- Delhi is the third worst-hit state/union territories by COVID-19 infections
- Delhi has reported over 1.2 lakh cases of COVID-19; recovered rate of 85.2%
- Doubling rate of cases has improved from 13 days (May 22) to 73 days now
New Delhi: On July 20, for the first time in seven weeks, Delhi recorded less than 1,000 fresh cases of COVID-19. Over the last few weeks, the daily rate of growth in COVID-19 cases has declined from 5.7 per cent (May 22) to 1 per cent (July 22). The doubling rate has also improved from 13 days (May 22) to 73 days (July 22). Parallely, the recovery rate has shot up to 85.2 per cent. According to Delhi Chief Minister Arvind Kejriwal, there are three key principles behind Delhi’s model of fighting Coronavirus.
In an online media briefing on July 15, CM had said,
In the last one and a half months, the Delhi government has worked on three principles. First, we learned that Corona is so huge a pandemic, that no one can fight it alone. Second, we never felt bad over what our critics had to say to us, rather, we worked on them to improve the situation. Third, we did not lose hope.
Though currently, Delhi is among the top three worst-hit states/union territories in terms of Coronavirus infections in India, experts believe that the national capital seems to have hit the peak. On July 20, AIIMS Director Dr Randeep Guleria had said,
My feeling is that certain areas have hit their peak. Delhi seems to have done so because the cases have declined significantly.
But to reach this incremental recovery rate, Delhi had to cross numerous hurdles. NDTV’s Banega Swasth India team spoke to experts to examine Delhi’s response to the pandemic so far.
Understanding Delhi’s Initial Response And The Progression In COVID-19 Cases
On March 1, Delhi reported the first case of Novel Coronavirus after a 45-year-old returning from Italy tested positive. On March 25, at the start of the nationwide lockdown, Delhi had just 35 COVID-19 cases of which six had already recovered. But soon the cases started to increase and the majority of them were linked to the Markaz event held in Delhi’s Nizamuddin in mid-March. By April 2, out of the 141 new COVID-19 cases reported, 129 were linked to the Markaz event.
Since May 28, Delhi started to register over 1,000 COVID-19 cases daily; within two weeks the numbers jumped and since June 10, the national capital has been registering more than 1,500 new infections every day. Delhi recorded over 32,000 cases in the first 19 days of June.
Talking about Delhi’s initial response and what changed in June that led to a spike, Dr Vikas Choudhry, Vice President, Public Health Practice, Sambodhi Research and Communications said,
Delhi has been a mixed bag in its performance. The problems to contain the epidemic in a densely populated city are multi-fold. Delhi did start well in terms of its better performance in testing and containment strategies compared to rest of the country in the first few weeks but over the course, a combination of factors like less than adequate preparation for health infrastructure, laxity of prevention measures among the population, confusion over testing and isolation strategies, constant changes in some guideline, among others, worked against Delhi. It reflected in rising numbers back in June.
Dr Rajesh Khanna, Deputy Director of Health and Nutrition at Save The Children also shared the same views and said when the lockdown was relaxed, people forgot the word ‘new’ and went on to lead their normal life. He added,
Suddenly, the quality of work that is required to control such a pandemic had gone down. Secondly, when a lockdown is relaxed and movement is allowed, you have to be more cautious, but I felt laxity among both authorities and people.
In addition to this, Dr Prabhakaran, Vice President, Research and Policy at Public Health Foundation of India believes that lack of communication and synergy between the public and private sector and central and state governments added to the chaos. He said,
I think they had to work together in order to bolster the health system to tide over the temporary period. Effective communication, meeting, and more collaboration and cooperation amongst various stakeholders were needed and lacking. But otherwise, in terms of planning and thinking, they were kind of okay.
Lockdown relaxations, opening up the movement of people, travel restrictions being lifted and people coming back to the country through Vande Bharat Mission (India’s repatriation operation) also fuelled the increase in caseload.
But in June, during the unlock phase 1, the situation went so out of control that the Supreme government called it “horrendous, horrific and pathetic”. While taking note of reports of improper handling of COVID-19 patients and disposal of bodies in the country, the Supreme Court slammed the Delhi government.
Why has your testing gone down from 7,000 to 5,000 a day when Chennai and Mumbai have increased their testing from 16,000 to 17,000?, the court asked.
Amidst this, the news of community transmission of coronavirus in the national capital started doing rounds and the Delhi Health Minister Satyendar Jain said,
AIIMS Director Dr Randeep Guleria has said that there is a community transmission in Delhi but the Centre has not accepted it yet.
Following this, the central government intervened and assisted the Delhi government in its fight against the pandemic. Together, they took some bold decisions like increasing of COVID-19 testing by three times in six days, converting establishments like hotels into quarantine facility, constituting helpline for patients, and adding beds across banquet halls, hotels, nursing homes.
To ensure the availability of life-saving plasma which is often used to help critically ill-patients recover, Delhi has even launched two plasma banks. The country’s first plasma bank set-up at Delhi’s ILBS (Institute of Liver and Biliary Sciences) Hospital was inaugurated on July 2. The second bank was operationalised at the Lok Nayak Jai Prakash Narayan (LNJP) hospital on (July 14).
Things started improving once the testing of samples was increased, beds and other emergency infrastructure were ramped up, home isolation was started, plasma banks were set up. This is reflected in the decreasing cases and positivity rates as well as the improving recovery rates in the last couple of weeks, said Dr Vikas Choudhry.
Did Delhi Utilise The Lockdown Period Well?
The aim of the lockdown was to bring down the R (eff) number – the average number of people that would be infected by a single infected person, taking into account the public health interventions implemented to contain the spread of the virus. Ideally, R (eff) should be less than 1. If any state or country manages that, it means the curve is flattening.
According to Dr Monica Mahajan, Director Internal Medicine, Max Healthcare, the lockdown was a laudable move and it did have a positive impact in terms of slowing down the growth curve. The lockdown gave Delhi government the time to prepare the healthcare infrastructure, procure personal protective equipment (PPE), and improve patients handling capacity of hospitals.
The doctors and nurses never had such exposure to any virus. The lockdown was a learning period; each hospital was preparing treatment protocol following the guidelines of the Indian Council of Medical Research (ICMR). Both infrastructure and manpower were increased but the lockdown wasn’t sustainable because there were economic implications, said Dr Monica Mahajan.
Though the Delhi government did take measures during the lockdown, Dr Vikas Choudhry believes Delhi should have used the time to plan and prepare a containment strategy implementation plan that involved active surveillance measures and stronger contact tracing through roping in human resources and training. He added,
I feel ramping up health infrastructure like hospital beds, ventilators, clear information around bed availability and others through applications that we have now, could have been done earlier.
COVID-19 Infrastructure In Delhi
Earlier in March, Delhi had declared only five hospitals as dedicated COVID-19 facilities. With the rise in cases, the number of hospitals – state government, central government and private – to address the needs of COVID-19 patients have been increased. According to the official data (as on July 12), over 100 hospitals in Delhi are treating COVID-19 patients. Together, these hospitals have 15,253 beds of which 4,315 are occupied and 10,938 are vacant.
Along with this, dedicated COVID Care Centres have 7,162 beds and dedicated COVID health centres have 544 beds. Over 11,000 (11,059) patients are in home isolation.
The number of vacant beds might seem encouraging but considering the constant rise in cases and the onset of monsoon which brings in other diseases like Dengue, Malaria, Delhi will need beds in the future for both COVID and other diseases. For this reason, Dr Monica Mahajan highlights the importance of home quarantine and says,
Earlier everyone testing positive for COVID-19 was being admitted to hospitals. But now only moderate and severe cases are being admitted. This has been streamlined and I will appreciate the rational use of bed allocation. We need to understand that not everyone can be put in a government facility and patients need to be segregated between home isolation, government facility and hotels – whoever can afford. We have to utilise hospital beds in a sensible manner as we will require the same beds for dengue, malaria and typhoid cases.
While talking to NDTV, Umesh Sehgal, who recently recovered from COVID-19 and was in home quarantine, said that though he was at home, he received full attention and support of the government as medical officials would call and check on him. Once when he wanted to see a doctor for a follow-up and didn’t get an online appointment at a private hospital, he approached a government dispensary and it delivered medicines at his doorstep.
Along with adequate infrastructure, an adequate focus on manpower is essential. Elaborating on the same, Dr Monica Mahajan said,
Right now this is the maximum manpower that we have. The government is trying to open up centers and setup beds but who will man those beds? You still need doctors and nurses. Setting up beds is the easiest task as we have ample stadiums and halls but the challenge is manpower.
A Look At COVID-19 Testing In Delhi
According to the information available on ICMR’s official website, as on June 24, Delhi has 46 labs for COVID-19 testing – 20 government labs and 26 private laboratories. Of this, 37 government and private facilities are involved in RT-PCR testing (Reverse transcription-polymerase chain reaction – for the qualitative detection of viral RNA), which is considered the gold standard for the diagnosis of COVID-19 as it detects the presence of the virus in the body; other three are for TrueNat testing and six labs are for CB NAAT(Cartridge Based Nucleic Acid Amplification Test).
Explaining the difference between three kinds of tests, Dr Harsh Mahajan, Founder of Mahajan Imaging and Chairman of CARINGdx, said,
All three – RT-PCR, TrueNat and CBNAAT give similar results. The difference is in the time they take to give results and the numbers of samples they can test in one go. In RT-PCR you can put 96 samples at a time whereas, in CBNAAT and TrueNat machine, you can test either one sample or four. The latter two technologies were being used earlier for other diseases; they have a cartridge which means they are automated and give results within half an hour. Because of their speed, they can be used in case of emergency.
Recently, Delhi has also started rapid antigen detection test – which is like a regular blood test and gives results within 20 minutes, thus helping in giving a fillip to the number of tests being conducted. Antigen test is also a diagnostic test that detects a specific protein called ‘spike protein’ present on the surface of the coronavirus. Currently, it is being done in containment zones in an effort to screen a large population. Talking about the new test, Dr Harsh Mahajan said,
Rapid antigen test is cheap and quick but it has moderate sensitivity (around 50 per cent) and high specificity which means if you test 100 COVID-19 patients, it will give positive results for only 50 of them. Every time a rapid antigen test gives a negative result; you will have to confirm it through RT-PCR test.
On July 12, 21,236 COVID-19 tests were done, taking the total tests tally to close to 8 lakh (7,89,853). According to the official data, Delhi is conducting 41,571 tests per million population as against the all India figure of 8,947 tests per million. Talking about whether this is enough, Dr Harsh Mahajan said,
No one knows what’s enough. The more you test, the better it is. The statistics say that Delhi is doing well and has picked up testing but we have to look at the positivity rate as well. When positivity is 1 in 4 or 1 in 5 then we know we need to ramp up testing.
To further improve testing, Dr Harsh Mahajan suggests introducing self-collection of samples as part of which, COVID-19 suspects will be providing a testing kit with a manual so that they can take their sample and give it to the concerned laboratory.
This way no technician will have to go inside someone’s house, he said.
Dr Harsh Mahajan also believes that though private laboratories have chipped in which has aided in increasing testing, an almost 50 per cent reduction in the price of COVID-19 testing, from Rs. 4,500 to Rs. 2,400 has been a setback for the private sector.
Contrary to this point of view, Dr Monica Mahajan is of the opinion that because of aggressive testing – which has been possible due to price capping, availability of testing kits, increase in the number of testing labs and antigen testing – Delhi is able to find more cases.
Experts Share Tips, Recommend The Way Forward For Delhi
Though Delhi has an incremental recovery rate and is seeing a downfall in the daily growth of cases, the fight is not over yet. Delhi has 673 containment zones. According to the latest sero-survey, over 77 per cent of the population is still susceptible to contracting the disease which means we cannot let our guards down.
Dr Monica Mahajan clarified that we haven’t yet faced the first wave properly and flattened the curve. The second wave and the expected peak are yet to come. This demands both government and citizens’ attention and action. While citizens need to follow the government’s advice, be extra vigilant and take all precautionary measures, the government needs to focus on containing the virus. Talking about the role of government, Dr Monica Mahajan said,
There are different models of containing the virus and what I find most effective is the way they did in Dharavi. Dharavi did extensive testing and isolated contacts. With current manpower and infrastructure, it’s impossible to do door-to-door testing and identifying cases. We can’t be over ambitious in terms of testing the entire community. We need to continue with extensive testing and contact tracing.
Dr Monica Mahajan shared that there are cases for which the source of COVID-19 cannot be traced and it’s clear that community transmission is happening in Delhi. Dr Rajesh Khanna backed the statement and said,
The government is not coming out in open with it but everybody knows that community transmission is happening. To fight this, testing will have to be important and maybe testing house to house might not be possible so you take those areas where the number of cases are increasing, lockdown them completely, go in-depth in those areas rather than having a uniform policy across the capital.
Both central and state governments are working towards preparing facilities like beds, ventilators, and isolation centres. The government has also started using railway coaches turned into COVID Care Centre for the treatment of patients with very mild and mild symptoms of Coronavirus.
Not letting your guards down in containment and testing measures, avoiding confusions through clear evidence based guidelines and concentrating resources on preventing deaths is certainly the need going forward, said Dr Vikas Choudhry. Echoing the same, Dr Prabhakaran says,
A rise in COVID-19 cases was expected. What would be more important to look at it is how many people are getting into the hospitals, what is the case fatality, what is the number of tests per million population. I’m not terribly worried about the cases increasing because as long as they remain asymptomatic or have mild to moderate symptoms and we can manage them at home, it’s fine. It’s only when patients become very sick they require hospitals and the problems arise. We should be nimble and ready to address that.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.