Featured image: Members of fire and emergency services decontaminate a road in Ahmedabad, India, April 24, 2020. Photo: REUTERS/Amit Dave
Gujarat overtook Delhi in the total number of COVID-19 cases, becoming the second major hotspot of infections in the country after Maharashtra. On April 29, Gujarat had 3,744 cases of COVID-19 (11.94%) of the total 31,332 of all India, when the state has only 4.3% of the national population. Also, Gujarat has experienced much higher death rate of the total cases (4.8) compared to 3.21 across India, and while 11.59% of the patients have recovered in Gujarat, this figure is 24.56% at the national level. IIT Delhi’s COVID-19 prediction model shows that the virus’s reproduction rate (RO) in Gujarat is 3.3, which is the highest in the country along with West Bengal.
The question that is repeatedly asked is this: Why is Gujarat, one of the most prosperous states in India, showing a worrisome performance with regards to COVID-19 spread compared to others?
There are seven states in India where the number of cases is above 3,000: Maharashtra (9,318), Gujarat (3,744) and Delhi (3,314). The death rate in Gujarat (4.8%), which is higher than that of Delhi (1.6%) and Maharashtra (4.2%). Similarly, the rate of recovery in Gujarat is much lower in Gujarat (11.59) than in Maharashtra (14.89) and in Delhi (32.52). The number of cases has continuously been increasing in Gujarat since April 8. On April 12, it reported 48 new cases, on April 17 it reported 170 news cases, on April 22 it reported 229 new cases and on April 27 it reported 226 new cases. On April 28, the new cases declined slightly to 226. There does not seem to be a flattening of the curve so far.
The primary reasons for COVID-19 increase in Gujarat
There are three reasons for the spike in COVID-19 cases in Gujarat. Firstly, because Gujarat is a highly globalised state, it experienced a huge inflow of people from abroad between the second half of January and March, until India banned international flights. These people came to Gujarat for trade and business, for tourism, for work, or to come home. Arrivals were mostly from the US, Canada and European countries; from China, Japan, Singapore, Hong Kong and other East Asian countries; and Dubai and other West Asian countries. Though thermal testing was done at airports and 14-day quarantine was recommended, the implementation was lax, resulting in spreading of the disease to many more areas.
Secondly, the Tablighi Jamaat gathering in March at Markaz Nizammudin in Delhi was reportedly attended by 1,500 people from Gujarat, particularly from Ahmedabad and other cities. Due to the complete segregation of Hindu and Muslim living area in cities in Gujarat, Muslims are ghettoised in limited areas in the three main cities – Ahmedabad, Surat and Vadodara – COVID-19 spread in these areas.
The third reason for the rapid increase in the numbers is because of a rapid increase in COVID-19 infections in Ahmedabad. For example, of the total 3,774 cases in Gujarat on April 29, 2,542 (67.35%) are in Ahmedabad district. Surat city stands at second position with 570 cases on April 29, which is one-fourth of that in Ahmedabad city. Surat’s population is 80% of that of Ahmedabad, but its population density is higher. While there are 136.8 persons per hectare in Surat, Ahmedabad’s density is 119.5 persons per hectare. In Gujarat, on the other hand, 3 districts have 1 case each, and 12 districts have 10 or fewer cases.
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In a press conference held on April 24, the municipal commissioner of Ahmedabad, Vijay Nehra, said that if the rate of doubling remains at 4 days, the city could have 50,000 COVID-19 cases by May 15 and 8 lakh by May 31.
Within Ahmedabad city, the spread is limited to the walled city wards and eastern Ahmedabad, which are high density, low-income wards. As of April 24, the highest number of cases are observed in congested areas such as Jamalpur (344), Behrampura (230), Dariyapur (106) and Danilimda (106). Jamalpur, Danilimda and Dariyapur are Muslim dominated areas whereas Behrampura has 37% Scheduled Caste (SC) and Scheduled Tribe (ST) population. The combined population of SCs and STs in Ahmedabad is only about 11.8%.
The other areas that have high COVID-19 cases are Khadiya (123) and Maninagar (41). These areas have a low proportion of SC+ST population (1.8% and 4.3% respectively). The areas in West Ahmedabad, residential areas of largely middle to high-income groups such as Naranpura, Navrangpura, Satellite and Vadaj have low numbers of reported cases, although the first COVID-19 case in the city was a person from West Ahmedabad who had travelled internationally.
The demographic characteristics of these wards explain the high numbers of COVID-19 cases. Except for Behrampura, the other three wards with the largest number of COVID-19 cases, which are also Muslim majority wards, are also highly dense, according to Census 2011. The same situation would have continued now, given that the ghettoization in Ahmedabad is complete since the 2002 communal violence.
Other indicators of high density are that very large number of households in Jamalpur (51.2%), Dariyapur (48.4%), Danilimda (45.8%) and Behrampura (57.7%) inhabit single-room houses, where social distancing is just not feasible. The household size (defined as the number of persons per household) is also high in these wards, wherein more than 50% of the households have more than 5 persons. Further, Berampura and Danilimda wards have a relatively low level of water supply and toilet facilities, with 11.7% and 22.3% households respectively, share water supply access and 17.2% and 9.7% households respectively share toilets. Thus, demographic and infrastructure factors favour the rapid spread of COVID-19. In Khadia and Maninagar, two other wards with high infections, the density is higher than the city’s average. But they do not have other demographic or infrastructure factors that support the spread of this virus.
There is a specific story of the spread of COVID-19 infections in the Muslim dominated wards. The first reason is, as mentioned above, some persons who had participated in the Tablighi Jamaat event returned to the city and carried the infection. Particular political dynamics within the Muslim majority areas led to the quick spread of the disease. The low level of trust in the state government in the current communally charge environment of the country, dependence on the instructions of the local level community leaders for actions, and low level of education among the population resulted in rules of lockdown and social distancing not being enforced stringently in the localities.
The demographic and infrastructure factors, as seen above, do not favour strict enforcement of social distance and lockdown. But, the political and social situation at the local level aggravated the spread. It was only after the local councillors moved from door to door in these localities that the lockdown measures were strictly followed. However, in the process, two political representatives, Imran Khedawala (MLA) and Badruddin Sheikh (councillor) tested positive for COVID-19 (the latter succumbed to it).
Thus, the ghettoisation of Muslims in dense localities and the very high housing stress due to non-availability of affordable housing in other parts of the city is, in the ultimate analysis, responsible for the rapid spread in three Muslim dominated wards in Ahmedabad.
High vulnerability of population
Apart from the three primary reasons for the spread of COVID-19 in Gujarat, the transmission of the disease in communities has been relatively high in Gujarat. This is due to two major reasons that tend to increase the vulnerability of its population: (1) low public expenditure on health and relatively high malnourishment in the state; (2) relatively high percentage of vulnerable workforce in the state.
Gujarat’s economic growth has always been at the cost of the development of its population. Since the beginning of this century, the government has focused on making Gujarat the most attractive investment destination to make Gujarat the fastest growing economy in the world – even at the cost of developmental goals like health, education and well-being of the people. The consequences are clear.
To start with, the workforce in Gujarat is more informalised than in other states. After the closure of large textile mills in Gujarat that employed permanent workers and were the backbone of the economy, a large number of workers lost jobs and joined decentralised units of textiles (power looms, spinning mills and process housing) as informal workers, or joined other informal work, frequently petty trade, services and manufacturing. Ahmedabad was perhaps the worst victim of this. New industries and business, which developed in the outskirts of the city, preferred to employ contract or casual workers. Again, Surat, one of the fastest-growing city for a long time, also is notorious for employing contract and casual workers – in diamond cutting and polishing, power looms, embroidery and Zari industry. The same was the employment pattern in the state.
According to the NSSO 2017-18 rounds, 94% of the workforce in Gujarat is unorganised. The data over the years show that Gujarat is the only state to record a decline in the share of formal secured employment in the last decade. Also, the wage rates in Gujarat – casual and regular, and rural and urban (except urban women) have been almost at the bottom win the major 20 states in India. The state has also recorded the lowest increase in the wages in the major 20 states of India. Gujarat is also experiencing a severe shortage of productive work with decent work conditions. The highly capital intensive and highly skilled jobs (including rapidly increasing use of robots and other high-tech) has created large low paid contract and casual jobs in the state. Most of these jobs have low or no social protection. In short, masses of the workers in Gujarat are unprotected and vulnerable.
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On the other hand, public health facilities in Gujarat are in a very poor state: to start with, the state spends just 1% of the SDP on public health. Of this, a significant portion goes to medical education and insurance. About 50-60% posts at the district and below district level are not filled. While there are provisions for the nutrition of children and women, as Patheya has pointed out, the utilisation is 60-70% only. Also, men are excluded from the nutrition budget. Given the low availability of public health services, about 70% of their health expenditure is from people’s pockets. As pointed out by several reports by scholars and national and international organisations like Global Hunger Reports, NFHS reports, UNICEF and others, the incidence of malnutrition is relatively high in Gujarat. The decline is very low as compared to many other states in India.
In short, a significant part of the population is poorly nourished and highly vulnerable in terms of quality of employment and they are susceptible to COVID-19.
It is also observed through quick surveys by scholars, NGOs and journalists that the government’s intensive efforts in implementing a large number of packages, cash transfers, free ration distribution and free food are not adequate. Also, many of these are too small and came too late. Much more needs to be done.
The way ahead
We suggest the following immediate steps to address the rising COVID-19 cases in the state:
- As the level of testing is low, it is necessary to increase the number of testing in all parts of the state. Rural areas also should not be left out, particularly large villages, which are like small urban centres. It is very important to isolate COVID-19 cases and treat them carefully in hospitals
- Raise public expenditure on health substantially. Gujarat today spends a meagre Rs 2,329 per year per person on health (Rs 6.38 per day), which needs to be raised substantially. This will help fill in all posts, develop infrastructure and provide medicines as well as testing. This year also, the budget must be raised from 1% of the SDP to at least 3%.
- Raise the nutrition budget by 100%, particularly to provide adequate food to Anganvadi children, school children (mid-day meal) and pregnant women and new mothers as well as to men. Though Gujarat has declared the intention to create public kitchens, it has not implemented it. Public kitchens that provide free nutritious food is a must in the malnourished state. All these steps will raise the immunity levels of people.
- Lastly, urbanisation pursued through such congested living conditions and sharing of basic facilities at the neighbourhood level increases the potential for the spread of viral diseases such as COVID-19. Ultimately, Gujarat and other states of India require a new model of urbanisation.
Indira Hirway works at the Centre for Development Alternatives, Ahmedabad. Darshini Mahadevia is with the Ahmedabad University.
The authors are thankful to Dr Dileep Mavlankar, director, Indian Institute of Public Health, Gandhinagar and Mahendra Jethmalani of Patheya.