Delhi needs to be prepared for about 15,000 fresh cases of COVID-19 per day taking into account the upcoming winter season-related respiratory problems, large influx of patients from outside and festive gatherings, a report drafted by the National Centre for Disease Control has warned.
The report drafted by the NCDC under the guidance of the expert group under the chairmanship of NITI Aayog member (Health) Dr V K Paul has recommended the Delhi government to make arrangements for hospitalisation of about one-fifth of these patients with moderate and severe disease.
The NCDC in its 'Revised Strategy for control of COVID-19 version 3.0' also observed that the overall COVID-19 case fatality rate in Delhi is 1.9 per cent, which is higher than the national average of 1.5 per cent. It stated that reducing mortality to the extent possible should be one of the key objectives of managing the pandemic.
According to the report submitted to the Delhi government, there are three reasons to worry that may cause excessive pressure on healthcare services such as winter months that make respiratory illnesses severe and with festive gatherings there could be a sudden rise in cases.
Also, patients may come from outside Delhi in large numbers. Patients coming from distant areas are likely to be more serious, the report underlined.
"Therefore, it is recommended that Delhi should prepare for a daily surge of 15,000 positive cases and make arrangements for inpatient admissions of patients with moderate and severe disease roughly amounting to 20 per cent of this surge," the report said.
According to it, till date 2,324 health care workers are affected due to COVID-19 in Delhi of which 23 per cent are doctors, 34 per cent nurses, 15 per cent paramedics, 18 per cent Group D staff and 10 per cent others.
"A total of 75 deaths are reported in HCWs of which 14 are of doctors which may be underreported.
"The increasing mortality in HCW and doctors is detrimental for maintaining the morale of these COVID warriors, hence all efforts should be undertaken to prevent the health care-associated infection in all the hospitals, labs and field workers engaged in active survey in containment zones," the report said.
Delhi has reported a total 5,401 deaths till date, the committee said, adding the average daily reported mortality ranges between 30 and 40 from 15 September onwards. The higher mortality in the co-morbid (66.6 per cent) and the elderly is inevitable and reported all over states and globally, the report said.
"However the concern is reported mortality in under 15 (1.5% approx) and young age groups 16-44 years of age group (17%). The mortality in this age group could be prevented with promoting early recognition of symptoms, timely testing, increased awareness in the younger population to adopt COVID-19 appropriate behaviour" it highlighted.
The report also recommended the Delhi government to launch a massive campaign for 100 per cent compliance with masks, citing this would be the single-most important measure to prevent the spread of the virus.
"With the resumption of economic activities and unlock, the changing community perception about COVID-19 and laxity in practice of social distancing, wearing of mask etc is significantly leading to increase in case count. If unchecked, this may lead to further increase during upcoming festive seasons in Delhi," the report said, stressing on the need for stringent implementation of COVID-19 appropriate behaviour.
"A two-fold strategy -- persuasion and enforcement -- should be followed," it underlined.
Further stating that large gatherings are super-spreading events, the report suggested making these events very low key, and essentially centred around family celebration.
It also recommended the Delhi government to reach out to opinion makers, opposition, religious leaders and people at large to develop a consensus to have these festivals with little or no gatherings.
"Coming festivals (Chhat, Puja, Dussehra, Deepavali, Id, Xmas, New year) pose a huge challenge in the pandemic control. It has been seen that Onam in Kerala and Ganesh Chaturthi in Maharashtra escalated the pandemic seriously. This must not be allowed to happen in Delhi," the report stated.
"Our emerging gains in reduction in cases will be reversed because of these festivities and the rush in markets /localities. Such a setback that is potentially avoidable will dent the image of the capital and the country. It is very important to take a rational view to make these events very low key, and essentially centred around family celebration.
"Next three months are crucial in our battle against the coronavirus, the report underscored.
It also recommended conducting a sero-survey which can be tentatively planned during the first week of November.
"After review of sero-survey by NCDC in July and subsequent survey by the Delhi government in August and September, it will be appropriate that next sero-survey to be conducted after a reasonable interval and can be tentatively planned during 1st week of November, 2020," the report said.
The report also stressed on focused efforts for timely referral of patients from lower to higher facilities or from home isolation, in case of deterioration of clinical condition by ensuring timely ambulance services, reviewing ambulance system and plug gaps and scaling up of critical care facilities such as oxygen beds, ICU beds and ventilators in pace with rising number of cases.
