The Covid 19 crisis in India’s most populous state: Need for better data collection and management strategies
The suspected under-reporting in Uttar Pradesh is hazardous from an epidemiological perspective as it would stand against the state preparing for a targeted vaccination drive and a potential third wave, writes Akshat Singh for South Asia Monitor
The dystopian portrait painted by a multitude of dead bodies dumped in the Ganga river in India’s most populous and politically crucial state Uttar Pradesh is a far cry from the "Ram Rajya" (righteous rule) its Chief Minister (CM) Yogi Adityanath had promised to usher in when he took over in 2017.
Notwithstanding the support the chief minister, a front-ranking leader of India’s ruling Bharatiya Janata Party (BJP), garnered through a combination of overzealous religious posturing and rhetorical promises of good governance, it is safe to say that he has not measured up as an efficient administrator when facing the stiffest challenge of his governance.
Uttar Pradesh, which borders the national capital, is home to over 234 million people and would be the fifth-largest country by population had it been an independent state. The strength of its population, however, is in stark contrast to the level of development in the state. Lagging in the development index, UP has one of the lowest per capita GDP in the country. The health infrastructure is not much better — there is just 1 doctor per 3,767 people in the state as opposed to 1 per 1000 recommended by the World Health Organisation (WHO). The situation in terms of availability of government doctors - 1 per 19,962 people in the state - is even direr. As one can guess, rural UP is now bearing most of the brunt of the pandemic.
One may be right in arguing that it is unfair to blame Yogi for the state’s dismal condition — after all the responsibility for this ‘glowing achievement’ must be shared by the litany of identical politicians who exploited deep-seated caste divisions to seek power in the state that sends the largest number of MPs to the Lok Sabha, the national parliament.
However, what makes Yogi responsible is the way he and his handpicked team of administrators displayed exacerbating heavy-handedness and warped priorities in tackling the virus.
The first reports of under-reporting from UP emerged in June, 2020. Incidentally, on 17 June, the CM held a meeting to assess the state of Covid 19 in UP. He was informed that the state had recorded its highest daily deaths that day (30). The official figure surprisingly dropped that day. After press inquiry, a government official wrote to the state health department that their "callousness" had unsettled the CM and that they should be more "careful" while reporting Covid 19 deaths. The state’s Covid 19 related deaths stayed well under 30 per day after the meeting. As per several reports, this was an exceedingly low number.
While the CM was busy campaigning in poll-bound states, recanting tales of good governance in UP, the state was seeing an onset of the second wave. But like several other states, UP went on with life as usual. While there were warnings of a new and more deadly variant issued by the national scientific community, this was conveniently ignored.
Beginning April, UP started feeling the heat. By 25 April, with over 37,000 new reported cases, the state had hit a peak. The peak in the number of daily deaths came on May 7 with 372 people officially succumbing to the viral disease. While the number is high in itself, added to the calamity is the alleged underreporting.
For instance, several journalists have been compiling the number of cremations of people who died due to Covid 19 in district crematoriums and comparing that against official district data. The disparity is massive. In Lucknow, the state capital, there is said to be a mismatch estimated up to a factor of 4. In Agra, the number goes up to 7. Similar stories are emerging from several other districts including Meerut, Muzaffarnagar, Mirzapur, Kanpur, and the PM’s parliamentary seat Varanasi. This, obviously, does not include the deaths of people who were not even tested for the infection. Given the massive rural areas in UP, this could be a substantial number.
Public health vs public image
The suspected under-reporting in Uttar Pradesh is hazardous from an epidemiological perspective as it would stand against the state preparing for a targeted vaccination drive and a potential third wave. Yet public health concerns seem to have been pushed under the rug when weighed against public image concerns.
On the other hand, the chief minister categorically denied any oxygen shortage in the state. It is sad to observe that not far away from his residence in the state capital Lucknow, several large hospitals reported oxygen shortages and accused the government of administrative delays and, also on multiple occasions asked the patients to go somewhere else.
Where they may go once turned away from the state capital, one wonders.
What should be done
The government, keen on fixing the façade, seems to have forgotten that the house is in disorder. While it is already late, it is about time the government starts picking up the pieces. There are several steps that the government can do. For one, it can hike up its data collection and management strategies. While the state lacks the necessary infrastructure for sophisticated data management, announcing that local administrators will not face reprisal by reporting the true numbers will go a long way.
Second, capacity building for rural areas should be seriously ramped up. Using existing government infrastructure and looping in private infrastructure the government can ensure people in rural areas get adequate testing and critical care.
Third, based on ground reports, potential hotspots should be targeted for vaccination on priority. Fourth, civil society and journalists should not be antagonized. During such an emergency, even a well-intentioned government may overlook some areas of serious concern, and a course correction can be done from the feedback provided by the media.
Fifth, the government should not let down its guard — for a state as dense as UP, the possibility of a third wave is very real. Working on building capacity - in terms of oxygen reserves and hospital beds that it lacked right now - should thus be a priority.
However, for doing any of this, the government needs to accept its fault and move on rather than engaging in a desperate PR management tactic.
(The writer is Research Associate, SPS and a student of Columbia University, New York. The views expressed are personal and not necessarily shared by editors of South Asia Monitor)