Delhi set to see crisis like second wave if govt doesn't act fast; can't presume Omicron is mild, warn experts

Medical experts have termed Delhi govt’s decision of imposing a ‘curfew’ on the next weekend in view of rising COVID-19 cases as a case of too little, too late which will do nothing to break the rapidly evolving chain of transmission of SARS-COV-2 (colloquially termed as Coronavirus) in the national capital.

There has been a dramatic spike in COVID-19 cases in the national capital, with as many as 5,481 new cases reported on Tuesday, the highest figure in over seven months; three deaths were also reported. The positivity rate, or the number of people testing positive for every 100 tests, is climbing and now stands at 8.3 per cent.

On Monday, official data had cited 4099 new cases, 1138 per cent more than a week ago, 11 deaths in 28 days, the highest in four months, and a positivity rate of 6.46 per cent.

As per the so-called Graded Response Action Plan (GRAP) announced by the Delhi govt last year, a positivity rate of above five per cent for two straight days would have triggered a ‘red alert’, calling for imposition of major restrictions to minimize human exposure to the virus, although the situation does not yet meet two other parameters set for it – cumulative daily cases touching over 16,000 or oxygenated bed occupancy rate exceeding 3,000.

“Such a response system developed by bureaucrats looks very attractive on paper, but you can’t expect a virus to respect or follow it. It’s a dynamic and rapidly-deteriorating pandemic situation that calls for immediate, visible and effective measures to stop the transmission,” a pulmonologist and front-line healthcare worker at a reputed Delhi govt-run hospital said on the condition of anonymity, not being authorized to speak to the media.

“What is particularly galling is that the DDMA has now actually removed restrictions on the number of passengers who can travel on public buses and Delhi Metro that were imposed as part of the ‘yellow alert’ announced on December 28, with the deputy Delhi CM attributing it to ‘chaotic situation due to queues’,” she said.

“So, in effect, they have actually eased restrictions instead of ramping them up, even while announcing a ‘curfew’ in the near future. It is not clear if they are being deliberately casual, unable to comprehend the gravity of the situation or pandering to vote bank politics. This is something straight out of a chapter titled ‘how not to deal with a full-blown pandemic situation’,” she said, pointing out that Dr NK Arora, Chairman of National Technical Advisory Group on Immunisation (NTAGI) on Tuesday acknowledged that India was now very clearly in the thrall of a third wave of COVID-19.

Noted infectious diseases expert Dr Ishwar Gilada, who also serves as president of AIDS Society of India and secretary general of Organised Medicine Academic Guild (OMAG) – a federation of 15 professional associations of post-graduate doctors in India, covering 250,000 consultants – observed that it was now clearly a situation where the Delhi govt needed to act decisively to save lives without bothering about optics or public perception or for petty political reasons.

“In our country, only two methods work to get the masses in line if and when necessary: jhanda (flag) or danda (stick). What I mean to say is that it is imperative for the administration in Delhi to impose calibrated, well-calculated, well thought out restrictions that will act as a kind of circuit breaker to halt or at least slow down the spiraling infection. Call it by any name: lockdown, curfew or anything else. But do it and do it now and do it effectively. If necessary, call in the armed police or even the armed forces to conduct flag marches. A fear psychosis needs to be created among the common man, or else everyone will continue to act casually, wearing thin cloth masks, jostling in markets, as if everything is hunky dory,” he said.

Dr Gilada opined that it would be a grave mistake to dismiss the threat posed by the Omicron variant by presuming that it causes ‘mild’ illness.

“We really can’t say at this point how it will pan out by citing anecdotal evidence from other nations or regions. What surely cannot be denied is that COV-SARS-2 straightaway attacks and thrives in the human respiratory system. According to a study, the Omicron variant replicates 70 times faster in the human respiratory tract as compared to Delta variant. Now, when the respiratory system is in distress, mildly or otherwise, it can quickly escalate to a medical emergency calling for intervention by trained doctors, in a healthcare facility setting in most cases. Whether it is high fever, hypoxia or other symptoms, people will panic. Such a crisis, caused by such a highly virulent variant, will most certainly lead to a total collapse of our creaking healthcare system much like the second wave,” he said, adding that as it is, there was a shortage of resident doctors due to the delay in holding NEET-PG exam.

Speaking to National Herald, a professor-doctor at an acclaimed Central govt-run hospital and medical college concurred with this opinion, adding that he had no doubt that the national capital was staring at the same situation as witnessed during the second wave within a week or two.

“The positivity rate is a matter of huge concern. If the chain of transmission does not get broken, it will continue to rise exponentially, going up to 20 to 30 per cent as happened during the second wave. At my hospital, it is already clocking 20 per cent,” he said, requesting anonymity since only the Director was authorised to speak to the media.

“Only two things could have acted as mitigating factors: Alertness and preparation. Both have been conspicuously missing so far as the govt is concerned. So, exactly the same situation is going to arise: panic stricken patients and relatives hunting for non-existent oxygen-equipped hospital beds, oxygen cylinders and concentrators selling at a huge premium, queues at crematoriums etc,” he said.

“Calling Omicron ‘mild’ etc just amounts to underplaying the extremely alarming situation we are faced with. We don’t know how it will play out, we don’t even know what medications like monoclonal antibodies may help patients. If a patient’s oxygen level drops below 94, as it will, it will call for emergency measures. And we mustn’t forget the dozens of long-term health complications caused by COVID-19,” he added.

He pointed out that one of the most critical parameters of how seriously ill a COVID patient was viral load. “This was seen to be 1000 times more in the case of Delta variant compared to the original variant. We still don’t know what it will be in case of patients infected with Omicron variant. Also, it is necessary to remember that there has always been a gap between rise of cases and consequent deaths,” he said.

“It is quite likely that patients will once again be administered steroids to alleviate their symptoms, again leading to cases of black fungus etc. What is certain is that our healthcare system, especially in the govt sector as most people can’t afford private hospitals, which can hardly serve the needy even normally, will collapse under sheer pressure. Even the medical and paramedical staff gives up or falls ill,” he added.

“Last time, the only option most patients eventually had was to jostle with the crowds at chemist shops, begging for medicines and pulse oximeters," he said.

Asked what measures could help in the present situation, he said, “A system needs to be put in place wherein patients could stay put at home and post or upload images of their oximeter readings etc. Doctors and trained personnel should monitor these and prescribe the appropriate course of action. Necessary medicines can be home delivered using the army of employees at the disposal of Delhi govt -- and even Central govt if necessary -- in various departments and wings. If hospitalization becomes imminent, patients/relatives should be able to use a dashboard like the railway reservation system to determine bed availability at the nearest facility and book a bed,” he said.

"This of course is an ideal case scenario but it can be implemented provided there is political will for it. Unfortunately, politicians don't really care about mortality among common people as they understand that public memory is short,” he said.

Dr Gilada was equally critical of politicians. “I don’t know how netas can take things so casually. How does it help to tweet that they are isolating after contracting COVID-19 and advising those who may have come in contact to get tested? It’s almost become a status symbol to post such tweets,” he said, adding that he was apprehensive that poll campaigns for the forthcoming Assembly polls will make a huge contribution to the spread of infection far and wide.

"It happened with Bengal elections and it will happen again, many times over in fact because Uttar Pradesh is the most populous state in the country and stakes are high for all parties, especially the BJP. But they care only for votes, not human lives," he said.

Administration relying on mechanical actions

Five of the 11 revenue districts in the capital have witnessed a three-fold increase in daily COVID cases in the past five days, with officials resorting to declare micro-containment zones and plans to cordon off an area, block, colony, or RWA if there are five or more containment zones.

As per official data, South, Southeast and West districts saw the highest spike between December 29 and January 2. In South district, which has been on top of the list since cases started going up, the cases went up from 175 to 484; Southeast district saw a jump from 124 to 492; while West saw cases increasing from 94 to 464.

Cases in Southwest and Northwest districts went up from 94 to 460 and 83 to 449 respectively. New Delhi and Central districts reported 387 and 388 cases respectively, while Northeast and Shahdara districts saw cases rising sharply from 12 to 120 and 17 to 246 respectively.

Speaking on the condition of anonymity, an official posted in New Delhi district said the situation was turning grim and they were just going by rote to declare houses and areas where COVID-19 positive patients were identified through tests at hospitals or elsewhere as containment or micro-containment zones.

“Orders for declaring a house or area as containment zones are being issued mechanically. In many cases it is just a theoretical exercise although the affected people are made to go through a huge inconvenience due to the stigma attached to the label,” he said.

He added, “Despite tall talk being made about ramped up testing and vaccination, not enough tests are being done in the city. Moreover, many people are reluctant to admit infected family members to hospitals, especially when they have mild symptoms which could be attributed to the cold or seasonal flue. As such, official data does not reflect the ground reality.”

He also admitted that curbs mandated by the yellow alert such as the odd-even rule at markets are not being effectively enforced as of now due to paucity of manpower even as voluntary compliance was low.