New Delhi: Standing under the shade of an umbrella, Vinod Kumar is rolling out one paratha after another for office-goers in Delhi’s central district, just as he has done for 31 years now. But a mask is missing on his face. He doesn’t plan on wearing one either.
“This coronavirus is nothing. I don’t believe it will harm me or my family. If something happens, it’s up to God to save us,” he says.
Down the road, a cigarette seller has his mask pulled down while tending to a customer. He says, “When we opened up in May, I tried to maintain every precaution and keep a metre’s distance between myself and a customer. But with time, people have stopped listening. Plus, if I wear this mask for too long, my glasses fog up and it makes me uncomfortable.”
What’s also uncomfortable, though, are these statistics in Delhi: ICU beds in hospitals are occupied at near-full capacity. Daily cases have been hovering around the 7,000-mark over the last week, and daily death count is now almost touching the 100-mark — Thursday saw the highest single-day spike so far as 107 people died due to the infection.
Testing has been ramped up in the hope of curbing the virus spread amid a ‘third wave’ of Covid-19 in the national capital. But thick smog, rife with pollutants, is raising the risk of the respiratory disease anyway.
So what’s making the people of Delhi, who are flooding the city’s markets ahead of festivities, avoid masks or other physical distancing measures?
The answer is ‘lockdown fatigue’ — the term experts have for this phenomenon, referring to the exhaustion in people after the varying degrees of lockdown imposed in the city from March.
“The disease doesn’t behave differently in different places or with the passage of time,” says epidemiologist Dr Samiran Panda, who is the director of ICMR-National Aids Research Institute (NARI).
“We’re seeing super spreader events where people have let their guard down. It’s well and good to enforce hand washing and social distancing for a few months, but what we really need is sustained behaviour change,” he adds.
Policy failure in controlling spread?
The spike in Delhi stands out like a sore thumb given India’s declining caseload since mid-September. Earlier this week, the Delhi High Court lambasted the Arvind Kejriwal government for not actively controlling the spread of the virus, which has left no household “untouched”.
“It has been noticed that even in such a critical situation, the Delhi Government has continued to relax the norms relating to movement of the public. This is apparent from the fact that as against an order capping 100 guests at marriage ceremonies, the number of guests has been permitted to be increased to 200,” said the court’s order Wednesday.
Dr Preeti Kumar, vice president, health support systems, Public Health Foundation of India, says, “Infectious diseases respond to social and behavioural changes. The principal strategy should be to delay infection, and then reduce its intensity.”
The HC observed that Delhi’s recent policies — including permitting full occupancy in buses since 1 November — encourage the opposite.
A sero-survey conducted by the Delhi government and submitted to the court showed that between 15 and 21 October, 25 per cent — or one in every four people — had tested positive for Covid antibodies. Cases in the central district of the city had gone up by over two and a half times compared to earlier surveys in August and September.
Officials from Delhi’s district administrations maintain they are doing everything they can to ensure people wear masks, maintain distance and sanitise as often as possible.
“We have increased the challan amount, offered to buy masks for people who can’t afford them, and even do one-on-one sessions on why Covid is a real threat. The test is seeing if people will stick to these norms even when no one is looking… And what we’re seeing is that it’s going to take a very long time,” says a senior official with the New Delhi district administration, on the condition of anonymity.
What testing is revealing
West Delhi District Magistrate Neha Bansal feels the crisis won’t get over anytime soon because of people’s callous attitudes and lack of a vaccine.
“Until it impacts someone in their own families, people tend to take it easy as the fear has reduced,” she says, adding that to further enforce Covid hygiene, shops not adhering to social distancing were being sealed for two days.
Districts are also conducting a combination of RT-PCR and rapid antigen tests on shopkeepers to detect the virus in crowded markets.
In Bansal’s district, markets in Raghubir Nagar, Rajouri Garden and Jail Road threw up high positivity rates of 62 per cent, 24 per cent, and 25 per cent, respectively. Tilak Nagar market was better off, with a lower positivity of 13 per cent.
In the South-West district, DM Vishvendra Singh says the administration is stricter about imposing challans on people not wearing masks.
The number of challans for mask violations, poor social distancing, spitting in public, have risen from 250 on 7 November to 881 on 12 November — “among the highest across Delhi”, claims Singh, adding that Lajpat Nagar’s Central Market “is among the most crowded and has witnessed a spurt in cases”.
New clusters and emerging patterns
In early October, a government expert group led by Dr V.K. Paul of the Niti Aayog had predicted that cases would hit 15,000 per day as they recommended workspace clusters be tested regularly for risk assessment.
With cases rising to new highs, new patterns — some predicted and others unexpected — are slowly emerging.
“We haven’t noticed that a younger demographic is more likely to violate, even though most studies suggest so. The positivity in markets is also less than what we are getting in our dispensaries. Instead what we’ve noticed is that cases are increasing in office areas,” says the New Delhi district official quoted above.
In Shahdara, an eastern district with mostly low-income inhabitants living in ghettoised colonies, hotspots are now emerging in more middle-class neighbourhoods such as those in Vivek Vihar, because “people have been stepping out for shopping or to their workplaces”, DM Sanjeev Kumar says. He adds that industrial zones have so far not been as badly affected.
What Delhi needs to do
Experts say while people have let their guard down, Delhi’s health infrastructure is still holding up as it should.
As on 12 November, 19,752 RT-PCR and 40,477 rapid antigen tests were conducted.
Delhi Health Minister Satyender Jain earlier this week said the AAP government has changed its strategy with more aggressive tracing and testing, citing it as one of the reasons for a sudden spike in Covid cases.
“On the system’s side, testing has gone up, and doctors are better prepared to handle cases. Any decision to increase economic activity will cause a spike in cases, but with people being non-compliant, testing widely is the best strategy,” Kumar said.
Gautam Menon, epidemiologist and professor of physics and biology at Ashoka University, says, “I think more warnings to the public, emphasising this aspect and telling them to stay at home and physically distance as far as possible, are called for, short of another local lockdown.”
Panda agrees. “It’s a good thing that Delhi is testing widely and relying less on antigen tests. But changing behaviour is difficult, and the strategy needs to consider that.”