On Tuesday, 27 October, 4,853 new cases of COVID-19 were recorded in Delhi in a single day, the highest spike it has ever witnessed since March when the virus first hit home.
This is the fourth time in the past five days that the city has crossed the 4,000 mark, and the eighth time in the last 10 days that it has seen over 3,000 cases in a day.
The previous record of daily cases was 4,473 on 16 September. The last two weeks have seen a stark rise in the cases, with Delhi crossing the 3,000 benchmark on 13 October, and over 4,000 cases on 23 October - barely 10 days later.
The total number of COVID-19 cases recorded in the city is now over 3.64 lakh, out of which active cases are 27,873 and recoveries are 3.3 lakh.
The case graph for the national capital shows three distinct peaks so far. The first during the end of June, the second in mid-September, and the third appears to be now, end of October.
In the press briefing on Tuesday, the Union Health Ministry expressed concern over the spike in cases in Delhi and a few other states like Kerala, West Bengal, Maharashtra, Karnataka, owing to the festive season.
Speaking at the briefing, Rajesh Bhushan, Union Health Secretary, shared that the troubling aspect of the situation in the national capital was the high positivity rate of infection.
“What is worrying is the cumulative positivity rate of 8.06 per cent. New cases and positivity rate have to be seen in tandem. When you look at these two together, questions are raised. How many tests are being conducted? How many are RT-PCR and how many are antigen? Those who are symptomatic negatives in antigen... are they all being retested through RT-PCR? If not, are they spreading the infection?”Rajesh Bhushan
Delhi Health Minister Satyendar Jain has partly attributed this rise in case positivity rate to contact tracing and targeted testing of the population. He said on Tuesday, “If one person tests positive, we are looking for all their family members and contacts and getting them tested. This strategy is being closely monitored. What we have seen is that if one person tests positive, usually several members of the same family test positive.”
The Centra has also noted that almost 50% of all cases in Delhi were coming from containment zones. “We have seen the efforts that were being made to contain the disease spread in Delhi that has led to about 50% of the cases being reported from designated containment zones,” NITI Aayog member Dr VK Paul said during the briefing.
The Role of Testing: More RT-PCR Tests Being Conducted
Importantly, the spike in cases in Delhi has been accompanied with an increase in the number of reverse-transcription polymerase chain reaction (RT-PCR) tests. According to a report, over 15,200 RT-PCR tests were conducted over the last seven days in Delhi, up from 13,900 the week before, and 10,471 the week before that.
Additionally, follow-up testing with RT-PCR has also been increasing lately. 85% of the symptomatic patients, who tested negative for COVID-19 in the rapid-antigen test, have been retested by the health authorities this month through RT-PCR, PTI reported citing official data.
In September, merely 10 to 15% of such cases were being followed up with an RT-PCR test.
It is critical to note here that RT-PCR is considered the gold-standard in COVID-19 testing. The alternative that is being used heavily in Delhi - rapid antigen test - is less accurate and could miss several positive cases. This is what is likely to have happened in September.
The rise in retesting follows a directive issued by Special Secretary (Health and Family Welfare) Udit Prakash Rai last month to ensure that all symptomatic negative cases of rapid-antigen tests are tested again using RT-PCR.
Deaths and Hospitalisation
44 COVID-19-related deaths were recorded in the national capital on Tuesday, taking the total to 6356, and amounting to a seven-day average case fatality rate (CFR) of 1.01%. The cumulative CFR (the total number of cases and deaths recorded so far) is 1.74%, which is higher than the national average of 1.50%.
It must be noted, however, that the cumulative CFR today is still much lower than the recorded CFR during the previous spikes in Delhi. On 23 June, for instance, when 3974 new cases were recorded, the CFR was 3.45 percent. Subsequently, on 16 September, when the city added 4473 cases (highest till then), the CFR had come down to 2.1%.
This means that even though the cases have been rising right now, the proportion of deaths is lower than what it was then, which could be indicative of better preparedness and control of the situation than earlier.
With the increase in the number of cases over the last two weeks, the number of hospitalisations has also risen. There are over 5,400 people admitted to city hospitals with COVID currently, a rise of almost 300 from last week (5149 on 20 October).
While over 10,000 beds designated for COVID patients are still vacant, nearly 60% of the ICU beds are reportedly occupied, according to the Delhi Corona app.
In conversation with FIT, Dr Sumit Ray, a senior consultant of Critical Care Medicine at Holy Family Hospital in Delhi, who runs a COVID ward, said that ICUs have remained 50-60% occupied for almost five weeks now.
“Ever since the second spike in mid-September, there has been an increase in regular as well as ICU admissions in our hospital, and it has remained at that high plateau. So we haven’t seen an unusual rise now, it has simply remained high. But it is also important to note here that if at all the current spike in cases were to reflect in hospital admissions, it would only reflect in the ICU numbers about two weeks later.”Dr Sumit Ray
“We are trying to put in more Bipap and non-invasive ventilation on our existing beds in the wards to create more intensive care beds,” said a senior Delhi government official, according to a Hindustan Times report.
“Delhi has been showing an up and down trend — this is the third time numbers are going up. Delhi is a mixing pot of people, and this non-steady-state is expected. There has been a lot of in-migration from other states — with some bringing the infection. That, coupled with the relaxation of discipline has led to a rise in cases,” Dr T Jacob John, former head of the department of clinical virology at Christian Medical College, Vellore, told HT.
Coming Months in Delhi Will Be Crucial, Experts Have Warned
In Delhi specifically, air pollution is an annual menace that adds to hospital admissions, respiratory issues and lung ailments. Combined with a fall in temperature, the situation could worsen immeasurably for COVID-19 management.
“During the festive season, cases have increased in Kerala, West Bengal, Maharashtra, Karnataka and Delhi," said Rajesh Bhushan, Secretary, Health Ministry in the press briefing.
“Health Ministry is in contact with all these states, where central teams have been sent. A few teams have returned after completing the task allotted, and after analyzing their report, further actions will be taken in formulating new strategies to be adopted in these states.”Rajesh Bhushan
With the pollution mounting to dangerous levels, the Centre and state governments have also leaped into action. On Monday, the central government told the Supreme Court it would create a permanent body through legislation to deal with the annual air pollution problem in Delhi and surrounding areas.
(With inputs from The Hindustan Times)