As Delhi Faces Fourth COVID Wave, How Do We Scale up the Response?

While Delhi hospital beds are filling up fast, what learnings can it apply from earlier waves?

On Monday, 5 April, Delhi reported over 4,033 cases of the novel coronavirus and 21 deaths, a steep rise in just over a month. According to the Ministry of Health and Family Welfare (MoHFW) data, on 1 March, Delhi had reported just 175 cases with 1 death.

It's also the time when a number of people declared the pandemic over, became causal and ignorant of the COVID-appropriate behaviours drilled down over the last one year, and the festive season towards the month's end meant these protocols were swept up in vivid colours.

The pandemic, though, is far from over and the capital city faces its fourth wave.

How Did We Get Here?

Delhi: Rapid Rise in COVID Numbers

As of 3 April, Delhi's positivity rate, the number of positive samples from total tests conducted, was 4.11 percent. Delhi's Health Minister, Satyendar Jain, says Delhi is testing the most number of people.

“With 87,505 testings, we are testing 5 times higher than other states. Delhi’s positivity rate stands at 4.11 percent. The number of beds in private hospitals has been escalated from 15 percent to 25 percent. At present, 2/3rds of the beds in Delhi hospitals are vacant.”

Satyendar Jain, Delhi Health Minister

Case fatality rate has remained at 1.6 percent for the capital and doctors attribute it to learnings from the past year and better treatment protocols. Over all, there is a 9 percent increase in younger patients compared to the last wave.

While these are early observations and a clearer picture will arise once more data comes in and more time has passed (remember, today's cases are 2-week-later's fatalities), there are other reasons why mortality could go up. It has to do with hospital systems getting overwhelmed, which is what happen in smaller cities in Maharashtra.

Gradually Increase Beds, Reduce Elective Surgeries, Impose Masks

According to the DelhiFightsCorona app, that the Delhi government set up last year to provide easy information on availability of beds, the city as of 5 April, has 50 percent beds available.

But when it comes to ICU beds, these are fast filling out. Of the 794 ventilator beds, 465 are occupied, while 329 are available.

While the Delhi government has asked the hospitals to increase bed capacity from 15 to 25 percent and progressively add more beds, it's easier said than done.

Dr Sumit Ray, Medical Superintendent and head of critical care unit at Delhi's Holy Family Hospital, says that the hospital has several patients for scheduled elective surgeries and other non-COVID healthcare services, many of these had been pushed due to COVID. Unlike the previous waves, when elective surgeries had almost stopped, it won't be easy to scale things up, and it needs a graded response.

“The govt needs to talk to us to scale up and add more and more beds over time with a week, 10 day, month long strategy. A lot of deaths occur when health systems are overwhelmed, and patients get delayed treatment, as is happening in cities like Nashik and Nagpur.”

Dr Sumit Ray

Chief Minister Arvind Kejriwal has ruled out a lockdown in the capital and written a letter to the Prime Minister asking for relaxing of rules to open more vaccination centers, and to open vaccination for everyone.

Meanwhile, night curfew has been imposed in Delhi from 10 pm to 5 am with immediate effect till 30 April in the wake of the COVID situation, the Delhi government said on Tuesday, 6 April.

“If the rules for opening new centers are simplified and everyone is allowed to vaccinate, then the Delhi government will be able to vaccinate all Delhi residents in three months.”

Arvind Kejriwal, Delhi CM 

He's also asked that the state be allowed to vaccinate outside hospitals. In order to speed up the vaccination campaign, he's proposed a two-step strategy:

"First, there is an urgent need to increase the number of vaccination centers. For this, the pre-conditions placed by the Centre regarding vaccination centers need to be relaxed. For example, according to the instructions of the Central government, vaccination centers can only be set up in hospitals or dispensaries."

He adds, "The vaccination drive in the last three months has shown that the vaccine is safe. It is, therefore, requested that this condition be removed so that large-scale vaccination centers can be built in schools, community centers, and other places."

In another order, the Delhi government has asked vaccine centers to remain open 24/7 in order to ramp up vaccination.

But Does Ramping Up Vaccination Really Serve to Control Cases Occurring Now?

Some public health experts disagree. While vaccination drive needs to be scaled up, it will not help the city deal with the current wave. Dr Chandrakant Lahariya, a health systems expert, says the focus has to be on immediate measures to tackle the wave. Test, Trace and Treat. That will be the key. He tweeted,

“While vaccines are safe, a person will be protected after completion of full schedule of 2 shots + 2 weeks. Therefore, benefit of vaccination for those who gets a shot will come 6 to 10 weeks from now.”

While vaccines will help in reducing the possibility of a third wave, to deal with the current crisis, it's back to the basics of public health.

In an article for The Quint, Dr K Srinath Reddy, chairperson of Public Health Foundation of India, laid down the path. It's worth reproducing here:

1. Reinforce COVID-appropriate behaviour through constant reinforcement of health messages through both mass media and community networks
2. Exhibit political will and administrative skill to rigorously curb large gatherings and violation of regulations on masks
3. Use testing wisely, to detect new cases early and screen for mutants
4. Place a high premium on symptom-based household surveillance followed by early testing of suspected cases and energetic contact-tracing (especially needed now for mutant strains)
5. Increase the pace and spread of vaccination against COVID-19, to cover all persons above the age of 40 years, and even younger persons with co-morbidities
6. Create vaccine-confidence among people, using multiple channels of communication.

Meanwhile, here's a refresher on the COVID-19 symptoms you need to be aware of.