5 reasons why Delhi’s Covid-19 cases spiked

From the mental fatigue of wearing masks, to opening of markets, and the threat of a second wave, several factors can be behind the resurgence of cases that Delhi has seen in the past few weeks. A look five key reasons that can be behind the spurt.

1. POOR MASK DISCIPLINE

Experts have repeatedly pointed out the laxity across the city when it comes to people wearing masks. While the police have started enforcement of masks inside cars, mask discipline and enforcement remains an area where the Capital leaves a lot of room for improvement.

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Data accessed by HT shows that nearly 175,000 people have been fined by Delhi Police for not wearing masks till August 23. “It is good that the people of Delhi have become confident, but it shouldn’t lead to complacency. People should always wear masks,” Delhi chief minister Arvind Kejriwal said on Wednesday.

During the Union health ministry briefing on Tuesday, Indian Council of Medical Research (ICMR) director general Balram Bhargava had blamed people who do not wear masks for driving the pandemic in India. “I would say irresponsible, less cautious people who are not wearing masks and not maintaining social distance are driving the pandemic in India,” he had said.

What can be done: Enforcement of mask regulations, including proper use with both the nose and mouth covered,must further strengthened. More awareness campaigns needed to emphasise on the importance of wearing masks

2. REOPENING OF THE CITY

On top of the list of guidelines by World Health Organization for control of Covid-19, is the request to people against going to crowded places. “Where people come together in crowds, you are more likely to come into close contact with someone that has Covid-19 and it is more difficult to maintain physical distance of 1 metre,” the advisory states. This formed the backbone of argument in favour of hundreds of lockdown enacted across the world.

The rise in cases in Delhi has coincided with the gradual reopening of city -- workplaces, markets, malls, restaurants, hotels and weekly markets. The last two have been opened just last week. There are also talks underway to open the Delhi Metro, which carries around 2.5 million people every day.

“As per the second sero survey report, nearly two-thirds of the city’s population is still unexposed (thus susceptible to Covid-19)... And if you create opportunities for people to mingle, then it will increase the chances of transmission of the infection,” said Dr Lalit Kant, former head of epidemiology and communicable diseases at ICMR told HT.

What we can do: The government needs to ensure that the city opens carefully, and that social distance is maintained in shops, markets and public transport, be it buses or Metro

3. PLATEAU IN TESTING

The rise in cases has corresponded with the number of daily tests being on a near-steady drop from peak levels. The seven-day average for tests stands at 17,924 — significantly off the peak of 21,660, which was for the week ending July 9. HT first reported this plateau in a report on August 15 when experts raised questions about whether the Capital is getting complacent in its testing strategy.

This drop in testing was acknowledged during Wednesday’s press briefing by Kejriwal, who said there are plans to double the numbers in a week – from roughly 20,000 tests to 40,000 per day.

Another issue with Delhi’s testing has been the heavy reliance on antigen, or rapid tests, which are not as reliable as the gold-standard RT-PCR tests. While ICMR says that at an average, around 30-40% of tests across India are antigen tests, which give out a higher number of false positives. In Delhi, this number has averaged around 70%.

What can be done: The government must maintain a very steady rate of high testing for a prolonged period of time and ensure that the number RT-PCR tests are increased, and that they are used at full capacity.

4. STATISTICAL VARIATION

A common occurrence among all Covid-19 statistical analysis across the world has been that infections can rise and drop in spurts. Several factors such as incubation period, delay/lag in test results, and age of infected patients can push heavily influence the daily (and by extension, weekly) numbers emerging out of any area. For instance, the incubation period for Covid-19 can vary between one to 12 days, so the same people who got infected on a day can test positive as much as 11 days apart.

Such variations in case rates have been visible throughout the world with cases rising and dropping in cycles. Countries such as Brazil and the United States generally see massive variation in daily data. Delhi had been one of those regions that had not seen major variation in daily cases. Therefore Delhi’s recent spurt in cases may also be connected to recent statistical spurt which may have been influenced by multiple factors.

What can be done: Statistical variation can be countered by closely monitoring any change in datasets from the city such as daily positivity rate, reproduction factor, and doubling rate

5. SECOND WAVE COMING?

Although the government and experts still say there is no second wave Covid-19 in Delhi, the chances of that happening in the not-too-distant future remains high.

Several countries, including those that have been lauded by global health experts for their handling of the disease, have seen a resurgence of cases after bringing the first wave under control. A large majority of countries in Europe such as Italy, Spain and Germany have all seen second waves. The positive news, though, is that the second wave has been milder than the first in terms of total cases and has generally caused far fewer fatalities.

Experts have warned that the recent spike in cases may be the start of Delhi’s second wave of infections.

What can be done: If data in Delhi points to a second wave, then the government should not hesitate in shutting down parts of the city a second time to contain cases again.