Are these India’s ‘forgotten victims’ of COVID?

In the village of Sultanpur Kheda, in Uttar Pradesh, as many as 18 people have died in the past three weeks. But without COVID testing, the cause of death is often listed as ‘unknown’.

A house in the village whose occupant has tested positive for COVID-19 [Saurabh Sharma/Al Jazeera]

Rae Bareli, Uttar Pradesh – Richa Gupta believes her father would still be alive if only he had received treatment sooner.

The 17-year-old who recently graduated from high school lives in Sultanpur Kheda, a village with a population of around 6,000 people that is located about 11 miles from Rae Bareli city and about 385 miles southeast of India’s capital, New Delhi.

Her 47-year-old father, Awadhesh Gupta, was previously healthy but died on April 27 – Richa believes from COVID-19. However, because he was never tested for the virus, no-one can be completely sure.

“My father was totally fit and fine,” she says. But on the evening of April 16 he developed a temperature. “The next day he started coughing,” Richa recalls.

She says he bought some medicines from the local pharmacy but they did not work and “his temperature kept on rising”.

According to Richa, her father consulted the local “quack” – an unregistered “doctor” who villagers would often go to in order to save time because public health services are remote and often over-crowded. These doctors are not officially permitted, but in rural areas of India, people often depend on them. This “doctor” prescribed more medicines, Richa says, adding that “he took them for two days but nothing worked.”

On April 22, Awadhesh went to a private hospital in Rae Bareli but was told to go to the city’s government hospital because he had COVID-like symptoms. There, doctors prescribed him yet more medicines and advised him to remain in home quarantine.

Richa cries as she explains that he was not tested for COVID-19 at the hospital. She is certain, however, that it was the virus that killed him.

Richa Gupta holds a picture of her late father [Saurabh Sharma/Al Jazeera]

Awadhesh started experiencing breathlessness on April 24 and, on the advice of a friend who was a doctor, went for a CT scan at a private laboratory in Rae Bareli. “After that, we came to know that my father’s lungs were heavily infected and [we were sure] he had COVID,” Richa explains.

“The CT scan report said that one of the lungs of my father was totally damaged while the other one was 50 percent damaged. My maternal uncle immediately rushed him to the district hospital from where he was referred to the COVID-dedicated L2 hospital in Lal Ganj [around 20 miles from Rae Bareli city].

“My father got admitted there on April 25, but he did not get any treatment other than the oxygen support. He was declared dead on April 27,” she says.

Because of the family’s certainty that he had COVID, Awadhesh’s death was recorded as a COVID death. However, in many cases where a sick person has not been tested for COVID, the authorities have attributed their deaths to “unknown” or “natural” causes, or “comorbidities” (underlying health conditions).

Richa believes she knows when and where her father contracted COVID.

“I am very sure that my father got infected when he went out to vote for the panchayat (village council) elections,” she says.

The village council elections in India’s most populous state of Uttar Pradesh were held over four non-consecutive days in April – the first of these being April 15, when Awadhesh went to vote. There has been criticism of the failure to enforce social distancing and mask-wearing during the election campaigns and during voting.

The home of Awadhesh Kumar Gupta, who died on April 27 [Saurabh Sharma/Al Jazeera]

A ‘mysterious fever’

Vinod Tiwari was the leader (or gram pradham) of the village until he was unseated in the recent election. He says he has heard of 12 people who have died in the village in the past three weeks but that only two of the deaths were recorded as being due to COVID-19.

“Not all the deaths that have happened in the village are [officially] due to COVID-19,” he says. “Two people from the village have died in the hospitals who were COVID-positive while two to three others had COVID-like symptoms. The cause of death for others is not known but people say that they were comorbid people [those with underlying health issues].”

Others believe the death count is higher. Sudeep Shukla, a farmer from the village, has been keeping an informal record of each person who has died. He puts the number at 18 over the past three weeks. Everyone is sick and yet nothing is being done to solve this “mysterious fever” which is taking life after life, he says. He is certain it is COVID-19.

“The cousin is sick. The neighbour is sick. The flour mill guy is sick. The grocery store owner is sick. The guy across the street is sick. Everyone is sick. Everyone is coughing and, so far, 18 people have died in a span of three weeks. We have never seen such a large number of deaths in such a short time. Elderly people dying seems normal but middle-aged people dying is not normal. This should come to an end now. Enough of the fever and virus,” says Sudeep.

Sudeep Shukla says 18 villagers have died in the past three weeks [Saurabh Sharma/Al Jazeera]

Vinod Tiwari says the villagers suspect that the spike in deaths is connected to the village council elections. “A lot of crowds were seen during all election-related activities, be it filing the candidacy, campaigning, voting or even counting of the election,” he explains.

“The natives of the village who live in other cities came to the village to exercise their franchise. They travelled through public transport and no screening or testing was done. God knows if they carried the virus with them but, soon after, people started dying.”

The closest state-run medical facility is the community health centre in Jatua village, about six miles away. But it is not equipped to handle complex cases like COVID. Those who display symptoms are referred either to the government hospital in Rae Bareli city or the COVID-dedicated hospital in Lal Ganj where Awadhesh died. It has 10 ventilators and 250 beds, 112 of which have oxygen support, according to the director of the facility, Dr B R Yadav. There are 15 doctors and 30 paramedics, enough to treat everyone, says the director.

A female patient is supported by her children while companions carry an oxygen cylinder behind her as she enters the COVID-dedicated hospital in Lal Ganj in the Rae Bareli district [Saurabh Sharma/Al Jazeera]

Small businesses like grocery shops and farming form the primary economy of the village – the north of which is primarily occupied by villagers from the more privileged castes while the west is largely home to members of less privileged castes.

The village is also home to three “quacks”, but all three have now “disappeared” from the village, the locals say. They believe these unregistered doctors have gone into hiding for fear of health department officials coming because of the COVID cases. The only pharmacy in the village has become a one-stop shop for villagers searching for instant medical help for their COVID-like symptoms. It is owned by Manoj Verma, who is in his late 30s.

“The state-run facilities are not of much use because the villagers have developed a habit of visiting the local doctors but they are non-registered doctors. Those doctors have stopped looking at patients due to the pandemic and surge in COVID-19 cases and now people come to my shop for the medication,” he explains.

“To get medicines, [a] prescription is a must but now people come and ask for medicines like painkillers, aspirins, antibiotics, anti-parasitics and for those medicines [a] prescription is not required and I give them but with a warning to visit the doctor first and take the medication only if it has been advised by the doctor.”

But there is another problem Manoj says he is witnessing – “people are scared to get themselves tested for COVID-19, even after developing serious symptoms like breathlessness [and] coughing .., because they feel that they might by shunned by society,” he explains.

Despite the spike in deaths, some villagers do not wear masks [Saurabh Sharma/Al Jazeera]

‘They brought the virus with them’

Official information about the death toll in the village is muddled. When asked about the surge in deaths in the village, Anshika Dikshit, a district administrative officer posted in the Rae Bareli district, told Al Jazeera: “As per my information, people have died but not in the last two or three weeks but in the last two months. Few of the deaths were due to COVID, while the rest of the deaths were natural and in many of the cases people had comorbidities.”

The chief medical officer for the district of Rae Bareli, Dr Virendra Singh, however, told Al Jazeera by phone that he was aware of only four or five deaths in the village – three of which were due to COVID.

Many Indian states have imposed strict lockdowns over the last month while others have placed curbs on movement and shut cinemas, restaurants, pubs, schools, educational institutes and shopping malls.

A worker unloads oxygen cylinders at the L2 hospital in Lal Ganj [Saurabh Sharma/Al Jazeera]

Brian Wahl, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health’s Department of International Health in New Delhi, says that the health infrastructure in rural parts of India is not equipped for such a surge in cases.

“We know that in rural parts, the access to quality services is challenging and these areas highly depend on frontline health workers only. We know that a mass gathering has the potential to be a super spreader event ..,” he said.

Dr Harjit Singh Bhatti, the national president of the Progressive Medicos & Scientists Forum (PMSF) in New Delhi, agrees.

“Earlier, people used to come to cities in crisis but now, watching the caseload increasing, they have nowhere to go. The very sad part is that we will never be able to know how many people have died and what was their cause of death,” he explains.

“In the previous wave, the Indian villages were safe, but this time, due to village council elections and also due to the Kumbh Mela festival [which around 3.5 million people attended], COVID has reached the countryside.”

Bhatti believes this situation could have been averted and many lives saved if a timely decision had been taken to postpone the elections.

“Elections strengthen democracy …. [But] people from big cities went to their villages to exercise their franchise and with them the virus also travelled and now we are seeing the result in the form of a large number of deaths,” he says.

‘They said his breathlessness was asthma’

Meanwhile, in Sultanpur Kheda, another tragedy is unfolding. Across the street from the Gupta family home, a middle-aged-woman in a grey saree cries under a thatched hut outside a two-storey home. Her 12-year-old granddaughter tries to console her. They flee back into the house when asked what is wrong.

But the woman’s son, 26-year-old Indrajeet Sahu, explains that his 52-year-old father, Ram Sajeevan Sahu, passed away on April 27.

“He fell sick after the village council elections,” Indrajeet explains.

“He had a high temperature and from April 23, he started complaining about breathlessness. For his temperature, he took medicines from the local pharmacy but was advised to consult a doctor immediately.”

Indrajeet Sahu and his mother outside their house in the village [Saurabh Sharma/Al Jazeera]

On April 25, the family took Ram Sajeevan to the community health centre in Jatua village. But the health centre did not test him for COVID – the family say they do not know why.

“The doctors gave him medicine, saying the breathlessness could be due to asthma, so we took the medicines and came back home. The problem continued and we heard that other hospitals nearby did not have oxygen and on the morning of April 27, he passed away at home,” says Indrajeet.

He explains that his father used to help him run a street food cart but that now he has died Indrajeet must financially support the entire family alone.

“It is very painful to see your father die in front of your eyes. The more painful [thing is not being able to help him [in] any way. There was no oxygen in any of the hospitals and things were very bad. Now my father is gone it seems like everything is gone,” he says, with tears in his eyes.

Source: Al Jazeera