Broken system

Print edition : July 17, 2020

People wait for their turn to give samples for COVID-19 test at a school in New Delhi, on June 25. Photo: Vijay Verma/PTI

Lack of any effort to trace or isolate contacts of COVID-19 patients sees the number of cases in Delhi to rise exponentially.

“Horrendous, horrific and pathetic!” is how the Supreme Court described the COVID-19 situation in Delhi on June 12. Since then the capital has surpassed the total number of cases in not only Mumbai but also Wuhan, the epicentre of the global pandemic in China. By June 25, Delhi reported 70,390 infections and 2,365 deaths. But the spread of virus in Delhi was not accidental as exemplified through various case studies of patients.

Sarika (name changed) works in the emergency department of a premier Central government hospital in the capital. A month ago, she tested positive for coronavirus. She called up all the ambulance numbers she had, but none agreed to come. Ultimately, a friend of hers wore an old raincoat, double hand gloves, a helmet and drove her to the hospital. Despite being a front-line worker in the same hospital and having a COVID positive report with her, the hospital did not admit her. After several hours, during which her temperature was taken and blood pressure measured with the same unsanitised equipment that was used on other incoming non-COVID patients as well, it was midnight when an ambulance finally arrived to take her to another wing of the hospital, two kilometers away. There were six more patients in that ambulance, one of whom was constantly vomiting.

Once at the isolation facility, Sarika thought her ordeal was over. But within a couple of days, she was asked to vacate the bed. As she was not tested before discharge, she could not return to her housing quarter that she shared with others and where she did not have a separate washroom. The hospital did not seem to care about that. They simply wanted her out. A friend was kind enough to let her isolate herself in his house. The day after she tested negative for the virus, the hospital asked her to rejoin work. Mentally traumatised from the disease as well as the ordeal, the prospect of treating other patients with COVID was unbearable for her and she proceeded to go on leave.

Sarika’s direct contacts during this period were neither tested for the virus nor asked to go into isolation. They did both on their own accord. “If front-line health workers, for whom the Prime Minister and the country clapped and cheered, are treated this way by the hospitals they work in, what chance do we, ordinary citizens, have if we get the virus?” Sarika’s friend asked Frontline.

A reporter with a digital news outlet nearly cried on air while reporting on the state of affairs outside LNJP (Lok Nayak Jai Prakash Narayan) Hospital, which is a dedicated facility for the treatment of COVID-19 under the Delhi government. Ambulances with more than a few patients were streaming in every 10 minutes and a relative he spoke to said he did not have any idea about his father’s status or whereabouts after he was admitted six days ago.

The spurt in Delhi could be directly attributed to the complete lack of any effort to trace or isolate contacts of COVID-19 patients. Without a proactive strategy to chase the virus, Delhi could not hope to shed its virus load.

PIL petition

A public interest litigation (PIL) petition was filed in the Delhi High Court requesting proper testing of both symptomatic and asymptomatic persons in private and government hospitals and laboratories. On June 24, a division bench of the High Court comprising Justices Hima Kohli and Subramonium Prasad said the “Delhi government has not conducted more than 50 per cent of the tests and failed to keep to the target”. The Delhi government responded by saying that it had a target of 22,000 rapid antigen tests a day.

Under severe flak for a dramatic rise in numbers, which was worsened by its reduced testing policy, the Delhi government announced an ambitious plan of screening every household for COVID-19 within 10 days. From June 26 to July 6, it would complete a door-to-door screening campaign. There are 33,40,538 households in Delhi, as per Census 2011, with five members in each house on an average.

Eight-point response plan

This was part of the Delhi government's eight-point Revised Delhi COVID Response Plan released on June 24. According to it, all houses within a containment zone would be screened by June 30. Beginning June 27, a sero-survey of 20,000 people across districts would be conducted and its results published on July 10. All symptomatic and asymptomatic high-risk contacts would be tested between the fifth and tenth day of contact. Teams in containment zones would undertake active case search and vigorous contact tracing of COVID-19 persons in order to analyse the reasons for clustering.

According to the plan, by June 26, the containment zones would be redefined in line with the guidelines of the National Centre for Disease Control. There are 263 such zones in Delhi. The plan also said that highly suspected cases that tested negative on rapid antigen test could be examined again using the RT-PCR (Reverse transcription polymerase chain reaction) test.

Political tussle

Meanwhile, the Arvind Kejriwal-led Aam Aadmi Party government and Lieutenant Governor Anil Baijal got into yet another tussle over the nuances of the anti-COVID policy. On June 19, Baijal ordered a compulsory five-day institutional quarantine for every COVID-19 patient. Only after that would a person be sent to either home isolation, a quarantine centre or a hospital as the symptoms warranted, said the order issued by the Lieutenant Governor.

But Kejriwal and his team were up in arms against the order. “Delhi’s home isolation plan has been working very well. I have personally spoken to many patients on phone who underwent home isolation. I wud urge Centre and LG not to tinker wid it and restore it back,” tweeted Kejriwal.

The order was revoked a day after the controversy broke. After meeting senior Ministers of the Delhi government, Baijal tweeted, “Regarding institutional isolation, only those COVID positive cases which do not require hospitalisation on clinical assessment & do not have adequate facilities for home isolation would be required to undergo institutional isolation.”

Ever since the beginning of the pandemic, the Delhi government has claimed that it has sufficient number of beds and proper treatment facilities for thousands of Delhiites. But when on June 17 Delhi’s Health Minister Satyendar Jain tested positive for the coronavirus, he was not kept in one of the acclaimed public hospitals. Instead, he was admitted to a private hospital in Saket where, after undergoing plasma therapy, his condition improved and he was shifted out of the ICU. Initially, he was admitted to Rajiv Gandhi Super Speciality Hospital (RGSSH), a dedicated COVID-19 facility, but was shifted out as it did not have permission to conduct plasma therapy. After his recovery, one can only hope that the Delhi government would understand the many weak links in its strategy to fight COVID-19 and improve upon them.

Moreover, a day before Jain showed symptoms of COVID-19, he had attended the high-profile meeting of the who's who of Delhi’s political circle, including Union Home Minister Amit Shah, Union Health Minister Harsh Vardhan, Baijal, Kejriwal, Deputy Chief Minister Manish Sisodia, and officers of the State Disaster Management Authority. According to the guidelines for precautionary measures, all of them should have gone into self-isolation, but it is unclear whether the guidelines were followed.