A timely study by NCCI founder Prof. Ruth DeFries and collaborators lays out possible scenarios for minimizing risk of exposure to COVID-19 in rural India as the lockdown is relaxed and migrants return to their villages.
 
What we know
Seasonal migration is a widespread livelihood option for households in forest-fringe areas of Central India, moving people from villages to the country’s cities for up to 6 months in a year. Typically, these migrants are young males and they return to the village in time to plant monsoon crops. Seasonal migrants are generally poorer and less educated than those that migrate permanently (for work or education) [1]. In the current pandemic of COVID-19, the risks of exposing rural India with returning migrants from cities is of major concern for both rural communities and government authorities, as well as for migrants who are desperate to return with no source of income during India’s lockdown.
 
Moreover, communities on the periphery of forest areas in the country are some of the most vulnerable and poorest. Central India, one of the main forested areas in the country, is important for tiger conservation and has a high proportion of Scheduled Tribe populations. In these villages of Central India, the poorest households use seasonal migration to supplement their incomes [2], increasing the risks of exposure to COVID-19 as migrants return. These villages are even more at risk as they have poor or non-existent health facilities and low quality diets in typically crowded households [3]. Additionally, most households continue to use fuelwood with high indoor air pollution already causing respiratory problems [4]. While the populations are not as dense as in cities, the spread from village to village and lack of medical facilities is a grave concern.
 
As of this writing, the country has been in lockdown since March 24th. Seasonal migrants are unable to access work or means to return home. News channels have documented migrants returning home on foot. Quarantine facilities have been set-up in villages but the quality and efficacy of these are unknown. The government restricted inter-state travel for migrants after April 20th. As restrictions ease, chances persist of exposure and spread to adjacent villages from migrants who have already returned.
 
Given the economic hardships of lockdown, the authors of this study provide some alternatives to severe physical distancing.  The objective is to reduce chances of exposure while allowing people to obtain essential supplies, plant crops, and carry out other necessities of daily life. A post-COVID-19 path could be informed by their results.
 
The study uses data from a 2018 study that surveyed approximately 5000 households in 500 forest-fringe villages in Central India. The original study was to assess patterns of migration over the previous five years (2013 – 2018) and was unrelated to tracking disease spread.
 
What they found
The researchers found that seasonal migration is widely dispersed across forest-fringe villages of Central India.  Eighteen percent of surveyed households sent migrant workers to cities in the last five years.  Seventy-five percent of villages had a least one household with migrants, and all districts had a least one village with migrants.  Similarly, migrants traveled to 124 locations over the last five years. Over eight percent of migrants went to cities were COVID-19 cases were reported at the beginning of the lockdown, based on the publicly-available COVID-19 tracker site (www.covid19india.org).

The researchers used a simple, epidemiological model of disease spread to examine different scenarios of movement between and within villages (Figure 2).  Using varying R0 values (the basic reproduction number that represents the expected number of cases generated by an infected individual), the researchers allowed for scenarios with lenient (no restriction R0=3), moderate (some restriction to interactions R0=2) and maximal (highest restriction R0=1) movement within and between villages. The findings highlight how different strategies for easing lockdown restrictions might vary in terms of the number of people exposed in the unlikely but possible event of the virus reaching a village.

The most effective way to limit exposure is obviously to keep everyone within and across villages in lockdown. But as most Indians are now familiar with, keeping an indefinite lockdown is not feasible with many states already easing some restrictions to save India from economic hardship. The more important question then becomes, how one would begin opening up the lockdown or easing restrictions to balance the economic needs with necessary caution to avoid exposure to the virus.

This study reports, for a hypothetical case of exposure in one village, that maximal limitations to movement between villages with lenient movement within villages (middle scenario in Figure 2) exposes fewer people than moderate restrictions that apply to both within and across villages (bottom scenario).

Incidentally, the scenario that led to the least number of exposed people in the model is similar to New Zealand’s successful “social bubble” and communities’ efforts in India to restrict entry to villages.