Delhi lost valuable time in testing, tracing & readying new beds; with the Centre now in, vital to get it right quickly
It is unfortunate that, with little cooperation between the central and the state—add to this, Delhi CM Arvind Kejriwal’s politics—the capital has lost valuable time in its Covid-19 battle; being a half-state doesn’t help since dual controls also hamper decision-making. During the last 45 days, Delhi increased its Covid-beds 3.2 times (see our page one graphic) and testing five times but the number of infections rose a whopping 12 times! The number of beds, also, may not strictly be accurate either since, given the shortage of doctors and nurses in Delhi, there are few takers for the state government’s hospitals—the 4,324 beds in Delhi government hospitals have just a 32% occupancy as compared to 80% for centrally-run hospitals and 71% for the privately-run ones.
On April 30, Delhi had 3,515 infections vs Mumbai’s 6,874, and it added just 487 cases per day during May as compared to Mumbai’s 1,024. But in the first 15 days of June, Delhi added 1,458 cases per day vs 1,323 for Mumbai.
And, while the ‘positivity rate’—new infections as a share of new tests—is not a foolproof way to judge whether infections are peaking, this rose from 6.1 on April 30 to 18.2 on May 31 and to 30.3 on June 15 in the case of Delhi; it fell from 32.7 on May 31 to 29.2 for Mumbai. It is early days, and Mumbai can see infections rising again. In any case, even at current levels of infections, and after all the new hospital beds added in Mumbai, the ICU utilisation is 99%, that of ventilators is 98%, and it is 89% for full-fledged hospitals.
The key to Mumbai’s infections slowing is managing to contain the spread in slums like Dharavi. According to Bloomberg (bloom.bg/37A0Jk2), fresh infection levels are down to 20 per day from 60 in early May thanks to the authorities knocking on 47,500 doors since April to measure temperatures and check oxygen levels, and around 700,000 persons were screened (that is around 70% of the slum’s population).
Delhi does not report data on contact-tracing but, in an interview (bit.ly/37wfOTo), Delhi’s health minister Satyendar Jain said contact-tracing was being done only for immediate contacts. To justify this, he said that while such an exercise had yielded 600 contacts in one case, doing this for 1,500 cases (Delhi had 2,224 new cases on June 15) meant 900,000 people would need to be traced every day. But, with a very limited amount of tracing, and even less testing, the government allowed the infected to merrily go around spreading the disease. Among states with a high number of infected, Delhi is perhaps the only one that is seeing its growth rate rise over time. The number of cases was growing at 5% in Lockdown 4 (May 17-31) and rose to 5.5% in the first 15 days of this month. The corresponding numbers for Mumbai were 5.4% and 2.8%.
Worse, the city is simply not testing enough. At 14,387 tests per million population, its testing is lower than Mumbai’s 17,108 persons per million population on June 15. And, when over 30% of the new people being tested are turning out to be positive—this was 6% on April 30—surely the city would have wanted to test more?
Indeed, while the ICMR’s original guidelines (ICMR is a central government body) tried to keep the testing of asymptomatic people to a minimum, Kejriwal made the guidelines even more stringent and, when some private testing laboratories didn’t follow these guidelines, he took away their Covid-testing privileges; he did this for even Sir Gangaram Hospital that, with 20% of its beds still kept for non-Covid patients, found this hurting even its ability to function.
He even tried to blame the state’s Lieutenant Governor (L-G)—and, implicitly, prime minister Narendra Modi—for allowing ‘outsiders’ to take away the beds that he felt must be reserved for true Dilliwallahs.
While few are projecting 550,000 Covid cases in Delhi by the end of July—this implies Delhi’s infections levels will grow even faster—as Manish Sisodia is, the deputy CM reckons this means the capital needs 88,000 beds. The very next day, Kejriwal decided to add 40% to this—the beds the ‘outsiders’ would take up!—to put the L-G in a spot, but never addressed the issue of how the city planned to get to even the 88,000 beds his deputy said were needed for the Dilliwallahs.
Indeed, as the city has gone about commandeering hotels and other facilities, no thought seems to have been paid to the massive shortage of doctors and nurses in the city. Given it is barely able to cope, Mumbai is not the best example, but it got doctors from other parts of Maharashtra and from other parts of the country; it even created new facilities that required less doctors/nurses per bed (bit.ly/3cXwXqo).
Now that the central government is actively involved, hopefully the city will be able to pull itself back from the brink of disaster. For one, home minister Amit Shah has promised testing-for-all soon and a ramp-up to 18,000 tests per day by June 20 (from 7,349 now). Hopefully, this means the ICMR guidelines will be quashed since, if Delhi is testing too little, others are doing even less; it is 3,350 per million population in West Bengal and 1,890 in Uttar Pradesh. The central government has also promised that the Railways will provide 8,000 beds for the capital; 500 coaches are to be parked in the Anand Vihar railway station and each coach has 16 isolation beds. Hospital bed capacity is also to be augmented in existing government and private hospitals.
While the central government playing a more active role is welcome, it would be foolhardy to expect that all will be well now. Certainly, the availability of funds should now increase, but the beds capacity is still nowhere near what is needed; especially if the Delhi government projections are correct. Apart from the huge shortage of doctors and nurses that needs to be taken into account, it is not even clear how the amount of contact-tracing is to be done; asking the army to help create facilities must be done and, as in some other states, an army of volunteers is required for tracing.