In the fortnight leading up to 16 July, the number of COVID-19 cases in Bihar doubled, reaching 20,612. Those infected included several senior officials of the state and political establishment, further slowing the state’s response to the pandemic. This was despite the state having one of the lowest testing rates in the country at 2784 tests per million people—compared to the national average of 9289. The state’s already poor medical infrastructure began failing to keep up with the rising number of patients. This situation, several senior doctors from the state told me, became more pronounced as little was done to test and accommodate the over 32 lakh migrant labourers who returned to the state after the announcement of the nationwide lockdown in late March.
The lack of medical infrastructure is far more pronounced in Bihar’s rural hinterland where the pandemic exposed the lack of doctors in primary health centres and the lack of testing centres or hospitals dedicated to COVID care. As of 20 July, the state had only four specialised hospitals for patients affected by the virus. The crisis was also magnified by the eagerness of the state government to ease all restrictions since the end of the nationwide lockdown on 31 May, in anticipation of the legislative election scheduled to occur later this year.
From the start of the spread of COVID in the state in March, the administration failed at identifying and avoiding the spread of the virus, and also failed in ensuring that the state had the medical infrastructure to deal with a crisis of this magnitude. Rural Bihar completely lacked even the most basic facilities to test and contain the spread of the virus. Many primary health centres lacked both beds and doctors. Quarantine centres in the state were often in squalorous conditions, lacking basic sanitation and food. Alongside this the state did little to ensure that frontline workers such as sanitation workers and Accredited Social Health Activists—government primary health workers at the local level, commonly called ASHA workers—were provided safety equipment.
One of the primary problems with the administration’s response to the pandemic was a complete failure to measure its magnitude and spread. On 15 April, Kumar announced that the state administration is aiming to screen the entire population of the state for the symptoms of COVID-19, including all returning migrants. On 23 April, health department officials reportedly claimed that the state’s healthcare workers had visited 65.61 lakh houses and screened more than 3.58 crore people. A report by the online news portal IndiaSpend suggests that these numbers are false and misleading. Their study pointed that in parts of Bihar entire localities were not screened, and in areas which were screened health workers did not document the travel history or symptoms of residents.
On 14 May, I spoke to 30 families in Patna to better understand how these screening procedures were conducted. All the families said a Patna Nagar Nigam—municipal corporation— volunteer had visited them, usually accompanied by an ASHA worker. The families told me that officials did not ask about their medical history. “The ASHA worker asked my father for the initial details of each member in our family, next she noted down everyone’s phone number and left,” Vivek Anand, a resident of Nehru Nagar, told me. “This seemed as if instead of being screened for COVID, we were duped into being registered for NPR”—referring to the National Population Register. “In the neighbouring colony, the health workers spoke to only one family, made them speak on behalf of every family and left.”