“Bhagwan Bharose!”: A black comedy plays out in Delhi as COVID-19 cases surge 

There is blind panic in the national capital. Video appeals posted on social media pleading for help in getting the sick, both COVID-19 and non-COVID patients, admitted to hospitals are growing by the day. Tweets seeking help are being tagged to the chief minister and other officials. But what about those who are not on Twitter and are not connected?

How did Jyotiraditya Scindia and his mother get admission in Max Hospital when the hospital has been denying admission to others for the past four days—when the Delhi Government app showed zero availability of beds in the hospitals?

If asymptomatic cases and patients with mild symptoms are neither to be tested nor hospitalised, how did BJP spokesperson Sambit Patra get admitted in Medanta Hospital?

Is it true that Delhi Government has allowed private hospitals to take a minimum deposit of Rupees three lakh from suspected COVID-19 patients before admission?

Is it true that the cost of getting a test done on four members of a family in private labs is as much as Rs 25 thousand?

Even as such questions blew in the wind and infections and death spiked, the response of the Delhi Government has been hardly reassuring. In a series of flip flops, it first decided to open up the city, allowing malls, offices and liquor shops to open and public transport to resume; it then declared that it would seal the borders to contain the virus and not allow people to move in from the NCR of Ghaziabad, Faridabad, Gurgaon and NOIDA. It then notified that only residents of Delhi would be admitted to hospitals run by the Delhi Government.

Amarpreet Kaur had taken to Twitter in panic after her father, who had high fever, chest infection and breathing trouble, was denied admission by several hospitals she contacted. The family reached out to several hospitals including Sir Ganga Ram Hospital, Max, Apollo, AIIMS and Safdarjung Hospital. All of them advised against bringing in the patient because no bed was available. By the time the family reached Lok Nayak Hospital, her father was declared ‘brought dead’. The family claimed he was alive when they reached the hospital but had died because of the delay in admitting him and providing him with ventilator support.

“The government failed us,” said Kaur.

Delhi government’s Covid-19 helplines are barely functional and people are rarely able to get through. They are all the time busy and despite repeated attempts, it was impossible to get through. On the other hand, the central government’s COVID-19 helpline in Delhi directs patients to Delhi hospitals. Patients are sandwiched between the two and many are dying without access to emergency health care.

“This is the state of affairs when Delhi has 57,000 hospital beds; no other city in India boasts of so many hospital beds,” quips former Union Minister Ajay Maken. Maken provides a break-up and informs that as many as 13,200 hospital beds are in Central Government institutions, around 3,500 under Municipal Corporations and 38 hospitals with 11,000 beds under the Delhi Government. The remaining 29,000 beds, more than 50% of the total, are in private hospitals.

Signs of mismanagement had begun to show by mid-April. Delhi Government, which had been parting with testing data transparently in March, stopped giving updates. After an uproar, it resumed giving testing details but began to under-report COVID casualties without realising it was impossible to hide a dead body. To cover-up, it set up a Death Audit Committee but even in June, the number of deaths released by the government and bodies administered “COVID-19 cremations and burials” do not match.

The state government then released a Corona App to provide live status of the number of hospital beds, ventilators and ICU beds available. However, the data on the app failed to match figures on health bulletins released by the government. Hospitals such as Max, Fortis, Ram Manohar Lohia and Sir Ganga Ram representatives then began to claim that no bed was available for COVID-19 patients, although the app showed the availability of the beds in the hospitals. Faced with a deluge of complaints, the state government in a knee jerk reaction accused private hospitals of ‘black marketing of hospital beds’ or selling beds at a premium.

Delhi heathcare workers were disgruntled too. Nurses at LN Hospital, the dedicated COVID-19 facility in Delhi, were given separate sanitised accommodation only three weeks after the lockdown began and that too following a protest. But doctors were given five-star hotel accommodation within a week.

The state government also shocked the health workers with a notice asking them to show cause and explain how they got infected despite wearing protective gear and maintaining safe distance. After an uproar, this order was withdrawn.

With the rising numbers, Delhi government quietly issued an order severely restricting tests of suspected patients. This order meant that asymptomatic people would not be eligible for COVID tests in Delhi except if they had ‘direct and high-risk’ contact with comorbidities and senior citizens. This was contrary to testing guidelines issued by the Indian Council of Medical Research.

Justifying it, Delhi CM Arvind Kejriwal said, “If every asymptomatic person wants to get tested, our system will collapse. We have sufficient labs and infrastructure, but if 1,000 people walk in for testing daily, our system won’t be able to handle it and the more serious patients would be denied health care.”

But Maken reinforces the growing suspicion among people that hospital beds have been held back in Delhi for VIP patients.

“Only 28% of dedicated COVID-19 beds in Delhi Government hospitals are filled. 72% are vacant,” he claimed in the second week of June. Attempts to get a response from health minister Satyendra Jain and his officials proved futile. We will update this report as and when we receive their response.

The situation is similar in other parts of the country. India never had universal healthcare and by the Government’s own admission it has been spending less than one percent of the GDP on public health. In contrast, the Prime Minister claimed to have sanctioned 10 percent of the GDP or Rs 20 lakh Crore for financial relief, rehabilitation and stimulus in the wake of the pandemic. With Government’s data enjoying little credibility, it is anybody’s guess how much is being spent, where and on whom.

Dr T. Jacob John is not surprised. The virologist and former Professor at Christian Medical College, Vellore, says that the collapse of the public health system was on the cards for several decades. The health infrastructure was already creaking and had no capacity to bear either the sudden load of patients or the sudden injection of funds.

“We do not have universal healthcare. In most countries there is a place, citizens can go to if they fall ill. They do not have to shop around as in India or in the United States. If you shop around, you are naturally on your own. It is nothing new,” says Dr Jacob John, pointing out that this is how it has been all along.

What worries him more is the low number of tests officially conducted in the country. With India having conducted around 47.5 lakh tests for 135 Crore people, he points out, the tests have covered just 0.3% of the population. “Information about 99.7% of the population is neither known nor available to anyone,” he adds.

“We cannot extrapolate the incidence of infection for the entire country from tests done on 0.3% of the population; because those who were tested were the ones who were mostly contact traced or had come in contact with an infected person”.

This is the reason why the government is able to deny community transmission, he feels. If community transmission is taking place, then contact tracing has no meaning, but the government was keen to conduct contact tracing. This was also the reason why the Government pushed so hard for people to download the Arogya Setu app.

“They are deluding themselves by saying there is no community transmission when community transmission is rampant in the untested 99.7% of the population. We have no idea about the infected cases,” asserts Dr John.

The chairperson of the Indian Public Health Association Dr Sanjiv Kumar concurs with the assessment. Contact tracing would help if the infected person is quickly identified and isolated. Picking up cases early and identifying patients and testing them early, he says, was the key. This was perhaps happening in the beginning in Delhi but he is not sure if this is happening now.

“For every positive case, two to four people other people would also get infected. So, people should be isolated and quarantined immediately. If you wait for the test result of one person, then the contacts would have spread the virus to many more people,” he explained. This is what has happened in most parts of the country, say experts. The failure to test early and extensively has led to the present situation, they feel.

In Delhi, feels Maken, the Government was unsettled by the loss of revenue following the pandemic. That would explain the erratic decisions it took while unlocking the city when cases are spiking. Diluting the definition of containment zones and putting a cap on tests, he felt, were part of the same design. The panic prompted the government to be less transparent and now it seems to have lost the plot.

“The first requirement is to bring down the positivity rate to single digit. Be transparent with the data. Increase the number of containment zones. The government’s aim should not be to just fill its coffers. Public health and lives should be of paramount importance,” said Maken. The number of cases would go up with more tests, agreed Dr Kumar. But states need to ramp up tests and utilise their full capacity even now, he felt. The bureaucratic approach needs to be replaced by a public health-centric approach, he held.

While the poor as usual are bearing the brunt of the public health crisis, the middle-class and the relatively affluent too have begun to feel the pinch. They are outraged at private hospitals demanding a deposit of several lakh Rupees for a disease which has no cure yet. Oxygen supply in critical cases is all that is needed but private hospitals insist that they need to follow protocols and conduct routine tests and so on. The patients are also required to pay for Personal Protective Equipment (PPE) for themselves and for the attendants daily, pushing up the rates for all procedures.

There is growing scepticism over the lockdown, which the Prime Minister had claimed would conquer the virus in just 21 days. The lockdown did not inconvenience the relatively well off but decimated the informal economy and the poor. “They along with people on the lower strata of the social hierarchy had to defy the lockdown to survive,” recalls Dr John.

What are the challenges ahead? “We have to work hard to make social contacts safe because the virus spreads through droplets ejected from the mouth and nose. The Western model is a lockdown, while the Eastern model is to make social contact safe. We always copy the Western model and that is a mistake. But, even the West did not lockdown like we did. We simply took the word lockdown and did not check what other countries such as Germany did,” says Dr John.

“We tried a drastic lockdown affecting everybody and all services – essential and non-essential. That was not a good idea. It was cruel. Lockdown should have been announced with a one-week notice and state governments should have been consulted”.

Highly critical of the failed lockdown, Dr John wonders aloud, “On March 19, the Prime Minister had taken personal leadership and said he was in charge of the Coronavirus fight. But where are the extra beds, where are the temporary hospitals, the army’s tented hospitals, ventilators, volunteers and staff that were meant to be created by the disaster management authority?”

What about the meticulous planning that was promised?