Why rise in Covid cases in smaller cities is a big worry

While the overwhelming majority of active Covid cases in states like Maharashtra, West Bengal and Gujarat are concentrated in the big cities, in UP, Bihar, Odisha and Andhra Pradesh, the biggest cities account for between 16% and 28% of active cases. This is a worry because in every state the concentration of health personnel and infrastructure is in the large urban centres.

In the case of West Bengal, 72.7% of active cases are concentrated in the Greater Kolkata region including North and South 24 Parganas, Howrah and Hooghly. Seven out of 19 government medical colleges are located in Kolkata. Similarly, in Maharashtra, 65.4% of the cases are in Greater Mumbai (including Thane), Pune and Nagpur and in Gujarat almost 67% of the cases are in Ahmedabad-Gandhinagar, Surat, Vadodara and Rajkot.

It is a well-established fact that 80% of doctors and 60% of hospitals in India are concentrated in urban areas and within them among the bigger cities. In these states, therefore, the concentration of cases mirrors the concentration of resources to deal with them. In contrast, in UP, only 27% of active cases are located in big cities of Lucknow, Kanpur, Ghaziabad-Noida, Agra and Meerut. The rest are scattered across the state which could pose a challenge in ensuring access to health services for those affected.
In Bihar, just 27.8% of active cases are in Patna, Gaya, Bhagalpur and Muzaffarpur. This pattern could well be because many of the trains of transmission in these states have originated from migrant workers returning to villages from the metropolises.

Even at the state-wide level, Bihar has among the lowest availability of beds per active case and in the smaller towns and villages the situation would be worse. Andhra Pradesh seems to be in the same situation with low bed availability per active case and just 16% of active cases in Visakhapatnam and Vijaywada. In Odisha, 25% of active cases are in Ganjam and just 21% in Khorda, the district that includes Bhubaneshwar, or 6% in Cuttack. With state-wide availability of beds per active case at a lowly 2, this is a real challenge. In Rajasthan too, just about a third of active cases are in Jaipur, Jodhpur and Kota, but the state’s beds per active case count is much better at 7. The actual bed availability for the remaining two-thirds of cases could, however, be much lower.

In Kerala and Himachal too, cases are spread out across districts, but bed availability per active cases is much higher for these states, 8.6 and 13.9 beds per active case, respectively. The challenge in dealing with a scenario where active cases are not concentrated in a few big cities would be in ensuring that those requiring hospitalisation have access to quality health services.