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Covid-19: The alarming case fatality rate of Punjab and its possible connection to farmer protests

Harvesting season begins close Baisakhi festival that falls on April 13. Data shows that the number of cases exploded during and after that period.

India is currently facing the worst health crisis in the form of the Covid-19 pandemic. As per the stats provided by the Ministry of Health and Family Welfare, the country has reported 3,82,847 new cases of Covid-19 infection on May 4. 3786 people have lost their lives due to Covid-19 related complications in the last 24 hours across the country. India has a case fatality rate (CFR) or death rate of close to 1.1%, which is lower than the other worst-hit countries, but there are some alarming numbers that are raising serious concerns in some parts of the nation. One of the biggest concerns right now is the higher CFR in Punjab, especially in rural areas.

As per the government data, Punjab has reported 7,514 cases on May 4. 173 people have lost their lives in just 24 hours, making it a CFR of 2.3%, which is the highest in the country. It is not about just one day on which Punjab had the highest CFR. The state is consistently reporting more deaths from the past several weeks since cases started to explode.

If we compare the data of Punjab with the worst-hit states like Maharashtra, Uttar Pradesh, Tamil Nadu and others, the numbers coming from Punjab raises even more serious alarms. For example, the average CFR in Maharashtra, the worst-hit state, is 1.7%. In the case of the most populous state, i.e. Uttar Pradesh, the average CFR is even lesser at 1.3%. While Gujarat has an average CFR of 1%, Tamil Nadu stands at 0.70%, and Karnataka stands at 0.6% on average. The only state that has a higher than 2% CFR other than Punjab is Jharkhand.

CFR in Punjab is higher than worst hit states including Maharashtra, Uttar Pradesh and Tamil Nadu. Source: Covid19india.org

The higher death rate in the rural areas

As per reports, the death rate is comparatively higher in rural areas of Punjab compared to urban areas. The situation is baffling the experts as in most places, the caseload in urban areas is much higher due to the dense population. The case is, however, different in Punjab. Reports suggest that 58% of the deaths reported in Punjab are from Rural areas.

Self-treatment at home deemed as a major reason

According to government officials, a large number of deaths in rural area are because of the fact that the people are not going to the hospital and getting self-treated at homes. In an official communication sent to the medical officers, the Punjab government has asked them to prepare a list of the elderly and comorbid patients in their area and call them to take feedback on their health. The order said, “Report any breach of home isolation or refusal to get referred to higher facilities as soon as possible to the SMOs and keep contacts of SHOs of the police stations concerned to involve them for the hospitalization.”

As per a report in Hindustan Times, Dr KK Talwar, Former director of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, and head of an expert group of Punjab government on Covid management, said that they are adopting a new strategy for the patients in home isolation that is more focused on the surveillance. “Reluctance in getting tested and late reporting has been the reasons behind high CFR in rural areas, but with the new system, we are hopeful of bringing down,” he added.

The second wave found deadlier for the rural areas

According to the HT report, CFR in rural areas is around 2.8% compared to 0.7% in urban areas. The health department data revealed that people are visiting hospitals only after their conditions have deteriorated. While 83.92% of patients visited the hospitals in the worst condition, only 0.11% came with moderate symptoms and 7% with mild symptoms.

Alarming CFR of Patiala Rural area

The villages in Patiala have reported 35% of the total deaths due to Covid-19 in the district. Between March and May 3, 268 deaths were reported in total, 94 were from rural areas. In the last two months, the positive rate in the rural region remained high at 21%, with 3,453 cases reported in villages of the district.

Dr Satinder Singh, Civil Surgeon, said that in the first wave of Covid-19, the death rate in villages was negligible. He said, “Such trends were not witnessed during the first wave of the Covid-19 last year, as the deaths reported in villages then were negligible,” he said. A doctor serving at a rural dispensary said that the patients are coming to the health centres at an advanced stage at which they can only refer them to Rajindra Hospital.

Patiala reported 16 deaths on May 4. Reports suggest that Rajindra hospital reported 38 deaths on the same day, out of which 12 were from Patiala district. Out of those 12, seven were from rural areas.

Patiala district reported 604 new cases on Covid-19 and 15 deaths of May 4. Source: Covid19india.org

Sangrur reported close to 100 deaths in rural areas

Sangrur district has reported 372 deaths in total. Out of these, 152 were from the villages, and 97 were reported this year itself. The district health department said that three patients lost their lives while being in home isolation in Sangrur’s rural areas.

Cases and deaths have dramatically increased in the last 90 days in Sangrur district. Source: Covid19india.org

UK strain causing major trouble in Punjab

During the first week of April, the health department in Punjab had reported that the 80% of the cases sent for genome sequence in March were found to have UK strain. The particular virus strain spread at a 70% higher rate in the state, causing a major health crisis in Congress-ruled state. Earlier in March, reports suggested 81% of 401 samples from Punjab had UK strain.

Doaba, which is often called the NRI belt, has reported around 60% of the total Covid deaths from rural areas since February. Health officials said that the UK strain that was found in Nurmahal and Phillaur is one of the major reasons for the higher death rate.

Doctors have warned against self-medication and taking medicines from local practitioners, which is increasing the chances of death by Covid. Dr Ranjit Singh, Civil Surgeon, Hoshiarpur and Dr Gurdeep Singh Kapoor, Civil Surgeon, Shaheed Bhagat Singh Nagar have attributed the habit of self-medication and a late visit to hospitals to the higher death rate. Dr Kapoor said, “We have increased contact tracing of Covid patients. People in rural go for self-medication resulting in more fatalities.”

The curious case of the harvest season and increased caseload in Punjab

If we see the graph of cases in the last 90 days in Punjab, it is easily noticeable that the cases started to rise in March. This was the time when farmers were preparing for the harvest season. It has to be noted that farmers of Punjab are protesting at Delhi borders since November 2020. According to reports, while they were protesting at the borders, the villagers were taking care of the crops. However, most of the farmers returned to Punjab to attend to their crops close to harvesting season and started preparations for the harvest.

Harvesting season begins close Baisakhi festival that falls on April 13. Data shows that the number of cases exploded during and after that period. For example, the state reported 1,510 cases on March 13, a month before Baisakhi. The cases doubled just 13 days before the festival, and the state reported 3,161 cases of Covid-19.

In the next few days, the farmers who allegedly came back from the protesting sites to attend their crops and went back to the protesting sites on Delhi borders. During that period, the cases kept on rising, and the state reported over 6,000 cases for the first time on April 23.

Since then, the trend continues for the state of Punjab, and it is consistently reporting over 6,500 cases on average. In the first four days of May, the state has reported over 7.000 cases on average.

Farmers marching back to the border adding to the problem?

On April 14, Kisan Union leaders announce that farmers will march towards Delhi on April 21. Thousands of farmers did so, and even Delhi saw a spike in the cases during that period adding to the fact that there is a possibility that ongoing farmer protests are adding to the problem. Sukhdev Singh, general secretary of the BKU (U), said, “On April 21, a contingent of around 18,000 farmers had left for Delhi. Now again, we are preparing to send a large number of people to Delhi ‘morchas’.”

Amidst all the worrisome data coming from Punjab, another lot of 15,000+ farmers is heading towards Delhi borders from Punjab starting May 5 from Amritsar district, which has reported over 600 cases in the last 24 hours. Bharatiya Kisan Union (Ugrahan) is planning to send large batches of farmers to Delhi borders after May 10.

Sarvan Singh Pandher, general secretary, Kisan Mazdoor Sangharsh Committee (KMSC), claimed that they would not let the number of protesting farmers fall at the Delhi borders. While talking to The Hindu, he said, “On May 5, at least one thousand tractor-trolleys and other vehicles will start their march from Amritsar district alone to Delhi. We are expecting 10,000-15,000 people to part of our latest batch, which will go to the Singhu-Kundli border. Since the agitation started on Delhi borders, this is our twelfth big batch that would be going. Small batches of farmers keep continuously going and come back from Delhi borders on a routine basis from many villages as well.”

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