Agra (Uttar Pradesh): In normal times, only a few bodies were cremated every week at the Poiya Ghat crematorium in rural Agra, 12 km and a world away from the glistening Taj Mahal. On 19 April, as two pyres burned, Article 14 asked a young man—who, having finished his work day in an adjoining farmland, was returning to his village—if these were Covid-19 victims.
“We don’t have corona in our villages,” the man shrugged, echoing a widespread public feeling, reinforced by frequent declarations by UP’s Bharatiya Janata Party (BJP) chief minister Yogi Adityanath (here and here) that the global pandemic was not an issue of concern in India’s most-populous state with, as Article 14 has reported, some of its worst health infrastructure.
On 27 April—a day after Adityanath said there were no oxygen shortages in his state—there were some 40 pyres, large crowds and queues of the dead, most wrapped in cadaver bags, marking them as victims of the virus. A shopkeeper nearby said that he had watched nearly 45 bodies arriving over the past “few days”, meaning about three or four days.
The scenes at the Poiya Ghat crematorium were repeated across Agra district, the largest by population in western UP—at 4,041 sq km, it is the size of Goa and Bengaluru city combined—with 93% of its land classified as rural. Elected representatives in village after village told Article 14 that sudden fevers and a deluge of death followed a few days after the panchayat or local polls on 15 April.
About 330 km to the east in the state capital of Lucknow, the view from the highest echelons of administration was substantially different. “The situation is getting better with the infection rate decreasing and the recovery rate increasing,” Adityanath said on 2 May.
The death and devastation in rural Agra contradicts every claim the chief minister makes about the pandemic, which goes mostly undetected and unreported, not only because medical facilities are overwhelmed but because the government is not registering the dead in official records.
Yet, even official data reveal the speed of the second Covid wave after spreader events.
On 15 March, Agra district reported zero Covid-19 patients. Cases began rising around Holi, in the last week of March, then swiftly climbed after the panchayat polls. Since then, the district has registered 22,699 cases and 260 deaths. About half the cases, 11,848, and 81 deaths were recorded over 35 days to 5 May. And these are clearly undercounts.
“The actual Covid cases in the district should be at least 20 times more,” said Dharmendra Sharma, MD, who runs the Care Well hospital on Agra city’s outskirts. Local newspapers (here, here and here) have been reporting the rush at crematoria.
UP’s second Covid wave has no parallel in living memory, said locals. They described to Article 14 their fears of loved ones passing on the coronavirus; of, inadvertently, infecting friends and family; of wondering who would be the next to be infected or to die.
Ravaged By The ‘Mahamari’ In A BJP Area, Medical Hub
About 20 km southeast of Poiya Ghat, in a village called Bamrauli Katara, former gram pradhan, or village chief, Jai Kishan Katara estimated that at least three people had been dying every day over the last fortnight. “The mahamari (epidemic) spread after the panchayat polls,” he said.
Sonu Katara, 33, of Bamrauli Katara said at least 60 had died over the previous fortnight, and many with illness are isolated at home, largely undiagnosed. The deaths of young people have, in particular, devastated the village. Early this month, Sonu said, the neighbouring village of Budhera reported five dead in 24 hours.
“I carry these bodies in my tractor,” said Jay Kishan.
With evident grief, Kishan recalled how he tried to get help for his friend, Sonu Sharma, who died at 32. In one, breathless sentence, Kishan narrated Sharma’s story: “He had trouble breathing. I took him to several hospitals, but all of them refused to admit. He was screaming. I called SDM (sub divisional magistrate) Madam, but she didn’t take the call. I called the MLA (member of legislative assembly) and councillors but I was told that achar sanhita lagi hui hai (the model code of conduct is in force). I then called the helpline, but couldn’t save my friend.”
Legislators refused to help Sharma citing the “model code of conduct”—guidelines that govern the conduct of political parties and candidates during elections—in force for the panchayat elections, and hospitals refused because they did not have oxygen.
Agra’s tragedies are unfolding in a district that is a regional medical hub, with a medical college and a range of hospitals catering to adjoining districts of UP, Rajasthan and Madhya Pradesh.
Many villages in the area come under the Agra rural assembly constituency, represented by Hemlata Diwakar, an MLA from Adityanath’s BJP, which controls the nine assembly and two parliamentary constituencies in Agra district.
“We get up with the news of death,” said Katara. “Every home has people down with fever.”
‘There Is No Record Of People Dying… It’s Horrible’
“There is no record of people dying in (these) villages,” said Sharma of the Care Well Hospital on Agra’s outskirts. “They are not being tested at all. The rural situation is horrible.”
During the first Covid-19 wave, said Sharma, his hospital “barely” had any patients from villages. “This year we have a large number of patients from villages,” said Sharma. “90% of them are turning positive.”
“Had there been no panchayat elections, the rural areas wouldn’t have seen such a disaster,” said Sharma. “This is not limited to Agra. This is the situation of the whole of UP.”
About 1,000 teachers who were deployed on panchayat poll duty have died. So have candidates, some before the results.
The widespread reports of infection and death in rural Agra may herald the beginning of a period of rising tolls. If the current deaths are a consequence of canvassing and polling, the consequences of the counting on 2 May, when Covid-19 safety protocols were flouted, may begin emerging a fortnight later, by the second half of the month.
On 29 April, the State Election Commission made compulsory an “antigen negative or RT-PCR (real-time reverse transcription polymerase chain reaction) negative report or completion of covid vaccination” for entry into counting booths. Two days later on 1 May, following a submission in the Supreme Court, the Commission replaced “or” with “and”. The safety guidelines were ignored: on 2 and 3 May, large crowds thronged counting centres.
A Sick Person In Every House, No Masks, No Vaccine
Agra district has been under a curfew since 30 April. That might have helped the city itself, but it has worsened the situation in the rural areas.
We heard frequent complaints of how the police refused to allow people to step out even for medical purposes. “Fewer patients are able to reach us now,” said Care Well Hospital’s Dharmendra Sharma. “It’s serious, if villagers are not even reaching doctors.”
Things seem worse in neighbouring districts that depend on Agra for medical care. Vijay Sharma, a resident of Gangroli village in Mathura’s Chhata tehsil, said that his village with 1,800 voters has a sick person in every home.
“Har ghar men do-ek khat padi hui hain,” he said. In every house, there is a cot (meaning a sick person on it).
Kuldip Singh, a local councillor in Mathura, said fever was rampant in his ward, where a small Covid-19 centre caters to five wards and a population of 200,000.
“It (the Covid centre) doesn’t admit anybody,” said Singh. “It doesn’t conduct tests. In the first wave it had a testing facility. The nearest testing centre is at the district hospital.”
Yet, he said, people barely use masks, whether in cities or the rural areas.
About 70 km south of Mathura city, Balvir Singh, the pradhan of Kakua village in Agra, reported at least 24 deaths since 15 April. Local journalist and resident of the neighbouring village of Ajijpur village, Pravin Rawat, said he had heard of deaths from “fever” every day from 40 villages of Bichpuri, Akola and Barauli Ahir blocks.
Rinki Kumari, a Bahujan Samaj Party (BSP) member and zila panchayat member from Ward Number 25, agreed with Rawat’s assessment. Her husband, Jitendra Kumar, said; “People suddenly develop fever and die in a day or two.”
No vaccine has reached their area, the couple said. As on 9 May, no more than 4.68% of UP’s population had received at least one dose of a Covid-19 vaccine, the lowest proportion of any state or union territory.
With Medical Care Absent, Resentment Against BJP
At the southern tip of rural Agra’s in Pinahat, local journalist Bal Kishan said most of the 12 who died in his village over a week could not find oxygen, despite Adityanath’s frequent declarations that there are no oxygen shortages.
“Many are infected, some are admitted in hospitals of Gwalior and Agra,” said Kishan. “Testing is almost zero.”
On 9 May, UP was ranked three by number of deaths—this does not include the vast uncounted numbers—but number 25 by tests conducted, according to the latest available data.
Situated along the wilderness alongside the Chambal river, Pinahat borders Madhya Pradesh and Rajasthan. The nearest Covid-19 centre is 60 km to the north in Agra. A new centre recently opened about 25 km in Bah. The block has just one community health centre, whose head Vijay Kumar, MBBS, has himself tested positive and was in hospital.
The absence of medical care as infection and death spread has caused discernible resentment against the ruling BJP. “We won’t let the BJP enter their area in the election,” said Sonu Katara.
The BJP has already had electoral setbacks in the panchayat polls that it insisted on holding and are now cited as a major source for second-wave infections. The party lost ground in several strongholds, including Ayodhya, Varanasi, Gorakhpur and Mathura.
Lack Of Testing, Oxygen Is Killing People
While the panchayat polls were apparently the immediate trigger for the second wave of the pandemic, the situation has been aggravated by the lack of testing and absence of oxygen.
Since 8 April, Agra district, with nearly 5 million people, has tested an average of 4,500 a day, or 800 per million, compared to the national average of 1,360 per million.
There has been a flurry of SOS calls for oxygen, with people ignoring Adityanath’s threat to have the police file criminal cases against those who spread “rumours” and try to “spoil the atmosphere”.
Manvendra Sharma, MS, Director of Jai Hospital, among 26 officially notified Covid-care hospitals in Agra, said “the biggest problem is of oxygen supply.” He refused to accept Adityanath’s claim that there was no oxygen shortage.
“Their claim is wrong,” said Sharma, “there is 100% shortage of oxygen. We cannot admit serious patients because that needs a ventilator, which consumes a lot of oxygen.”
The district administration has taken over the supply of oxygen and Remdesivir, a drug used to treat some Covid-19 cases, but that has not changed the situation, said hospital administrators. There are reports of hoarding and an oxygen blackmarket.
“Some hospitals receive more oxygen, some get less,” said Manvendra Sharma. “Vendors are also supplying more to some.” On 6 May, the Agra district administration ordered an inquiry into the supply of 810 oxygen cylinders to five non-Covid private hospitals, over five days to 4 May, at a time of a districtwide oxygen shortage.
As those shortages endure, estimations of the pandemic’s spread are difficult because of the government restrictions on testing.
How To Hide Infections: Restrict Testing, Testing Methods
Only the Sarojini Naidu Medical College (SNMC) has an authorised lab to conduct RT-PCR tests for the district, a move that effectively reduces the official prevalence of the disease. While the administration denies imposing any restriction on tests, private hospitals and labs told Article 14 that they had been ordered by the administration not to conduct tests.
Locals in Pinahat, for instance, said they were unlikely to travel 60 km to reach district headquarters and stand in a torturous queue for a test whose report comes several days later. On May 10, a month after the surge, Jitendra Kumar and Sonu Katara said, the first government teams arrived in their villages to run less-reliable rapid antigen tests. No RT-PCR or vaccination, only some rapid tests.
While “notified” or officially recognised Covid hospitals can only do antigen tests, other hospitals and private labs are not even allowed to do that.
Private labs cannot test, and Covid centres, according to Dharmendra Sharma, have been asked to scale back tests. With RT-PCR tests, now free at SNMC, barely available, patients who can afford it must pay Rs 4,500 or so for a CT scan for diagnosis.
But even if a CT scan reveals a Covid-19 infection, it will not go into official data because the government does not allow such a scan as proof of positivity.
Each of Agra district's 15-odd CT-scan centres sees some 30 patients a day, almost all tests concern the chest and indicate the presence of Covid, said Manvendra Sharma.
Some private hospitals have secretly purchased antigen kits and offer tests at Rs 800 or more. “We wanted to do official purchases, sent a letter to the administration, but we were denied,” said a doctor, requesting anonymity for fear of reprisal. “How will we treat patients if we don’t have the diagnosis?”
In the absence of proper diagnosis, doctors grope in the dark, more patients suffer and die, and the only thing that is controlled is the official death count.
“We are unable to declare it a Covid death until we have a certified positive report,” said Manvendra Sharma. “So, we are forced to write viral pneumonia in their death certificates.”
To ascertain the condition of his patients, one doctor told us he conducted secret antigen tests in his Covid hospital. All 11 patients in the ICU tested positive.
Poor testing also means that government compensation and insurance claims are denied to Covid-positive patients and families of the dead.
Around 4.15 pm on 5 May, Agra district magistrate Prabhu N Singh, who had otherwise marshalled his limited resources reasonably well, said local doctors, tweeted a “real time dashboard” showing how many hospital beds were available in his district.
Article 14 found 969 Covid beds and 216 Covid-intensive-care-unit beds vacant in nearly two dozen hospitals. We randomly selected four hospitals that showed over 40 vacant beds each and called them. Each said the beds were occupied.
All of them had the same response: call tomorrow.
(Ashutosh Bhardwaj is an independent journalist and author. His recent book, The Death Script, was chosen as the Atta Galatta non fiction book of the year for 2020.)