Delhi COVID Crisis: What Explains the Rising Number of Deaths?

The national capital has been recording over 90 COVID-19-linked deaths daily for almost ten consecutive days now.

(Photo: FIT)

As the third COVID-19 wave grips Delhi, a worrying accompaniment has been a sporadic rise in the number of deaths from the viral illness.

The national capital has been recording over 90 deaths daily for almost ten consecutive days now (since 11 November). According to the Delhi bulletin on 18 November, the city reported 131 deaths in 24 hours - the highest it had ever seen ever since the pandemic first hit (Figure 1).

With 131 deaths in a single day, Delhi accounted for 22.39 percent of the total COVID deaths reported in the country during the same time (585).

(Image Courtesy: FIT)

Compare this to the deaths recorded during the previous COVID peaks in Delhi. On 23 June, the city witnessed 3,947 new cases and 68 deaths. Then on 16 September, 4,473 cases and 33 deaths were recorded in 24 hours.

The cumulative Case Fatality Rate (CFR), however, was higher than it stands today, meaning the proportion of deaths from the total cases was more during the previous peaks than it is as on 18 November (Figure 2).

Over 25 percent of the daily deaths in Delhi are happening within the first 72 hours of admission, according to the health ministry data, which is down from 60 percent during June-July. These improvements could partially be explained by a better understanding of the disease and its management.

(Image Courtesy: FIT)

Highest Ever Deaths; What Are the Reasons?

FIT reached out to several doctors to explore the possible reasons why the national capital has been seeing a spike in COVID deaths. Some common explanations emerged:

1. Higher cases have led to a higher number of deaths
2. Lapse/complacency in following precautions
3. The festive season that just went by
4. Pollution making COVID outcomes worse
5. Winter season exasperating respiratory illnesses
6. Delay in seeking hospital admissions

Dr Pankaj Kumar, head of critical care unit at Fortis hospital, Shalimar Bagh, says, “There are multiple factors working at once in Delhi. Everything is open - all the markets and malls - and people are taking lesser precautions. They seem to not be afraid of the virus anymore. Delhi also has a higher population density, leading to higher transmission and more number of cases. A record-high number of cases would again translate into more deaths. The alarming pollution levels and low temperatures worsen the situation further.”

Dr Vijay Dutta, Internal and Respiratory at Indian Spinal Injuries Centre, said,

“The most important reason is the blatant flouting of the social distancing norms during the festive season and at social gatherings. Besides, the high pollution level before Diwali contributed to breathing issues and other respiratory problems in healthy people and aggravated COVID-induced respiratory problems, especially in people with pre-existing health conditions.”

Dr Vijay Dutta

Dr Arun Dewan, Senior Director (Critical Care) and Associate Director (Internal Medicine) at Max Hospital, Saket, again pointed towards the correlation between a higher number of cases in Delhi and the increase in deaths. “The air pollution and winter season have also turned the disease severe in high-risk patients by making their lungs even more vulnerable. Another important thing to note here is that ever since the home isolation guidelines came in, people have gone too far. They have started coming in later to the hospitals because they think it can all be managed at home.”

“They need to understand that if they start experiencing respiratory symptoms and their oxygen levels dip, the oxygen cylinder they have at home can only buy them a few hours, not a few days. Things can worsen in just the next hour, leading to severe respiratory failure and the need for ventilation. They tend to miss the golden period, when they can still control the disease progression, and land up directly at the emergency gates when things have gone out of hand already. Hospitals are overwhelmed, and it becomes hard to get beds at the last moment.”

Dr Arun Dewan

Dr Sumit Ray, Head, Critical Care at Holy Family Hospital, also said that the mortality is more than doctors have ever seen during the pandemic in Delhi. “We haven’t changed treatment modalities, so we don’t know what’s leading to the different kind of outcomes.”

“One observation is that there are more and more of elderly people coming in. Since people are getting lax and moving around, it is plausible that the elderly are getting exposed. As we know, they are at higher risk of complications and death. At our hospital, for instance, we have only recorded deaths of people above 55 years of age in the last few weeks.”

Dr Sumit Ray

“It could be a combination of age, pollution, diabetes, winter - all coming in together - as we have also seen with other respiratory infections such as H1N1.”

Dr Ray added that a similar surge could be expected in other northern cities such as Ahmedabad, Surat, Rajasthan and in states like Uttar Pradesh, with winter months and the festive season worsening the situation.

These cities have already started taking measures to control the spread. Ahmedabad, for instance, will go under complete curfew from Friday night till Monday morning with only shops selling milk and medicines remaining open, and night curfew will continue thereafter. The Centre has also deployed high-level teams to Haryana, Rajasthan, Gujarat and Manipur in response to the daily surge in cases.

(The article was first published in FIT and has been republished with permission)