IN DELHI, BETWEEN life and death, there is a dashboard of numbers. You could look at the Delhi government's Corona Dashboard that gives an estimate of beds and ventilators dedicated to Covid-19 and feel, at least somewhat, reassured. On June 10, out of 9,061 beds and 509 ventilators, 4,378 beds and 245 ventilators were vacant. But, juxtapose this with the latest Delhi health bulletin that shows an active case count of 18,543, and you could not be faulted for being unsettled. Moreover, when the estimate of beds and ventilators is read against Deputy Chief Minister Manish Sisodia’s dystopian estimate of 5.5 lakh cases by July 31, and the need for 80,000 beds, you ought to feel terrified.
Sisodia’s comments imply that over the next month and a half, around one in 40 people in Delhi would be infected. Chief Minister Arvind Kejriwal’s repeated assurances—most recently on May 25 and June 10—that Delhi was ready to handle the deluge, will be put to the test. Experiences from the early phase of the pandemic in the capital, however, are far from encouraging. Anecdotal accounts from those seeking health care in the capital, including several prominent citizens, suggest that it is difficult to get a simple Covid-19 test, find a hospital bed and even a place to lay the deceased to rest.
The government’s claims of adequate infrastructure seem to have fallen flat. Short of ideas, it has tried to rope in private hospitals, luxury hotels, and encountered some resistance from both. A five-member expert committee has now suggested that a few stadiums be taken over for makeshift Covid-19 facilities. After asking 117 private hospitals to reserve 20 per cent of the beds for Covid-19 patients, on June 9, the government increased the quota of beds by 50 per cent in 22 private hospitals.
“On paper, it looks good,” says Dr Aqsa Shaikh, assistant professor, department of community medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Delhi. “On the ground, however, the situation is pretty chaotic.” Last week, Union Health Minister Harsh Vardhan termed the Delhi Covid-19 situation worrisome. At a meeting with top Delhi health officials, he said that the average test per million in some districts, such as North East Delhi and South East Delhi, was around 500-700, as against Delhi's average of 2,018. He also said that while the Union territory's positivity rate was 25.7 per cent, several districts reported figures above 38 per cent. A high positivity rate implies that only the sickest are getting tested, and testing needs to be expanded.
An order by the Delhi government restricting testing to only symptomatic people—now overturned by the lieutenant governor—further exacerbated the crisis. “While it is true that most of the people have mild symptoms and can recover at home, there is anxiety among them to know their status,” says Shaikh, who is part of a volunteer group helping people access Covid-19 care. “The demand for testing has been increasing, especially since offices have reopened.” Instead of expanding access to tests, government testing laboratories that are short of kits have resorted to restricting timings for testing from 8am to 4pm. Moreover, reports take a long time because of the backlog at laboratories.
According to Professor Jugal Kishore, head, department of community medicine, Safdarjung Hospital and Vardhman Medical College, testing for Covid-19 requires a processing time of up to eight hours. This has contributed to backlogs. Kishore says that given the high demand, the Delhi government was compelled to restrict the testing to symptomatic people so as to better manage the increasing load. “Fear drove many to seek a test, creating a backlog,” he says.
At the heart of the crisis, according to Kishore, who has been part of the rapid response team of the Union health ministry for several states, is the capital’s “unique” health care system. “It’s a problem of coordination,” he says. Delhi has Central government hospitals, railways hospitals, state government hospitals, municipal hospitals and ESI (Employees' State Insurance) hospitals, among others. “Unlike other cities such as Mumbai and Chennai, we do not have one chain of command,” says Kishore. If all the beds and facilities were merged into a single system, the issue could be resolved, he adds.
Besides, in Delhi, the government has also been locked in a battle with the private health care system. “In a pandemic, the first line of defence has to be government hospitals,” says Dr Giridhar Gyani, who heads the Association of Healthcare Providers (India). “The Delhi government has 37 hospitals, out of which only five have been made into dedicated Covid-19 facilities. What is stopping the government from turning the rest into Covid-19 hospitals?”
He adds that it is difficult for all private hospitals to reserve 20 per cent beds for Covid-19 patients. “The big hospitals have separate buildings which they can convert into Covid-19 facilities,” he says. “But how will smaller hospitals that have 70 to 100 beds with common entry and exit points and central air-conditioning do that? We even said that we would give them the 3,000-odd beds that they wanted. If we talk, solutions can be found. We are willing to work with the government.”
Gyani says that the government ought to discuss alternative ways to manage the situation, such as converting community centres in residential colonies to makeshift Covid-19 facilities with the help of hospitals. “This way, if we manage patients early with oxygen , they won’t need the ICUs and ventilators,” he says. “In Mumbai, this is already being done.”
Another issue is that the cost of Covid-19 treatment has not been regulated, leading to inflated bills. The matter has now reached the Supreme Court. “Private hospitals have hiked charges to make up for the losses they incurred during the lockdown,” says Shaikh. “A bed at one of the hospitals, that used to cost Rs1,000 a day, now costs Rs10,000,” says Shaikh. The government is trying to discipline the private sector, but it would not be able to manage by using the stick, she adds. “Not only do the patients pay huge amounts, they are also telling us that until they can prove they are almost dying, hospitals are turning them away saying your symptoms are mild and can be managed at home,” she says. A government-appointed nursing officer has now been handed over the responsibility to decide which cases are severe. “So now it is not an experienced consultant who decides whether the patient is severe, but a nursing officer,” says Shaikh.
Dr G.S. Grewal, president-elect of Delhi Medical Association, says that there is a communication gap between the government and the medical fraternity. “The government needs to speak to relevant experts, especially those in the fields of epidemiology and community medicine,” he says. “The five-member committee appointed by the government does not even have a single expert from these fields.” He says that apart from creating infrastructure, there has to be an aggressive push on behavioural change, and adds that governments seem to have forgotten the lessons learnt from HIV. Says Grewal: “Then, while the government kept focusing on blood transfusion to prevent transmission, the simple strategy of advocating safe sex helped control the spread more effectively.”