NEW DELHI - India has reported nearly 2.5 million cases of Covid-19, the third worst-hit country in the world, but concerns are growing over the pandemic spreading to rural areas, where 70 per cent of the population live.
The number of cases in major cities like Mumbai and Delhi, once hot spots, appears to be stabilising but infections are rising in smaller towns and rural areas in several major states like Bihar, Uttar Pradesh and Andhra Pradesh.
"When this pandemic began, it was through people coming in from other countries... It was then localised in urban areas and big cities. When the unlocking took place and people migrated from urban to rural... it started spreading in rural areas," said Dr Rajni Kant, head of the research management, policy, planning and coordination cell at the state-run Indian Council of Medical Research (ICMR). The "unlocking" referred to the to the easing of stringent restrictions imposed as part of a lockdown in March.
Bihar and Uttar Pradesh, in particular, witnessed the return of hundreds of thousands of migrant workers to villages and smaller towns from the cities. All were fearful of the pandemic and had fled home after losing their jobs
"Still, in rural areas, the population density is low compared with urban parts. The only problem is that health infrastructure is not as good as available in urban areas," said Dr Kant.
India imposed a stringent lockdown in late March, bringing economic activity and cross-country movement of people to a complete halt.
Nearly all restrictions have been eased in stages but how the situation evolves in rural India could pose another major challenge for the government, with the number of cases climbing seemingly inexorably.
"At the moment, we are seeing the smaller towns affected and sporadic reports in rural India are coming in. Without adequate testing, it is difficult to say how much the virus is spreading in rural parts. The major reports of large scale cases of hospitalisation, at the moment, it's still in the smaller towns, district towns... We have to wait and see how rural areas are affected," said Professor K. Srinath Reddy, president of the Public Health Foundation of India (PHFI) and a member of the government's National Task Force on Covid-19.
"In Pakistan and Bangladesh, it got controlled in cities and towns and rural areas were not too affected. Can we have a similar experience? We have to wait and see," he added.
A Lancet study last month said several districts in nine major states, including the poorest states of Bihar, Madhya Pradesh and Uttar Pradesh with big rural populations, were vulnerable to new infections.
Controlling infections in the rural areas will be a lot more difficult than in urban centres. The wearing of masks and social distancing, for example, are not as strictly practised as in the urban areas, where enforcement, including police action, is also stronger.
Mr Javed Jung, a local farmer in the district of Shamli, an overwhelmingly rural district in Uttar Pradesh, spoke of hearing of Covid-19 cases where once there were none.
"First, it was not there at all. Now we are hearing cases from the villages. But testing is also increasing," he said.
Shamli has reported 224 cases.
Mr Javed also said the pandemic has had an impact on lifestyle in the village.
"We would all sit and smoke a hookah (shared pipe). It's a very common practice. Five to 10 people would sit in one place and share a hookah. Now no one is doing that, including me," he said.
Prof Sudhir Panwar of Lucknow University in Uttar Pradesh believes the virus is also moving into the villages through markets.
"It's not migrant labour any more. It's mainly from the grain market and vegetable market (where farmers go to sell their produce)."