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.