Current spike in COVID-19 cases in Delhi likely to continue for four weeks, say experts     

The only thing that can be done now is to interrupt this movement of people and put in place a centralised triage system to decrease the waiting time for patients needing immediate medical attention

Current spike in COVID-19 cases in Delhi likely to continue for four weeks, say experts      
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Ashlin Mathew

The COVID-19 cases in Delhi have been on the rise and in the last 24 hours, there have been 7,546 new coronavirus cases and 98 new deaths. Two days ago, 131 new deaths had been recorded. Delhi has recorded more than 5.03 lakh COVID-19 cases, along with 7,943 deaths. Yet, the government has done too little and nothing new, assert epidemiologists.

On Tuesday, the government announced there was a plan to selectively shut down markets. On Wednesday, two of his ministers disputed the claim. On Friday, Chief Minister Arvind Kejriwal met representatives of market associations and assured them that markets would not be shut. He sought their cooperation to ensure appropriate COVID-19 behaviour at markets.

On Thursday, November 19, Kejriwal announced that Rs 2,000 fine would be imposed on anyone found not wearing a mask in public. However, former head of epidemiology at Indian Council of Medical Research Dr Lalit Kant questioned the science behind these fines.

“What is the idea behind stating that people without masks would be fined Rs 2,000 and earlier it was Rs 500? Even with that people weren’t scared. How can it be enforced? All of this is eyewash. Everyone is talking about hospital beds and ventilators, but why don’t we first move to prevent the spread so that people don’t become seriously ill,” underscored Kant.

The current spurt is likely to continue for at least another four weeks because all these people who interacted with each other over this period will get infected and they will infect others. “This trend will be seen in the next one month. The only thing that can be done now is to interrupt this movement of people and interrupt the infection moving from one person to another. This can only be done when there is a barrier in between,” explained Kant.

The government does not feel it is important to put people under lockdown, but Kant emphasised that nothing short of a lockdown would have much of an effect. “Delhi government should learn from the mistakes of other countries and cities, which opened too soon and too much. Now, they have gone back to lockdown. Take the case of Europe, they had opened too soon and too much. People went on vacations and came back to their countries with the infection,” added Kant.

As there is a surge in the number of cases, the demand is competing against finite resources. “There is a mismatch in resources. There is a disparity in the number of beds and ventilators. People who need immediate attention will be stuck in the queue to get those beds and their condition will deteriorate,” pointed out Dr Oommen John, a senior research fellow at The George Institute of Global Health.

The government should try and identify people in the early stages of COVID-19, so that they have more chances of survival. “There needs to be a multiple pronged approaches to such situations. Deaths are the function of the capacity of a system to take care of people who need institutionalised and intensive care. We should try and put in place mechanisms where this should be addressed. This could have been done a few weeks ago,” explained John.

There needs to be a minimal lag between someone who needs an intervention versus the waiting period. “One way to do it is to have a centralised triage mechanism, where the admission to hospitals is based on a clinical assessment done by a mobile team. The central coordinating agency will then direct the patient to hospitals where beds are available. No one should be able to pull strings to demand hospital beds,” said John.

The third and most important thing, John asserts, is that people still do not think that COVID-19 is serious. This is despite there having been large number of hospitalisations and deaths. “There is absolutely no change in the behaviour of the people on the street, which means there is a huge disconnect between what is happening in terms of reality versus what people believe and how they behave,” observed John.

The government has to bring in behavioural scientists to understand what is going on in the minds of people, so that they can intervene to change their behaviour, said John.

There needs to be important trust building exercises, which would encourage people to voluntarily admit that they are turning positive or that they need care. Currently, there is a huge hesitancy in reporting or testing. “Even if there are initial symptoms of COVID-19, people dismiss it off as change in weather. In the process, they could be harbouring the virus and infecting all those around them as well. People are afraid that they would get labelled. People have to realise that if they call a government helpline number, the state is responsive, and they will take care. Currently, none of that happens,” mentioned John.

The least that can be done is decrease the period where people can stick to each other. “Timings of various services need to be curtailed. Buses should not run on full capacity. The government has now decided to curtail the number of people who can attend weddings, but the step should have been taken a few weeks earlier. The government should weigh economic loss against the health of individuals. The government has to decide whether it chooses health of people or government revenue,” maintained Kant.

Currently, the Delhi government has announced that there would be door-to-door survey to check on symptomatic patients. The government said it would cover all 4,500 containment zones, in addition to the areas with high caseload.

As the pandemic has been on for almost nine months, John underscored that the capacity of the system to respond has reduced. “Currently, they may not be able to test, trace and isolate. It takes a lot of effort. But, they can test aggressively and be serious about containment zones. If they find out that in certain areas, cases are higher, then they should target interventions for those areas,” said John.

However, Kant pointed out that currently, no one knew if anyone was infected or containment zones were strictly maintained. He questioned if there was a mechanism where the government ensured that people who were infected were not moving about? “Is the garbage collected separately? The government said it would take these measures, but currently, none of it can be seen on the ground. No one seems to know either. The government doesn’t seem to want to do it, but it has to be done. I only wish the government heeds to the advice of scientists, but they don’t seem to be listening to anyone,” added Kant.

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