On May 15, in the wee hours of the morning, the Ahmedabad police stumbled upon a body at the Danilimda BRTS stand. They took it to V.S. Hospital for an autopsy which revealed that Gunvant Makwana, 67, was a COVID-19-positive patient.

Five days earlier, Makwana had developed a fever, cold and a cough. His family got him admitted to the Ahmedabad Civil Hospital. The family said they learnt from the daily medical bulletin issued by the Ahmedabad Municipal Corporation on May 13 that Makwana had tested positive for COVID-19. Makwana was discharged two days later as he had mild symptoms. He was asked to remain under home quarantine. How he turned up dead at a bus stop close to his home remains a mystery.

The police said they told his son, Kirti Makwana, to collect his father’s body when the autopsy was completed. The family said they had no idea about his condition until then. Gujarat’s largest COVID-19 hospital, with a capacity of 2,000 beds, had not informed them that Makwana was being discharged, they said. “We came to know only from the police that he had passed away. We had no contact with him after he was admitted on May 10,” said Kirti.

The tragic incident caused outrage in the State, which has reported over 12,000 COVID-19 cases and over 750 deaths. Under fire for the apparent mismanagement by the State health authorities, Chief Minister Vijay Rupani ordered a probe into the matter by a senior bureaucrat.

However, this was not the first such incident. Earlier, on April 20, around 25 COVID-19 patients were forced to spend hours on a street after they were denied admission into the Ahmedabad Civil Hospital, prompting the Gujarat government to rush senior health officials there to resolve the matter. One of the patients, a woman, posted their story on social media. She said they had been waiting for hours without food to get admitted after testing positive for the virus. When the video was shared widely, officials rushed to the spot and promptly admitted the patients. They cited discrepancies in case papers for admission, which they said had made data entry a problem.

Coronavirus | COVID-19 patients segregated on basis of religion at Ahmedabad Civil Hospital, according to reports

On May 11, 44-year-old Umesh Tamaicha was admitted in the Civil Hospital after testing positive for COVID-19. Early morning on May 16, Tamaicha succumbed to the infection, but his family was informed about his death only about 10 hours after he died. “We were told about his death only in the evening. Till then, we had no idea about the treatment given to him and how and when his condition deteriorated,” said Kalpana, Tamaicha’s sister. The family did not receive his watch and mobile phone — both were allegedly stolen after his death. This too had happened at the hospital earlier — a woman’s gold jewellery, cash and mobile phone were all allegedly stolen after her death.

Such horror stories have become routine at the Civil Hospital as the Gujarat government grapples with the pandemic. The State, touted as a “model of development” by Prime Minister Narendra Modi, is facing its worst crisis in recent memory.

Preparing for ‘Namaste Trump’

On March 17, Ahmedabad recorded its first COVID-19 case. By the end of the month, the city had recorded fewer than 30 cases and three deaths. But since then, in just two months, the city, with a population of about 6.5 million, has recorded 9,724 cases and 645 deaths. Despite stringent lockdown measures in the city, the deadly virus has spread quickly. Over the last three weeks, about 250 cases have been reported daily in Ahmedabad.

Though it is the second hardest hit city in India by the pandemic (the first being Mumbai) in terms of total cases and fatalities, in absolute numbers Ahmedabad’s mortality rate is nearly 6.5%, which is almost double the national average. In Gujarat, Ahmedabad accounts for nearly 74% of the total cases and 80% of the total fatalities.

Coronavirus | Ahmedabad’s mortality rate way above national average

While the rapidly rising number of infections and deaths is a matter of concern for the people in Gandhinagar as well as in New Delhi, what is of particular concern is that the virus has spread through the lower-income areas in the walled city. Political events in Gujarat in February and March indicate that the State and civic authorities perhaps underestimated the ferocity of the pathogen in striking Ahmedabad in the initial phase of the outbreak.

In late February, weeks before the pandemic gripped the city, there were frenzied preparations for the high-profile visit of U.S. President Donald Trump to Ahmedabad. A mega event, ‘Namaste Trump’, was scheduled at the Motera Stadium where President Trump and Prime Minister Modi were to address a crowd of 1.25 lakh people. The entire State government machinery and the Ahmedabad Municipal Corporation were tasked with making arrangements for the ‘Namaste Trump’ event, scheduled on February 24. They spent half of January and the whole of February preparing for the President’s visit. This was despite the fact that nearly a month earlier, on January 30, the World Health Organization (WHO) had declared COVID-19 as a ‘public health emergency of international concern’.

Namaste Trump | Walls rise in Ahmedabad ahead of Donald Trump visit

It was only on March 5, 10 days after Trump’s visit, that the Gujarat government woke up to the potential health crisis and announced its plan to combat COVID-19. According to the plan, the civic body and the State Health Department were to work together and screen people coming from abroad. Gradually, the ambit of screening was widened to include domestic passengers. Screening meant measuring a person’s temperature using a thermal infrared thermometer.

From March 6 to March 22, as many as 6,000 passengers arrived at Ahmedabad airport. All of them were screened. Those who landed after March 15 were asked to remain quarantined at home for two weeks.

Coronavirus | ‘Model State’ Gujarat under great strain

A political drama unfolds

During this month, however, the State government was preoccupied with something else. The Assembly was in session for the Budget and was to convene 26 times between February 24 and March 31. In addition, Rajya Sabha elections for four seats from the State were scheduled to be held on March 26. According to the numbers then, the Bharatiya Janata Party was expected to retain two of the three seats it held, while the Congress was set to increase its tally from one seat to two.

Despite being short of numbers, the BJP was determined to retain all the three seats. Within a few days, five Congress MLAs resigned from the House, forcing the Opposition party to take its remaining MLAs to neighbouring Rajasthan to prevent poaching by the ruling party. While a potential healthcare crisis loomed on the horizon, a political drama began to unfold in the State.

Just days before the first COVID-19 case was reported in Ahmedabad, the Gujarat government declared the virus an epidemic under the Epidemic Diseases Act of 1897. As a precautionary measure, the government decided to shut all schools, colleges and educational institutions, swimming pools and multiplexes for two weeks starting from March 16. However, on March 14, two days after the WHO declared COVID-19 a pandemic, the Principal Secretary (Health and Family Welfare), Jayanti Ravi, told the media in Gandhinagar: “There is no epidemic. It is only a provision for legal empowerment for preventive action and empowerment.”

On March 13, the Opposition party leader in the State Assembly, Paresh Dhanani, demanded that the government adjourn the Assembly session indefinitely as the COVID-19 threat was becoming worse. However, the government rejected the demand and continued the Assembly proceedings till March 23. During this period, there was barely any presence from the Opposition party as it had flown its legislators to Jaipur to prevent them from being poached. By the time the government finally adjourned the Assembly on March 23, the number of cases had started growing.

Infections in the walled city

According to a top medical practitioner in the city, while the authorities mainly focused on people returning from abroad, Ahmedabad was receiving its routine flow of visitors from Mumbai, Indore, Delhi and other places either by train or by road. “No one in the government at the State level or in the civic body could gauge the threat posed by inter-State travellers as potential virus carriers,” he said.

By mid-April, the city had 350 confirmed cases of which 27 had come to the State through domestic travel and 15 through international. The rest were local transmissions in the lower-income areas which are thickly populated and highly congested. Many of these cases were traced to the Tablighi Jamaat Markaz held in Nizamuddin in Delhi.

Coronavirus | The story of India’s largest COVID-19 cluster

Highly congested localities such as Jamalpur, Raikhad, Saraspur, Shahpur, Dariapur, Danilimda, Behrampura and Asarva have emerged as major hotspots. These areas are mainly populated by poorer sections. Physical distancing is impossible in these areas. To make matters worse, rumours began spreading on social media and in these localities that the National Register of Citizens exercise was being carried out in the name of testing for COVID-19. Fear that had gripped these localities last year only grew deeper. People turned suspicious.

Ahmedabad Municipal Commissioner Vijay Nehra, who was later transferred to the post of Commissioner, Rural Development, soon after the Centre reportedly censured the Chief Minister for failing to control the rapid spread of the virus, took the help of leaders such as Jamalpur MLA Imran Khedawala, Dariapur MLA Gyasuddin Sheikh, and Behrampura Municipal Councillor Badaruddin Sheikh to persuade community members to get tested.

These leaders along with the health workers and medical teams of the civic body repeatedly visited societies and homes to track people with illnesses in order to get them tested. Consequently, Khedawala himself tested positive and recovered from the infection after a few days, while Sheikh, who also tested positive, succumbed to COVID-19.

The entire walled city was declared a buffer zone and cordoned off. There was heavy deployment of police and paramilitary personnel.

As the infection numbers surged, Nehra, who had adopted an intensive testing strategy as part of the containment strategy, warned on April 24 that the city may have as many as 8 lakh cases by the end of May. His statement created a flutter in Gandhinagar, prompting the Chief Minister to assure the people that the situation was under control.

Coronavirus | Ahmedabad adopts South Korean model

Delays in containing the spread

However, on May 5, the situation turned alarming when the State reported as many as 441 cases and 49 deaths. In Ahmedabad alone there were 349 cases and 39 deaths. Sensing that things were spiralling out of control, the Centre directed the Rupani administration to quickly bring matters under control. The State government appointed Additional Chief Secretary Rajiv Kumar Gupta to supervise, monitor and coordinate works related to COVID-19 in the city. Another senior bureaucrat, Mukesh Kumar from Gandhinagar, was brought in to be the Municipal Commissioner since Nehra had to be placed under quarantine at home after coming in contact with an infected person. Chief Secretary Anil Mukim and Prime Minister Modi’s point person in Gujarat, K. Kailashnathan, rushed from Gandhinagar to the municipal corporation to take stock of the situation. Additionally, Chief Minister Rupani also made a statement that “Ahmedabad was his top priority” and requested Union Home Minister Amit Shah to send a team of experts from AIIMS to Ahmedabad.

Coronavirus | Centre steps in as COVID-19 cases rise in Gujarat

However, on the ground there is ample evidence that there were delays in containing the spread of the virus. Since April 30, fruit and vegetable vendors, shopkeepers and salesmen at grocery markets were identified, but screening and testing on a mass scale was done only after Gupta was roped in by the State administration.

On May 16, the government said that out of 35,000 people identified as ‘super spreaders’, approximately 6,500 were tested. Of them, 709 were found to be infected. Earlier, around 350 ‘super spreaders’ had tested positive. In all, over 1,000 ‘super spreaders’ have tested positive indicating that there is a serious problem.

Second, it was only on May 6 that the civic body ordered all private clinics, nursing homes and hospitals to open in the next 48 hours or lose their licence, to allow screening and checking of people. “More than 60% of those dying of COVID-19 have co-morbidities like diabetes, hypertension and heart-related ailments,” Principal Secretary Ravi said.

“Co-morbidities and delayed hospitalisation due to late diagnosis have played havoc as more than 25% of those who died succumbed to the infection within two days of hospitalisation,” said an infectious disease expert who is on the panel of experts of the State government.

Coronavirus | Gujarat ‘super-spreaders’ spike national tally

Burden on government hospitals

Ahmedabad had imposed stringent lockdown measures. It shut down all essential services except milk parlours and pharmacies when the number of cases began increasing. But the burden of tackling the rising numbers, like everywhere else in India, has fallen on government hospitals. The Ahmedabad Civil Hospital became the primary hospital for COVID-19 treatment in the city. Plagued by mismanagement and lack of adequate staff, both doctors and paramedical, the hospital has recorded almost 50% of the State’s total deaths due to COVID-19. “Senior doctors have stayed away from treating COVID-19 patients as they fear contracting the virus. So, the entire burden is on resident doctors, juniors and paramedical staff,” a doctor at the hospital said.

Patients at the 1200-bed Civil Hospital in Ahmedabad. Photo: Special Arrangement.

Patients at the 1200-bed Civil Hospital in Ahmedabad. Photo: Special Arrangement.
 

Subsequently, testing was reduced substantially despite the rising number of cases. “The positivity rate in Ahmedabad is more than 20%. This means 20% of the total samples test positive. That’s massive,” said the infectious disease expert. He recommended enhancing testing to gauge the magnitude of the epidemic in the city.

When Kalpana’s brother Umesh Tamaicha tested positive, the family said it had to force the health authorities to test his wife and two daughters. “Umesh’s wife tested positive and we admitted her in a private hospital. One daughter also contracted the infection but she is quarantined at home. Thankfully both are asymptomatic,” said Kalpana. Similarly, when a local Congress leader, Habib Mev, died of COVID-19, his family too said they had to beg the municipal authorities to get tested.

Right now, the city’s main COVID-19 centres have nearly reached their capacity. Private hospitals requisitioned under the Epidemic Diseases Act are at loggerheads with the municipal authorities about charges fixed by the administration for providing treatment to the infected persons. The days ahead will be extremely crucial for the city as lockdown measures are being relaxed everywhere except in containment zones.

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