With over 77,000 cases of Covid-19, the capital of India, Delhi has become the country’s largest hot spot. Aparna Alluri of the BBC explains how this is a missed opportunity.
The city administration seems to have missed the opportunity provided by a tight national blockade that lasted more than two months.
Lack of contact tracing, excessive bureaucracy, poor coordination or lack of coordination with private health services and political disputes have led to an increase in numbers.
Smaller Indian cities seem to have done a much better job than the capital, the seat of the federal government of India. The southern city of Bangalore is praised for its efforts to track contacts that hold back the infection, and there have been relatively few deaths in Chennai (formerly Madras), despite an increase in the number of cases.
But just like the financial capital of Mumbai, which has also been hit hard by the virus, Delhi is flooded with cases, and its state hospitals, some of the best, largest and best in the country, are struggling.
This is despite the fact that Delhi is controlled by the Aam Aadmi Party (AAP) of Arvind Keirival, which received a large majority at the beginning of this year thanks to strong public services, including health care.
So what went wrong?
Not enough testing and tracing
Since the beginning of June, the number of cases in Delhi has increased dramatically – this month alone, more than 50,000 cases of Covid-19 were confirmed. One reason may be accelerated testing using recently approved sets of antigens – a quick diagnostic test that produces results in just half an hour.
“Testing is not a panacea,” said BBC C. Srinat Reddy, president of the Indian Public Health Foundation and a member of the Covid-19 national task force.
“Of course, you should test – but test reasonably, test based on symptoms or other clear criteria.”
And this, he adds, is possible only with “early detection of cases and exhaustive tracking of contacts,” which did not happen.
Indian Medical Research Council Contact Tracking Study (ICMR) found that between January and April, India averaged 20 contacts for each confirmed case. And there were huge differences.
While some states, such as Karnataka, had an average of 93 contacts, there were only nine in Delhi.
In fact, earlier this month Delhi Health Minister says officials track only direct contacts given the large number of cases.
But some people turned to Twitter, claiming that even family members of Covid-positive patients did not pass the test, and their surroundings were not contained.
“I know of several cases where families were not contacted after one of them had a positive result,” said Malini Aisola of the All India Drug Control Network, a health sector watchdog.
“In many cases, testing of family members was not carried out for several days, and only after serious treatment and perseverance in the government.”
Delhi has now announced an ambitious set of measures, including cross-screening of all of its 29 million inhabitants, a sample of 26,000 people throughout the city, and the use of drones and police to maintain physical distance.
On Saturday, Mr. Ceyrival blamed the spread of coronavirus for the strain on the Delhi health system.
But, according to experts, much of this should have been done earlier, during the blocking. And if that had happened, the government could have taken quick, informed action when restrictions began to loosen from the third week of May.
Government failed to establish partnerships
“This whole disease is extremely stigmatized. It has become a law enforcement problem, not a public health problem, ”says Dr. Ambarish Satvik, a vascular surgeon at the Sir Del Gang Hospital.
Severe testing restrictions, poor reporting of what happens after a positive test result, and fear of being quarantined in poorly maintained public institutions made people reluctant to take the test.
“If they call you from the police, if they call you from the district surveillance officer and say that you were dragged to some quarantine center, who would you check?” Dr. Satvik asks. “Would you rather wait. The process is a punishment. ”
Despite the enormous role that private health plays in India, a large part of the burden falls on under-loaded and overloaded state laboratories and public hospitals. This means that many people with symptoms prefer to stay at home rather than queuing in public hospitals.
And in recent weeks, when there are stories that there are not enough beds in Delhi hospitals or they refuse to accept patients with Covid-19 disease, chaos and anxiety only intensified.
“Fear and stigma drive the epidemic underground,” says Professor Reddy.
He says the government should better coordinate with private players in order to be able to expand testing and hospitalization at an early stage, as well as control prices. But the Delhi government spent several weeks sparring with private hospitals due to prices, testing criteria, and hospital beds.
All of this meant fewer options for patients, which led to what Dr. Satvik calls “systematic refusal to participate” for testing.
Professor Reddy says the government was also so preoccupied with the pursuit of clinical services – tests and inpatient care – that it ignored the basic functions of public health.
“They should have created an enabling environment – primary care teams supported by public health workers to find out who has the fever and cough. These home visiting teams were supposed to allow patients to be transferred to hospitals. ”
He says that this would create a clear process and provide confidence without which it is difficult to defeat a pandemic.
“People need to be sure that they will receive the help they need, that they will be treated with sympathy,” he says.
But reality was far from that.
Delhi has two power centers
Delhi’s unusual administrative position only adds to the confusion. Although it is a state run by Mr. Ceyrival, the Lieutenant Governor, representing the federal government, also has competing powers.
The result was a series of conflicting orders issued and then revoked, sometimes in just 24 hours — proof that there has always been a conflicting relationship between Mr. Keyrival and the federal government of India, led by Prime Minister Narendra Modi.
“We cannot continue to hesitate between one decision and another because of this daily drama about refuting orders and protests,” says Professor Reddy.
He says that Delhi, as the capital, should pay close attention, and not “fall prey to the complexity of the many decision-making bodies.”
But, as some argue, the very role of Delhi as a center of power made it difficult to answer – its bureaucracy, for example, made it more opaque, and important data is often reluctant to exchange.
To be honest, this is also a numbers game. Mumbai still has 500 more active cases than in Delhi. The capital is only slightly ahead in confirmed cases – about 5,000 – and may again fall to second place.
But in any case, Delhi cannot afford to weaken its efforts.
“It’s never too late in an epidemic,” says Professor Reddy. “Even now, great efforts must be made to contain the infection. You have to do it.