NEW DELHI - Amid the raging Covid-19 pandemic, the central state of Madhya Pradesh does not have a health minister or, for that matter, a Cabinet.
Three of its most senior bureaucrats dealing with health issues have tested positive for the coronavirus.
Over 50 health workers with the state's health department have tested positive and scores of others are in quarantine.
Madhya Pradesh, which saw political turmoil leading to a change of government as the pandemic was taking root in India, has emerged among the worst affected states in the country.
It recorded 257 new cases on Wednesday (April 15), second only to Maharashtra state, which had 350 positive new cases that day.
Indore, the state's industrial hub and the country's cleanest city, has emerged as one of the country's epicentres, with 427 cases in a population of 1.9 million residents.
"It's a fact Madhya Pradesh has not handled it as it should have been. This is due to the battle for power when the problem was blowing up. Our political leaders were busy in political wrestling," said social and food rights activist Sachin Jain.
"They (government) haven't involved civil society organisations. We are struggling to get passes for food distribution (for the poor). The police (instead of healthcare workers, in many instances) are going to pick up coronavirus cases. There is a total disconnect."
Madhya Pradesh was hit by political turbulence after Congress' Mr Jyotiradita Scindia and 22 Congress legislators defected to the Bharatiya Janata Party (BJP), which was then in opposition, destabilising the government.
Then Congress chief minister Kamal Nath resigned leading to the swearing in of BJP chief minister Shivraj Singh Chouhan on March 23, two days before Prime Minister Narendra Modi announced a lockdown.
Mr Chouhan is seen to have had little time to choose his Cabinet, usually a lengthy process in India involving multiple negotiations to ensure representation of different castes amid other political considerations.
And the fact that the state has a weaker health infrastructure than states like Kerala and Tamil Nadu has not helped the situation.
"Madhya Pradesh is a backward state. State health services have been very bad. Successive governments have not been making any effort to put strategy in place to deal with health services," said Bhopal based political analyst Rasheed Kidwai.
"All those things need to be addressed. What is happening in the fight against the coronavirus is that they are enlisting other health services. They don't have the capabilities,"he added.
The state has been sending samples for testing to Delhi, though it has nine designated private and government labs to test for coronavirus.
Still, government officials and BJP leaders denied lack of planning or strategy.
A Covid-19 task force, involving political leaders but no health experts, was set up on Monday to coordinate the response.
BJP president V.D. Sharma, who heads the task force along with the state's chief minister, said the delayed response was because of the earlier Congress government. The Congress in turn has blamed the BJP government of a poor response.
"The BJP setup is working with strength. Our people (BJP workers) like doctors, nurses, police and others are working on the front line,'' Mr Sharma told The Straits Times.
"The chief minister is working day and night. He has taken it (the situation) in hand from the first day."
Mr Parikipandla Narahari, a secretary in the state government's public relations department, also said that top bureaucrats and health department workers testing positive had not impacted the state's response.
"If an officer is affected or not available for work, there is a second line of officers who can take care of things and a third line of officials. We are well equipped, as of today, to deal with the entire crisis," said Mr Narahari.
He noted that the chief minister had chalked out a strategy of IITT: identify, isolate, test high-risk patients and treat the affected persons. Testing is being ramped up, he said, adding that in Indore 2,100 tests per million of population were taking place.
India's response to the coronavirus has also been dependent on state leadership, with public health being a state issue in India's federal system. Strategies to curb the infection have differed from state to state and have been defined as much by state leadership even as by the overall country-wide directives that have come from the Prime Minister.
One piece of good news in all of this is that parties are now seen to be striving for some political unity.
"We have to be united in our fight against the coronavirus. Fighting together is going to take India forward. If we fight each other we will lose," said Congress leader Rahul Gandhi.