Delhi chief minister Arvind Kejriwal spoke to Sweta Goswami and Binayak Dasgupta about combating the Covid-19 crisis, the rise and fall in the Delhi virus curve, the strategies that worked, the pitfalls that may still lie ahead, and the road to unlocking all of the city, along with other issues. Edited excerpts:
One month ago, when daily cases were hitting a new record every day, and frantic efforts by the administration did not seem to be working, did you think we would at the point we have reached now – when there is a sustained fall in new infections?
The situation was under control till the last week of May – the time till when the lockdown was in place. When the lockdown opened, our preparedness was there, but the number of Covid-19 cases began increasing at a faster rate. In the first week of June, we did an assessment based on the formula provided by the Central government. It was projected that Delhi would have 550,000 cases by July 31, and 80,000 beds would be required. At that time, we decided to put these projections upfront before the public, and stress that all of us need to work together.
We realised that this virus cannot be fought alone. It needs huge financial, medical and human resources. We studied the entire cycle of a Covid-19 patient to identify problems. Testing was found to be a major problem. People wanted to get tested but weren’t able to. So, we demanded more testing from the Centre. They accepted our request, and introduced rapid antigen detection tests in Delhi, before starting it in any other states. With that, all of a sudden, our testing went up from 6,000 to 20,000-22,000 every day. The problem of testing was over.
The second problem we found was that anyone who was testing positive would invariably come to a hospital. There was a lot of panic. We realised if everyone turns up in the hospital, no amount of beds would suffice. So we started focusing on home isolation. We started advertising stories of people who recovered under home isolation, and we hired a private company which used to talk to these patients through tele-counselling. People started feeling very comfortable with home isolation in Delhi.
There was also an ambulance shortage in Delhi. We were at a stage where at one point as much as 25-30% of the calls received for an ambulance were being rejected. We increased the number of ambulances manifold because of which, today, no calls are being rejected. We also had some horror stories of patients dying waiting in an ambulance outside the hospital. Why? Because the hospitals did not used to admit a patient until the formalities were completed. We then made it mandatory for all hospitals to create a holding area, where a patient is directly given oxygen and other facilities while the all paperwork is being done.
Another challenge was beds. When coronavirus was at its peak and things were not as good as it is now in Delhi, even then we used to have 1,000-1,500 beds vacant in our government hospitals. But, people did not know about the availability of beds. Then we made the Corona App. We also saw that people were choosing private hospitals over our government ones. In the first week of June, there were only 700 beds in Delhi’s private hospitals, of which almost 650 were occupied. We decided to reserve 40% beds in all private hospitals for Covid-19 patients. With this, we created 5,000 new beds within 24 hours. We reached out to hotels as well and attached them with hospitals which then took the total beds further to 7,000.
The other thing was the convalescent plasma therapy, which helped saved lives.
With all these efforts, now we are seeing the curve of daily infections, deaths and positivity rate bending downwards. The positivity rate is down, and the recovery rate is getting better by the day.
But this virus is unpredictable. We do not know how it will spread a month later. So, I am saying again that we should not be complacent. Till there is a vaccine, rules such as wearing a mask and maintaining social distancing and hygiene must be strictly followed by the public.
Looking at what is happening in Delhi, and taking cues from what we have seen in other countries, can we say that Delhi has crossed the peak – or at least its first peak?
Yes, in a sense we can say that we have overcome the difficult situation that we saw in the month of June. But, we must be prepared if this reoccurs. In 1918, the Spanish Flu had seen three peaks and the second peak was much worse than the first one.
Hotels are coming to us with the request of relieving their rooms and beds from Covid duty because the majority of them are lying unused. Same pressure is coming from some private hospitals too. Today, only around 3,700 beds are occupied of the 16,000 Covid-19 beds in Delhi. But we would like to keep things as it is for a few more days before we take any call.
If we take Wuhan’s example from not far back, after beating back infections, it carried out near complete testing of its entire population of 11 million people. Can such an exercise be feasible and can we expect it at some time?
That kind of lull actually has not yet come in Delhi yet. In Wuhan, the count of daily fresh cases reached zero. In Delhi’s case, a downward trend has just begun. There are several best practices from around the world. But we still have to wait a bit till the daily count of fresh cases to come down further. We are happy now because, on June 23, the daily new cases had hit the 4,000-mark. But what we have now – about 1,600 — is not a small number. It needs to go down further.
So, if we were to ask you to define the Delhi Model to fight Covid – what is it?
The five things I said at the start – testing, home isolation, transparent data, hospital beds and plasma therapy – are the key elements.
But we used three principles help us achieve this.
One is teamwork. No one can individually end or handle corona. It is only possible keeping all the egos and race for credit aside. In this various governments, civil societies, religious institutes, everyone has to get involved.
Our second principle is acknowledging constructive criticism and working on fixing the problems highlighted by others. Lok Nayak hospital was shown in very bad light at the start, and rightly so. We understood the problems and fixed all the problems that were highlighted by the people, including the media.
The third principle is that no matter how bad the situation gets, you as a government cannot give up. Recently, a health minister from a state said: ‘Only now God can save us’. (Laughs) I can understand the anxiety and helplessness of that minister. But as a government, you cannot give up – because if you give up, then you cannot imagine the number of deaths that will lead you to.
From the five points we were talking about, home isolation is a key part of Delhi’s Covid management strategy. Even now, some states in the country are making a big mistake by not allowing home isolation. These states are picking anyone who tests Covid positive, even if they are asymptomatic or mild cases, and putting them in quarantine centres. The condition of these centres is pathetic. People do not want to go to quarantine centres, and fear testing as a result. And if you start putting everyone under institutional quarantine, then your Covid health infrastructure will collapse.
Though the Central government was dead against home isolation at one point of time – they passed orders cancelling the system – I am very happy that due to public pressure they saw the importance of the system and put back the old system.
You mention that Centre was opposed to your home quarantine rules. Are you saying that if that order had not been reversed, Delhi would not have seen the improvement we’re seeing now?
That was the most critical point in Delhi’s Covid-19 crisis. If that order was not reversed, and if home isolation was actually cancelled, Delhi’s Covid situation would be extremely bad.
That order by the LG (lieutenant-governor) also included that all positive people would have to line up at Covid Care Centres for medical screening. The treatment to serious patients would have been undermined if they were standing in queues instead of being in hospitals. The order also cancelled the contract of the private company which used to make follow-up calls to all patients recovering under home isolation through tele-counselling.
But, we decided that we will not fight about this. We explained our stand to everyone in the central government in several rounds of meetings, and they ultimately agreed.
So home isolation is the one crucial ingredient?
Testing and isolation are both very important. Many state governments are currently not testing enough. My suggestion to them is to scale up testing in a big way. Let the problem come on the table. Let everyone know the number of cases. If you do not test enough, you won’t know the real picture in your fight against coronavirus. Open centres in every nook and corner of your state; in schools. Antigen testing kits are very easily available now – so test people and isolate them in their homes.
These two things, I feel, the Central government can do across the country on its own.
Union home minister Amit Shah said in an interview in June that Covid deaths in Delhi were high because home isolations protocols were not being followed properly.
The assessment was wrong. Their data was showing that in the first 48 hours nearly 45%-50% Covid deaths happen. But, they did not know that these deaths were hospital death cases and not formal home isolation cases.
In fact, our latest home isolation data shows that from July 1 to July 15, only six Covid-19 deaths have happened. That is not even one death per day. Deaths in home isolation further reduced after we started giving pulse oximeters to all patients – since monitoring oxygen is the key.
The number of deaths in June hit up to 101 deaths on a single day. This has now come down to 30-40 every day. Apart from plasma therapy, how did the government manage to control the fatality rate?
In the beginning of June, Delhi saw a huge number of ‘suspect cases’. We reduced these by augmenting our beds and ambulance fleet and making their availability transparent.
We are currently conducting a study to identify how Covid deaths are happening – in a hospital, Covid deaths can happen either in the ward or the ICU. If a death has happened in a ward, it means there was neglige