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On Tuesday, the tally ofCovid-19 cases in India crossed 5.6 million. Maharashtra’s tally rose to 1.24million with a third of the infections reported among rural populations. UttarPradesh and Bihar have also reported an uptick in cases in rural areas. Thestates represent a nationwide trend of the pandemic shifting to the rural areaswhere health systems are weak and human resources are stretched or missingaltogether. This leaves the sick with no option but to seek treatment incities, where the strain on the health care system is beginning to show.Testing is still concentrated in urban and peri-urban areas. Testing in ruralareas remains below the national average of 46,440 tests per million, which maylead to undetected and asymptomatic spread in the young, mobile ruraldemographic, and, in turn, bring the infection back to cities.

Meeting the challenge ofcontaining the spread in rural areas is a monumental task. Of the little over1.2 million allopathic doctors registered with the Medical Council of India(June 30), around a million are available for active service. This puts thedoctor-population ratio at 1:1,343 for a population of 1.35 billion, againstthe World Health Organization-recommended 1:1,000. With most tertiary carehospitals situated in cities, at least 90% doctors live and work urban areas,home to 40% of the population.

Prime Minister Narendra Modi’s review of the Covid-19situation with the chief ministers of seven states that account for 63% of thecountry’s cases focused on scaling up testing and containment in rural Indiaahead of the last phase of unlocking on September 30. To win the war againstthe pandemic, battles have to be fought and won on every front.