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COVID-19 and Delhi's healthcare system: How the cookie crumbled

The National Capital's healthcare system has been one of its biggest selling points. But the 'fourth wave' of COVID-19 has left the city's system on the verge of collapse, while the Centre-State blame game rages

April 28, 2021 / 05:08 PM IST
A patient with breathing problem is rushed to a hospital for treatment, amidst the spread of the coronavirus disease (COVID-19) in Ahmedabad, India, April 15, 2021. REUTERS/Amit Dave - RC27WM9GEUI5

A patient with breathing problem is rushed to a hospital for treatment, amidst the spread of the coronavirus disease (COVID-19) in Ahmedabad, India, April 15, 2021. REUTERS/Amit Dave - RC27WM9GEUI5

On April 27, The Delhi High Court slammed the Delhi government for oxygen shortages in the national capital, saying that its confidence was ‘shaken’ and if the State government couldn't manage to provide oxygen, the court would ask the Centre to step in.

“Set your house in order. Enough is enough. If you can’t manage it, tell us, then we will ask the central government to send their officers and do it. We will ask them to take over. We cannot let people die like this,” a division bench of Justices Vipin Sanghi and Rekha Palli said, according to a report in Indian Express.

The city-state of Delhi, whose political leadership has repeatedly pitched healthcare as one of its main planks, has witnessed its health infrastructure nearly collapse with the alarming spread of COVID-19 infections and surge in deaths, coupled with a shortage of oxygen and ICU beds across hospitals -- be they Centre, State, or private hospitals.

With a little over 200 daily infections and single-digit deaths in March, the Capital reported 24,149 fresh cases and 381 deaths -- the highest ever in a day -- on April 27. The case positivity rate remains at 32.72 percent, which is alarming, way above the WHO norm of 5 percent. Even tests, which used to be over 1 lakh per day, have come down to 70,000.

So far, 10,72,065 people have been infected with COVID-19 in Delhi of which 9,58,792 patients have recovered and 15,009 people have died. At least 98,264 patients are getting treated, according to Delhi health department details as on April 27.

COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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“We saw in this wave there a huge demand for ICU Beds. We are trying to have 1,000 ICU beds at two places before May 10.  Oxygen supply was affected for three days. Things have started to improve since yesterday. We cannot predict. We have 30 percent positivity, which is a concern,” Delhi Health Minister Satyendar Jain said.

This situation is different from the last wave in November (8,593 cases on November 11, 2020) in more ways than one. Apart from the severity of the infections and the number of deaths and nearly crumbling health services, the union government has not directly been seen on the ground like the last time.

In the November 2020 peak, Union Home Minister Amit Shah was directly involved in managing Delhi and he personally took stock of preparedness. This time no such thing happened perhaps because of the similar situation across the country and the ongoing elections.

“In the last wave, one person would get infected and we would track him. But this time the transmission is very serious. By the time, we come to know about a case, the whole family is infected already,” said a health department official.

“The situation is similar across the country, including Delhi, we had the experience of last year to know that there was always a possibility of another wave. That was also the global experience. But a lot of steps that were taken were temporary. Many Covid-care centres that were set up were later dismantled when the cases went down,” said health policy expert Dr Anant Bhan.

Delhi’s Health Budget

The Arvind Kejriwal government has historically been earmarking most of its budget allocations towards the health and education sectors. In its budget for 2021-22, presented in March, Finance Minister Manish Sisodia proposed an outlay of Rs 9,934 crore for the health sector, an increase of Rs 2,230 crore from last year’s budget -- the highest sector-wise increase.

Chief Minister Arvind Kejriwal said on April 27 that his government has decided to import 21 ready-to-use oxygen plants from France and 18 oxygen tankers from Bangkok to ensure a steady supply of oxygen in hospitals across the national capital.

“The current wave is extremely dangerous and contagious and the hospitals are overloaded, to combat the load, 1,200 beds will be added in Delhi by May 10 and Ramleela Maidan is also being converted into an ICU bed centre,” Kejriwal said in a virtual press conference.

It is worth noting that while the country as a whole is seeing its ‘second wave’ of COVID-19 cases, the Delhi government has been referring to the current spike in cases as the city’s ‘fourth wave’

Kejriwal said the situation has seen an improvement this week and the number of SOS messages received from hospitals has reduced due to hard work and coordination between the Central and State government officials, who have spent many nights trying to overcome the oxygen shortage. He also said that many industrialists have given a positive response to his call for help, but on condition of anonymity.

“A major issue facing us today in the supply of oxygen is the shortage in the number of tankers. Even when we find oxygen, transporting it to Delhi becomes a problem because of this shortage of tankers. The Delhi government has decided to import 18 tankers from Bangkok, which will start reaching Delhi tomorrow. For this, we have requested the central government to lend us air force planes."

‘Centre-state politics needs to end’

Health sector experts are unanimous in their views that the politicking between the BJP-run central government and the AAP-run Delhi government needs to end, and there needs to be better cooperation.

“We need to ask how do we respond to such challenges and how prepared are we for future eventualities. There is always a case for better coordination and cooperation. Every agency has tried to do what it could but Oxygen supply shortage is an issue. We know that distribution and the supply chain is a problem,” said public health policy and epidemiology expert Dr Chandrakant Lahariya.

Lahariya, however, stressed that given the unprecedented rise in cases, especially in the second wave, any healthcare system would have been overwhelmed.

“You prepare a healthcare system up to a particular level. In this scenario, every health system will be overwhelmed. In fact, given the circumstances, the healthcare system in cities like Mumbai and Delhi have done relatively well. Of course, more could have been done in terms of oxygen and other aspects,” he said.

Bhan, on the other hand, said that the system was underprepared. “Delhi is unique in a way that it has hospitals being run by the Central government, State government and the private sector. That creates issues in not being able to regulate which resources are available and which are not.”

“There needs to be better coordination and cooperation between the Delhi administration and the Central government. Hospitals need to have maximum resources available at their disposal. Corrective action is important, rather than finding fault with each other, which helps no one,” Bhan said.

On April 28, the Prime Minister’s Office reportedly pulled up the Arvind Kejriwal government for the dip in daily testing numbers, the inability to procure oxygen and failing to ensure its equitable distribution.

The meeting was chaired by Principal Secretary to prime minister PK Mishra and attended by Delhi Chief Secretary Vijay Dev, according to a report in The Print. The central government, according to sources quoted by the Print, cited a delay in test results as the reason for the dip. Delhi, which was testing over 1 lakh people a day, has now reduced testing to 70,000-75,000 per day

Opposition hits out

The Delhi Congress has accused the Arvind Kejriwal government of spending crores on publicity but doing nothing in the past year to augment oxygen storage capacity and set up new plants in the national capital. The party has demanded Kejriwal’s resignation over his government's alleged failure to provide health services to people gasping for oxygen.

Senior Congress leader Ajay Maken alleged that the Delhi government spent Rs 355 crore on advertising and publicity over the last year and another Rs 467 crore has been earmarked as the publicity budget for this year.

“With the total of Rs 822 crore being spent on advertisements and publicity on Delhi in the last two years, one can set up as many as 800 oxygen plants, and add 750 metric tonnes capacity of oxygen, but the government will not take such a step in public welfare,” Maken alleged.

The road ahead as L-G gets more powers

Delhi’s lieutenant governor (L-G) Anil Baijal is now the ‘government’ in the Union territory after the Centre notified the amended Government of National Capital Territory of Delhi (Amendment) Act, 2021, which came into effect on April 27.

“In exercise of the powers conferred by sub-section (2) of section 1 of the Government of National Capital Territory of Delhi (Amendment) Act, 2021 (15 of 2021), the Central Government hereby appoints the 27th day of April, 2021, as the date on which the provisions of the said Act shall come into force,” the Ministry of Home Affairs said in a notification.

The controversial Act, which effectively hands executive powers to the L-G from the city-state’s government and legislative assembly, was cleared by Parliament last month amid a walkout by Opposition parties.

Now, it is mandatory for the Delhi government to take the opinion of the L-G before taking any executive action in the city. The Kejriwal government is also not allowed to make any rule to enable itself or its Committees with regard to the day-to-day administration of the Capital or conduct inquiries in relation to administrative decisions. How all this will worsen the already fraught relations between the Delhi Secretariat and the Union Home Ministry remains to be seen.

One of the AAP government’s strongest pitches has been regarding healthcare at a community level, through its ‘Mohalla Clinics’. Bhan and Lahariya both say that these can play an important role in the coming months, as the onus of vaccinating those in the 18-45 age group shifts to the States. They also say that all stakeholders need to prepare for the month of May, which is expected to be worse in terms of the caseload.

“Some of the mohalla clinics have been working as testing centres. Going ahead, they can be used as vaccination centres,” Lahariya says.

“We need to prepare for the coming months. There is a need to enhance all facilities including beds, ventilators, ICUs, oxygen and staffing requirements. We need to ensure that no patient is left wanting,” says Bhan.

Gulam Jeelani
Gulam Jeelani is a journalist with over 11 years of reporting experience. Based in New Delhi, he covers politics and governance for Moneycontrol.
Arup Roychoudhury