"Five of us live in our single-room house with one bathroom. I could have easily infected my siblings and parents," says 18-year-old Ramavath Shiva Nayak, who recently recovered from COVID-19. Ramavath was in the news earlier this week, after he isolated himself on a tree in front of his house in Telangana for 11 days. He was later shifted to a state-run COVID-19 isolation facility. The incident took place in Kothanandikonda tribal hamlet in Telanganaâ€™s Nalgonda district. While Ramavath has fully recovered now, his plight pointed to the lack of dignity of housing facilities and lack of state-run facilities in Telangana for COVID-19 patients.
Hundreds of people in Telangana, who test positive for coronavirus and have no facilities at home for self-isolation, are facing a similar plight. Such situations are especially prevalent in rural areas and slums in cities and towns. In most cases, this affects the most vulnerable sections of society.
Ramzani Md, a 35-year-old auto driver in a small town in Telangana who got infected earlier this month, said that the 10 days after testing positive for the virus were a nightmare for him. Ramzani was asymptomatic and doctors at the local government hospital advised home isolation and gave him a medicine kit.
"I confined myself to two-meter space in the room. I did not touch anything that other family members could potentially touch. I took tablets and followed a diet as advised. I was sure that I would recover but I was scared about my children and my aged parents," he said.
Of the total COVID-19 cases tested in the state, 71.70% of them are asymptomatic. The state Public Health and Family Welfare department has directed hospitals to only admit patients with moderate and severe symptoms. This meant that patients like Ramzani had to isolate themselves at home.
Lack of isolation facilities at the village level
Unlike the first wave where cities and towns saw a high number of cases, the second wave has hit rural areas too. While there are isolation facilities run by the state, they remain in the area or block level, posing difficulties for patients to travel to these facilities.
Several healthcare workers who work on the ground also highlight the severity of the problem. Bandi Praveena, an Accredited Social Health Activist (ASHA) worker in Sirikonda of Nizamabad, who works at a Primary Health Center (PHC) in the mandal headquarters, said, "COVID-19 patients with severe symptoms are being directed to district hospitals. However, so far, most of the patients I have attended to are asymptomatic. If they are isolating in small houses, other family members move to their farms. Sometimes, the patient moves to the farm."
While she spoke about a man who isolated at his farm and recovered, thanks to ASHA workers monitoring his health every day, Praveena also pointed out that such arrangements become difficult if the patient is a woman or a child.
In another case earlier this week, in Kishtampalli Thanda of Nawabpet in Mahbubnagar district, five people, who travelled from Pune and contracted COVID-19, were isolated at a newly built burial ground as it had rooms and electricity and water facility. According to the sarpanch of the village, the decision was taken as the patients' houses were small and congested.
Samala Lakhsmi, an ASHA worker at Bijinapally PHC of Nagarkurnool, said that she, too, had attended to a couple of patients who isolated themselves at their farms. "While patients with big houses and adequate facilities are isolating at home, some patients are staying at farms. In such cases, one of the family members would arrange the required food and medicines and deliver it to the patient," she said.
Professor Sujatha Surepally, an academic and social activist, said that smaller institutional isolation facilities at the village level would help COID-19 patients isolate themselves with dignity. "For example, ASHA workers who do not enter the homes due to COVID-19 stigma or caste prejudice can easily enter isolation centres and monitor patients regularly. The centre can also ensure a nutritious diet, as this is impossible for many, as they are daily wagers," said Sujatha.
Activists also suggest that having a designated isolation facility at the village level in school buildings or gram panchayat-owned buildings makes it easier to connect vital services like transportation, to ensure further treatment and shifting to a hospital if required.
Situation no different in urban areas
Incidentally, there are many COVID-19 patients who live in cramped houses in urban areas like Hyderabad and other cities. They, too, are struggling to fight back the virus and prevent it from infecting others in their family.
Sanjeev Kumar, an activist from CHATRI (Campaign for Housing and Tenurial Rights), said, "Several patients are suffering due to poor housing facilities as it is not possible for one to safely isolate in a cramped room. Government authorities should convert school and college buildings into isolation facilities and offer treatment to such patients."
The Human Rights Forum (HRF) has also written to the Chief Secretary to set up COVID Care Centers in densely populated areas. In view of the growing number of cases in slums of the East Zone under the Greater Hyderabad Municipal Corporation (GHMC), which consists of 2.5 lakh to 3 lakh residents, the HRF demanded that a COVID Care Center be set up in the City Model School at Chaderghat.
They said that it has the required facilities and is within the close vicinity of hospitals such as Malakpet Area Hospital, Osmania General Hospital (OGH), King Koti Hospital and other nursing homes. The HRF said that such initiatives can break the chain of transmission and reduce the pressure on public health care facilities.