On April 9, as soon as the death of a general physician in Indore made headlines, there appeared a viral video of the doctor. Filmed a week before his death, Dr Shatrughan Panjwani asserted in the video that he had not tested positive for Covid-19. “I am fit and healthy and have no problems. I am at home with my family and doing fine. Please do not pay any attention to rumours,” he said after testing negative.
His second Covid-19 test, however, returned positive. A day later, Dr Panjwani, with a history of diabetes and hypertension, succumbed at Sri Aurobindo Institute of Medical Sciences, a designated Covid-19 facility in Indore. There was panic on social media as people felt if even a doctor was not sure of his condition, the risk for the common man was far greater.
The panic was understandable, as Panjwani’s was the 23rd Covid-19 death in Indore (and 33rd in Madhya Pradesh) in less than two weeks. As on April 13, Indore had 362 Covid-19 cases and 35 deaths, while the state had 648 cases and 50 deaths. The only other Indian state to have more deaths was Maharashtra (160).
Madhya Pradesh had the highest death rate (deaths per 100 infections) at 7.71 per cent. The national average was 3.6 per cent. The only Indian city with more deaths than Indore was Mumbai (101). And only Pune (11.02 per cent, 30 deaths) had a higher death rate.
Chief Minister Shivraj Singh Chouhan told THE WEEK that the spike in cases in Indore was because the patients had hidden their travel history. “Indore is the prime commercial centre of the state,” he said. “Many people here travel abroad for business. Initially, such people hid their travel histories and mingled with others, and the infection spread.” Chouhan sent a team of officers to contain the situation in Indore by focusing on wider testing in affected areas.
Interestingly, the first Covid-19 case in the state was reported on March 20—a good 50 days after the first case in the country—yet it has become a hotspot for the virus in a sudden surge.
Perhaps the political instability in March had something to do with it. As the Kamal Nath government was tottering, the state machinery was engrossed for three weeks with the political drama. Chouhan took oath as chief minister on March 23, just hours before the national lockdown was announced.
During those critical weeks, politicians focused on their power games rather than on preparing for a health emergency, according to Amulya Nidhi of Jan Swasthya Abhiyan, the regional circle of the global People’s Health Movement.
Former Congress minister Jitu Patwari, who is from Indore, said Kamal Nath had declared Covid-19 an emergency on March 16. “But because of political intentions, the BJP government delayed everything and lost the crucial 8 to 10 days of preparedness and prevention,” said. “The result is there to see.”
The BJP’s state spokesperson Deepak Vijayvargiya said the Central and state governments had taken steps to contain Covid-19 well in time. “The situation in Madhya Pradesh is also because of the Nizamuddin Markaz connection,” he said. “This is a global pandemic and giving it a political angle is not right.”
Women maintain social distancing outside a bank in Bhopal as they wait to collect their pension | AFP
On enquiring, however, it was revealed that though 20 out of the 121 cases in Bhopal were linked to the Nizamuddin event, no cases in Indore had any contact with them.
As Chouhan is yet to appoint any minister, effectiveness of administration is suspect particularly in crucial departments like health, home, civil supplies and urban administration. The chief minister is single-handedly steering the ship.
To make matters worse, the virus sent into quarantine almost the entire top brass of the health department, including three IAS officers. In addition, health commissioner Prateek Hajela was replaced for ‘dereliction of work’. On April 8, Chouhan told THE WEEK that things were in control and that the second and third line of officials were competent to handle any situation. As for the absence of ministers, he said that all the state’s MPs and MLAs were working together to handle the crisis.
The spread of the virus, said a health expert, was aided by factors such as poor health service infrastructure and lack of public awareness. The new health commissioner Faiz Ahmed Kidwai said a major reason for the high death rate was the delay in patients reporting themselves. “In most cases, deaths occurred within 24 to 48 hours of being admitted to hospital,” Kidwai said. He accepted that the delay was probably because of the stigma attached to the disease.
“The public health system in the state struggles with an acute shortage of health professionals and poor infrastructure and service delivery,” said Amulya Nidhi. “As per the health report of 2019, there are only around 39,900 hospital beds in the state, making it approximately 1 bed per 1,800 people. And this is just one point. The unpreparedness is clear.”
An audit of the first 23 deaths in Indore showed that many of these patients had severe existing comorbidities like diabetes and hypertension, said Dr Jyoti Bindal, dean, MGM Medical College, Indore. “Most of the patients had respiratory symptoms for eight days at the time of reporting themselves, which indicates how late they reported,” she said.
Indore divisional commissioner Akash Tripathi said that in about a dozen cases, the positive reports came in only after the deaths. Both Bindal and Tripathi dismissed the argument that enough testing was not being done. However, Kidwai conceded that in the initial phases, tests and results were delayed. He said 50,000 rapid testing kits were being procured to ensure community-level testing in hotspots.
Chouhan said that honest implementation of the lockdown would be key to stopping the spread. “The areas in the state where positive cases were found have been declared as containment areas and are completely sealed,” he said, noting that 26,800 volunteers had come forward to monitor patients. Nurses and paramedical staff, he said, were being trained by the WHO and UNICEF.
Veteran health activist Chinmay Mishra saw a big shortcoming: the government was looking at the situation as an administrative and law-and-order problem rather than a health crisis. “The public health system is a shambles,” said Mishra. “Doctors and health workers are not prepared for this. India is a welfare state and a humane approach is needed to handle the crisis.”