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COVID-19: Lessons to be learnt from Delhi, Mumbai

July 27, 2020 08:46 IST

The two cities finally got their act together by ramping up the testing capacity and implementing stricter quarantine norms.

Ruchika Chitravanshi, Sohini Das & Sachin Mampatta report

IMAGE: A health worker collects a swab sample from a person during a check up campaign for the coronavirus disease in Mumbai. Photograph: Francis Mascarenhas/Reuters

With Covid-19 cases rising steadily in India, Delhi and Mumbai, which have turned a corner in fight against coronavirus, could show the way forward in tackling the pandemic.

While daily Covid cases have dropped significantly in Delhi -- from over 3,000 in June to around 1,000 during the last week, the daily growth rate of cases has come down to 1 per cent for both cities.

The drop in the curve, experts say, is partially because of the pandemic playing itself out, and partially because of the two cities finally getting their act together by ramping up the testing capacity and implementing stricter quarantine norms.

In Mumbai, the success of contact tracing in the densely populated slum like Dharavi has been a lesson in enhancing community involvement in controlling the pandemic in such areas.

Both cities conducted house to house surveys by roping in Asha workers and NGOs to track symptomatic patients. “The population density and geog-raphical layout of Mumbai is a challenge. We have a strong team of 3,500 community health volunteers working with us who conducted the surveys. Anyone with SpO2 levels below 95 per cent was taken to Covid-care centres and kept under observation,” Suresh Kakani, additional municipal commissioner, Municipal Corporation of Greater Mumbai said.

While sharing the findings of the Delhi’s sero survey V K Paul, Niti Aayog member and chairman of Empowered Group 1, said: “The disease was accelerating in Delhi but without imposing any new restrictions… by bringing the same measures with more rigour we could control our numbers.”

Experts say now that the crisis seems to be under control, Delhi and Mumbai need to assess their data to understand what worked and what did not.

“Delhi and Mumbai have a huge responsibility in terms of teaching the country what they did right and what they did wrong... In terms of treating severely ill patients they have much more experience,” Rakhal Gaitonde, professor, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum.

Mumbai, for instance, adopted a three-pronged approach -- early diagnosis through door-to-door surveys, strict monitoring of patients for oxygen and glucose level, and early use of steroids and antiviral drugs such as tocilizumab and remdesivir. “Mumbai took some of these clinical management decisions ahead of the country. That is because it always had a high number of patients,” said Dr Avinash Supe, former dean of KEM Hospital, Mumbai, and a member of the state task force on Covid-19.

The other area of intervention has been testing. In the first week of June, when Delhi was conducting 9,500 tests per day on average, the positivity rate was 37 per cent. In July first week, the tests were increased to over 25,000 and the positivity rate came down to 9 per cent.

Experts, however, suggest that the detection of cases in the light of the NCDC’s sero survey, which said 23 per cent of people in Delhi could be affected by coronavirus, has been very low. This also means that the total number of deaths due to Covid-19 may also not have been captured accurately.

“Delhi should have peaked in July instead of June... The city did not anticipate the problem and prepare for it adequately,” said Jacob John, former head, virology department, Christian Medical College, Vellore.

According to Thyrocare’s pin code data, the seroprevalence -- presence of antibodies in the population -- is around 34 per cent in Delhi and 27 per cent in Mumbai. Some experts believe that unless the prevalence reaches 70 per cent, we would not be safe from the virus. 

Ruchika Chitravanshi, Sohini Das & Sachin Mampatta
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