In its fight against coronavirus, Capital has turned a corner: CM Kejriwal
“We should be prepared if there is another difficult situation,” chief minister Arvind Kejriwal said in an interview with HT, citing the example of the Spanish flu outbreak in 1918 (when subsequent peaks were worse than the initial one) to urge people not to become complacent
Delhi chief minister Arvind Kejriwal spoke to Sweta Goswami and Binayak Dasgupta about combating the Covid-19 crisis, the rise and fall in the Delhi virus curve, the strategies that worked, the pitfalls that may still lie ahead, and the road to unlocking all of the city, along with other issues. Edited excerpts:
One month ago, when daily cases were hitting a new record every day, and frantic efforts by the administration did not seem to be working, did you think we would at the point we have reached now – when there is a sustained fall in new infections?
The situation was under control till the last week of May – the time till when the lockdown was in place. When the lockdown opened, our preparedness was there, but the number of Covid-19 cases began increasing at a faster rate. In the first week of June, we did an assessment based on the formula provided by the Central government. It was projected that Delhi would have 550,000 cases by July 31, and 80,000 beds would be required. At that time, we decided to put these projections upfront before the public, and stress that all of us need to work together.
We realised that this virus cannot be fought alone. It needs huge financial, medical and human resources. We studied the entire cycle of a Covid-19 patient to identify problems. Testing was found to be a major problem. People wanted to get tested but weren’t able to. So, we demanded more testing from the Centre. They accepted our request, and introduced rapid antigen detection tests in Delhi, before starting it in any other states. With that, all of a sudden, our testing went up from 6,000 to 20,000-22,000 every day. The problem of testing was over.
The second problem we found was that anyone who was testing positive would invariably come to a hospital. There was a lot of panic. We realised if everyone turns up in the hospital, no amount of beds would suffice. So we started focusing on home isolation. We started advertising stories of people who recovered under home isolation, and we hired a private company which used to talk to these patients through tele-counselling. People started feeling very comfortable with home isolation in Delhi.
There was also an ambulance shortage in Delhi. We were at a stage where at one point as much as 25-30% of the calls received for an ambulance were being rejected. We increased the number of ambulances manifold because of which, today, no calls are being rejected. We also had some horror stories of patients dying waiting in an ambulance outside the hospital. Why? Because the hospitals did not used to admit a patient until the formalities were completed. We then made it mandatory for all hospitals to create a holding area, where a patient is directly given oxygen and other facilities while the all paperwork is being done.
Another challenge was beds. When coronavirus was at its peak and things were not as good as it is now in Delhi, even then we used to have 1,000-1,500 beds vacant in our government hospitals. But, people did not know about the availability of beds. Then we made the Corona App. We also saw that people were choosing private hospitals over our government ones. In the first week of June, there were only 700 beds in Delhi’s private hospitals, of which almost 650 were occupied. We decided to reserve 40% beds in all private hospitals for Covid-19 patients. With this, we created 5,000 new beds within 24 hours. We reached out to hotels as well and attached them with hospitals which then took the total beds further to 7,000.
The other thing was the convalescent plasma therapy, which helped saved lives.
With all these efforts, now we are seeing the curve of daily infections, deaths and positivity rate bending downwards. The positivity rate is down, and the recovery rate is getting better by the day.
But this virus is unpredictable. We do not know how it will spread a month later. So, I am saying again that we should not be complacent. Till there is a vaccine, rules such as wearing a mask and maintaining social distancing and hygiene must be strictly followed by the public.
Looking at what is happening in Delhi, and taking cues from what we have seen in other countries, can we say that Delhi has crossed the peak – or at least its first peak?
Yes, in a sense we can say that we have overcome the difficult situation that we saw in the month of June. But, we must be prepared if this reoccurs. In 1918, the Spanish Flu had seen three peaks and the second peak was much worse than the first one.
Hotels are coming to us with the request of relieving their rooms and beds from Covid duty because the majority of them are lying unused. Same pressure is coming from some private hospitals too. Today, only around 3,700 beds are occupied of the 16,000 Covid-19 beds in Delhi. But we would like to keep things as it is for a few more days before we take any call.
If we take Wuhan’s example from not far back, after beating back infections, it carried out near complete testing of its entire population of 11 million people. Can such an exercise be feasible and can we expect it at some time?
That kind of lull actually has not yet come in Delhi yet. In Wuhan, the count of daily fresh cases reached zero. In Delhi’s case, a downward trend has just begun. There are several best practices from around the world. But we still have to wait a bit till the daily count of fresh cases to come down further. We are happy now because, on June 23, the daily new cases had hit the 4,000-mark. But what we have now – about 1,600 -- is not a small number. It needs to go down further.
So, if we were to ask you to define the Delhi Model to fight Covid – what is it?
The five things I said at the start – testing, home isolation, transparent data, hospital beds and plasma therapy – are the key elements.
But we used three principles help us achieve this.
One is teamwork. No one can individually end or handle corona. It is only possible keeping all the egos and race for credit aside. In this various governments, civil societies, religious institutes, everyone has to get involved.
Our second principle is acknowledging constructive criticism and working on fixing the problems highlighted by others. Lok Nayak hospital was shown in very bad light at the start, and rightly so. We understood the problems and fixed all the problems that were highlighted by the people, including the media.
The third principle is that no matter how bad the situation gets, you as a government cannot give up. Recently, a health minister from a state said: ‘Only now God can save us’. (Laughs) I can understand the anxiety and helplessness of that minister. But as a government, you cannot give up – because if you give up, then you cannot imagine the number of deaths that will lead you to.
From the five points we were talking about, home isolation is a key part of Delhi’s Covid management strategy. Even now, some states in the country are making a big mistake by not allowing home isolation. These states are picking anyone who tests Covid positive, even if they are asymptomatic or mild cases, and putting them in quarantine centres. The condition of these centres is pathetic. People do not want to go to quarantine centres, and fear testing as a result. And if you start putting everyone under institutional quarantine, then your Covid health infrastructure will collapse.
Though the Central government was dead against home isolation at one point of time – they passed orders cancelling the system – I am very happy that due to public pressure they saw the importance of the system and put back the old system.
You mention that Centre was opposed to your home quarantine rules. Are you saying that if that order had not been reversed, Delhi would not have seen the improvement we’re seeing now?
That was the most critical point in Delhi’s Covid-19 crisis. If that order was not reversed, and if home isolation was actually cancelled, Delhi’s Covid situation would be extremely bad.
That order by the LG (lieutenant-governor) also included that all positive people would have to line up at Covid Care Centres for medical screening. The treatment to serious patients would have been undermined if they were standing in queues instead of being in hospitals. The order also cancelled the contract of the private company which used to make follow-up calls to all patients recovering under home isolation through tele-counselling.
But, we decided that we will not fight about this. We explained our stand to everyone in the central government in several rounds of meetings, and they ultimately agreed.
So home isolation is the one crucial ingredient?
Testing and isolation are both very important. Many state governments are currently not testing enough. My suggestion to them is to scale up testing in a big way. Let the problem come on the table. Let everyone know the number of cases. If you do not test enough, you won’t know the real picture in your fight against coronavirus. Open centres in every nook and corner of your state; in schools. Antigen testing kits are very easily available now – so test people and isolate them in their homes.
These two things, I feel, the Central government can do across the country on its own.
Union home minister Amit Shah said in an interview in June that Covid deaths in Delhi were high because home isolations protocols were not being followed properly.
The assessment was wrong. Their data was showing that in the first 48 hours nearly 45%-50% Covid deaths happen. But, they did not know that these deaths were hospital death cases and not formal home isolation cases.
In fact, our latest home isolation data shows that from July 1 to July 15, only six Covid-19 deaths have happened. That is not even one death per day. Deaths in home isolation further reduced after we started giving pulse oximeters to all patients – since monitoring oxygen is the key.
The number of deaths in June hit up to 101 deaths on a single day. This has now come down to 30-40 every day. Apart from plasma therapy, how did the government manage to control the fatality rate?
In the beginning of June, Delhi saw a huge number of ‘suspect cases’. We reduced these by augmenting our beds and ambulance fleet and making their availability transparent.
We are currently conducting a study to identify how Covid deaths are happening – in a hospital, Covid deaths can happen either in the ward or the ICU. If a death has happened in a ward, it means there was negligence on the part of the hospital staff. It means that the patient turned serious and was not transferred to an ICU on time. This means the monitoring was not right. If a patient died in an ICU, it can be considered as a natural one. This will help us control the situation further.
Aside of the run-ins, how has the Centre helped you in this pandemic?
When the virus started, no one had anything. We asked them for testing kits and PPE kits; they immediately sent it to us. In June, they started antigen testing. We demanded oxygen cylinders, they sent us 500 cylinders immediately. So whenever we asked them for help, they have come forward.
It was more in terms of resources than strategy?
They also made available to us the services of people such as Dr Vinod Paul, Dr Randeep Guleria and Dr Balram Bhargava. We had a series of meetings with them. So expertise was also made available to us.
What about the mega Covid Care Centres that have been built?
It is good that it was built. But after allowing home isolation, there was not much relevance left of these centres because the care centres are for mild patients, who are mostly being treated at home. Delhi’s Covid strategy has been hospitals and home isolation.
There institutional quarantine facilities are mostly for those who are residing in slum clusters or JJ colonies -- who do not have a separate room or toilet. But, there are only around 1,500 Covid-19 patients who fall under that category at the moment.
There was a time when you considered reserving hospitals only for the people of Delhi. It led to a controversy. Looking back, do you regret the decision to curtail hospital access for outsiders?
At that time, our concern was related to Delhi based on the projection that there would be 550,000 cases by July 31. Delhi has always welcomed everyone. We felt that, for at least two months, such a restriction was required. But we accepted whatever the decision the Centre took. Now, we are in a better position. We have heard that some people are coming from other states to get treated in Delhi. Now, we are in position to handle that.
There is one state which has allocated its hospitals based on districts. So patients of one district cannot go to the hospital of another district. These are all part of Covid management strategies.
So, you’re in a position to offer your hospital services to other states now?
You don’t need to offer. If facilities are there, they will come on their own — as they have been coming all this while.
Do you think Delhi is now in position to start thinking in terms of a genuine ‘unlock’ of the city?
A lot of things have already been unlocked. Whatever unlocking the Centre has allowed, we have opened. Beyond that, we are legally not allowed to unlock on our own. The Centre has more experts at their command; they take decisions after consulting with them and states follow.
But at the right time, what is the first thing that you feel needs to be unlocked?
Delhi Metro. It is the city’s lifeline. So, running the Delhi Metro is very important. But, the decision lies with the Central government.
There are now more than 650 containment zones in Delhi, and there are problems being reported from areas that have been locked down for weeks. What is happening on that front?
There is a problem with the Centre’s rule on containment zones. It says that if there is no new Covid case for 28 days straight, then that area can be de-contained. But if even a single new Covid case emerges in a containment zone, then it will remain under lockdown for 28 more days. As a result there are some containment zones which are under lockdown for 3-4 months. People are very distressed in these zones because they are completely locked down in their houses.
We have spoken to the Central government, to the Union health and family welfare ministry and have requested them to fix an outer time limit as well.
What about the serological survey? Are you eager what its results will throw up?
The NCDC has asked for one more week from the high court to submit its preliminary report. I am anxiously awaiting the results of the survey — the findings will indicate to what extent the virus has spread. And, most importantly, whether Delhi is inching towards herd immunity.
Antigen testing seems to have been accurate in terms of its specificity rate. But only around 0.5% of over 262,000 people in these tests were followed up with an RT-PCR test. Do you think more people should be double checked?
We do not have the capacity to double check those many people with an RT-PCR test. If you see today’s data – 14,000 were antigen tests and 7,000 were RT-PCR tests. We are already using our RT-PCR testing infrastructure to its full capacity. It is not only in terms of kits and machines, capacity is also a question of manpower. Even antigen tests are being conducted to their full capacity.
As cases reduce, will you consider locking Delhi’s borders, just as other NCR cities locked their borders to Delhi?
Some states had restricted the entry of people coming from Delhi. Those states which had stopped people of Delhi from coming; their cases have now increased despite that restriction, and ours have gone down.
So, such restrictions do not work I feel. We have to improve our Covid management instead of doing all this. No matter what the situation, we will not lock our Delhi borders for others.
The economy has taken a big hit because of the virus. What do we need to re-start to get it back on the recovery path? Do migrant workers need to be brought back safely?
All kinds of activities have to start again. Construction activities need to re-start.
I feel that the tussle that is going on with China; this can actually be used as an opportunity for us. We are importing things as small as toys from China. I feel the Central government should prepare a list of such small items, and start producing them indigenously. If entrepreneurs and industrialists are called upon and given all facilities and technologies, such items can be produced at a war mode to cater to India’s domestic demand. This will create jobs, production and the GDP will increase and the dependence on China will also end.
Your view is that India should take a hard stand on China?
Yes, we need our land back.
While cases are down in Delhi, they are rising in the rest of the country. What are your views on the India’s Covid trajectory?
I am not the right person to predict that, only experts can. But, we must learn from each other. We can take lessons from New York, Sweden, Spain, etc. We can take lessons from other states. Delhi and Mumbai are a bit ahead in the trajectory from the rest of the country. So other states can learn from the experiences of Delhi and Mumbai.
All of us should help each other at this stage. I am not just saying Centre and states, but state governments should also help each other.
We are now seeing many states are doing weekend lockdowns. Would you suggest to other states that they should be more relaxed and focus on other areas?
I am happy that we did not need to do a lockdown. Even when the cases were rising, we did not impose a lockdown. Overall, my own assessment is that a lockdown can only temporarily delay the spread of the virus. It does not end it. You can use a lockdown to ramp up your existing facilities, get prepared and then open up. I do not think lockdowns can put an end to Corona it can only delay it.
What has been the key learning for you in the pandemic — not just about fighting the pandemic but as a chief minister faced with such a big crisis?
An interesting thing we are seeing now is that volunteers and party workers of all political parties who, used to fight a lot before the pandemic are now working together. We have seen if a BJP worker is bringing a Covid patient, then an AAP worker or a Congress worker is helping the person to get admitted.
If this spirit and feeling of oneness is nurtured and kept alive throughout, then the sky’s the limit for our country.
But a different political story seems to be playing out in Rajasthan…
What we are seeing in Rajasthan now is very sad. It is particularly sad at this hour when China is knocking on our doors and the whole country is battling a pandemic — the two biggest national parties of India are fighting with each other so bitterly. If they fight with each other, who will fight against China, who will fight against Corona, who will protect the country?
Once Covid is over, what innovations are you planning based on your learnings from it – particularly in school education where classes have gone online?
There are several things which Corona has given us that now going to be permanent. The mass use of video conference call is going to stay for sure. It saves a lot of time, money and other resources. Physical meeting also has its own benefits, but this aspect will stay.
In terms of schools and colleges, however, it cannot be a permanent solution. I feel the online system can only be a supportive system. At some point of time, students will have to play in the grounds and sit in classrooms. There cannot be any substitute to that.
The pandemic struck just after the Delhi elections. You had then released a 10-point guarantee card. What happens to that?
We will fulfil all of them, there are five years more to go.
Last question. Success has many fathers, who is the father of Delhi’s Covid success at this time?
I will just say this: Credit sara unka, zimmedari saari meri. (Credit all Centre’s, responsibility all Delhi government’s).