Come July -India, and particularly Delhi is in for an unprecedented public health crisis. The figures speak for themselves. The increasing death-rate, the increasing Corona-positive patients, low contact mapping, monsoon leading to infections of chikungunya and dengue, crumbling and inefficient hospital management, mistaken notion that increasing confirmed cases is because of increased testing, the ill-considered opening of the economy putting India behind Brazil in controlling the situation and almost behind Russia in terms of Covid-19 positive patients should set the alarm bells ringing. Delhi has overtaken Mumbai and is the COVID-19 hotspot Numero Uno in the country. In this elaborate factual analysis, once again, public affairs analyst Kumar Sanjay Singh sounds an SOS alert to non-governmental groups and community efforts to gear up. You can ignore to read at your own peril.

JULY MAY TURN OUT TO BE THE CRUELLEST MONTH (with due apologies to TS Elliot) for the citizens of India in general and that of its national capital Delhi in particular. As on 27 June 2020, the country had 529579 confirmed cases of covid19 infections. With the rate of infections still on the rise on 27 June India breached for the first time the mark of over 20000 new confirmed cases in a single day. The number of deaths attributed to covid19 crossed 16000.

A very worrying data that has hitherto escaped analysis is that almost 9000 of the total confirmed cases are of serious/critical patients. That the number of serious/critical patients hasn’t come down, inspite of an improvement in the rate of recovery implies an uninterrupted increase in the number of deaths improving recovery rates notwithstanding. (infection-related data referred from worldometers.info)

 Read also: Wages of hubris: India overtakes Italy as a Covid19 hotspot

There is a caveat that the real extent of the spread of the contagion may be larger than that being reflected in the official figures. Testing rates in India continue to be very low, despite an increase of testing rates from below 5000 tests per million population in the first half of June to 5963 tests per million population on 27 June.

With this acceleration, the number of confirmed cases will reach or surpass 6 lakhs by Tuesday, 30 June 2020. India may overtake Russia as the country with the third-largest number of confirmed cases by 3rd or 4th July 2020.

Even Brazil, where Bolsenaro’s idiosyncratic approach towards covid19 has been panned universally, has tested 13766 persons per million population, which is over twice the current testing rates in India. Countries such as Peru and Bolivia that aren’t aflush with resources are testing 49297 person and 55522 persons per million population respectively. In India, the decision to conduct door to door testing in Delhi was approved only on 26 June 2020. (Testing related figures referred from worldometers.info)

July will be particularly unforgiving for the national capital. Available trends establish Delhi as the hotspot of covid19 infections in India. Delhi replaced Mumbai, as the city with the largest number of confirmed cases in June, precisely when the contagion entered the phase of aggressive spread.

Correlation between the low level of testing and underreporting of the actual spread of the disease has been revealed by the sero-survey results of ICMR. The survey was conducted in May 2020, involving 26400 persons from 28595 households in 89 districts of the country. Of them, 15 districts had no confirmed case, 22 had a low number of cases, 16 with a medium number of cases, and 18 were high-risk districts. As per the data released, 0.73% of those tested had been infected. Extrapolated on the total population figure, this works out to 1 crore infected Indians.

It also a call to medical NGO’s and activists to launch a coordinated community-level action plan to curb the contagion.

Since this survey was conducted in May the figure of 1,00,00,000 positive cases is 52 times the approximately 1,90,000 confirmed cases as on 31 May 2020. The extent of suppression could be much higher since the provisional data on high prevalence districts and areas suggests the infection of 15% to 30% of the population.

Keeping this limitation of the official data in mind it can, nevertheless, be safely concluded that the contagion has entered a phase of aggressive spread in June 2020. The all-India figures of total confirmed cases reveal a very significant trend, that between 30 January and 31 May 2020, the number of confirmed cases increased from 01 cases to 1,98, 371 cases. Thus, in five months there were less than 2 lakh confirmed cases. In the month of June alone, till 27 June, there have been 3,31,579 new confirmed cases. The spread of the contagion becoming particularly aggressive since the third week (19 June seems to be the day from where acceleration begins) with a daily increase of approximately 20000 new confirmed cases from 21 June to 27 June. With this acceleration, the number of confirmed cases will reach or surpass 6 lakhs by Tuesday, 30 June 2020. India may overtake Russia as the country with the third-largest number of confirmed cases by 3rd or 4th July 2020. (infection-related data referred from covid19india.org).

With a weekly average of over 3000 new confirmed cases between 21 to 27 June, the total new confirmed cases in Delhi in a single month of June 2020 will be approximately 70000. Thus, the rate of increase in daily testing alone cannot explain the spurt in the increase in the rate of infections.

July will be particularly unforgiving for the national capital. Available trends establish Delhi as the hotspot of covid19 infections in India. Delhi replaced Mumbai, as the city with the largest number of confirmed cases in June, precisely when the contagion entered the phase of aggressive spread. The daily cases of new infections began decelerating in Mumbai in the month of June till finally, Delhi overtook Mumbai on 25th of June. The total number of confirmed cases in Delhi increased from 59746 persons on 21st June 2020 to 80188 persons on 27th June 2020. That is a weekly average of slightly less than 3000 new confirmed cases per day. It stands to reason then, that for the next fortnight or more Delhi is going to be the hotspot driving up the figures of total confirmed cases in India.

It has been argued that the increase in new confirmed cases may be attributed to the increase in the number of tests. On 19 June 2020, the number of daily tests increased from less than 9,000 daily tests to over 13,000 tests. This coincides with the daily increase in the number of confirmed new cases by over 3,000. However, this coincidence is belied by the fact that the rate of increase in new confirmed cases far exceeds the increase in the number of daily tests. Between March 2020 and 31 May 2020, the number of confirmed cases increased from 01 on 3 March to 19884 confirmed cases on 31 May 2020. Whereas between 1and 27 June 2020, 60314 new confirmed cases were reported in Delhi. With a weekly average of over 3000 new confirmed cases between 21 to 27 June, the total new confirmed cases in Delhi in a single month of June 2020 will be approximately 70000. Thus, the rate of increase in daily testing alone cannot explain the spurt in the increase in the rate of infections.

In early June, Satyendra Jain, Delhi’s Health Minister declared that contact tracing is now being done only for immediate contacts of patients. Even this was contested by several families whose member was confirmed as Covid19 positive. As per the family members of the patients, no official agency approached them for the necessary follow up.

There’s a significant correlation between the acceleration in the number of new confirmed cases and the average number of tracing of contacts per confirmed case. As per the ICMR data between the months of January and April, an average of 20 contacts per confirmed case was traced in India. Herein lies the difference between a metropolitan centre such as Bangaluru, which has successfully managed the contagion, and Delhi, which has not. Whereas Karnataka traced an average of 89 contacts per confirmed case, Delhi traced an average of 9 contacts. (Source: BBC News, ‘Coronavirus: How Delhi ‘wasted’ lockdown to become India’s biggest hotspot.’ 28 June 2020).

Alarmingly, the rate of contact tracing declined with the spurt of confirmed cases in June. In early June, Satyendra Jain, Delhi’s Health Minister, declared that contact tracing is now being done only for immediate contacts of patients. Even this was contested by several families whose member was confirmed as Covid19 positive. As per the family members of the patients, no official agency approached them for the necessary follow up.

The Delhi Government has now announced 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. One wonders whether the timely implementation of contact tracing, as being done in Bengaluru, could be more effective and cost-efficient in checking the spread of the contagion.

In a bizarre admission of the fraying of health facilities; the Delhi and central government were in unison over the handing over of new COVID centres to the army and the ITBP -Ind–Tibetan Border Police.

The ambitious slew of new measures to be initiated from 6 July would require substantial diversion of resources from the other heads of public health expenditure. Thus, this note of caution. Months between July to September are identified with the advent of monsoon and the accompanying mosquito-borne diseases– malaria, dengue and chikungunya. Since 2015 Delhi has been ravaged by dengue epidemic. In 2015, 2017 and 2018 the dengue infections hit peaks of 15867 cases, 9271 cases and 7136 cases respectively. 2016 and 2019 witnessed over 4000 cases of dengue infections each year.

Months between July to September are identified with the advent of monsoon and the accompanying mosquito-borne diseases– malaria, dengue and chikungunya. Since 2015 Delhi has been ravaged by dengue epidemic.

Given that the only existing vaccine for dengue– Dangvaxio manufactured by Sanofi Pasteur, is yet to be approved by the Drug Controller General of India; hospitalization is the only method for managing and treating the patients. Herein lies the rub. The health facility in Delhi is already overwhelmed by the covid19 contagion. There are reports of doctors and other health workers taking recourse to strikes to protest unfavourable work conditions and even non-payment of salaries. In a bizarre admission of the fraying of health facilities; the Delhi and central government were in unison over the handing over of new COVID centres to the army and the ITBP -Ind–Tibetan Border Police.

That, the civil health facilities have crumbled, and defence services (technically the last recourse during civilian emergencies) deployed even before we hit the peak infection rates of the first stage of covid19 pandemic, doesn’t augur well for us. Remember dengue epidemic (July 2020 to September 2020) and the second wave of covid19 pandemic (expected between November 2020 and February 2021) will further exacerbate an already grave public health situation. With the early deployment of the military and the paramilitary staff, exposing them further to the ravages of the contagion; one wonders what will be the remaining line of defence once dengue epidemic and second wave of covid19 pandemic hit us?

It is time, therefore, that the GOI and the Government of Delhi reconsidered its policy of progressive reopening of the country. It also a call to medical NGO’s and activists to launch a coordinated community-level action plan to curb the contagion.

Kumar Sanjay Singh is Associate Professor in the Department of History at the Swami Shraddhanand College, University of Delhi with specialisation in Mutations in Indian State formation post-1947, Extraordinary laws especially Internal Security Legislations and Human Rights with special focus on North-east India and Adivasi society.