How Ganjam – and not capital Bhubaneshwar – became Odisha’s Covid-19 hotspot

The buses arrived well past midnight on April 30. Four of them, carrying 217 people from Surat, most of them textile workers. Their employers had stopped paying them wages in the wake of the nationwide lockdown that led to the closure of factories and businesses. It had taken the workers nearly sixty hours – and the last of their savings – to make the journey back home to the coastal district of Ganjam in Odisha.

As they alighted from the buses one by one, health workers clad in protective gear from head to toe pointed thermal guns at them and took their body temperature. Twenty-two workers were identified to be running a fever and immediately dispatched to the Berhampur district hospital to be tested for Covid-19. The rest were bundled into schools and panchayat offices that had been converted into quarantine centres where they would spend the next fourteen days.

Ganjam, Odisha’s most populous district, had till then not reported even a single case of Covid-19. The authorities wanted to identify and isolate the potentially infectious new entrants so that they did not spread it to others in the community.

But things did not go to plan. While none of the 22 feared to be infected tested positive for the virus, it would later turn out that those who had made it past the temperature screening and were already sharing common living space with the others in quarantine centres had the virus.

As the district administration started testing all of the returnees gradually, a 22-year-old man and a 17-year-old boy tested positive on May 2 – Ganjam’s first Covid-19 cases and Odisha’s case number 158 and 159.

Soon, the number of Covid-19 cases in the district ballooned to 28.

By May 7, Ganjam had the dubious distinction of having the maximum number of positive cases in Odisha.

Non-capital hotspot

Since then, Ganjam has remained Odisha’s Covid-19 hotspot with the virus no longer limited to migrant workers housed in quarantine centres.

As of July 31, the district had reported 10,364 cases and 100 deaths – the highest by a long margin in the state. Khordha district, which houses the administrative capital of Bhubaneshwar, was a distant second with 4,200 cases and 30 deaths.

Herein lies another of Ganjam’s dubious distinctions: it is one of the rare non-capital districts to bear the highest caseload in a state. In most Indian states, the district that houses the capital city has been the worst-affected.

What explains this?

Returning migrants

According to district officials, the explanation is simple: massive in-migration. Out of the around 5,50,000 people who have returned to Odisha since lockdown rules were relaxed to allow inter-state movement of stranded people, the final destination of almost 4,00,000 of them was Ganjam, said Vijay Amruta Kulange, Ganjam’s collector. “We handled more than 200 Shramik trains and more than 1000 buses,” said Kulange. “Other than that, we have received people in cars, motorcycles and other means.”

The total number of trains to have arrived in Odisha since the relaxation of the lockdown is 256, according to the state government’s figures. Which means Ganjam has been the recipient of almost 80% of the people who have returned to Odisha by rail.

But it is not just returnees from other states that flooded Ganjam’s quarantine centres May onwards. The district also saw a lot of people from other parts of Odisha return. “Not just interstate migrants, Ganjam also had a very high share of intrastate migrants,” said Jayant Panda, a physician who is the technical adviser to the state government on Covid-19.

To add to all of that, Ganjam shares its borders with Andhra Pradesh, which has seen a sharp surge in recent times.

“That is why,” Kulange said, “we have a very sizeable number of positives if you compare to the rest of the state.”

Odd one out?

While that sounds like a plausible enough explanation, the number of returnees and Covid-19 cases have not always shown a linear relationship in states which have witnessed large scale return migration. In Bihar, for instance, data shows that districts with large numbers of returnees have reported fewer cases. The capital district of Patna accounts for the largest share of cases in the country, mirroring the national trend.

In Assam, which has also witnessed a surge after the return of migrants, Kamrup Metro, the district where capital Guwahati is located, accounts for almost 45% of the state’s cases. Ditto with Jharkhand and Chhattisgarh where Ranchi and Raipur lead with the maximum number of cases respectively.

Observers say comparison to other states may not be useful as the migration pattern in Odisha was somewhat unique. “In other states, for example in Jharkhand and Bihar, though people migrated to different district headquarters, migration to the state headquarters was much more,” said Bhuputra Panda of the Indian Institute of Public Health, Bhubaneswar. “But in Odisha, not many people migrated to Khordha at all; instead they returned to Ganjam, which has historically seen the maximum amount of out-migration from the state.”

While Bhuputra Panda said the pattern of return migration to Odisha was the most obvious explanation of the somewhat unique distribution of cases in the state, he said district-wise testing data across states would provide more insight. “The math is simple: more number of tests would give more number of positives,” he said. “So, you have to look at how testing is distributed in other states and if it is more concentrated in certain areas.”

While most states do not provide a district-wise breakdown of testing numbers, limited data available in the public domain shows that it is the capital city that accounts for the bulk of the tests in a state. This is partly because testing facilities tend to be concentrated around the capital (as in the case of Bihar) and partly because Covid-19 testing follows a chicken-and-egg principle – more testing leads to more cases leading to more testing.

A ‘very virulent’ virus strain

There were also other factors which compounded Ganjam’s problems, state experts say. Jayant Panda, the government’s technical adviser, said a study carried out in the Bhubaneswar-situated Institute of Life Sciences had thrown up a startling revelation: the strain of the virus in Ganjam was “highly infectious and very virulent” compared to other three strains that the state could isolate.

“It was a strain that people who had come from Surat and Ahmedabad had brought in,” he said. “On the other hand, the strain returnees from Bengal got in was much less infectious – even family members were not getting infected.”

Kulange, Ganjam’s collector, agreed. “More than 2 lakh returnees of the 4 lakh who came to Ganjam were from Gujarat,” he said. “The positivity rate among them was very high.”

The disproportionately high number of returnees from Gujarat is for a reason – an overwhelming number of workers powering Surat’s textile and diamond polishing industries are from Ganjam.

Government missed the train?

Critics of the state government say it had only itself to blame for letting the virus (and supposedly a particularly virulent strain at that) come in from Gujarat. Biraj Swain, a development and public health expert from the state, said the state government should have moved early in repatriating the workers from Gujarat. “Covid was raging in Gujarat in March-April – least one expected was for the Naveen Patnaik government to negotiate an early and safe passage back home for these workers,” said Swain. “But migrant workers from Ganjam were infected in Surat and only then allowed to return. No surprise that now these workers’ villages, families are infected too and Ganjam is raging.”

Swain pointed out that Jharkhand chief minister Hemant Kumar Soren had initiated early reparation of the state’s migrant workers from many parts of the country by running special trains.

In contrast, Odisha did not only not move early, cancelling two early special trains from Surat because it wanted returnees to be tested before boarding. This had led to great resentment among the state’s workers who had hit the streets in protest.

Jayant Panda defended the state government’s actions. “Government approached other states and tried to help the migrant workers, but I don’t think they took adequate care,” he said. “We offered our senior bureaucrats and leaders to go there, but that is not feasible as their orders do not hold there, so initially there was a lack of coordination.”

Isolation troubles

But it is not just late repatriation that detractors accuse the government of. The government, many say, was not prepared once they arrived either.

“Once the number of returnees increased, the number of quarantine centres fell short forcing the government to ask people to quarantine at home partially,” said Bibhu Prasad Sahu, a Berhampur-based activist. “But houses in Ganjam are not suitable for isolation at all, so that led to the virus spreading to the community.”

While a large number of Indians lived in cramped quarters, Ganjam’s houses have a peculiar train-like architecture – they are extremely narrow and extend longitudinally. “Most houses share a common partition wall,” said the public health expert Bhuputra Panda. “That could be one of the reasons that containment could not be achieved to the extent desirable.”

The administration, for its part, said it enforced 14 days of institutional quarantine for most part. “Only for a week did we do seven days’ institutional quarantine and seven days’ home quarantine,” said Kulange.

But many residents say there were lapses in enforcing institutional quarantine. Many people purportedly would sneak out and spend the night at home. Jayant Patra conceded that there had been slips. “As opposed to other districts, some people in Ganjam did not follow the administration’s directives strictly,” he said.

‘We have managed to contain it’

But Kulange said the worst was over and things were under control in Ganjam. “There will always be some errors when you are handling a big population – some positive people went to the society and that’s how the virus spread,” he said. “But we have managed to contain it.”

As proof, Kulange cited the district’s mortality rate: less than 1%. “That is much less than the national average,” he pointed out.

While space in quarantine centres may have come under pressure at some point, Ganjam never ran out of beds in its Covid care centres and hospitals, Kulange claimed.

“Considering the kind of migration, we witnessed, I will say there is no outbreak in Ganjam,” he said.

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.