquiry into the issue. In a letter to Modi, Badal wrote: “I am sure you would agree with me that supplying defective and inferior quality ventilators during a time of national health emergency is a criminal offence. The company responsible for this should be booked and they should be proceeded against as per law.”

The Aam Aadmi Party (AAP), meanwhile, claimed credit for bringing the issue to public knowledge. Its MLA Kular Singh Sandhwan tweeted a picture of ventilators lying in a store room in Faridkot, saying, “When patients are dying on a daily basis for want of ventilators or better care, this junkyard room really shows a sorry state of affairs….”

He claimed, “In March’s Budget session, I had raised the matter about faulty ventilators and I was told that they will be repaired soon. This shows how serious the Central government is while spending funds which the public gave them for improvement of health facilities and further how serious the State government is to raise the issue if an inferior quality product is provided. In addition to this, it needs to be seen that once they are repaired, whether the medical college has this many staff to operate these ventilators? I don’t think they have recruited any more staff as yet.”