(Bloomberg) --

In the villages of India’s most populous state of Uttar Pradesh, even some family members returning home from the cities aren’t allowed in.

State officials have told village councils to keep returning laborers from entering the town or meeting people due to fears they may be infected with the coronavirus. Instead, they’re forced to stay in schools or farms outside the village, where local authorities and doctors make regular visits and police make sure lockdown orders are followed.

“People are very afraid here. There might be a lot of misinformation also spreading,” said Malkhan Singh, head of Daipur village, some 450 kilometers (280 miles) southeast of the Indian capital. “We are not sure but we are not even letting our relatives stay with us.”

Similar stories are playing out in small towns and villages across India’s hinterland -- home to two-thirds of its 1.3 billion people -- where broken state hospital systems fear getting swamped as local infections rise. They now anticipate the worst as hundreds of thousands of migrant workers reach their homes amid the country’s 21-day lockdown that wiped out their jobs.

Front line health workers are gripped with anxiety as they operate with some of the world’s worst medical infrastructure in the face of the pandemic.

“Government hospitals will run out of beds in rural India even if only 0.03% of the rural population is hit by the virus,” said Steve Hanke, professor of applied economics at Johns Hopkins University and the Founder and Co-Director of the Johns Hopkins Institute for Applied Economics, Global Health, and the Study of Business Enterprise. “Nine million people travel back and forth from cities to villages each year -- they will be carrying the virus from cities back to villages where the health infrastructure is even worse.”

Interviews with nearly two dozen people in rural India -- including doctors, hospital workers, village governing body heads, government officials and citizens -- revealed a state of despair and panic. Medical supplies face critical shortages, testing is insufficient and authorities banking on the success of the heavy-handed police-enforced lockdown to avoid a surge in cases.

Fear Looms

Protective gear for doctors and other staff was abysmally low when the lockdown began, according to a person with information about hospital stock positions in Bihar state who is not authorized to speak to the media. Almost 60% of government hospitals had 100 or fewer PPEs, some of them had none. Some hospitals didn’t even have aprons in stock.

On Thursday the federal health ministry said India had placed orders for more than 17 million PPEs and 49,000 ventilators. In the meantime, medical professionals in India’s small-town public hospitals continue to work at great personal risk.

India’s low testing rates over the last two months have added to the uncertainty. India had tested 144,910 samples as of April 9, according to data from the Indian Council for Medical Research. Data for testing in Uttar Pradesh and Bihar was not immediately available. The country has so far reported 7,600 infections and 249 deaths due to the virus, according to data from Johns Hopkins University.

The state of Uttar Pradesh, which has a population equivalent to Brazil, has only 11 testing facilities as of April 10, according to the ICMR. Noida, one of the identified hotspots, has only one private testing lab.

“We have four testing centers in Bihar,” said N.R. Biswas, a doctor and the director of Indira Gandhi Institute of Medical Sciences in Bihar’s capital Patna. “The number should have been 40 but the capacity can’t be increased overnight.”

The mass exodus of hundreds of thousands of poor, migrant workers heading homeward, packed in crowded trains and buses or on foot over hundreds of miles, has only increased the pressure.

While many did make it back home, more than a million migrant workers have been housed in around 31,000 relief camps set up by state governments and voluntary organizations across the country to ensure they do not complete their journey, according to a government filing in the country’s top court earlier this week. If they did reach their villages, the federal government said, the pandemic would become “unmanageable to contain.”

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