A Closer Look at COVID-19 in Rural India
With the 5-year anniversary of COVID-19 just passing, it's important to reflect on the lessons we've learned — and the ones we still haven’t. Since the pandemic began, over 3 million deaths have been confirmed worldwide due to COVID-19 (WHO, 2021). While the virus was initially framed as the great equalizer, affecting both rich and poor alike, it is clear that COVID-19 affected certain groups more, particularly the rural communities of India (Mein, 2020).
On March 24, 2020, a lockdown was declared for Indian residents that caused a mass exodus, where millions of migrant labor workers left major metropolitan cities, such as Mumbai, Delhi, and Chennai, to return to their native, rural villages. This mass exodus was recorded as the second largest exodus, just after the mass exodus that was triggered by the partition of India and Pakistan in 1947 (Bhattacharyya et al., 2023). Either by walking, biking, or cramming into tight buses and trains, many workers endured a long journey, over hundreds of kilometers, to return to their villages (Sahoo et al., 2021). With news of the impending lockdown and a spike in unemployment, many thought returning home would offer safety, security, and comfort. However, this mass movement of people did the opposite. The mass exodus introduced COVID-19 to these remote communities that were otherwise unaffected by the transmission of the virus. It would not be long until reports of a spike in COVID-19 cases in these communities were reported.
The wave of cases hit rural communities hard, especially considering that two-thirds of Indians live in such areas (Frayer & Pathak, 2021). Places like Uttar Pradesh and Bihar, where the majority of people live in secluded, rural communities, were severely affected (Adem, 2011). Before the pandemic was introduced, these areas already suffered from pre-existing inadequacies that were only exacerbated by the pandemic. Inequities such as a shortage of doctors, as well as a lack of medical equipment and housing beds were heightened and made the response to COVID-19 difficult and slow. For instance, Uttar Pradesh had fewer hospital beds in rural areas compared to the national average, with an average of 2.5 beds per every 10,000 people. This was greatly under the recommended guidelines by the World Health Organization (WHO) (Kumar et al., 2020). To make matters worse, the number of medical professionals available was under the WHO guidelines, as well, with India’s health system having at least 1 doctor for every 1,500 citizens. The recommended number was at least 1 doctor for every 1,000 citizens (Frayer & Pathak, 2021).
Once the pandemic hit, the lack of resources became clear. Doctors found themselves under significant stress. Hospitals could not keep up with the influx of patients being admitted. One resident reported that his hospital had fewer than 10 beds available on a given day for a sick, positive COVID-19 patient (Frayer & Pathak, 2021). This forced many to stay home without care. It has been reported that during the peak of the pandemic, rural India experienced over 500,000 deaths on a monthly basis. In just 3 months, from April to June of 2021, an excess of 2.6 million people died because of the lack of preparedness and resources in rural India (Kumar et al., 2024). These limitations were not new, but the pandemic exposed them with brutal clarity.
The data coming from these rural, impoverished areas, however, may not tell the full story. A lack of testing in rural areas led to severe underreporting of the amount of cases affecting rural areas (Ani, 2021). Not only was there a lack of available testing centers and kits, but testing hesitancy also spread among the population driven by fears of testing positive, a lack of trust in science, and concerns about social stigmatization. Rural communities, which often included some of the country's most impoverished individuals, were disproportionately affected, with many belonging to the lower rungs of India's long-standing caste system. Given their socio-economic status, a positive test meant further reinforcement of intensifying systemic social disparities (Agarwal, 2021). In addition, a lack of death registration also added to the invisibility of the crisis. Many COVID-related deaths went unrecorded, especially among those who passed away at home without ever seeking formal medical care. In areas where literacy rates were low and access to government services was limited, the bureaucratic process of registering a death—let alone attributing it to COVID-19—was often out of reach (Frayer & Pathak, 2021). This secret death toll was also uncovered with an increasing number of human bodies being washed onto banks of the Ganges River in Uttar Pradesh and Bihar during the pandemic. This tragic reality further highlighted how the official numbers vastly underrepresented the true death toll of COVID-19’s impact on rural communities (BBC news, 2021).
Five years later, India is now recovering, but the damage is already done. Despite increased growth in India’s finance and real estate sectors, little growth is being made to increase India’s pandemic preparedness and to help their healthcare sector. For instance, in 2019 to 2020, at the beginning of the pandemic, India’s health budget allocation was nearly 2.3 percent of its total budget. However, in 2024 to 2025, the health budget made up only 1.9% of the total budget, signifying a decrease in spending (Mukhopadhyay, 2024). Coming off of a major pandemic, the path India is currently headed down poses serious concerns for public health of its citizens.
The situation in rural India highlights the need for greater investment in India’s health structure. More robust measures need to be taken to ensure that India’s healthcare response is equitable and fair. Rural India cannot continue to be treated as an afterthought in times of crisis. The five-year anniversary of COVID-19 should serve not only as a moment of remembrance but also as a call to action. It demands action that supports sustained investment in rural healthcare infrastructure, equitable access to medical resources, the dismantling of long-standing social barriers, and increased awareness and education. Only then can India ensure that its rural communities are no longer left behind when the next health crisis arrives. The lessons are crystal clear—it’s now time to learn from them.
A big thank you to Georgetown Project RISHI Vice President of Public Relations and Marketing, Neha Gunda, for offering me the opportunity to write about my interests in public health and rural health disparities.
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References
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Mein, S. A. (2020). COVID-19 and Health Disparities: the Reality of “the Great Equalizer.” Journal of General Internal Medicine, 35(8), 2439–2440. https://doi.org/10.1007/s11606-020-05880-5
Bhattacharyya, R., Sarma, P. K., & Das, T. K. (2023). Mass exodus of India’s internal migrant labourers during the first phase of COVID-19: a critical analysis. SN Social Sciences, 3(7). https://doi.org/10.1007/s43545-023-00691-x
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