New Delhi: As cases rise in Haryana’s Gurugram, the city stands at a crossroads — it can go the way of neighbouring Delhi, which has struggled to contain the Covid-19 spread or it can set an example by containing the virus before its health infrastructure is overburdened.
Gurugram, where cases rose to 4,307 Sunday, is in a much better place compared to Delhi, but is the worst-hit district in Haryana, which has a total of 10,223 cases. There have been 59 deaths in the city.
A closer look at the city’s positivity and doubling rates suggests cases will rise exponentially in the next few weeks. While district authorities assure that there are adequate facilities, doctors warn that unless this time is used to effectively trace contacts and ramp up testing, the city could be headed towards a crisis.
Testing in Gurugram
According to the district health bulletin, Gurgram, which has a population of approximately 23 lakhs, has collected a total of 22,723 samples as of 21 June, 4,307 of which are positive.
The rise in cases hasn’t been uniform: Between 31 May and 11 June, the number of daily cases went up six fold — from 774 to 2,737 — indicating that a bulk of the cases have emerged this month. Similarly of the 59 deaths in the city so far, three were in May (with the first death being registered on 21 May), while the rest took place in June.
Gurugram’s stark rise in numbers led to the transfer of its chief medical officer Dr J.S. Punia on 10 June, for delays in surveillance and inadequate testing. Punia was replaced with Dr Virender Yadav, who is credited with having controlled the spread of Covid-19 in Nuh district.
While overall testing has seen an increase over the last week, the positivity rate, which measures the ratio of positive tests to samples tested, continues to be a cause of concern, as does the doubling rate, which stands at nine days.
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“The test positivity rate in Gurugram is still extremely high, indicating the infection is spreading and there aren’t enough tests being done,” said Dheeraj Singh, a city-based data scientist tracking the spread of Covid-19.
According to Singh’s calculations, Gurugram’s test positivity rate stands at 20 per cent, much higher than the national average of 7.8 per cent, while for June alone, the positivity rate stands at 43 per cent.
“The district needs to be doing at least 1,800 tests daily to keep the positivity at 10 per cent. With the lockdown opening up, it’s necessary to start testing more now rather than later,” Singh added.
For perspective, Mumbai’s positivity rate is at 23 per cent, while Delhi’s is 15 per cent for 2,69,608 and 3,12,576 samples tested respectively.
“A high test positivity rate combined with a spike in the number of cases suggests testing needs to be scaled up, but so does contact tracing and surveillance. While the case count is still low, it’s important to isolate contacts to limit the spread of infection,” said Dr D. Prabhakaran, an epidemiologist with the Public Health Foundation of India .
CMO Dr. Yadav told ThePrint that plans to ramp up testing in Gurugram were underway, and that the district administration isn’t worried about facing a shortage in beds, oxygen supply, or healthcare workers when cases begin to rise further.
According to data submitted to the Centre by the Gurugram district administration on 18 June and accessed by ThePrint, the city plans to increase testing capacity to 20,000 antigen tests and 4,000 RT-PCR tests by 30 June, and 46,000 antigen tests and 7,000 RT-PCR tests by 15 July. According to a district government source, cases are projected to reach 35,000 by the end of June, and 1.5 lakhs in July.
“One of our biggest concerns is educating people about the virus so there isn’t a rush to go to hospital if a patient has a positive result,” Dr. Yadav said, adding that surveillance teams and a rapid response team would be stationed at the district’s 25 primary health care centres and would go door-to-door to educate patients about how to manage the virus at an individual and household level.
ThePrint contacted District Magistrate Amit Khatri through text messages and phone calls but he is yet to respond.
Currently, there are 2,591 beds available across public and private facilities for Covid-19 patients who require hospitalisation in the district. To prepare for the surge that is to come, district administration data shows that this number is projected to rise to 5,068 by 30 June and then 7,078 by 15 July, all through the private sector.
But doctors in the city are skeptical about how effectively this capacity will serve patients in need, particularly since the state government will lean heavily on the private sector. On 13 June, District Magistrate Amit Khatri ordered all private hospitals to reserve 25 per cent of their beds for Covid-19 patients. But even as the total capacity of beds is set to rise, the government has no plans of increasing its own capacity.
Data shows that the number of beds offered by public hospitals will remain stagnant at 318 through June and July.
Dr. Ramesh Goel, central representative of the Indian Medical Association’s Haryana chapter, said it was impractical for the government to depend so heavily on private players.
“Gurgaon’s health infrastructure is full of small and medium-sized hospitals. The government has ordered 25 per cent beds be kept aside, but that requires extra manpower, shifting exit and entry points, which many hospitals don’t have the ability to do,” he said. “This is the time for the government to build its own public health infrastructure.”
According to the “Haryana Sub-Region of NCR-2021”, Gurugram should build its bed capacity to 10,299 by 2021 to fit Indian Public Health Standards, with an emphasis on public healthcare centres (PHCs). But despite the pressure the pandemic will put on the city’s health infrastructure, officials in Gurugram are confident the city will handle it successfully.
“Apart from reserving beds at designated hospitals, we have also identified isolation centres which can serve as step down facilities for the hospitals, where mild patients who don’t require hospitalisation will be attended to,” said Vivek Kalia, nodal officer for hospital and ventilator management. “We are doing active surveillance and keeping a track on patients so that things don’t go out of hand.”
On Thursday, Home Minister Amit Shah ordered that the National Capital Region work on a plan to fight Covid-19 together. So far, states have been working in silos, and given that Delhi and Gurugram are at different stages of infection, an official who didn’t wish to be named admitted that the time for such a plan may have already passed.
“It’s a good thing, since borders are open and movement is increasing. But practically, it’s hard to say how helpful it will be, or how each state can pool its resources meaningfully,” the official said.
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