A medic arranges samples to test for COVID-19 with an antigen test kit, in Kolkata, August 2020. Photo: PTI/Swapan Mahapatra.
New Delhi: Dr S.P. Kalantri, the medical superintendent of a hospital in rural Maharashtra, has said in an interview with IndiaSpend that there has been a sudden increase, by nearly 40%, in the fraction of people who test positive for COVID-19 at the hospital, in Wardha district, Maharashtra.
Dr Kalantri said in the interview that this and other factors pointed to the presence of community transmission of the novel coronavirus in villages – where a paucity of data and the threat of monsoon diseases has always threatened to exacerbate the COVID-19 problem. Dr Kalantri is the medical superintendent at Kasturba Gandhi Hospital at Sevagram in Wardha, and has been a professor at the Mahatma Gandhi Institute of Medical Sciences for over 30 years.
He also recognised that a lot of what he had predicted at an earlier stage of the pandemic had turned out to be true. Among them was his idea that even a district as remote as Wardha wouldn’t be spared a visit by the virus. And according to him, Wardha had its first case on May 10.
“Right now in my hospital … there are 175 COVID-positive patients; 27 of them are in the ICU and a dozen of them are on mechanical ventilation,” he said. “Every day, our Wardha district is recording between 150 and 175 new cases, and it looks like these cases are now coming from smaller villages also.”
Dr Kalantri said he believes these cases are the result of the virus being transmitted in the community – instead of being ‘imported’ from elsewhere – given that many of the patients did not travel outside Wardha recently and in fact come from smaller villages.
Indian authorities have been loathe to admit community transmission in the country, although officials of some state governments have publicly expressed suspicion. Raman R. Gangakhedkar, the former chief epidemiologist at the Indian Council of Medical Research, admitted shortly after he retired in July that community transmission could be underway in “parts of Delhi and Mumbai”.
Fortunately, Dr Kalantri said, most people own smartphones and are willing to get themselves tested when they notice symptoms related to COVID-19.
“The district hospital has a contact-tracing, testing and isolating protocol and the district administration also finds some cases. Right now, Wardha district has two labs that can do RT-PCR tests and both put together are doing close to 400-500 tests per day,” Dr Kalantri noted – adding that these labs first spotted the sudden rise in test positivity.
He described three challenges ahead vis-à-vis COVID-19 in India’s rural areas. First, many rural healthcare workers are exhausted and burned out. Second, lifestyle diseases like diabetes, high blood-pressure and heart problems have become more common in rural India in the last decade or so. Third, officials and healthcare workers have to contend with the spectre of ‘monsoon fevers’.
“Every year we have our share of the top five [diseases] – malaria, dengue, chikungunya, leptospirosis and scrub typhus – and the story is repeating itself,” Dr Kalantri said. “… every day we see 1,600 patients in our outpatient department, of which 20-30% come with fever or fever-like symptoms. It is extremely difficult and challenging given the sheer numbers, given the lack of proper and reliable diagnostic tests and given the fact that in large public hospitals, it is nearly impossible to segregate non-COVID-19 patients from COVID-19 patients.”