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COVID-19 Is Devastating Rural India. But We Don't Know How Much

LULU GARCIA-NAVARRO, HOST:

In India's biggest cities, there are some early indications the coronavirus case numbers may be reaching a slight plateau. The country's confirmed 311,000 new cases today. And that's down from just a week ago, when the daily count was 400,000. But it is too soon to tell whether the world's biggest COVID-19 outbreak is easing because the virus is now spreading into rural areas, where two-thirds of India's population lives and where access to testing and medical care is limited. That's led to some horrifying sights, as NPR's Lauren Frayer describes in this report from Mumbai.

LAUREN FRAYER, BYLINE: In this video recorded by villagers, bloated bodies can be seen washing up on the banks of the Ganges River in northern India. Dogs wade in. Crows swoop and squawk. It is a ghastly scene.

(SOUNDBITE OF DOG BARKING)

BRIJ BIHARI: (Speaking Hindu).

FRAYER: Brij Bihari is the former head of one of the villages where the bodies have been washing up.

BIHARI: (Speaking Hindu).

FRAYER: "These aren't necessarily COVID victims," he tells NPR. "In this area, some people have always immersed their deceased loved ones in the Holy River. And they might be doing it more so now because it's too hot to build funeral pyres," he says.

But in the same village, a local aid worker, Abhimanyu Singh, tells a different story.

ABHIMANYU SINGH: (Speaking Hindu).

FRAYER: "People are scared to tell you the truth," he says. "Our local cremation ground used to see one or two funerals a day. Now there are 35 to 40. The price of wood has gone up. People who can afford to cremate their loved ones are still doing so, but so many others can't," he says.

SINGH: (Speaking Hindu).

FRAYER: "It's hard to know who is dying of COVID here and who's not," he says. "People rarely seek any medical care."

YOGESH KALKONDE: You know, rural people are used to that. It's a part of their life. That is very accepted - accepted very easily in many rural areas of India.

FRAYER: Dr. Yogesh Kalkonde works in rural Maharashtra in central India. He says India's rural caseload is likely even more of an undercount than in urban areas. His patients have long been hesitant to even get tested for the coronavirus. Many are afraid to go anywhere near a hospital.

KALKONDE: But that is gradually changing now because of the deaths that are occurring. People are now getting scared, and gradually their changing behavior towards getting tested. But that's a very slow process.

FRAYER: And this is how bad it is now. In April, his district recorded the same number of coronavirus cases as the past 13 months put together and three times as many deaths. That's straining an already weak rural health system. Even the best equipped hospitals in the capital New Delhi have run out of beds and oxygen. People can't get ambulances. But in parts of rural India, those services have never been easy to get.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON: Stretcher, stretcher.

FRAYER: A news clip from rural Bihar, one of India's poorest states, shows a woman being wheeled up to a hospital sprawled atop a fruit seller's rickety cart. Saurav Kumar grew up in a village in Bihar. He now works in tech in the capital New Delhi. And when he saw COVID's scourge there, he thought of Bihar and how weak its health system is. So he went home to help his neighbors.

SAURAV KUMAR: Like, 80% is not having much information about how to use the internet.

FRAYER: Eighty percent of the people he knows there have never used the internet and have no way to access it anyway, Saurav told me over a bad phone line. He's been going house to house with his smartphone, helping people register for vaccination appointments online. But what he's found is that...

KUMAR: Every third household has one person having the COVID-like symptoms, but they are not able to get tested.

FRAYER: A sick person in every third house, he says. In his district of 4 million people, there are only two or three ventilators.

KUMAR: So only two or three ventilators are working as of now.

FRAYER: And no technicians to operate them, he says. Such shortages were common in rural India even before COVID hit. This is where illiteracy is high. And many deaths never get registered anyway. But it's where two-thirds of Indians live and where scientists predict the world's biggest COVID wave could claim many, many more lives. Lauren Frayer, NPR News, Mumbai.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.