How Delhi flattened the COVID curve

The Delhi model, as described by the chief minister Kejriwal himself: “Testing, home isolation, transparent data, hospital beds and plasma therapy."

Delhi has no COVID war room. But the capital had become the centre of attention in the fight against COVID-19 when on June 9th, Deputy Chief Minister Manish Sisodia estimated that Delhi, groaning under an acute shortage of hospital beds, would need over 5.5 lakh beds by end July.

A shocked public, the city administration, hospitals and even Union Home Minister Amit Shah stepped in. The BJP at the Centre and AAP in Delhi called a truce as they joined hands to deal with what was becoming a crisis in the capital. Their crisis management efforts finally yielded some positive results.

At 10.25 am on August 7th, the Corona Dashboard of the Delhi government showed a total availability of 13,557 COVID-19 beds. The numbers were as follows:

August 7 2020

Total number of beds: 13, 557
Vacant: 10,491 (3066 were occupied)

ICU beds with ventilators: 1214
Vacant: 829 

ICU beds without ventilators: 956
Vacant: 668

Just ten days earlier, the situation had been thus:

July 29 2020

Total COVID beds: 15,921 
Vacant: 12,963 (2958 occupied)

ICU  beds with ventilators: 1207
Vacant: 811 

ICU beds without ventilators: 958
Vacant: 651

That same day, the Delhi government issued an order, discontinuing the scheme of creating health care facilities at hotels by private hospitals, which was operationalized by an order of exactly two months earlier, on May 29th.

The number of Covid deaths too had come down signifcantly. August 6th registered 15 deaths, with 1008 patients discharged. The next day, on August 7th, the Government of India’s COVID portal put Delhi’s total COVID- confirmed cases at 1,41,531, active cases at 10,348, the number of people discharged at 1,27,124, and total deaths at 4059. 

The same day, the COVID-designated crematorium at Punjabi Bagh in West Delhi was given the green signal to reopen for non-COVID cremations too. The number of COVID bodies being brought had happily reduced to a 3 or 4 for some days — down from 60 to 70 a day all through June!

Flattening the Covid curve. Vacant beds in a Covid designated hospital in Delhi

The Delhi model

All the numbers showed that by end July, Delhi had “flattened” the COVID curve. “The Delhi Model” is what Union Home Minister Amit Shah later cited to the other states battling with rising figures. 

The Delhi government had also managed to successfully implement the cap on treatment charges by private hospitals that had reserved  60% of their beds for COVID patients. Hospitals that had converted all their facilities for COVID, were free to charge their own rates for the remaining 40% beds.

The government capped cost of isolation beds was between Rs 8,000 and Rs 10,000 per day. 

The cost of an intensive care unit without a ventilator was slashed to Rs 13,000 to Rs 15,000 per day. 

For ICU with ventilators, it is between Rs 15,000 and Rs 18,000, which included the cost of personal protective equipment (PPE).

Steps taken

Chief Minister Arvind Kejriwal joined the battle on June 14th, when several measures were announced following a meeting with Amit Shah. These included a huge ramp up in testing and treatment capacities in Delhi.

This was at a time when patients with symptoms were facing a nightmare to get themselves tested, and were dying as they desperately went from one hospital to another to find a bed, only to be turned away everywhere.

Testing was doubled over the next two days and trebled in the next three days. From June 6th to 13th, an average of 5193 tests were conducted. But between June 14th and 21st, it shot up to 10,846 tests.

How did this happen?

The government decided to include the far quicker rapid antigen tests from June 18th, following approval by the centre. Only those who tested positive were then sent for the RT-PCR test. 

The Centre had also on June 17th capped the testing price in Delhi to Rs 2,400. Union Minister of State for Home G Kishan Reddy announced on June 18th that the Centre had planned to conduct six lakh rapid antigen tests across 169 facilities that were still being set up.

Simultaneously, infrastructure was beefed up. Sleeper coaches of ordinary, non-airconditioned trains, three, four and five star hotels, banquet halls, all were converted into COVID Care Centres and were attached to hospitals in the neighbourhood. 

Around 500 railway coaches were converted into isolation centres. 

Ordinary  sleeper compartments were redone to include a doctor’s cabin, oxygen cylinders, toilet facilities etc for patients with mild symptoms. 

The state government, the Indian army and the Centre chipped in with medical and paramedical professionals.

Hospitals treating COVID patients received a checklist from the Delhi government on July 16th. While the government has not made this list public, sources say they are “basically ICMR guidelines to hospitals across the country.”

Willingness to experiment

Kejriwal championed every line of treatment that held promise. Hardly had plasma therapy been mentioned  as promising, the Delhi government promoted it vigorously. “We got permission for plasma therapy trial in the Lok Nayak Jaiprakash Narayan Hospital,” said Kejriwal on May 2nd. “The first patient given the therapy was in the ICU and has since been discharged”. 

Exactly two months later, a plasma bank was set up at the Institute of Liver and Biliary Sciences, and the government regularly woos recovered patients to donate plasma.

Quietly and unknown to most, save close friends and family, Delhi citizens too were contributing to this fall in COVID numbers. Because of the awareness generated on the subject, many who developed any symptom associated with COVID were being isolated and their symptoms treated by family doctors by consultations on the phone. 

“My neighbour’s cousin in Patparganj had all the symptoms of COVID,” said Kritika Rastogi, a teller at a bank in Mayur Vihar. But since he had no co-morbidities and was only 41, they did not even bother with testing, or use the COVID home care packages from big hospitals, but took medicines as prescribed by their doctor.

Three weeks later, he was fine and was in isolation for two weeks after the fever subsided. “All ICMR protocols and guidelines were observed,” says Kritika.

It was one of many similar cases that we learnt of while working on this story.

Serological survey

Delhi also conducted a serological survey. Blood samples of 21,387 people at random were taken, from pockets of dense population, between June 27th and July 10th, and tested for antibodies.

According to the Health Ministry, the survey results showed that 22.86% of the surveyed people had developed antibodies, indicating that they had been exposed to the novel corona virus. The health ministry also said that citizens’ compliance had yielded benefits. On July 25th, the capital’s COVID recovery rate crossed 87%, the best among all states.

According to Chief Minister Arvind Kejriwal, the Delhi model was about “testing, home isolation, transparent data, hospital beds and plasma therapy. But to achieve these five things, we followed three principles—team work, acknowledging constructive criticism and fixing what is wrong, and not giving up as a government, no matter how bad the situation got”.

Reducing mortality

On July 30th, four committees were set up to inspect about a dozen private and government hospitals with the highest coronavirus mortality rate. They were directed to  give hospital-wise recommendations on following standard operating procedures and protocols, specifically to  recommend  measures for the betterment of coronavirus patient care services and reducing mortality of corona patients.

These hospitals included Lok Nayak Hospital, GTB Hospital, Safdarjung Hospital, Max East & West, Sir Ganga Ram Hospital, RML Hospital, Jaipur Golden Hospital, Sir Balaji Action Medical Institute, Escorts, and St. Stephen’s Hospital. They were also given a checklist to follow. 

One recommendations made by all the four committees was that high-risk cases must be transferred to ICU/ HDU at the earliest sign of deterioration.

Officially, OPD and other non-COVID services have not yet resumed in COVID-designated hospitals. But as the number of COVID admissions are dropping, some, like the Hindu Rao Hospital under the North Delhi Municipal Corporation, are considering reopening OPDs.

Downward trend

Neither has the capital allowed hotels and gyms to open. The city’s many Thursday, Friday, Saturday and Sunday bazaars were told to open on an odd-even basis.

Bishamber Kumar who used to be a permanent fixture selling dry snacks at these bazaars says his income has been hit. “But even if the government allows us to open the bazaar, customers won’t come as there is fear,” says Bishamber.

AIIMS director Randeep Guleria, who also heads the Clinical Research Group of the National COVID Task Force, believes that Delhi may have gone over the peak and is now heading downwards. Chief Minister Kejriwal, however, now wants the health department and hospitals to work towards a zero COVID death count in the capital. 

And all this was done without Delhi having to go into a second lockdown!

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