TROUBLED STATE

As infections slow in many other countries, India is still reporting more than 50,000 cases per day. Its total of more than 2 million cases trails only the United States and Brazil, and cases show no signs of slowing. Since the pandemic struck India, more than 46,000 people have died.

Although India’s major cities, such as New Delhi and Mumbai – the first to be hit by the virus – have registered a decline in cases, numbers in second-tier cities and rural areas continue to rise.

Bihar is India’s third-most-populous state; if it were a country, it would be the 14th-most-populous in the world.

The state has a rich history, including the site where the Buddha is said to have attained enlightenment beneath the shade of a Bodhi tree.

But today, Bihar has a reputation as one of India’s problem-plagued states.

Based on indicators including infant nutrition, Bihar’s level of development has more in common with sub-Saharan Africa than India’s prosperous southern states. Almost half of children under 5 in the state are stunted from malnutrition, with more than four in 10 underweight for their age, according to federal data.

Bihar also has the highest population growth in India, and one of the worst education systems, scoring poorly on indicators including adult literacy, the percentage of children attending school and exam results.

The healthcare system was overburdened even before the pandemic struck. Dr. Sunil Kumar, the Bihar secretary of the Indian Medical Association – the main healthcare union in India – said more than half the doctors’ posts in the state are unfilled. That’s because many doctors don’t want to serve in rural areas, according to Bihar’s top court, which urged the state government to do more to fill the roles in a ruling in May.

There have been around 87,000 cases of coronavirus in the state and 465 deaths – relatively small compared to other states. Given the low testing levels in the state, the numbers may be conservative. Still, Bihar’s healthcare system is already close to breaking point, unlike places such as New Delhi, which has had many more cases but enjoys better resources.

The state government’s response to the outbreak has prompted public interest litigation asking that India’s federal government, led by Prime Minister Narendra Modi, take over management of the pandemic here.

One case, filed by local businessman Aditya Jalan, says “incalculable” lives will be lost if action isn’t taken soon, especially with the pandemic spreading into less developed and more rural areas.

His petition cites a “complete breakdown of the public health infrastructure in the state of Bihar, including the lack of COVID-19 hospitals, the lack of hospital beds, the insufficient testing, the unsanitary quarantine centres, the lack of enforcement of social distancing measures, the insufficient medical personnel, [and] the failure to provide PPE to front-line workers.”

India’s Supreme Court is due to hear the case Friday.