With more than 77,000 cases of Covid-19, the capital of India, Delhi has become the country’s largest access point. BBC’s Aparna Alluri explains how this appears to be a missed opportunity.
The city administration appears to have squandered the opportunity provided by a strict national blockade that lasted more than two months.
Laxity in the search for contacts, excessive bureaucracy, poor or no coordination with private health services and political disputes have led to an increase in the number.
Smaller Indian cities seem to have done a much better job than the capital, the seat of India’s federal government. The southern city of Bangalore has been praised for its efforts to trace contacts that have contained the infection, and Chennai (formerly Madras) has had relatively few deaths despite an increase in cases.
But like Mumbai, the financial capital that has also been hard hit by the virus, Delhi has been overrun with cases and its public hospitals, some of the best and biggest and best in the country, are struggling.
This despite the fact that Delhi is governed by Arvind Kejriwal’s Aam Aadmi Party (AAP), which won an overwhelming majority earlier this year thanks to strong public services, including medical care.
So what went wrong?
Not enough evidence and trace
Delhi’s number of cases has increased dramatically since early June: more than 50,000 of its Covid-19 cases were confirmed this month alone. One reason could be to increase testing with newly approved antigen kits, a rapid diagnostic test that gives results in as little as half an hour.
“Testing is not a panacea,” K Srinath Reddy, president of the India Public Health Foundation and a member of the national Covid-19 task force, told the BBC.
“Of course, you should evaluate, but evaluate wisely based on symptoms or other clear criteria.”
And that, he adds, is only possible with “early identification of cases and exhaustive contact tracking,” neither of which has happened.
A study on contact tracking by the Indian Council for Medical Research (ICMR) found that between January and April, India tested 20 contacts on average for each confirmed case. And there were big discrepancies.
While some states like Karnataka averaged 93 contacts, Delhi tested just nine.
In fact, earlier this month, Delhi’s health minister said officials were only tracking immediate contacts given the large number of cases.
But some people have turned to Twitter, claiming that even family members of Covid-positive patients were not being screened, and their neighborhoods were not being contained.
“I know of several cases where families were not contacted after a family member tested positive,” says Malini Aisola of the All India Drug Action Network, a health sector watchdog.
“In many cases, tests of family members were not conducted for several days, and only after strong calls and insistence from the government.”
Delhi has now announced a series of ambitious measures, including door-to-door checks on all of its 29 million residents, random sampling of 26,000 people across the city, and the use of drones and police to maintain physical distance.
On Saturday, Kejriwal blamed the speed at which the coronavirus has spread due to the burden on the Delhi health system.
But according to experts, much of this should have been done earlier, during the blockade. And if that had happened, the government could have taken swift and informed action when restrictions began to ease starting in the third week of May.
The government failed to establish associations
“All of this disease is immensely stigmatized. It has become a problem of law enforcement and order rather than a public health problem, “says Dr. Ambarish Satwik, a vascular surgeon at Sir Ganga Ram Hospital in Delhi.
Strong testing restrictions, lack of communication about what happens after a positive test, and fear of being quarantined in poorly maintained government facilities have made people reluctant to be tested.
“If you get calls from the police, if you get calls from the district surveillance officer who says they will take you to some quarantine facility, who will you be tested for?” Dr. Satwik asks. “You’d rather wait. The process is punishment. ”
Despite the huge role of private health care in India, much of the responsibility falls on under-staffed and underworked government laboratories and public hospitals. This has meant that many people with symptoms prefer to stay home rather than stand in line at public hospitals.
And in recent weeks as stories emerge that Delhi hospitals run out of beds or refuse to admit Covid-19 patients, chaos and anxiety have only increased.
“Fear and stigma drive the epidemic underground,” says Professor Reddy.
He says the government should have better coordinated with private players to be able to expand testing and hospitalization from the start, and control prices. But the Delhi government has spent weeks arguing with private hospitals about prices, test criteria, and hospital beds.
All of this has meant less choice for patients, leading to what Dr. Satwik calls a “systematic disincentive” for testing.
Professor Reddy says the government was also so busy chasing clinical services, tests and hospital treatment that it ignored basic public health functions.
“They should have built a caring environment: primary health teams backed by community health workers to find out who has a fever and a cough. These teams visiting homes should have allowed patients to be transferred to hospitals. ”
He says that would have created a clear process and offered reassurance, without which it is difficult to beat a pandemic.
“People must be confident that they will receive the care they need, that they will be treated with empathy,” he says.
But reality was far from that.
Delhi has two centers of power
Delhi’s unusual administrative position only adds to the confusion. Although it is a state governed by Kejriwal, the lieutenant governor, who represents the federal government, also has competing powers.
The result has been a series of conflicting orders, issued and then retracted, sometimes in as little as 24 hours, proof of what has always been an irritable relationship between Kejriwal and India’s federal government led by Prime Minister Narendra Modi.
“We cannot go from one decision to another in the midst of this daily drama of revoked orders and protests,” says Professor Reddy.
He says that Delhi, being the capital, should have received the best care instead of “falling victim to the complexity of multiple decision-making authorities.”
But, some have argued, Delhi’s role as a center of power has hampered its response: its bureaucracy, for example, has made it more opaque, and crucial data is often reluctantly shared.
To be fair, this is also a numbers game. Mumbai still has about 500 more active cases than Delhi. The capital is only slightly ahead in confirmed cases, around 5,000, and could fall to second place again.
But either way, Delhi cannot afford to loosen its efforts.
“It is never too late in an epidemic,” says Professor Reddy. “It takes a very strong effort even now to contain the infection. You have to do that. ”