New Delhi: On 4 May, Delhi Chief Minister Arvind Kejriwal made a confident appeal to the Centre to open up the national capital as the Delhi government was prepared to handle a surge in Covid-19 cases.
“We have made adequate arrangements. We have enough testing kits. We have hospitals,” Kejriwal had said at the time. The city, at that point, had about 4,500 cases. The lockdown, nevertheless, continued until 31 May.
Cut to 19 June, when the total number of cases in Delhi stands at 53,116, the Aam Aadmi Party (AAP) government wants to limit access of Delhi hospitals to city residents, a decision eventually overturned by the lieutenant governor (L-G), and the Union home ministry is overseeing the Covid battle in the city.
In May, there were about 3,000 beds reserved for Covid patients, but currently there are over 10,000 beds. Yet the city government is under fire for Covid patients being denied hospital beds.
How Delhi slipped from the confidence of May to the helplessness of June is a story of lapses — both in governance and in public health.
Officials, both in the central and state governments, said Delhi has been a victim of its own complacency. The Delhi government initially did a good job in ramping up health infrastructure and Covid testing, but later faltered. The biggest lapse, however, has been the failure, to do contact-tracing, said officials in the central government.
Delhi’s poor handling of the Covid crisis prompted Union Home Minister Amit Shah to intervene. He held a high-level meeting on 14 June during which he announced testing in the capital would be doubled in the next two days and three times in the next six days. Shah also announced 500 railway coaches will be converted to wards and this will increase the number of beds available by 8,000.
‘Delhi dropped the ball on contact-tracing’
A senior official in the health ministry said Delhi dropped the ball on contact-tracing. “It is not as if they did not do it. But very little, very reluctantly, often after we flagged the issue. That has landed them here,” he added.
Top sources in various agencies of the Government of India involved in the Covid fight said it was pointed out to the Delhi government several times during review meetings that the small containment zones they were marking out cannot work unless there is door-to-door search and strict perimeter control.
“They (Delhi government) insisted on smaller zones, promised strict enforcement, but on the ground what they did was they developed some random methodology of checking on some 50-60 families around the place where the case is. In a congested area, it would mean about a 100-foot radius. It cannot work under any circumstances,” said an epidemiologist working with a government agency, requesting anonymity.
“Even during lockdown, our team went to areas like Chandni Mahal and Nabi Karim, and found it was business as usual. Lanes were narrow, 10-12 people live in one house and they were sitting outside their houses and chatting. Then, when the unlocking started, these people started mingling with those in other places and cases surged,” the epidemiologist added.
“In 7-8 districts of Delhi, the positivity rates are unacceptably high. Tests have to go up, but they cannot be antigen tests because negatives in these tests are not reliable. They will just show lower positivity, citing antigen tests, when they will really need to be retested,” he said.
The containment plan for large outbreaks issued by the health ministry requires large cities, entire zones/districts from where cases are reported to be declared containment zones, while the buffer zone can be neighbouring urban/rural districts.
The micro containment plan lays down a containment zone of 3-km radius and a buffer zone of 5-km radius.
Dr K.S. Reddy, president, Public Health Foundation of India and a member of the Indian Council of Medical Research (ICMR) Covid-19 task force, summed up what most people in the government said off the record.
“Planning for clinical care took precedence over public health functions. Household syndromic surveillance based on symptoms of Covid-19 and influenza-like illness should have led to early testing according to guidelines, isolation of cases, micro containment and energetic contact-tracing,” he said.
“Coordination between central and state agencies was disjointed until recently. Multiplicity of decision-making authorities did not help. Citizen engagement was lacking, which is surprising for a governance model that emerged from a people’s movement. All of these contributory factors need to be urgently addressed for creating the template of an efficient, equitable and empathetic response to Covid-19 or any other public health emergency,” he said.
Calls and messages to Delhi Chief Secretary Vijay Dev went unanswered.
Price cap lowered, more tests after Centre’s intervention
Delhi started strong on the testing front, but lost the plot somewhere midway.
On 27 May, the city did 6,087 tests, but as cases started spiking, the testing dipped, hitting a low of 3,379 on 31 May and 3,063 on 7 June — lows even for Sundays when testing dips nationally.
Somewhat inexplicably, as positivity rates kept rising, the Delhi government called for testing of asymptomatic people to be stopped. This is against the ICMR’s testing protocol and crucial for contact-tracing. The protocol requires asymptomatic contacts of positive cases to be tested once. It took another intervention from the L-G to get Delhi to return to the ICMR guidelines.
Many experts suspected it was the Delhi government’s way of keeping numbers down in the face of rising criticism.
The price of Covid packages in private hospitals has been proposed to be capped and the price ceiling for tests has been brought down to Rs 2,400 from an earlier Rs 4,800. How the latter works out may be a tricky question because private hospitals are not happy about it, and even those that have not openly opposed it have asked for some support from the government to keep the tests running.
In a series of tweets Friday, the Ministry of Home Affairs wrote: “Sample testing has been doubled immediately in pursuance of decisions taken by HM @AmitShah in series of meetings. A total of testing samples of 27,263 have been collected in #Delhi from 15 to 17 June 2020 against the daily collection which varied between 4,000-4,500 earlier…”
“On directions of HM @AmitShah to increase testing capacity & quick delivery of results in Delhi — testing via Rapid Antigen testing methodology was started yesterday. 7,040 people have been tested in 193 testing Centres. Testing will continue with increased numbers in coming days,” it said.
On directions of HM @AmitShah to increase testing capacity & quick delivery of results in Delhi – testing via Rapid Antigen testing methodology was started yesterday. 7040 people have been tested in 193 testing Centres. Testing will continue with increased numbers in coming days.
— Spokesperson, Ministry of Home Affairs (@PIBHomeAffairs) June 19, 2020
Sample testing has been doubled immediately in pursuance of decisions taken by HM @AmitShah in series of meetings. A total of testing samples of 27,263 have been collected in #Delhi from 15 to 17 June 2020 against the daily collection which varied between 4,000-4,500 earlier.
— Spokesperson, Ministry of Home Affairs (@PIBHomeAffairs) June 19, 2020
‘Delhi is our New York’
On 1 June, the city had tested 4,753 samples, out of which 20.8 per cent were positive. On 14 June, however, the testing numbers sharply shot up to 7,353 from 5,776 the day before and the positivity rate came down to 30 per cent.
From there, the daily positivity dipped to 26.9 per cent on 15 June and 23 per cent on 16 June. However on 17 June, it spiked again to 29.8 per cent and on 18 June, it was 25 per cent.
If antigen tests are taken into account, the positivity for 18 June dips sharply to 18 per cent. On 19 June, 3,137 of 13,074 tests were positive, which is about 23.9 per cent.
During the 7-13 June week, district-wise positivity figures for Delhi had touched very high levels — 75.4 per cent in Shahdara, 63.4 per cent in Southeast Delhi, 57.1 per cent in Northeast Delhi, 45 per cent in East Delhi, 44.1 per cent each in West and Northwest Delhi, 39.2 per cent in North Delhi, 34.9 per cent in Southwest Delhi, 34.2 per cent in central Delhi, 27.6 per cent in South Delhi and 22.3 per cent in New Delhi.
A senior health expert working with a government agency said: “Any positivity of over 10 per cent and you have to be testing more. That is clear. But Delhi’s problem perhaps was complacency.”
He compared New Delhi with New York when all the initial emphasis was on capacity creation and no attention was paid to contact-tracing.
“Look what happened there. Delhi is our New York. There are two aspects of this, public health and governance. They failed completely on public health. They did not enforce containment zones well, and failed on contact-tracing. They were foolish. We will be reviewing more closely in the coming days what went wrong,” he added.
The problem of lack of contact-tracing is compounded by the lack of monitoring of people under home-quarantine.
Sources in the Integrated Disease Surveillance Programme said except for pasting home-quarantine posters outside, there is very little follow-up to check compliance levels.
Late Friday night, the Delhi Disaster Management Authority (DDMA) issued an order for mandatory physical verification of each case under home-isolation by district surveillance officers under the supervision of the district magistrates. The health ministry too wrote to states Friday, asking them to enforce home-quarantine.
Delhi had sufficient health workers, but still slipped up
Delhi does not have the typical urban problem of lack of frontline health workers, who are the field-level staff that perform functions such as contact-tracing and checking on people isolated at home.
In cities like Mumbai and Ahmedabad, this has been a major hindrance in contact-tracing operations, according to central government officials.
According to the 2019 Rural Health Statistics, Delhi is among the rare states where there are more Accredited Social Health Activists (ASHA) than required — 3,585 in position as on 31 March 2019, against the 1,174 required.
The location advantage of being a small city-state with borders with Uttar Pradesh and Haryana means there is no dearth of people willing to come to the national capital to work.
Yet, Delhi faltered on contact-tracing.
“I would say they were overconfident. Looking at updates on the central dashboard and the availability of beds and isolation facilities, states are being constantly asked to stay prepared. They did very well on isolation beds, still are fairly well-off.
“But the isolation facilities were just not there. They just had to take over schools, stadia banquet halls like say Jammu and Kashmir had done. That is happening only now. Moreover, the multiplicity of authorities created additional hindrances,” said another senior official in the health ministry.
It was only three days ago the Delhi government put in place a unified command system for Covid management with all officials in a district, regardless of seniority, reporting to the district magistrate.
Even on health infrastructure, the city government fell short.
CM Kejriwal has said the city could need 1.5 lakh beds by 31 July. The government has decided to acquire 78 banquet halls and 40 hotels to convert them into isolation facilities attached to hospitals. The biggest Covid facility in the city with 10,000 beds is coming up in an ashram in Chhatarpur. Of these, 1,000 beds will have oxygen facilities.
Covid politics heats up
Delhi’s Covid situation remains precarious. It is not just the positivity rates, but the absolute numbers for a city with less than 2 crore population are worrying. There were 3,137 fresh cases Friday. On 18 June, there were 3,000 cases and the day before, there were 2,214.
However, no sooner had Amit Shah stepped in last week holding meetings with the Delhi government, touring the state government’s Lok Nayak Jaiprakash Hospital and pledging time-bound doubling and trebling of tests, than his party’s stance on Delhi started changing.
From the earlier belligerence and criticism, there are now celebratory messages.
BJP’s national general secretary (organisation) B.L. Santhosh tweeted Friday: “It took an @AmitShah to move @ArvindKejriwal & his bunch of @AamAadmiParty. All dead bodies are cremated, testing rate brought down to ₹2400, 500 railway cabins stationed at various rly stations, hospital bed rates will be capped. Yesterday testing was around 18000, NCR strategy meeting held, mass screening in containment areas held, central ministers visiting testing centres.
“After all this @ArvindKejriwal & @msisodia came out of their propaganda towers .@AamAadmiParty leaders are still not visiting hospitals. But they are at least out of their slumber & visiting hotels, banquet halls & other facilities. #Delhideservedbetter,” he wrote.
It took an @AmitShah to move @ArvindKejriwal & his bunch of @AamAadmiParty . All dead bodies are cremated , testing rate brought down to ₹2400 , 500 railway cabins stationed at various rly stations , hospital bed rates will be capped .
— B L Santhosh (@blsanthosh) June 19, 2020
Meanwhile, trouble is brewing between the Delhi government and the home ministry over the DDMA’s proposal for compulsory five-day institutional quarantine for all those who test positive.
The Delhi government Saturday said it would meet L-G Anil Baijal, who head’s the DDMA, to urge him to withdraw the DDMA order. Deputy CM Manish Sisodia said the L-G’s order is against ICMR guidelines and will cause panic among people.
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