COVID-19 Update

Local body elections and the Kumbh Mela has taken COVID-19 infections into the rural areas of Uttar Pradesh

Print edition : June 18, 2021

Tasawur Chaudhary, a community health worker from Kairana, has been conducting monthly health camps for internally displaced people since 2015. Photo: Tasawur Chaudhary

Wajid Chauhan from Khandrawali has been running a clinic for years without any formal training in medicine. Here, a patient seeking referrals to doctors in Panipat or Meerut. Photo: Akram Akhtar Choudhary

As western Uttar Pradesh counts it dead, Shamli tells a story of how ill-timed local elections turned into a COVID-19 superspreader event. The administration has only offered paltry assurances and pious advisories to the sick and vulnerable, while invisibilising the full impact of the pandemic.

The ganna (sugar) belt of western Uttar Pradesh is paying a heavy price for the recently held local body elections and the Kumbh Mela. For a region where a large demographic subsists on daily wages, the pandemic has widened the fissures that were exposed by Lockdown 1.0. Since 2014, Muslims in the State have faced systemic exclusion because of the majoritarian shifts that followed the riots of 2013. The violence displaced thousands of families who now live in squalid conditions in Shamli and Muzaffarnagar districts.

A season of hate has lasted throughout the tenure of Chief Minister Yogi Adityanath’s government. Minorities have been targeted in encounters, mob lynchings and through the State’s wanton abuse of provisions of the National Security Act. This has had an effect on how people in the hinterland have responded to the pandemic. The marginalised Dalits and Muslims are relying on older community-driven networks of care to deal with the virus. In contrast, dominant castes have navigated the past two months by relying on kith and kin networks within the police and civil administration.

With a population of around 12 million, western Uttar Pradesh comprises the districts of Saharanpur, Muzaffarnagar, Meerut and Shamli and is located to the north-east of Delhi and east of Haryana. Shamli has a population of 1.3 million and is less densely populated than Saharanpur (3.4 million) in the north, Muzaffarnagar (4.1 million) to the east and Meerut (3.4 million) to the south. Shamli district is administered through five blocks—comprising Kairana, Kandhla, Shamli, Uun and Thana Bhawan—covering a total of 230 village panchayats.

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Cane cultivation has historically contributed to dominant caste (Jat, Gujjar, Rajput) consolidation. But faced with mounting arrears from sugar mills, these castes have diversified into sand mining, real estate, brick making and organised crime. Dalits and Pasmanda Muslims either subsist on these economies or resort to migration.

Engineering elections

The current COVID situation can be traced to February. The Allahabad High Court pulled up the State Election Commission (SEC) for not adhering to Article 243E of the Constitution, which says: “Every panchayat… shall continue for five years from the date appointed for its first meeting and no longer.” Accordingly, local elections in Uttar Pradesh should have been conducted by January 2021. The SEC cited procedural lapses in preparing the list of gram sabhas and allocation of reserved seats for the delay. The court would eventually consent to the SEC’s plea to conduct the elections in four phases on April 15, 19, 26 and 29. Counting was to occur on May 2 along with Assam, West Bengal, Puducherry, Tamil Nadu and Kerala, all of which had Assembly elections.

February also saw the Uttarakhand government announce its readiness to commence the Kumbh Mela in Haridwar from April 1. The elections and the Kumbh gave official sanction to mass violations of the elementary provisions of the COVID protocol in the election-bound States and Union Territory. The Central government dismissed COVID-related concerns about the local elections and the Kumbh. Earlier, in January, the Prime Minister had used the platform of the World Economic Summit in Davos to proclaim India’s victory over the virus. In early March, Health Minister Harsh Vardhan defended the government’s decision to export vaccines. He claimed India was in the “endgame” of the pandemic.

The past seven years of Bharatiya Janata Party (BJP) rule suggests that the party has so much faith in the public mandate that it feels that it will be able to blunt criticism and regain lost ground. A question then arises: Was the timing of the local elections in Uttar Pradesh a result of official delays as the SEC suggested or was the delay engineered to prevent an electoral pushback arising from widespread discontent, most dramatically illustrated by the snowballing farmer agitation?

The peasant mobilisation grew in strength through the winter and gathered momentum after the Republic Day march to Delhi. Rakesh Tikait, a leader of the Bharatiya Kisan Union, emerged as an important face of the farmer resistance in Uttar Pradesh and Haryana. He emerged as a hero after an attempt was made on January 28 to evict him from the protest site at Delhi’s Ghazipur border, which ignited Jat anger across western Uttar Pradesh, Rajasthan and Haryana.

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What followed were mahapanchayats and mass boycotts by Jat khaps of BJP leaders. Sanjeev Baliyan, the Jat MP from Muzaffarnagar, was asked by his party to assuage the khap biradaris (kinship). In Bhainswal–Shamli, he faced confrontations with protesting farmers. In Shorum-Muzaffarnagar, considered sacred to the Jat community, Baliyan’s supporters allegedly resorted to violence. Numerous incidents were reported from across western Uttar Pradesh and Haryana where village residents put up boards to restrict the entry of BJP leaders. It is widely believed that by postponing the elections to April and scheduling the counting for May 2, the government was trying to prevent a negative mandate in Uttar Pradesh from rubbing off on the other States.

In the elections, 8.69 lakh local body offices were at stake; of these 3,839 were for positions in Shamli district. In western Uttar Pradesh, Jat resistance to the farm laws was seen as potentially leading to a return of the pre-2013 Muslim-Jat alliance. As a result, the local elections were a testing ground for a rewound arithmetic based on inter-communal fraternity (bhaichara).

But for Dalits and the marginalised Muslim Pasmanda castes, fraternity remains a distant dream, given their precarious existence as daily wage earners. Their electoral aspirations are confined to issues such as unpaid wages, flooding and drainage, and the scarcity of life-saving drugs.

The second wave makes landfall

The elections resulted in a month-long spell of campaigning, public meetings and social media activity. Levels of enthusiasm for the elections were not visible through televised rallies but through WhatsApp images of localised community engagement. In Shamli, a village lane became an election ward, and numerous wards became a contested constituency for the posts of pradhan and members of block development committees (BDCs) and zilla committees.

Well-off candidates paid outstation voters, or parvasi mazdoor, to return to villages to cast votes. Trucks were hired to ferry voters from across India to bolster election prospects where the winning margins are occasionally in the single digits. Candidates backed by political parties fought with modest budgets and sought endorsements from same caste biradaris. They relied on door-to-door meetings and public gatherings at the village choupals (village square) and met with village elders over multiple home visits and rounds of tea. All the meetings were photographed and communicated to silent voters via WhatsApp and Facebook.

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On the basis of the allocation of phase-wise polling, voters in Saharanpur, Muzaffarnagar and Shamli were to vote on April 15, 19 and 26 respectively. The number of daily COVID-19 cases began to climb through the first week of April, indicating that the second wave had made landfall in Uttar Pradesh. Wide coverage of the massive election rallies across election-bound States and images of the Kumbh caused alarm within Uttar Pradesh. A public interest litigation petition was filed on April 9 at the Allahabad High Court seeking cancellation of the panchayat elections because of the COVID situation. The plea was defeated as the SEC was able to assure the court that there would be strict adherence to the COVID protocol during the election.

Managing an election under the shadow of a pandemic required deputation and training of thousands of government schoolteachers, which was a challenge. Training was meant to communicate the COVID protocol and instructions to manage the polling and counting centres across the 75 districts of Uttar Pradesh. Arguably, this agitated the teachers’ federation of the State, which questioned the risks posed to teacher safety during transit, training, polling and counting.

Teacher victims

Pleas and letters to the SEC went unheard and teachers seeking leave were met with threats of dismissal and police inquiries. In Shamli alone, up to 2,000 teachers were asked to report for election duty. The Hindi daily Amar Ujala reported that when 35 teachers were found to be absent from training at the National Inter College-Kandhla, Shamli District Magistrate Jasjit Kaur ordered a first information report to be filed against them.

Satender Kumar (name changed), a government teacher from Kandhla, witnessed the whole election process from training to counting. He portrayed the fear that struck not just the teachers but also the police and Election Commission officials. Ironically, pre-election training that was meant to communicate the COVID protocol was held in packed spaces. Transportation was always in crowded buses, and election centres lacked hygienic toilets and sanitisers.

On the day of the elections, Satender Kumar’s colleagues began to show signs of COVID-19. Many fainted, passed uncontrollable stools and vomited. There were no facilities to test symptomatic teachers or provide them with medical help. Questions of livelihood outweighed fear of the virus; Satender Kumar too worked throughout the elections despite experiencing symptoms himself.

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The evidence of teacher deaths was brought to the High Court’s attention after the first phase of polling. In court, the SEC was asked to explain its ill-preparedness that allegedly led to the deaths. The Assistant Solicitor General dismissed the causality between the elections and the COVID-19 cases. He used the example of Delhi to suggest that the surge was occurring even before the elections got under way. The surge now had a free rein, and Uttar Pradesh reported its highest COVID-19 case count of 34,813 on April 27, a day after the fourth phase.

On May 1, a day before counting began, the Supreme Court said it had apprehensions about two things: the possibility of non-adherence to the COVID protocol during counting and the arrangements to manage victory celebrations. New assurances were offered such as mandatory COVID negative tests for election agents and the use of CCTV cameras to monitor the counting centres.

According to Satender Kumar, the mandatory COVID negative rule was applied discretionarily to exclude the teachers from the counting centres. Election agents flouted the rule by procuring COVID negative certificates on payment of Rs.500. When counting began, crowds thronged the centres. Many did not wear masks or adhere to physical distancing norms.

Court’s warnings not heeded

As the results started trickling in, the court’s ominous warnings went unheeded. A visibly under-equipped and fatigued police force stood by as people either broke into large-scale celebrations or committed violence against opponents. It has now been revealed that the teaching fraternity lost over 1,600 members during the elections. The report of illnesses and fatalities amongst non-teaching staff and officials of the Election Commission and the district administration is yet to be ascertained.

The Uttar Pradesh government’s COVID preparedness plan requires each district to have a designated three-tier (L1, L2, L3) health system. Asymptomatic patients and those with mild symptoms are received at the L1 centres, while more serious cases are to be referred to L2 or L3 hospitals. In Shamli, an L1 centre was set up in Jhinjhana last year but was shut down when the district declared itself COVID free.

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Community health centres (CHCs) are currently working as quasi L1 facilities and offering testing, vaccination and providing non-COVID-related care. The L2 facility is the district hospital, inaugurated in September 2020, and currently being used as a dedicated COVID facility. There is no government designated L3 or multi-specialty hospital, so critical patients with Arogya cards are either referred to a local private hospital or to hospitals in Saharanpur.

The daily infection graphs for western Uttar Pradesh taken from the website covid19.org show a uniform increase in reported cases from the middle of April 2021. Tohid Khan and Atul Garg, data entry operators at the Kairana and Kandhla CHCs respectively, offered details about the nature of testing between May 2 and May 15. The two CHCs saw a daily average of 150 out of 500 people testing positive: a positivity rate of 30 per cent. In the same period, Shamli district reported a total of 4,026 cases with a daily average of 309 cases recorded across five CHCs. This roughly corroborates the figures from Kandhla and Kairana and confirms a pan-district positivity rate of 25-30 per cent.

Fatalities

The approximate number of overall deaths reported from Meerut, Muzaffarnagar and Saharanpur, as of May 24, stands at 420, 926 and 426 respectively. Dr Sanjay Aggarwal, the Chief Medical Officer (CMO) of Shamli, puts the overall official death count in Shamli at 38. Eight of these deaths are said to have occurred between April 24 and May 24. Asked about the possibility of deaths being under-reported, the CMO said that he could only speak about the officially recorded number. Tohid Khan’s figures from the Kandhla CHC reveal a discrepancy. The Kandhla block, which covers 60 villages, shows an overall death count of 28, as of May 21. Official counts from the four other CHCs would certainly reveal a much higher figure than the one the CMO quoted.

It is evident that official COVID figures do not correspond to the number of actual dead. But the positivity rate of 25-30 per cent is an important lead that underlines the spike in fatalities between May 2 and May 15. Rahul Neemia, associated with the Ambedkar Yuva Jan Sanghatan, has witnessed 10 deaths in Khandrawali village in the last one month alone. The number of dead from other villages is even more startling, with Ailum recording 40 deaths, Bhabisa 30 and Nala 16.

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The CMO confirmed that contact tracing and testing teams were being sent out regularly. Yet, testimonies from numerous villages state that testing is done on those who voluntarily visit the CHCs. Dr Ramveer Singh, Deputy CMO at Kandhla CHC, explained the limitations in increasing the scope of tracing and testing. The facility is burdened with having to perform testing, vaccination and non-COVID care. Contact tracing is limited because there are only two two-member teams to cover the over 60 villages under their watch. The guidelines of the National Centre for Disease Control for contact tracing, monitoring and safety of front-line workers require frequent follow-ups in COVID-infected zones. Instead, the district administration has been running a door-to-door campaign to screen for symptomatic patients.

Prolonged neglect of health care

The campaign is being carried out by teams of auxiliary nurse midwives and accredited social health activists (ASHAs). According to Murshida Begum, an ASHA worker assigned to the Kandhla block, they are only required to identify persons with COVID symptoms and suggest testing. The local media reported that the campaign touched one lakh homes between May 5 and May 10. Medical kits containing vitamins and paracetamols were distributed to the 2,113 people who were found to be symptomatic. The arrangement is being flashed in the local press and the Shamli District Magistrate’s twitter handle as a COVID containment strategy.

The failure to have a system in place to monitor a symptomatic person means that the authorities have not acknowledged the possibility that the SpO2 levels of those in home isolation could fall. A majority of patients who report shortness of breath are unaware of their falling SpO2 levels. Oximeters are not sold over the counter or included in the medical kits given by the administration. There are numerous instances of those who reported shortness of breath but only found out about their alarmingly low SpO2 levels just before death.

The wife of Umesh Sharma from Kairana went into home isolation after showing COVID symptoms such as fever and cough. Although the symptoms began to subside, she began reporting shortness of breath by day 9-10. The family, unaware of SpO2 levels and pulse oximeters, reported her breathlessness to the L2 facility but were denied admission after a routine temperature check revealed no fever. The same day, Umesh Sharma dropped by Tasawur Chaudhary’s clinic in Kairana. Tasawur Choudhary has a diploma in community health and physiotherapy and is one of the few people in the village with a pulse oximeter. He checked the patient’s SpO2 levels and was alarmed by the saturation value of 34 per cent (the normal range is 95-100 per cent). She was rushed again to the hospital but passed away within a couple of hours of being put on oxygen support.

In most cases, symptoms are not limited to fever and cough. As Satender Kumar observed during election duty, many people reported diarrhoea and vomiting, which are also common in typhoid. As a result, those who tested COVID positive also got tested for typhoid (the Widal test). According to Sajid Bankar, a technician at a private pathology laboratory in Kairana, during the surge of COVID-19 cases Widal tests had a 70 per cent positivity rate. Dr Ramveer Singh confirmed that a high prevalence of malaria and typhoid meant that COVID positive patients needed to be simultaneously treated for waterborne illnesses. The onset of typhoid-like symptoms and COVID-related breathlessness has punctuated fears.

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The antecedents of typhoid can be found in colonial irrigation technology. Land here is a mix of lowlands (khadir) and upland (bangur), which encumbers the draining of excessive water. Colonial statistics from the 1850s show how the Ganges and Jumna canal spillages induced swamps that led to bowel problems and fevers.

By1890, Shamli town wore an abandoned look that mirrored the post-1857 desertions. Canal water had seeped through homes and tahsil offices. It caused a major outbreak of illnesses, and the office had to be shifted temporarily to Kairana until the irrigation department found ways to drain the excess water. Over the last 120 years, Shamli has grown into a densely populated district. The new settlements that emerged, such as the colonies of riot-displaced people, jostle for space, aggravating the problem of drainage (nikasi).

Official claims of preparedness are belied by the understaffed, under-equipped and neglected state of L2 facilities. An online dashboard that should have been the source for basic COVID-related information was inactive until May 14. The local media have highlighted how the L2 facility in Shamli has remained understaffed and ill-equipped since its inauguration in September 2020. The facility received 12 ventilators during the first wave, but they remained non-operational owing to delays in appointing a technician. It is reported that the vacancy was only filled by May 17, and currently only five of the 12 machines are operational.

Recently, a patient who had paid an operation theatre assistant Rs.10,000 for an oxygen cylinder died because it turned out to be empty. Another patient admitted to Meerut’s L2 facility was declared dead and cremated without his family being informed of his death. In another case, the family of a patient who died was only told of the death 10 days afterwards. The truth was revealed after the patient’s daughter reached the hospital and was unable to trace her father. When such incidents are brought to light, the administration promptly responds by offering assurances of an inquiry. Doing this allows it to fix accountability on to individuals and absolve itself of blame in enabling a system that is mismanaging the pandemic.

Finding assurance through care

The press and the local community parody the available health facilities by referring to it as an endless referral system. This is not new in a place where critically ill patients frequently board the overcrowded local train from Shamli to Delhi to seek referrals. These experiences are not lost on those who are currently battling COVID-19.

It is reported that amongst the rural community informal networks of care offer some assurance of help and timely intervention. These responses are differentiated by caste and class positions as the experience of dominant and marginalised castes suggest. Members of the dominant castes have expansive kith and kin relations represented in the local administration and the police across north India. During the second wave, many found help online by putting out SOS calls on caste-centric social media channels and, because of their deep pockets, were able to secure beds in private hospitals in Panipat or Meerut for the critically ill.

Rijwan Saifi, a community mobiliser displaced in the riots in 2013, portrays a more desperate situation for the displaced. He compares the ongoing surge to conditions during the lockdown in 2020. At that time, households witnessed acute food shortages and bankruptcy. Work was not available, and the gram pradhans redirected food entitlements from the public distribution system to members of their caste.

This year is a little different. Work is still available on construction sites. But death is near and ever present. The infirm rely on community mobilisers and local doctors to battle the pandemic. Those who approach private hospitals are turned away because they are unable to pay the exorbitant rates. Sonu Rawal, an admission attendant at a private hospital in Panipat, confirmed that many critically ill patients do not get admitted because the hospital charges upwards of Rs.1 lakh for an admission.

Social workers have in the past been able to help tackle communicable diseases and provide relief during riots. They are also able to articulate their political ambitions through such work. Tasawur Chaudhary, the community health worker from Kairana, has been working in the internally displaced settlements. He contested the BDC election but lost by 27 votes. A win for him would have meant an opportunity to extend the community health work to fixing the problems of drainage and the shortage of essential drugs.

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Wajid Chauhan from Khandrawali has been running a clinic for years without any formal training in medicine. He has been responding to calls for oxygen and uses his referral network with doctors in Shamli and Meerut to help COVID symptomatic patients. This contributed to his victorious campaign in the BDC election where he polled 800 votes, winning by a margin of 500.

As COVID situates itself in tense and differentiated agrarian spaces, ties of solidarity will remain at the front lines of fighting the pandemic. But for how long? After hitting a peak on April 27, the number of reported cases in Uttar Pradesh has rapidly declined. As of May 24, the State reported just 5,000 cases and a couple of hundred deaths.

The historical experience with fevers suggests that when they spread to the hinterland, they are invisibilised and normalised. COVID-19, too, faces such a fate given how deaths are being hidden and how testing lacks strategy. Official assurances about the pandemic in Uttar Pradesh may soon lend themselves to a situation where the State declares itself COVID free.

Vishal Singh Deo is a doctoral candidate at the Department of History at the University of Delhi. Akram Akhtar Choudhary is a lawyer and human rights activist based in Shamli, Uttar Pradesh. They are associated with the Afkar Foundation in Shamli, a collective that works with victims of hate crimes and forced displacement.

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