How Delhi Wasted Lockdown To Become India’s Biggest Hotspot


How Delhi Wasted Lockdown To Become India’s Biggest Hotspot

With more than 77,000 cases of Covid-19, India’s capital, Delhi, has become the country’s biggest hotspot. The BBC’s Aparna Alluri explains how this appears to be an opportunity missed.

The city administration seems to have squandered the opportunity afforded by a stringent nationwide lockdown that lasted more than two months.

Lax contact tracing, excessive bureaucracy, poor or no co-ordination with private health services and political wrangles have all led to a surge in numbers.

Smaller Indian cities seem to be doing a far better job than the capital, the seat of India’s federal government. The southern city of Bangalore has been lauded for its contact-tracing efforts which have contained the infection, and Chennai (formerly Madras) has had relatively few deaths despite a surge in cases.

Not enough testing and tracing

Delhi’s caseload has risen sharply since the beginning of June – more than 50,000 of its Covid-19 cases were confirmed this month alone. One reason could be increased rate of testing with newly approved antigen kits – a rapid diagnostic test that gives results in as little as a half hour.

“Testing is not a panacea,” K Srinath Reddy, president of the Public health Foundation of India and member of the national Covid-19 taskforce, told the BBC.

“Of course you must test – but test judiciously, test based on symptoms or other clear criteria.”

And that, he adds, is only possible with “early case identification and exhaustive contact tracing” – neither of which has happened.

A study on contact tracing by the Indian Council of Medical Research (ICMR) found that between January and April, India, on average, tested 20 contacts for every confirmed case. But there were massive discrepancies.

While some states such as Karnataka averaged 93 contacts, Delhi tested as few as nine.

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In fact, earlier this month, Delhi’s health minister said that officials were tracing only immediate contacts given the high number of cases.

But some people have taken to Twitter, alleging that even family members of Covid-positive patients were not being tested, and their neighbourhoods were not being contained.

“I know of several instances where families were not contacted after a family member tested positive,” says Malini Aisola, from the All India Drug Action Network, a health sector watchdog.

“In many cases, testing of family members did not happen for several days, and only after heavy appeals and insistence to the government.”

Delhi has now announced an ambitious slew of measures, including door-to-door screenings of all its 29 million residents, random sampling of 26,000 people across the city, and the use of drones and police to maintain physical distancing.

Asha health workers talk amongst themselves while conducting door to door survey to identify Covid-19 cases as JJ colony in Patparganj has already reported above 70,000 cases, near Mayur Vihar on June 25, 2020 in New Delhi, IndiaImage copyrightGETTY IMAGES
Image captionDelhi health workers have begun screening every household

But, experts say, a lot of this should have been done earlier, during the lockdown. And if that had happened, the government would have been able to take swift, informed measures when restrictions started to ease from the third week of May.

The government failed to build partnerships

“This whole disease is immensely stigmatised. It’s become a law and order enforcement problem rather than a public health issue,” says Dr Ambarish Satwik, a vascular surgeon at Delhi’s Sir Ganga Ram Hospital.

Heavy restrictions on testing, poor communication on what happens after you test positive, and the fear of being quarantined in poorly maintained government facilities have all made people reluctant to get tested.

“If you get calls from the police, if you get calls from the district surveillance officer saying you’ll get dragged away to some quarantine facility, who would get tested?” Dr Satwik asks. “You would rather wait it out. The process is the punishment.”

Despite the huge role private healthcare plays in India, much of the onus has been on understaffed and overstretched government laboratories and public hospitals. This has meant that many people who have symptoms prefer to stay home rather than queue up in long lines at public hospitals.

And in recent weeks as stories emerge of Delhi’s hospitals running out of beds or refusing to admit Covid-19 patients, the chaos and anxiety have only increased.

On Saturday, Mr Kejriwal blamed the speed at which coronavirus has spread for the burden on Delhi’s health system.

“Fear and stigma drive the epidemic underground,” Prof Reddy says.

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He says the government should have co-ordinated better with private players to be able to expand testing and hospitalisation early on, and to control prices. But Delhi’s government has spent weeks sparring with private hospitals over prices, testing criteria and hospital beds.

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All of this has meant fewer options for patients, leading to what Dr Satwik calls a “systematic disincentivisaiton” for testing.

Prof Reddy says the government was also so busy chasing clinical services – tests and hospital treatment – that it ignored basic public health functions.

How Delhi Wasted Lockdown To Become India’s Biggest Hotspot


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