Delhi needs coordination across agencies and proactive leadership to fight Covid
The recipe for the earlier successes included close technical coordination between central, state and municipal agencies as well as a proactive political leadership, ably backed by a strong public health establishment of the Municipal Corporation.
A boy at Delhi’s Sarojini market after the easing of lockdown restrictions (Express Photo by Amit Mehra)
The cumulative COVID-19 case count for Delhi crossed 85,000 by the end of June, the highest among the country’s megacities. Delhi’s test positivity rate also increased (that is, worsened), despite a four-fold increase in daily testing, between mid-May and mid-June, coinciding with Lockdown 4.0 and Unlock 1.0. This period also witnessed a marked rise in daily cases, from an average of about 300 to more than 3,000 — it has since come down to about 2,000. The warning bells were loud and clear, culminating in meetings between the Union and Delhi government along with the mayors of the city’s municipalities.
Despite an impressive early start, the initiatives in Delhi seem to have lost steam along the way. The “revised” testing guidelines — of only testing symptomatic contacts of COVID-19 patients — attracted some criticism, as did the handling of the private sector, particularly on the issue of price caps. The issue of data management and the government-appointed death audit committee certifying “official COVID deaths” showed the Delhi government in poor light. There were reports of “horrific scenes” regarding the lack of dignity in handling the dead. This culminated in the Supreme Court making adverse observations about the Delhi government.
Delhi has now set up large temporary hospital facilities with support from the Indo-Tibetan Border Police (ITBP) — more facilities are likely to follow. But the ambitious door-to-door survey, mass screening and the sero-survey projects are not sailing smoothly going by reports. The submission of the Delhi government before the High Court on June 29 was ominous — it was facing a shortage of human resources with at least 2,000 healthcare professionals being infected and four doctors losing their lives.
Getting a handle on this crisis was never going to be simple. Success stories of various “models” from around the country abound, but the cold truth is that this is not about models but playing the game of epidemiology by its basic rules. The term “incident management” describes the activities an organisation takes to prepare, respond and learn from an event or hazard. The epidemiologist’s skills and expertise apply to scenarios that require enhanced preparedness and responses even when pathogens associated with outbreaks are poorly characterised or when they require additional interventions. These interventions are not necessarily pathogen-specific and apply to a range of infectious diseases outbreaks. The command structure and system is extremely crucial to incident management and epidemiologists are trained for that function. The Delhi government has reportedly never revealed if there were any epidemiologists or virologists in its task force.
The invocation of the National Disaster Management Act (2005) early on brought a sense of much-needed urgency but also led to an over-reliance on generalist bureaucrat-administrators. The situation did not evoke an adequately broad-based response from the government as the inter-disciplinary and inter-agency nature of the challenge warranted. Delhi has for long been riddled with a multiplicity of agencies, and political, resource-linked and inter-agency conflicts. Yet, epidemics were successfully managed in the past. Care systems and information-communication systems are now vastly improved. Therefore, the current failure is even starker. The recipe for the earlier successes included close technical coordination between central, state and municipal agencies as well as a proactive political leadership, ably backed by a strong public health establishment of the Municipal Corporation. The weakening and marginalisation of municipal structures and the failure of the incident management system has badly exposed chinks in the armour.
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On June 29, the Director General, WHO, cautioned: “This is not even being close to over”. Disaster management principles are typically designed for short-term acute needs. Perhaps the leadership was guided by the notion that “flattening the curve” shall automatically follow a stringent lockdown — this perhaps explains the elaborate securitisation. Caleb A Scharf observed in his article in Scientific American (May 14) that the COVID response, in general, has been marked by a “failure of imagination” and “a state of cognitive lockdown, flipping from one small piece of the problem to another and not quite building a cohesive whole”. Delhi needs to reset itself and prepare for the long haul. In short, reignite the imagination.
This article first appeared in the print edition on July 10, 2020 under the title ‘A cognitive lockdown’. Dasgupta is professor at the Centre of Social Medicine & Community Health, JNU and former deputy health officer with MCD.
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