It has been more than a week since Union Home Minister Amit Shah and Delhi Chief Minister Arvind Kejriwal held meetings and announced several measures on June 14 to ramp up Covid-19 testing and treatment capacities in Delhi.

These announcements came after the Supreme Court on June 12 pulled up the Delhi government for its rigid procedures and low testing numbers. The court issued a notice to the government about poor patient care as well.

As has reported over the past month, patients in Delhi have faced tremendous difficulties in finding beds in public and private hospitals for Covid-19 care as the national capital saw a surge of cases. A visit to two Covid-19 dedicated hospitals in Delhi revealed that relatives were entering wards to care for patients because they were not receiving adequate care from healthcare workers.

As of June 21, Delhi reported 3,000 fresh cases, taking the total count up to 59,746 cases with 2,175 deaths.

What are the changes that have occurred since these slew of announcements?

More testing

Earlier, the Delhi government had limited its testing by issuing guidelines on June 2 that excluded asymptomatic patients from being tested except for those who have comorbidities or are senior citizens. This was, however, overturned by the Lieutenant Governor Anil Baijal on June 8 in his capacity as chairman of the Delhi Disaster Management Authority.

On June 14, Shah stated that testing in Delhi would be doubled in the next two days and trebled in the next three days. This announcement was significant considering that Delhi had only conducted an average of 5,193 tests between June 6 and June 13 even though its capacity to process samples is at 8,600 per day and its testing per million is one of the highest in the country at 13,446, according to its submission in the Delhi High Court on June 11.

During this period, the lowest numbers were recorded on June 8 with just 3,700 tests.

After June 14, these numbers increased significantly. The average from June 14 till June 21 shot up to 10,846 tests. Interestingly, a huge spike in tests took place between June 18 and June 21.

On June 18, 8,726 tests were conducted followed by 13,074 tests on June 19, 17,533 on June 20 and 18,105 on June 21.

The rise in the number of tests is also because they include rapid antigen tests that were started on June 18, said a Delhi government spokesperson.

Delhi started to conduct rapid antigen tests after the Centre on June 17 gave the nod, The Indian Express reported. This method is quicker than the RT-PCR test, and searches for the antibodies produced when the body is exposed to the pathogen.

The spokesperson added that Delhi’s capacity to process samples from the two different types of tests remains at just about 8,600 samples everyday, indicating that the pendency in processing these samples has increased.

In its High Court submission, the Delhi government stated that it processed an average of 4,853 samples were tested between June 1 and June 9, The Indian Express reported.

Meanwhile, the Centre capped the testing price in Delhi to Rs 2,400 on June 17. In addition to this, Union Minister of State for Home G Kishan Reddy announced on June 18 that the Centre had planned to conduct six lakh rapid antigen tests across 169 facilities that were still being set up, Hindustan Times reported.

Expanding infrastructure and capping prices

The Centre on June 14 also announced that they would give 500 railway coaches to the Delhi government to convert them into isolation facilities. These coaches are non air-conditioned sleeper compartments that will be used for patients with mild symptoms and will be equipped with a doctor’s cabin, oxygen cylinders and toilet facilities.

These coaches are, however, not yet functional as officials still grapple with making them habitable during the summer heat. The state administration will have to provide medical staff and healthcare workers to attend to patients in these coaches, The Indian Express reported on June 21.

As far as hospitals are concerned, on June 19, a panel set up under the Union Home Ministry made several recommendations to put a cap on the cost of Covid-19 treatment at private hospitals.

The panel recommended that the cost of isolation beds be between Rs 8,000 and Rs 10,000 per day. And the cost of an intensive care unit without a ventilator be slashed to Rs 13,000 to Rs 15,000 per day. For ICU with ventilators, the suggested cost was between Rs 15,000 and Rs 18,000. The revised rates would also include the cost of personal protective equipment or PPE.

On June 20, the Delhi government issued an order on the basis of these recommendations but added that these rates would apply to all occupied Covid-19 beds where hospitals had reserved less than 60% beds for the treatment.

But in private hospitals that have reserved 60% or more number of beds for Covid-19 treatment, the order states that the prescribed rates would apply only to 60% of the patients while the remaining 40% would be charged at rates scheduled by the hospital. The order is unclear on how patients would be allotted beds in either category but adds that the hospital would have to seek written consent from the patient or attendant before admitting them into the 40% category.

So far, only seven private hospitals in Delhi have reserved more than 60% of their beds. For instance, Max Saket that has a total bed capacity of 250 has reserved 200 beds for Covid care, and will be able to charge prescribed rates for 60% of the 200 beds, while 40% would be charged at scheduled rates.

“We have done this to incentivise more private hospitals to reserve beds,” said an official in the health department who did not wish to be identified. “If you reserve 59% beds for Covid then you have to charge all patients with prescribed rates.”

A policeman is tested for coronavirus in Delhi. Credit: PTI

Home isolation

While the Delhi government supported the measures, there was one policy change that was introduced by the Centre that it did not agree with.

On June 19, under the Delhi Disaster Management Authority, Lieutenant Governor Anil Baijal issued an order making it mandatory for Covid-19 positive patients who are asymptomatic or have mild symptoms to be under institutional quarantine for the first five days. If their condition improved, they would be sent back home otherwise they would be hospitalised, according to the order.

The order stated that home isolation “without physical contact to monitor patients may be a reason for increase in spread of Covid-19 infections in Delhi.”

This move was criticised by the Delhi government as it reversed their protocol of isolating patients with mild symptoms at home so as to not burden the hospital facilities. Deputy chief minister Manish Sisodia said that the move would “create chaos” as more than 10,000 patients come under home isolation.

Aam Aadmi Party MLA Atishi pointed that this could further the spread of the virus as many would fear getting themselves tested because of forced institutional quarantine.

On June 20, however, Baijal withdrew the order and clarified that it would apply only to those cases which “do not require hospitalisation on clinical assessment and do not have adequate facilities for home isolation”.

This article was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.