“Ganga has revealed the truth!” exclaims Vishwambhar Nath Mishra, head priest of the Sankat Mochan temple in Varanasi. Located in the heart of the ancient city, the temple is where the faithful come to seek an end to their problems. But the region has been witness to a grisly sight over the past week. Semi-decomposed and bloated bodies have been found floating in the sacred river. Mishra, who is also a professor at the Indian Institute of Technology-BHU, says this indicates that the COVID-19 situation in rural Uttar Pradesh is far worse than it appears.
Ever since the bodies were discovered, police personnel have been patrolling the waters and ghats . They have set up pickets in at least seven districts and even offered a support sum of ₹5,000 to those who cannot afford wood for cremation, to dissuade them from immersing bodies in rivers.
The State police have so far admitted to having found 44 bodies floating in the rivers, mainly the Ganga, in the districts of Ballia , Chandauli, Ghazipur , Varanasi, Hamirpur and Kanpur. For residents of Ghazipur, where the bodies were first spotted in U.P., the sight was shocking. Balwant Singh Bala of Gahmar village says he has never seen anything like this before. “We are used to bodies floating in the river once in a while. But this time we knew that there was something very grave happening,” he says. A senior police officer, who led the clean-up of the ghats with lime powder, agrees.
U.P. is officially yet to acknowledge that all or some of these were COVID-19 victims. Many observers suspect that these bodies could be of COVID-19 victims who were abandoned or disposed of in the waters by families due to lack of money for cremations , the waiting lines at cremation grounds, or the social stigma attached to the disease. Speculation intensified when countless shallow graves were found on the ghats of the Ganga in some districts, including Unnao, Prayagraj, Kannauj and Rae Bareli.
At the Baksar ghat in Unnao , cleaners, priests, locals and attendants of the dead say that though bodies have been cremated and buried there according to customs, in April, when the wave was at its peak, the number of bodies arriving at the ghat for final rites reached 70-80 a day against the daily figure of 15-20. Those who could not afford to buy wood and fuel for cremation chose to bury the dead, they say. Since there is no way of knowing whether the bodies in the river are of COVID-19 victims, the question of uncounted COVID-19 deaths in the State still hangs in the air.
Battling COVID-19 in the villages
The pandemic has put tremendous strain on the fragile health infrastructure in U.P. and exposed the lack of preparedness in urban areas. Every day, there are desperate pleas for hospital beds, essential medicine and oxygen cylinders. Crematoriums and graveyards are packed. But now, the focus has shifted to the rural areas after the discovery of the bodies in the Ganga and the alarms raised in the wake of the recently conducted panchayat polls.
According to official figures, the daily number of positive cases and deaths has drastically dropped over the last three weeks. On April 30, the State had 3.1 lakh active cases. On May 21, this dropped to over a lakh. On April 24, the State had recorded 38,055 new cases out of 2.25 lakh samples tested, while on May 21, it recorded 7,735 out of the over 2.89 lakh samples tested. The recovery rate in U.P. is now 92.5%.
However, the spread of the infection in rural areas is alarming. During a testing drive in 89,512 villages, 28,742 villages (32%) reported positive cases , says Amit Mohan Prasad, Additional Chief Secretary, Health. Prasad, however, chooses to look at the bright side. “Sixty-eight percent of our villages are still safe from the infection,” he says, adding that the government’s focus is to keep testing in rural areas. Even after aggressive testing, new cases have been decreasing while recoveries are increasing, a government official says.
All these numbers offer little consolation to the bereaved. In Mau district, nursing staff Deepak Yadav’s experience encapsulates the tragedy of battling COVID-19 in the hinterland where medical infrastructure is poor. After his parents tested positive (they were tested at home with a rapid antigen test kit), Yadav desperately searched for a hospital bed in Mau and in the neighbouring districts of eastern U.P. without success. He then arranged for oxygen cylinders at home. When his mother’s health continued to deteriorate, Yadav dialled for an ambulance but the oxygen cylinder that came with it ran out in five minutes, he says. The local community health centre in Dohrighat was shut. The family then went to a private hospital across the Ghaghara river in Barhalganj in Gorakhpur but was told that it had no oxygen. In panic, Yadav tried to move his mother to his workplace in Deoria. Meanwhile, the private hospital which had rejected him earlier called him back following the intervention of a politician, he says. The entire episode lasted more than three hours, of which the family spent an hour stuck on a 3-km stretch of road in a traffic jam, which Yadav’s brother, an Army jawan, frantically tried to clear. Yadav attempted resuscitation in the ambulance meanwhile, but by the time they reached the hospital, his mother had died. His father, who was also hospitalised for a few days, is critical at home. Barring two or three members, everyone is his house has tested positive for COVID-19.
Yadav, who was busy during the panchayat polls and vaccination drive, cannot explain how his parents who live a rural life got the virus. “It means the virus has spread in the villages,” he says.
While a large part of the media’s focus was on the worst-affected urban centres of the State such as Lucknow, Varanasi city, Kanpur, Prayagraj and Meerut, the pandemic steadily crept into the semi-urban and rural areas. In several districts, the death count doubled and even tripled within a fortnight in April. Largely rural and backward districts like Chandauli, Hardoi, Shahjahanpur, Basti, Ghazipur and Sonbhadra have recorded a high number of deaths, between 230 and 320 each, indicating the devastating impact of COVID-19 in the rural areas of U.P.
Problems with testing
Bihari Lal, a journalist in a Hindi daily in Chandauli, is among the dead. His son Ashutosh Jaiswal, who serves in the Railways, says his father faced no shortage of oxygen supply, but was not treated well at the private hospital where he was admitted. The family did not take Bihari Lal to a government centre as they do not trust government hospitals and found it easier to find a bed in a private centre, Jaiswal says. Bihari Lal, who also served as an LIC agent and ran a photo editing store, had developed a cough and fever after moving about during the panchayat polls, his family says. Initially, a local doctor prescribed some antibiotics for him. Then a blood test revealed that he had typhoid. While his fever subsided, Bihari Lal’s oxygen levels continued to drop and he was admitted in hospital. A CT scan revealed that he had lung infection. Three-four days later, a rapid antigen test showed that Bihari Lal was COVID-19 positive.
Also read | COVID surveillance in rural U.P. hit by lack of kits
Jaiswal feels that the initial delay in starting COVID-19 treatment may have cost his father precious time. According to a senior district official, this is a common concern as people rely on quacks and are slow to start precautionary treatment for COVID-19 as per the guidelines issued by the State.
For many days after his initial symptoms, Bihari Lal’s family relied on the usual care and steam treatment as they believed that he was getting better. “People are taking the fever and cough lightly and going to doctors for usual treatment. When the doctor says the patient has COVID-19, they are unable to understand what to do,” says Jaiswal.
Despite raising a flag on the district portal, Jaiswal says no sanitation work was carried out in his house in Purwa village after his father tested positive. Similar complaints were raised by people in other districts as well.
The State government says it is conducting a massive testing and door-to-door surveillance drive in 97,000 villages. This included a special drive from May 5 to 9. However, representatives of several villages have alleged that the administration has provided minimal facilities for testing. Testimonies from rural areas show that deaths and positive cases may be much higher than recorded as not all symptomatic or suspected cases are being sent for tests. This is due to infrastructural issues such as shortage of manpower and equipment, lack of accessibility and urgency, or hesitancy on behalf of the people.
A cremation takes place at the Baksar Ghat in Unnao in early May.
In Unnao, front-line ASHA (Accredited Social Health Activist) workers, who go door to door to trace cases in villages, say they are at high risk as many of them do not have the necessary instruments to measure temperature or oxygen levels. They are not even provided sanitisers, they say. Veermati Singh, an ASHA worker, says all she was given was a medicine kit with some strips of tablets, mainly for fever; a face mask; and a pair of gloves. “People don’t take us seriously. Why would they when I cannot even record their temperature and oxygen levels,” she says.
Many who had COVID-19 symptoms and lung infection, detected through CT scans, say they did not get RT-PCR tests done. If they did have COVID-19, they would not have been officially counted in the State’s daily case count.
Inspecting deaths
On May 10, Seema Jaiswal, the Pradhan of Sauram village in Ghazipur, not too far from the Ganga, wrote to the district magistrate stating that the number of people dying due to COVID-19 in her gram sabha was increasing by the day. She attached a list of 16 persons who had died. Manoj Kumar Jaiswal, her husband, says three more people have died since, including a six-month-old girl. Though he is not sure if they died of COVID-19, he says the symptoms could not have been anything else. “ Bas khasi aur bukhar (Just cough and fever)! Some had it for 2-4 days and died. Others had it for barely 12-24 hours and died,” he claims. However, he is quick to add, “We can’t say that they died of COVID-19. Only after testing will we be able to say that.” Jaiswal alleges that no tests were carried out in the village till his wife wrote the letter.
The Chief Medical Officer of Ghazipur, Girish Chandra Maurya, visited the village to inspect the deaths. He says two-three people did die in the village but due to “age and natural process” or some other illness, not COVID-19.
The administration then held testing camps in two sessions. Of the 142 persons with symptoms, four were found positive through rapid antigen tests. They were put under quarantine. Medicine kits were distributed among the others. Three sacks of bleaching powder were provided to the village head for sanitisation.
Maurya admits that “more people are dying” in the rural areas in the second wave. This has scared the rural folk and has forced many to come forward to get tested, he says. “Now more people are also wearing masks. They feel they need to get tested and treated on time,” says Maurya. The district had a target of conducting 2,000 tests per day but was testing 8,000 samples, he says. He adds that teams are especially being sent to the villages for testing drives. Neighbouring Chandauli was testing only 1,500-1,700 samples, says an official.
In Baghpat’s Lumb village, the headman released on social media a list of 34-37 persons who had allegedly died of COVID-19 over the past month. After carrying out a survey, officials said the reports were false. The teams did not find any death due to COVID-19, says the Chief Medical Officer, R. K. Tandon. Officials say though fever was reported in a couple of cases, it was not correct to say that all deaths in the village were due to COVID-19. In the last two months, 20-25 persons had died, but due to other illnesses, says Tandon. He also rubbished claims that no tests were being carried out. The administration tested 362 persons through RT-PCR and 428 through rapid antigen tests and found 21 persons positive for COVID-19. All of them have recovered, he says.
The role of Panchayat polls
The spread of the pandemic in rural U.P. has coincided with the panchayat polls, which many have blamed for the spike in cases and deaths . Despite guidelines being issued, it was impractical to imagine social distancing and proper safety norms being followed in the tightly contested rural polls which had around 13 crore registered voters, over 2 lakh voting booths and 80,762 voting centres, and over 2.43 lakh officials and staff on polling duty.
While the government says that it conducted the polls on the instructions of the Allahabad High Court, it ignored several warnings, including by its own legislators, to defer the process of voting as well as counting when the second wave hit its peak. The counting could lead to a “super explosion” of COVID-19 cases in rural areas, wrote the Bharatiya Janata Party MLA from Hardoi district, Madhvendra Pratap, to Chief Minister Yogi Adityanath. Concerned about the deaths of those on polling duty, teacher unions had declared that they would boycott the counting process on May 2. However, after the Supreme Court allowed the counting process to go ahead, on assurances by the State government that proper COVID-19 safety norms would be followed, the unions called off their boycott. The counting centres across U.P. presented a worrying picture. Social distancing went for a toss. Large numbers of people, mostly men, gathered outside or lined up at the gates of the centres in close physical proximity to one another.
Also read | Only three teachers on polling duty died of COVID-19, says U.P. govt
The U.P. Prathmik Shikshak Sangh, a union of primary teachers, alleged that 1,621 teachers and staff died of COVID-19 after being assigned duty in the panchayat polls and control rooms for the pandemic. The Allahabad High Court, which has taken note of the issue in regular hearings , reprimanded the State over the deaths and said the ₹30 lakh compensation offered to the kin of the dead was not enough. It suggested that the amount be increased to ₹1 crore. However, the government left the teacher unions fuming after it announced that it had confirmed only three deaths due to COVID-19. The kin of the deceased and the Opposition parties say this is a ploy by the government to avoid paying huge sums of compensation.
Lawyer Satyam Rai, whose father Pankaj Rai, a school principal, died on April 24 after serving in the second phase of the panchayat polls in Azamgarh, says the election could have easily been deferred given the surge in cases. Pankaj Rai, though he tested negative in a rapid antigen test, was diagnosed with “typical COVID-19” in his CT scan. He died before the RT-PCR test could be conducted and will perhaps not be counted among the 18,760 persons who have died in U.P. till May 21. “A person does not develop symptoms and die immediately. The government’s figure is pure eyewash,” says Satyam, still reeling from his loss.
He is referring to the explanation offered by the State Basic Education Department, which said that only three teachers had died on polling duty. Citing the rules of the State Election Commission, the Education Department said that an official was considered to be on election duty only from the period he or she left their residence for training, polling and counting work till they reached their residence after work.
Dinesh Chandra Sharma, president of the union, which is at the forefront of the fight for the deceased teachers, says this guideline does not make sense since people develop symptoms and die days or weeks after exposure. “This is a scam of deaths,” says Sharma, claiming that 80% of the teachers who had died had either RT-PCR or antigen test reports taken. “They have to change the rules for COVID-19. Saying that someone didn’t die on the spot... how does that make sense,” he asks. Following the furore over the issue, Adityanath instructed officials to amend the guidelines.
Learning from the urban areas
As U.P. tackles the surge in rural areas, the Allahabad High Court recently said, “So far as the medical infrastructure is concerned, in these few months we have realised that in the manner it stands today, it is very delicate, fragile and debilitated.” Adityanath, however, is confident. He said the results of “ gaon-gaon, ghar-ghar (village to village, door to door)” screening and testing have shown that the rural areas are “safe to a large extent”. At the same time, he has asked officials to further improve medical facilities in rural areas.
Also read | Medical system of U.P. in smaller cities and villages is Ram Bharose , says Allahabad High Court
Neeraj Mishra, president of the United Resident and Doctors Association, U.P., who is himself recovering from post-COVID-19 complications, feels that the government should have judiciously used the experience in the urban areas to prevent the spread in the villages. “The administration should have been vigilant and active. But they left people to fend for themselves. There needs to be accountability,” he says.
Meanwhile, in Ballia, Superintendent of Police Vipin Tada says no new bodies have been found floating in the Ganga after the initial phase. Nine police teams in the district are out on patrol. The final rites of the bodies found were carried out according to customs, the police say. However, five police constables in Ballia were suspended for insensitive behaviour after an unclaimed body was cremated with petrol and tyres on a ghat.
As the State takes fresh measures to arrest the growth of the virus in its villages and the debate over the bodies in the Ganga rages on, Mishra says there is no religious sanction for the disposal of bodies in the Ganga. Even the jal samadhi ritual for seers is done through a specific process of encasing the body in a box with stones, he points out. Highlighting the religious significance of the river for Hindus, he says, “The Ganga is not meant for this purpose. She is the giver of mukti and bhukti .”
