The second wave of the Covid-19 pandemic has deeply affected Indian states and Union Territories, and Bihar and Jharkhand have been no exception. Due to lack of infrastructure and human resources in the two states, both rural and urban citizens were caged in the web of grief and misery, wherein even seeing one’s loved ones for the last time before they succumbed to Covid 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 Impact and Policy Research Institute (IMPRI), New Delhi, organised a panel discussion on ‘Rural Realities | Bihar and Jharkhand Practitioners’ Experiences in Tackling the Second Wave of Covid-19 in the Indian Villages’ on May 15, 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 and Jharkhand to set the context for the broader discussion on the topic by the esteemed panellists.
Bihar is a state in eastern India. It is the 12th largest state by territory. It currently has 38 administrative districts and 101 subdivisions. Patna, Bhagalpur and Gaya are some of the known cities. On November 15, 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 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 of the state.
As per the 2011 Census of India, Bihar is the third most populous state of India with a total population of above 100 million (104,099,452), of which nearly 89% is rural. It is also India’s most densely populated state.
On the other hand, Jharkhand has a population of 32.96 million and is the 14th largest by population, of which nearly 76% is rural.
Both Bihar and Jharkhand lie in the bottom five when it comes to SDG (Sustainable Development Goals) Index and per capita income. The decadal growth rate is 25.4% for Bihar and 23.6% for Jharkhand.
During the first wave of Covid-19, both Bihar and Jharkhand witnessed an accelerating daily average of the number of Covid cases in the month of July. The numbers peaked during the month of August. But both the states were not at the frontier during the first wave. Even the case-fatality rate of both the states lied below the national average, with Jharkhand’s rate slightly higher than Bihar’s. But when it comes to doubling time, Bihar had a slightly higher rate compared with Jharkhand and other Indian states.
For both the effective reproduction number and test-positive rate, Bihar lies closer to the national average estimate. Its effective reproduction number is slightly lower than Jharkhand’s, while it is marginally higher than Jharkhand 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 the numbers. It dropped from over 15% in late July 2020 to under 2% a month later, and was at around 1% in August. For two weeks during late July and early August, test positivity was falling fast even as cases were rising fast.
Both Bihar and Jharkhand have managed to restrict the pandemic to a manageable limit by increasing their testing and tracing the infected population. Both the states are currently at the bottom of the ladder with their positivity rates below 1%.
During the second 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 third week of April 2021, Bihar and Jharkhand had a recovery rate of 80%, which is less than the national average, whereas the state’s mortality rate was higher than the national rate.
Even as the second wave continue to sweep along across the country, restrictions on movement and public activity are becoming lenient, even though the caseload and death rate in most states are worse than before. One reason is that this time, it is the states, and not the Centre, that are deciding the extent of the restrictions.
This has resulted in varying degrees of restrictions across the country. The severity of restrictions is high in Jharkhand, while only a partial lockdown has been imposed in 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 that the pandemic might be growing faster in Jharkhand and Bihar. After tracking the daily new cases across two weeks, the effective reproduction number for Jharkhand was estimated at 2.13 and Bihar at 2.09. This means that one infected person, on an average, infects more than two people in Jharkhand and the neighbouring state of Bihar.
Till March 2021, in terms of doses per 100 population, Bihar is at the bottom of the inoculation list, with only 0.67 doses per 100 people administered. In case of Jharkhand, only 1.05 doses per 100 people have been administered. As of March 2021, 4.1 lakh people have been vaccinated in Jharkhand, whereas in Bihar, this numbers is 8.4 lakh.
The increasing number of 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 the very high percentage of positive tests in rural areas, suggesting that a large number of cases are going undetected. As per a Times of India survey, on May 9, 2021, 54% of the cases in Jharkhand were from rural areas whereas in Bihar, it was at an alarming range of 76%.
The issue of acute vaccine shortage has been raised by both the states. Even the much-touted four-day ‘Tika Utsav’ that was announced by Prime Minister Narendra Modi 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 its hoarding and black marketing. Hospitals are also facing a shortage of doctors and medical staff. It has been reported that in government hospitals, 75% of the posts of nursing and para-medical staff are lying vacant.
As the number of Covid-19 cases are surging, Bihar’s health system has collapsed and its VIP culture is only making things worse. While the National Health Mission, the Clinical Establishments Act of 2010 and formation of the Empowered Action Group (EAG) provide federal funds to expand and improve healthcare services, Bihar’s ability to fully utilise 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 a hospital in Ranchi.
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. People are unable to access home-care facilities. Moreover, government-sponsored MGNREGA work has not been able to attract more people due to its lengthy processes and late payment.
Currently, the states are taking necessary steps to minimise the impact of the second wave and prepare for a third wave in moving towards a healthy and prosperous society.
YouTube Video for An Overview of the Catastrophic Second Wave in Bihar and Jharkhand
Written by: Ritika Gupta, Sakshi Sharda, Ishika Chaudhary, Swati Solanki, Sunidhi Aggarwal, Priyanka, Ramya Kathal, Mahima Kapoor, Chhavi Kapoor, Arjun Kumar and the IMPRI Team