Ritika Gupta, Sunidhi Agarwal, Sakshi Sharda, Ishika Chaudhary, Swati Solanki, Priyanka, Ramya Kathal, Mahima Kapoor, Chhavi Kapoor, Arjun Kumar, and IMPRI Team
The second wave of the COVID-19 pandemic has deeply affected Indian states and Union Territories and Bihar & Jharkhand has been no exception. Due to issues like lack of infrastructure and human resources, both rural and urban people were caged in the web of grief and misery wherein even to see one’s loved one last time who succumbed to Coronavirus became an act of privilege.
Focusing on the Rural Realities around the country during the pandemic, the Centre for Habitat, Urban and Regional Studies (CHURS)and IMPRI Impact and Policy Research Institute, New Delhi organized a panel discussion on “Rural Realities | Bihar & Jharkhand Practitioners’ Experiences in Tackling the Second Wave of COVID-19 in the Indian Villages” on 15 May 2021.
This article is an excerpt of the presentation given by Sunidhi Agarwal and the IMPRI team which provided an overview of the COVID-19 situation in India with special reference to Bihar & Jharkhand to set the context for the broader discussion on the topic by the esteemed panelists.
About Bihar and Jharkhand
Bihar is a state in eastern India. It is the 12th largest by territory. Bihar currently has 38 administrative districts and 101 subdivisions. Patna, Bhagalpur, and Gaya are some of the known cities. On 15 November 2000, southern Bihar was ceded to form the new state of Jharkhand.
Jharkhand too is a state in eastern India and shares its border with the states of Bihar to the north. It is the 15th largest state by area. Currently, there are 24 districts and 45 sub-divisions in Jharkhand. Ranchi, Dhanbad, and Jamshedpur are some of the known cities.
As per the 2011 Census of India, Bihar was the 3rd most populous state of India with a total population of above 100 million (104,099,452) and nearly 89% of it rural. It is also India’s most densely populated state. Jharkhand has a population of 32.96 million and is the 14th largest by population and nearly 76% of it is rural.
Both Bihar & Jharkhand lies in the bottom 5 when it comes to SDG index and Per capita income. The decadal growth rate is 25.4% for Bihar and 23.6% for Jharkhand.
COVID-19 Second Wave
In the first wave of covid-19, in both Bihar & Jharkhand, the average daily covid cases started increasing at an accelerating rate in the month of July and peaked during the month of August. But both the states were not the frontier during the first wave as compared to coming to the case-fatality rate, both Bihar & Jharkhand lie below the national average and Jharkhand had a slightly higher rate than Bihar. But when it comes to doubling time, Bihar had a slightly higher rate compared with Jharkhand and other Indian states.
In both the effective reproduction number and test-positive rate, Bihar lies closer to the national average estimate but was slightly lower as compare to Jharkhand in the effective reproduction number whereas marginally higher in the test-positive rate.
Talking about test positivity, the rise in testing, and the fact that most tests were relatively low-sensitivity Rapid antigen tests led to a dramatic fall in test positivity. This dropped from over 15% in late July to under 2% a month later and is currently at around 1%. For two weeks during late July and early August test positivity was falling fast, even as cases were rising fast.
Both Bihar & Jharkhand have managed to restrict the pandemic to a manageable limit by increasing testing and tracing of the infected population. Both the states are at the bottom of the ladder with their positivity rates below 1%.
During the 2nd wave, the test positivity rate of Bihar & Jharkhand was above 10% in the first two weeks of April 2021 while the fatality rate was alarmingly higher than 1% for Jharkhand but below 0.5% for Bihar.
Till the 3rd week of April 2021, Bihar and Jharkhand have recovered more than 80% of their cases which is less than the national average whereas the state’s mortality rate is higher than the national rate.
Counting the Dead
As the second wave sweeps through the country, restrictions on movement and public activity are not as strict, even though the caseload and death rate is worse than before. One reason is that this time, it is the states and not the Centre that is deciding the extent of the restrictions. This has resulted in varying degrees of restrictions across the country. The severity of restrictions is strict for Jharkhand while only partial lockdown is imposed on Bihar. Despite lockdown measures being in place, Jharkhand averages to over 100 fatalities a day.
One of the parameters of transmission referred to as R or the reproduction number, suggests the pandemic might be growing faster in Jharkhand and Bihar. After tracking the daily new cases of the two weeks, the effective reproduction number for Jharkhand is estimated at 2.13 and Bihar 2.09. That means one infected person, on average, infects more than two people in Jharkhand and the neighboring state Bihar.
Till March 2021, in terms of doses per 100 population, Bihar is at the bottom of the inoculation lists with 0.67 doses per 100 people as well as Jharkhand with 1.05 doses per 100 people. As of March 2021, 4.1 lakh people are vaccinated in Jharkhand whereas in Bihar 8.4 lakh people are vaccinated.
Increasing covid cases have started hitting the heartland of India as district-level data shows a surge in cases in small towns and rural areas. More worrying than the reported case numbers is a very high percentage of positive tests in rural areas, which suggests a large number of cases are going undetected. As per the Times of India survey, on May 9th, 54% of the cases in Jharkhand were from rural areas whereas in Bihar it was at an alarming range of 76%.
The point of acute vaccine shortage has been raised by both states. Even the much-touted four-day “Tika Utsav” as announced by Prime Minister Narendra Modi has proved to be a damp squib in Bihar owing to an acute shortage of vaccines. Bihar is also experiencing a shortage in oxygen supply and essential medical supplies to treat Covid-19 patients because of the hoarding and black marketing of the same. The hospitals are also facing a shortage of doctors and medical staff. It is reported that in government hospitals, 75% of the posts of nursing and para-medical staff are lying vacant.
As Covid-19 cases are surging, Bihar’s health system has collapsed and VIP culture makes things worse. While the National Health Mission, the Clinical Establishments Act of 2010, and the formation of the Empowered Action Group (EAG) provide federal funds to expand and improve healthcare services, Bihar’s ability to fully utilize this funding is lacking.
In Jharkhand, the worst affected because of the lockdown are the tribal communities as they are not able to earn any income. Jharkhand is also experiencing a shortage of hospital beds. An elderly Covid patient from Hazaribag died waiting for hours for a bed outside Ranchi hospital. Technicians at government-run labs, where testing is supposed to be free, are demanding Rs 500 for sample collection, without any guarantee of when the result will arrive. Even people are unable to access home-care facilities. Government-sponsored MGNREGA work has not been able to attract more people due to its lengthy processes and late payment.
The state has been taking all the necessary steps to minimize the impact of the second wave and prepare for a third wave in moving towards a healthy and prosperous Bihar and Jharkhand.