Coronavirus tests the limits of India’s capital
Even as COVID-19 cases and deaths are rapidly rising in the capital, the AAP government is grappling with complaints of under-reporting, inadequate facilities and exploitative private hospitals. Nikhil M. Babu reports on how it frittered away an opportunity to ramp up healthcare facilities during the lockdown period
On February 29 afternoon, when 45-year-old Rohit Dutta walked into the Ram Manohar Lohia Hospital in New Delhi to take a COVID-19 test, he didn’t think the hospital would ask him to stay the night. The process of getting admitted was “very easy” and the stay “extremely comfortable,” he said. The next day, at around 8 p.m., the doctors said they would move him and three other patients suspected of having COVID-19 to a “better facility,” Dutta said. “They shifted us in an ambulance to the Safdarjung Hospital. We didn’t have to arrange for anything. The next morning, at Safdarjung, three doctors approached me and asked me sit down. I knew then that I had tested positive for COVID-19,” he said.
Dutta, a businessman with a travel history to Italy, was Delhi’s first confirmed COVID-19 case. On March 10, after lunch, he received an unexpected call. It was none other than the Union Health Minister, Dr. Harsh Vardhan, calling to enquire about his health. “He called me on WhatsApp and asked me if I faced any problem. He asked me what I ate. He told me that even the Prime Minister had enquired about my health,” he said. Four days later, Dutta walked out of the hospital relieved and happy, after testing negative twice for the virus.
That was the Delhi of three and a half months ago. Today, the story is starkly different. On June 14, Rohit, 25, clambered onto his scooter. He left his house in Azadpur, in north-east Delhi, in search of a hospital to admit his mother who had tested positive for the virus. “I first went to AIIMS. Then I went to Safdarjung Hospital and then to Ram Manohar Lohia Hospital. None of them had beds despite the Delhi government app, Delhi Corona, showing us beds being available. Finally, I reached GTB (Guru Teg Bahadur) Hospital. There the authorities told me that beds were available,” he said.
But Rohit’s problems did not end there. “I called 102 (the emergency number for an ambulance), but no one answered. I had to pay ₹5,000 for an ambulance to get my mother admitted,” he said, at the parking area of GTB Hospital, where he had spent the previous night. Rohit said his mother, Rajkumari, was miserable in the hospital. Doctors were busy and there was no one to attend to her. “Yesterday, she called me at 12 p.m. and told me that she was not getting water. I bought two bottles of water. I asked many people for help and finally a guard agreed to give her the water. By the time she got the water, it was around 4 p.m.,” Rohit said. Food for her was kept outside the door of her room, but she had trouble walking which made it difficult for her to get it, he said.
The contrast between the two stories paints a picture of the Delhi government’s handling of the COVID-19 crisis. From having an initial grip over the situation, the Aam Aadmi Party government is now fighting several accusations — of delayed decision-making, poor planning, hiding data on the dead, disappearing numbers, and poor testing — even as it grapples with the surging cases. Further, unlike Mumbai, Delhi is yet to cap the charges for treatment of COVID-19 in private hospitals. On June 12, the Supreme Court expressed shock at the videos of the “deplorable conditions of wards” and the “pathetic condition of patients” in Delhi hospitals. The Centre intervened, with Home Minister Amit Shah calling for a meeting with all the stakeholders in Delhi. However, with estimates showing cases rising rapidly over the next two months, the government is worried. Chief Minister Arvind Kejriwal described the challenge as being “unprecedented”. The government will do its best to salvage the situation, he said, even as he urged neighbouring States to help create more facilities so that fewer people come to Delhi from these States.
A cluster, and a delayed response
How did things come to such a pass? On April 1, at around 5 a.m., the last bus carrying people from a religious centre in Nizamuddin left the area. A total of 2,346 people had been evacuated from the headquarters of the Tablighi Jamaat, according to the Delhi government. Evacuating them was the government’s first big challenge, and the religious congregation for which they had gathered, one of its first failures.
The religious congregation was held in mid-March despite two orders by the Delhi government restricting the size of gatherings. The attendees of the congregation violated the orders, while the police and the Delhi government failed to enforce the orders. A local police station was hardly 100 metres from the Markaz. In the weeks that followed, about 3,000 people, including those evacuated, were traced to the religious gathering and about 1,100 of them tested positive for COVID-19 in Delhi alone, according to officials. In parallel, the number of healthcare workers and their family members who tested positive too gradually increased.
Though the first case was reported on March 2 and though a huge cluster of cases was reported from Nizamuddin in late March and early April, it was only in June that the government issued a flurry of new orders aimed at fixing basic issues in hospitals. After reports of numerous complaints from people about lack of helplines, lack of help desks in hospitals, and lack of information on availability of beds, on June 2 the Delhi government launched an app to enable people to check the availability of hospital beds. In addition, 1031 was launched as a Central helpline number. On June 4, the government ordered all hospitals to create a 24X7 helpline number for people to register their complaints. On June 6, Kejriwal released a government order that patients suspected of suffering from the disease cannot be denied treatment by any hospital. A June 7 order said that “some patients” are facing difficulties in admission in government hospitals. Hospitals were ordered to set up a 24X7 help desk. Another order on the same day noted that rules were not being followed in “letter and spirit”. A senior nursing officer was to be appointed in each private hospital to monitor the admission of patients.
“Delhi did not do as well as one would expect,” M.C. Mishra, former AIIMS Director, told The Hindu. “These things should have been done in the beginning. Things were not planned properly.” To this a Delhi government spokesperson responded: “Initially, no one expected that the situation would get this big. Also, at different stages our main challenges were different and we kept addressing them. Whenever we noticed issues, we fixed them.”
The sorry plight of patients
Issues have not been fixed, however. On June 16, at the GTB Hospital, there was no help desk, no helpline number displayed, and no LED board displaying the number of beds. Rohit said he could not find any help despite all the government orders. “There is no one to listen to us. The guards are also very rude,” Rohit said. Hospital authorities blamed the Public Works Department for its failure to provide the information on a LED board.
At the Lok Nayak Jai Prakash Narayan (LNJP) Hospital, there is a help desk, and information on the number of beds is displayed, but the hospital has been in the spotlight for all the wrong reasons. There was shock and anger when a video surfaced of a naked body lying under a bed in a ward in the hospital, Delhi’s biggest COVID-19 treatment facility. The Supreme Court took note of the video, but Delhi’s Health Minister, Satyendra Jain, dismissed it as the “mischievous” act of a contract staff.
In the blistering heat, on June 15, Sandeep Kumar, 21, and his father sat on the steps of LNJP Hospital, tired and helpless. “My mother was admitted here on June 9. But they are yet to tell us whether she has tested positive or not. She has breathing issues,” said Kumar. The doctor on duty said people often provide the wrong number or switch off their phones making it very difficult for hospital authorities to reach them.
At the Max Super Speciality Hospital in Patparganj, Divya Sharma, 28, was angry. She had come with her father who was complaining of shortness of breath. She said they had to argue for nearly half an hour with the hospital staff who told them that beds were not available. “They did not allow him inside though he was sweating in an air-conditioned car. His condition was really bad,” Sharma said in the waiting area of the hospital. She went to the hospital because the government app showed beds being available there, she said. In the admission area of the hospital there was no notice displaying the number of vacant beds or the rates for treatment, despite government orders. By 6 p.m., Divya’s father, Sanjay, died at the hospital. Max Hospital refused to comment.
While there are some families like the Sharmas who are being refused admission in private hospitals due to lack of beds, there are other families in Delhi that simply cannot afford private hospitals. Private hospitals in Delhi have been demanding anywhere between ₹2 lakh and ₹8 lakh for COVID-19 testing and treatment even before patients get admitted into hospitals. Responding to reports on the issue, Kejriwal said his government would not allow “black marketing” of beds in private hospitals.
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In contrast, in mid-March, the Brihanmumbai Municipal Corporation announced that private hospitals in Mumbai allocating isolation beds for COVID-19 patients will have to limit their charges per bed to ₹4,000. On May 21, the Maharashtra government said in a notification that 80% of beds in private hospitals would be regulated to ensure that patients are billed according to the government price cap. While the charges for a COVID-19 patient in an isolation ward cannot be more than ₹4,000 a day in the State, the maximum charge for an intensive care unit is capped at ₹7,500 a day, and charges for a ventilator are capped at ₹9,000 a day. Also, items such as personal protective equipment cannot be charged over 10% mark-up on the net procurement cost.
Ten days since Kejriwal made that promise, there are still no details in the public domain of action being taken against Delhi hospitals that are charging such high rates. Nor has the government capped the rates. The Delhi government spokesperson said that they were working, along with the Central government, on capping the prices. “It will happen soon,” she said. On June 19, the Union Home Ministry said that a committee set up by it has recommended capping the price of isolation beds for COVID-19 patients in private hospitals in Delhi in the range of ₹8,000-₹18,000 per day.
Medical staff guiding a patient at the COVID-19 ward of the LNJP Hospital in Delhi. | Photo Credit: R.V. Moorthy
Apart from complaints of exploitative billing, the government is also facing complaints of under-reporting cases and deaths. Delhi has had a serious data problem since the COVID-19 outbreak. First, in the second week of May, The Hindu reported that the total number of COVID-19-related deaths reported by the Delhi government was fewer than the number of deaths being reported by hospitals. The government responded that the hospitals sent data on deaths to a government-appointed death audit committee, and only deaths certified by the committee were counted as part of the official death toll. The government blamed the hospitals for delaying reporting deaths. And thus ensued a blame game between the Delhi government and the city’s hospitals. On May 14, the government stopped releasing the hospital-wise number of COVID-19-related deaths happening in the city.
Second, from April 15, the government stopped providing details of cases “under investigation”. In a “case under investigation”, it is unknown how a patient got infected by the virus, suggesting chances of community transmission. The health bulletin on April 14 had 85 cases that were “under investigation”. After that, the category was simply removed from the bulletin.
Third, data on testing too has been inconsistent. At one point, the government stopped providing details of the number of COVID-19 tests being done and began to provide the data again only after a High Court order on May 4.
Fourth, there has been a drop in daily testing in June. During the first week of June, daily testing fell to 3,700 even though the government had a capacity of 8,600 tests per day. The Delhi government said it was a “momentary drop” and that the number of tests per million of the population in Delhi was higher than the national average.
Fifth, on June 2, the Delhi government issued an order limiting the scope of people who can be tested for COVID-19. Also, eight labs were asked not to collect samples and conduct tests as they allegedly violated Indian Council of Medical Research guidelines.
Finally, the number of containment zones also reduced. On May 18, the Secretary of the Health and Family Welfare Department, Padmini Singla, raised this issue in an order. She said the number of containment zones had gone down despite cases going up. A month since then, the number of containment zones has increased from 73 on May 18 to 247 on June 17.
A controversial decision
Through the months of March, April and May, Kejriwal made multiple statements assuring people that “things are under control” and that “there was no need to panic”. He said on June 2 that “Delhi is four steps ahead of corona”. Sufficient arrangements have been made for a potential increase in cases, he said. But on June 7, he said Delhi government-run hospitals and private hospitals would be reserved only for the residents of Delhi. He cited an expert committee report and suggestions from lakhs of residents who apparently said that Delhi hospitals should be reserved only for the people of Delhi. “The expert committee has said that if we open the hospitals for all, then the 9,000 beds that the Delhi government has kept for COVID-19 patients will be filled within just three days,” Kejriwal said.
The decision came under criticism from many quarters. “It was made overnight. The government shouldn’t have gone forward with it as the High Court had struck down a decision for preferential treatment for Delhiites in the GTB Hospital in 2018,” a Delhi government official told The Hindu.
On June 8, the Lieutenant Governor of Delhi, Anil Baijal, overruled the Kejriwal government’s controversial decision as well as a June 2 order restricting testing. Harking back to a series of Supreme Court judgments, Baijal said that the right to health is an integral part of the right to life under Article 21 of the Constitution.
In the next three days, the 9,000 beds in the city did not get filled as Kejriwal said. As on June 17, 4,245 of the 9,647 beds were vacant, according to the Delhi Corona app.
But why did the Delhi government take such a decision in the first place? The capital witnessed its first 1,000-plus daily new cases on May 28. The number of daily new cases has been consistently exceeding that mark since then, except on one day. The committee which recommended restricting access to hospitals was formed on June 2. An earlier committee, headed by S.K. Sarin, formed by the Delhi government, had not made any such recommendation.
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“We had made an extensive plan on the need for beds at different stages, based on the recommendations of the Sarin Committee. It included details on when we should start acquiring banquet halls or stadiums. The plan was already in place during the lockdown. And we are ramping up facilities whenever cases reach a particular mark. Our preparations have been ahead of the virus,” the Delhi government spokesperson said.
K. Srinath Reddy, President of the Public Health Foundation of India, does not think so. “The lockdown should have been used to ramp up systems. But that level of organisation and planning has not been done in Delhi,” he said. Mishra said the government panicked. “They thought they won’t be able to cope with the increase in cases. It was an impulsive decision,” he said.
On June 9, the Deputy Chief Minister of Delhi, Manish Sisodia, said after a meeting with the Lieutenant Governor that the latter had not done “any calculation” on the requirement of beds before overturning the government’s decision. Kejriwal said 1.5 lakh beds would be needed by July 31, based on estimates. The AAP government has ordered the Taj Man Singh Hotel to isolate all its rooms and place them at the disposal of the Sri Ganga Ram Hospital. It has began to convert a large tent of the spiritual organisation, Radha Soami Satsang Beas, to a 10,000-bed COVID-19 facility. It has also identified 77 banquet halls which are expected to have 11,229 beds. A panel formed by the government had suggested in June that Pragati Maidan, the Talkatora Stadium, the Thyagaraj Stadium, the Indira Gandhi Stadium, the Jawaharlal Nehru Stadium, and the Dhyanchand National Stadium be converted into COVID-19 facilities. “These beds should have been arranged a little earlier. But now work has gathered speed,” the Delhi government official said.
When Baijal overturned the two decisions by the AAP government, the Centre stepped in. Shah reviewed the preparedness of Delhi in a meeting with Baijal and Kejriwal. After the meeting, he said testing would be increased two-fold in the next two days and three-fold after six days. He said testing will begin at every polling station in containment zones after a few days. He promised to provide 500 railway coaches to augment bed capacity. On Wednesday, the Central government capped the price of COVID-19 testing in Delhi at ₹2,400.
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Seeing the chaos in Delhi, Dutta said he considers himself lucky for being infected at the beginning of the epidemic and not later on. “What is happening is depressing,” he said. “I would have faced problems if I was infected now. The government did not prepare well.”