COVID-19 Update

Gujarat: Unlockdown impact

Print edition : August 14, 2020

The police trying to disperse as devotees gathered to participate in religious rituals on the first day of the Dashama Vrat near the Sabarmati river in Ahmedabad on July 20. Photo: SAM PANTHAKY/AFP

A health-care worker collecting a swab sample from a woman travelling from Saurashtra region, on the outskirts of Ahmedabad on July 16. Photo: Vijay Soneji

Gujarat is again showing a surge after businesses and factories start operating as part of the unlocking process and people move across districts.

Gujarat has slipped from the fourth position to the fifth among the States most affected by COVID-19. However, this happened not because of an actual improvement in the situation but because a surge in Karnataka put the southern State ahead of it. New cases and COVID deaths are being reported in Gujarat at a rate that has been alarming enough for a Central team to make a second trip to Ahmedabad and Surat in mid July to guide the administration in managing the crisis and to provide direction on treatment methods. A study done by the Population Council says Gujarat is among the nine most vulnerable States. 

On July 21, Gujarat’s caseload hit the 50,000-mark, and the highest ever single-day spike with 993 cases was recorded on that day. The State Ministry of Health and Family Welfare data indicate the disease is rapidly spreading to the districts. Some of the tribal pockets that had remained unaffected until a week earlier are now reporting cases. A look at the districts that show a spike reveals a pattern. Apart from the cities, high incidence is noticed around industrial hubs and special economic zones, indicating that Gujarat is paying the price for trying to revive its economy. Factories and businesses had begun functioning with the easing of lockdown restrictions as people started braving the prospect of an infection in order to get back to work. 

In mid July, Chief Minister Vijay Rupani issued an official statement saying businesses and industries had picked up pace after Unlock 1 owing to the cooperation of citizens, and factories had started operating. Large industrial and MSME (Medium, Small and Micro Enterprise) units started operating despite a massive labour shortage caused by the migrant exodus.

Sources connected to labour unions in Ahmedabad, however, said industry and business were unlikely to get back to functioning to full capacity unless the migrant workers returned. One activist said that the only thing that was visibly back to normal was public works and infrastructure projects. 

Numbers tell a dismal tale

On July 21, State Ministry of Health and Family Welfare data clocked the death toll at 2,162 and the total number of positive cases, including successful discharges, at 47,191. The death (mortality) rate is pegged at 4.5 per cent against the national average of 2.5 per cent. Additionally, the Case Fatality Ratio (CFR) at 4.48 per cent remains higher than the national average of 1.78 and Maharashtra’s 3.85 per cent. (CFR is the number of people who die for every 100 people who test positive.)

A doctor who treats COVID-19 patients in Ahmedabad said the CFR was high because patients waited too long to seek treatment. 

Gujarat is still struggling to cope with the pressure on its health-care infrastructure, but there has been an improvement since the early days of the pandemic. The State authorities had been rebuked by the Gujarat High Court, and also apparently pulled up by the Centre, for their shoddy management of the disease. The State government has since increased the number of dedicated COVID hospitals across districts. Private laboratories are allowed to test samples. Recent news reports said final year medical students would be trained to treat patients. 

“More testing needed”

According to State government data, 5,36,620 people were tested until July 21. Following the Centre’s instructions on increased testing, daily tests have doubled from an average of 5,300 in June to 11,000-12,000 in mid July. However, the Ahmedabad Medical Association (AMA), which represents close to 9,000 doctors in the State, says even this is not enough. The AMA filed an appeal in the High Court asking for a rate of testing that is commensurate with the State’s population size. Dr Mona Desai, who heads the association, told the media that States as big as Gujarat, Tamil Nadu for instance, were conducting 30,000 tests a day. 

Gujarat’s Total Positivity Ratio (TPR) stands at 8.6 per cent. (TPR is the percentage of tests that return positive results.) A high rate means a good percentage of people being tested are turning out positive, which indicates that only the sickest are going for testing. Doctors believe an increase in testing will reveal a better picture. 

Reinforcing the AMA’s stand, the Central government team, which comprised Dr Randeep Guleria, Director, All India Institute of Medical Sciences (AIIMS), New Delhi, and Dr Balram Bhargava, Director General, Indian Council for Medical Research, asked the State to increase testing for a clearer understanding of the larger picture. The team was in the State to look into the high fatality rate and advise the medical community on treatment protocols. Dr Guleria supported the use of oxygen therapy and cautioned doctors on the use of Tocilizumab, which he said must be used only in severe cases. 

A recent study titled “A vulnerability index for the management and response to the COVID-19 epidemic in India: an ecological study,” published by The Lancet, a medical journal in the United Kingdom, said Gujarat was among the nine most vulnerable States in India. The computation locates Gujarat at 0.77 on a zero to one scale (1.0 is the most vulnerable and 0.0 the least). The study says “it computed a composite index of vulnerability at the State and district levels based on 15 indicators across the following five domains: socioeconomic, demographic, housing and hygiene, epidemiological, and health system. We used a percentile ranking method to compute both domain-specific and overall vulnerability and presented results spatially with number of positive COVID-19 cases in districts.” 

Researchers Rajjib Acharya and Akash Porwal from the Population Council, New Delhi, write in the introduction to their report: “The main value of our study is the State and district ranking provided to policymakers to prioritise resource allocation and devise effective mitigation and reconstruction strategies for affected populations. Additionally, vulnerability in the era of COVID-19 is more than the risk of contracting the disease. A person or group might not be vulnerable at the beginning of the pandemic, but could subsequently become vulnerable depending on government response.” 

In the early days of the pandemic, Ahmedabad was the hardest hit in Gujarat. It was not unexpected that once the State started unlocking the disease should start spreading to the districts, riding on the back of inter-district movement. Surat has been declared a hotspot after reporting 9,709 cases and 269 deaths. The districts showing high incidence are Vadodara (3,610 cases), Rajkot (1,017), Mehsana (580), Bharuch (590), Bhavnagar (487), Amreli (230) and Dahod (251). Of the two predominantly tribal districts, the Dangs, which earlier had no cases, now reports eight, and Chota Udaipur has 98.