Madhya Pradesh is spiralling into one of India’s worst-affected states by the COVID-19 pandemic. According to the data released by the ministry of health on its website, as of 24 April, the state has shown the highest fatality rate, at 4.88 percent, with 83 deaths reported from a total of 1,699 cases. Several factors contributed to the crisis in the state, not least that while other states were preparing to combat the virus, Madhya Pradesh was in the midst of a political battle. The Bharatiya Janata Party toppled the Congress government in the state on 23 March, the day before Prime Minister Narendra Modi announced a nationwide lockdown. Yet, it took almost a whole month before the new chief minister, Shivraj Singh Chouhan, appointed any cabinet members—or even a health minister. On 21 April, Chouhan appointed his first five members to the cabinet, and the next day, he finally appointed Narottam Mishra as the state’s health minister.
The state has suffered gravely in this period. The pandemic has spread rapidly across Madhya Pradesh, leading to it recording the fifth-highest number of cases across the country, and the third-highest number of deaths, as of 24 April. Indore has been affected most severely, reportedly with 945 confirmed cases and 53 deaths.
On 21 April, Vidya Krishnan, an independent journalist, spoke to Dr Anand Rai, a medical officer in Indore, about the escalating crisis in Madhya Pradesh, and how it devolved into its current state. Rai is a doctor empanelled with the National Health Mission and among the doctors who are part of the state’s “COVID-19 combat team.” He is also well known as an activist who was one of the whistle-blowers in the Vyapam scam—a corruption scandal that had embroiled Chouhan’s previous term as chief minister, which led to over a thousand arrests and is suspected to have caused at least forty deaths. Rai identified both failures of the state machinery, for its inaction, and of the public, for violating the lockdown, as reasons behind the current situation in Madhya Pradesh.
Vidya Krishnan: We are all watching the news from Madhya Pradesh and both Bhopal and Indore are reeling under COVID-19 infections. It seems that the state machinery is not able to respond to this crisis as well as we would have thought. The first thing I would like to ask you is that last week, on Twitter, you compared Indore with Wuhan. Can you explain what similarities you are seeing between these two cities? Why did you make this comparison?
Anand Rai: See, if you look at the infected cases per million population, Indore tops the list in India—it has more than three hundred per million of the population. If you look at fatality rate, it’s more than six percent here. Looked at this way, you will see Indore tops the list of India’s top cities affected by the virus. That’s why I made the comparison with Wuhan. The most important thing is that I hoped that drawing a comparison with Wuhan would perhaps draw the prime minister and the centre’s focus to this city. Because until you control pockets or epicentres, corona is not going to away from this country.
VK: Would you give us some explanation on the situation of the lockdown in Indore? How are people living in this new normal? How is it being implemented in the city?
AR: See, Indore’s populace was not ready for a lockdown. They compared it to curfew-like situations, which the city had been under in the past. They did not recognise that we needed to stay home due to a pandemic. So, people who live in slums would hide in their homes when the police arrived. With the police gone, they would once again occupy the streets and lanes.
Indore is a city devoted to religious festivals and rituals. The city does not spare any reason to enjoy and celebrate. A festival called Rang Panchami is celebrated here five days after Holi. More than five thousand people had reached Rajwada [a historical palace in Indore] on 14 March. This was despite the fact that Indore already had two suspected cases around 5 March, who were in hospital—a young Italian woman and a traveller from Dubai. Prior to that, on 31 January, two students studying for their MBBS in Wuhan had returned from there and were admitted. So it’s not as though corona had not arrived here. It had. Many people who had relevant travel history and could be asymptomatic carriers had arrived in Indore. The gatherings that took place thereafter are a reason for the infection’s spread in Indore.
VK: Over the past few weeks, several cases have come to light in which personnel of the state machinery—such as people in the health department, police officials or Indian Administrative Service officers themselves—have fallen ill. You were telling me that this week a station-house officer and a doctor have died in Indore. Could you take us through how heart-breaking these stories are? These are people on the frontline of India’s COVID response. Today, these are the people in MP who are most affected.
AR: See, two doctors have died and two SHOs have died. More than ninety officials of the health department have tested positive for coronavirus. There are some in Bhopal. In Indore as well, more than ten people are COVID positive. This shows that there is a high risk for people who are present and working on the frontline. People will need to understand that these workers have put their lives on the line, but ultimately the public has up to 99 percent of a role in the mitigation of the disease.
The public has to stay at home and keep their requirements to a minimum. There are about 167 containment areas in Indore. We are living in this city along with 915 positive patients. More than 52 people have died. The condition here is severe. Centre will need to maintain vigilance over the city. We do not have such good facilities either. We don’t have enough ventilators. I think that there are barely fifty ventilators in the city.
Even so, we have divided hospitals into three categories: red, where those who are COVID positive go; yellow, where we keep suspects; and green, where ordinary patients go for treatment. We have seen that the green-category private hospitals, nursing and maternity homes are not working well. Doctors and paramedical staff are not reporting for work. So some patients are dying due to fear and panic. This is largely in areas where there was a high rate of corona. When they had another disease, such as a heart attack or their blood-pressure increased, when they went to hospitals, they died out of panic.
If we look at the indexes and compare this month with the last, there have been around five times as many deaths, but they are not on record, because testing is not being done. If you don’t test, how can you say whether the person is COVID positive? Many times we have seen that a person dies in the eight–ten days it takes for reports to become available. When someone dies, we have to quarantine those close to the diseased. If reports are late, then we are in a sense leaving the asymptomatic carriers free to roam their colonies and streets. This is the primary reason for the spread of the disease.
The second important reason is that the police wasn’t trained to build quarantine houses. By principle, tents should be set up on open grounds where each person is kept separately. Here, people were kept within party lawns, in the manner of an open jail. They would come together for namaz, or to eat together. Now people from various communities are also afflicted. People will have to understand how to stay in quarantine. Ten–twenty people living in quarantine together tested positive. Due to this, the cases have increased.
VK: You mentioned that policies were not being effectively implemented and cases are on the rise due to this failure. This takes me back to March-end, when MP was in political turmoil, an elected government was toppled and the BJP swore in a chief minister. What has been the effect of the government’s absence on the increase in cases?
AR: See, the government plays an important role. When the initial cases came, in the first week of March, we treated those cases seriously. We sent the reports to Pune. We didn’t issue a lockdown, but closed down malls and schools, and banned large public gatherings. But when the assembly was suspended here by the speaker, the BJP made light of it, saying, “It’s not corona, it’s daro na [be scared], you are just being paranoid.”
More than twenty two MLAs, including our health minister, were abducted and taken to Bangalore. When he should have been holding meetings with principal secretary and monitoring the health department, the health minister was making merry in resorts, and coveting power. The IAS and IPS officers, too, thought that the BJP was going to come to power in place of the Congress. They began to scheme ways to get close to BJP politicians who would keep their postings intact.
As soon as the BJP came to power, it immediately transferred Indore’s collector. They transferred officers. The new officials were not adequately accustomed to the local geography. These things come into play, especially in the absence of a health minister. In direct terms, I believe that the political turmoil is responsible for depleting conditions in Bhopal and Indore.
VK: What do you think is the ideal government response today, in order to contain the damage? In Indore alone, as you’re telling me, there are 167 containment zones. What are the most important things the government must do? If a health minister is sworn into office today, what should the response look like?
AR: First, we will have to implement an effective lockdown. We will need to have zero tolerance. Only the seriously ill should be allowed to step out. In terms of rations, only the minimum requirements should be delivered. Especially those engaged in emergency work—whether those distributing ration, or sanitation workers who collect waste, or health workers, or petrol-pump operators, or gas-tank providers. The people who are on the streets must be selected randomly for sampling. For this, we will need to take help of rapid antibody kits, and use pool testing, in order to cover large portions of society.
We will need to throw out the notion that a cold and flu-like symptoms are necessary for coronavirus. Eighty percent of the cases we are seeing are asymptomatic. People need to be tested if they have come into contact with more than hundred people in the last 15 days, or come into contact with any such person. We need to use rapid antibody kits to perform swift testing. Once we see that a case is positive, then we can quickly quarantine or home-isolate the afflicted. In this way, we can achieve control over the spread.
VK: Other states have reported shortage of kits. In Indore, as far as you know, does the state government have PCR and antibody kits?
AR: When this all started, there were just 21 tests a day. We have increased testing capacity by a level, and as activists, we have had to make many demands. We have tried to increase capacity, new PCR [polymerase chain-reaction] machines have been bought, but tests should have been conducted in Bhopal, Jabalpur, Gwalior. Every medical college’s pathology department should have had this facility. A percentage of our GDP that’s allocated to health will need to, somehow, be spent on health research. We will need to set up virology labs. Rapid-testing kits are not available currently. PCR has a limit of around 150–200 tests a day. If we had rapid antibody kits, then we would be able to perform even more tests and control the disease faster.
This interview has been edited and condensed.