Since the onset of the COVID-19 pandemic in India, the approach of the Aam Aadmi Party (AAP) government in Delhi has been clear—de-politicise all governance activity in the national capital. Prime Minister Narendra Modi's clarion call of ‘minimum government, maximum governance’ is being honoured in the national capital. Delhi’s approach towards Covid was lauded by the Prime Minister at a Cabinet Meeting on July 11. What has come to be known as the Delhi Model is not a fixed monolith, but an approach that adapts to counter the frustrating mutations of COVID-19.
The newest concept embraced by the Delhi government is that of post-COVID-19 care. The state’s Department of Health and Family Welfare has set up a post-COVID-19 care clinic at the Rajiv Gandhi Super Speciality Hospital in North East Delhi, which became functional on August 20. The clinic has a counselling centre; a yoga room; a physiotherapist, neurologist and endocrinologist; a team of general physicians for primary examinations; and laboratory testing facilities. According to Dr BL Sherwal, medical director of the hospital, an increasing number of patients were experiencing a relapse of symptoms but were reluctant to re-enter COVID-19 hospitals for further care, which is why such a post illness centre is needed.
Delhi’s Department of Health and Family Welfare has constantly adapted its model to tackle the spread of the deadly virus. During the lockdown, the primary need was to feed those who had lost their livelihoods. At that time, the Delhi model was focused on providing food and shelter for those in need. NGOs and civil society members were able to identify hunger relief centres, temporary shelter homes and active ration shops through a dedicated website. The government was also able to scale up the daily food programme to cover two meals a day for about 10 lakh people. At the same time, Chief Minister Arvind Kejriwal launched ‘Operation Shield,’ the primary goal of which was to contain the spread of the virus at the street level for minimal disturbance in the city. Through decentralised management, Delhi assembly members, the BJP-led Municipal Corporation of Delhi, district magistrates and the police were involved in mitigation efforts.
On June 1, curfew timings were relaxed, and salons, shops, malls, restaurants and hotels began operations. Kejriwal was quick to identify that unlocking and restarting businesses as the real challenge. Despite being fully functional, Delhi saw a 44 percent decline in the number of COVID-19 deaths in early July as compared to early June (Figures shared by Government of NCT of Delhi: 605 deaths between July 1-12, and 1,089 deaths over the same period in June). The consistent decline in the number of cases is a result of transparency and teamwork in each of the experiments undertaken. The national capital's coronavirus positivity rate has again shot up as 7.4% of the total tests undertaken in the last week came back positive. One of the key reasons for this is the return of migrant workers. To curb the return of the virus, a rapid antigen test centre has been set up at the interstate bus terminal (ISBT) in Anand Vihar. in light of migrant workers returning to the capital with the slow revival of the economy.
“To formulate tracking, the last prong of the strategy, a sub-committee with representation from public sector, academia, and private sector was established. Within the committee, a technical task-force composed of experts from various sectors was charged with ideating and designing situation-appropriate policies. A centralized dashboard, containing up-to-date information on COVID-19 beds and ventilator capacity was established and is shared with the public via a mobile and web application. While tracking and data collection efforts have been decentralized through district magistrates and other local authorities, critical information is compiled in a central NODE monitored by the Chief Minister’s Office. Additionally, clear channels of internal communication are maintained to enable effective top-down policy implementation,” said Roshan Shankar, convenor of the technology and innovation group that developed and maintained IT platforms for COVID-19 management in Delhi.
At the start of June, social media was abuzz with complaints on the lack of beds for COVID-19-positive persons and the incorrect data on bed availability. Yet two aspects were left unexamined in this discussion. First, the availability of beds in government and private medical instritutions did not match patients’ needs. Factors like familiarity with the doctor, distance from one’s own home and preference for a private hospital added to the chaos of the unprecedented situation. Second was the dearth of medical personnel. While the government arranged nearly 15,000 beds (including in banquet halls, hotels and convention centres), medical staff could not be readied overnight. The government even set up a helpline number where doctors wishing to volunteer for the government’s COVID-19 telemedicine helpline were asked to give a missed call. Besides the fear of infection, healthcare workers also had to face an economic setback as routine surgeries were put off and outpatient clinics were closed during the lockdown.
When the government noticed that the rush at hospitals mainly comprised patients who did not need professional monitoring, the home isolation plan was launched. The distribution of pulse oximeters helped people self-monitor more effectively. If authorities noticed a dip in a person’s oxygen levels, oxygen concentrators were dispatched to their homes or they were brought to COVID-19 care centres, depending on the severity of the situation.
Once plasma therapy proved successful in some cases, the Delhi government sought permission from the Centre to offer the treatment technique at the Lok Nayak Jai Prakash Narayan hospital. On July 2, the first plasma bank came into existence. The government honoured those who donated plasma by providing them with certificates signed by the chief minister. This was one way to destigmatise plasma donation and ensure that other patients could be helped as well.
Once plasma therapy proved successful in some cases, the Delhi Government sought permission from the centre to offer this treatment technique at Lok Nayak Jai Prakash Narayan hospital. On July 2, the first-of-its-kind plasma bank came into existence. In a country like India which has a massive shortage of blood, donation of plasma needed to be destigmatised and the government knew that well. As per review on challenges and opputunities on plasma fractionation, ‘The issues related to plasma fractionation industry did not come up for serious discussion at higher level of deliberation….This could be one of the reasons that many of the haemophiliacs who received contaminated lyophilized cryoprecipitate during late 1980s and early 1990s died silently without any large public outcry and any compensation.’ The Delhi government’s push for plasma donation in Covid cases has created awareness which will benefit other patients in the long run.
COVID-19 has an asymptomatic character. To help identify antibodies in fit population that could potentially increase the number of plasma donors, nearly 160 antigen detection test (a rapid test) centres have been set up in the capital over the last month, along with two plasma banks (at Lok Nayak Jai Prakash Hospital and at Rajiv Gandhi Super Speciality Hospital). Delhi Health Minister Satyendar Jain said his department came up with ideas as the need arose. “Our government has constantly re-strategized, been open to advice from the people and engaged experts. The goal is to make Delhi a Covid-free zone,” he said.
The Delhi model is multi-layered, extensively decentralised in operation, and centralised through an information dashboard. The state government collaborated with the Centre, NGOs, religious institutions and civil society to combat COVID-19. Although there has been a rise in daily numbers of positive cases in recent days, the challenge lies in the in-flow of patients from neighbouring states who are seeking treatment in Delhi. The government has continued to inaugurate new medical facilities, such as the 600-bed hospital in Ambedkar Nagar, with 200 beds earmarked for COVID-19 patients.
On July 31, Kejriwal constituted four committees to examine the cause of COVID-19 deaths in 11 Delhi hospitals. Breaking down the causes into smaller issues—such as why there are more deaths in certain wards and whether patients are being taken into ICUs on time—has helped strengthen the Delhi government’s response.
COVID-19 is not going to disappear anytime soon, but as long as government efforts such as those by Delhi do not cease, hope remains.
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Pallavi Rebbapragada is an author a journalist and a Research Fellow attached to the Department of Health &: Family Welfare Government of NCT of Delhi.
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