An alarming rise in Delhi’s death toll
The TLDR: The number of daily deaths in Delhi have crossed the 100-mark four times over the past ten days. Cremation ghats are overflowing even as the case count spirals—hitting 5,29,863 on Sunday. The government is belatedly scrambling to reserve additional hospital beds and ramp up testing—to meet a crisis that everyone could see coming. This is the first of a two-part series. We focus on Delhi today and on India’s overall death rate in part two.
What’s happening in Delhi?
The numbers: The tally of new cases added daily hit 6,746 over the weekend. But more importantly, the number of deaths is rising. On Saturday, 111 deaths were recorded—and it confirms an alarming new pattern. Deaths recorded on November 20: 118. November 18: 131. November 12: 104. To put the numbers in perspective: On November 18—which marked an all-time high—there was a death every ten minutes in Delhi.
And yet, the Delhi government insists that it has the outbreak under control. The reason: the most recent high was 8,593 cases added on November 11. The Health Minister claims the downward dip since that day shows that Delhi has turned the corner.
The cremations: While municipal officials deny it, cremation grounds are reporting long lines of families waiting to cremate the bodies.
- Now there are 19 crematoriums and graveyards in Delhi that have permission to cremate or bury Covid victims—and they are run by different municipal bodies in various parts of the city.
- Data is not available from all these bodies. According to the South Delhi numbers—which handles six crematoriums—883 bodies have been cremated between November 1 and 18. This compared to 720 in all of October.
- For further comparison, consider this: between June 1 and October 31 (five whole months), the same six crematoriums handled 3,697 Covid bodies.
That sounds worrying…
Yes, what’s more alarming is that Covid death counts are problematic for a number of reasons.
Anecdotal media reporting: varies wildly. Take the example of Nigambodh Ghat. A municipal official told Indian Express: “Over 100 bodies are being cremated here every day for the last two weeks, and roughly 20 a day are Covid patients.” Someone working at the same ghat confirmed the 100-110/day estimate to the Hindustan Times, but claimed: “More than 60% of them had died of Covid-19.”
The key missing data: What struck us is that there is no information as to the normal daily number for these ghats.
Why does this matter?
Because there may be a critical discrepancy between what is happening at the hospital and what happens at the crematorium.
At the hospital: The official Covid death count only includes cases where the doctor records Covid as a primary cause of death. Now, a lot of patients fall into the “suspected” category—these include patients who have symptoms but aren’t tested, test negative or show an inconclusive result. Point to note: Covid tests throw up a false negative at least 30% of the time—and often need a second test. If the person dies before that happens, then they are labeled as ‘suspected’ cases by the hospital. (Doctors also don’t report confirmed Covid deaths in many cases, which we will explain in part two).
At the crematorium: We don’t know what’s happening in Delhi, but previous experience shows that the hospital and crematorium records often don’t match up.
In late June, the Madhya Pradesh government posted only 91 deaths in Bhopal. But crematoriums and graveyards showed double that number: 180. The reason: The Bhopal Municipal Corporation had asked them to follow Covid protocols even for suspected cases.
Point to note: Some of that may be happening in Delhi. Former MLA Jitender Singh Shunty—who runs a charitable hearse service for those who die of Covid—claims:
“The government is not revealing the whole data. Those who die in home quarantine are not being reported. Till last month, we were only cremating only 5-6 bodies every day, but for seven days, we are cremating 20-22 bodies daily. The situation is horrible now.”
But we won’t know if any of this is true until we have more information about the other bodies at these ghats—the ones that are not being recorded as Covid deaths.
And all this is due to Diwali right?
No, it is too early for the post-Diwali pollution or partying to show up in the case or death tally. The reason: It takes an average of 18 days from initial infection to death. What we’re seeing is the effect of the run up to Diwali.
Pollution: Delhi air quality had already started to deteriorate in October—due to the early retreat of the monsoon and crop burning in nearby states. A new study shows that between November 6 and 11, there was a very high concentration of both PM 2.5 and PM 1.0 particulate matter. Quick explainer: the numbers refer to the size of particles that hang in the air—finer the particle, more deeply it can penetrate our blood stream, causing severe damage. PM 1.0 is the smallest and most dangerous of the lot.
And as we explained at length in October, global studies confirm that pollution increases the number of severe cases—and therefore the number of deaths. Certainly, this is the number one reason cited by CM Kejriwal.
Collapse of social distancing: For over a month now, Delhi’s markets have been packed to the gills with shoppers. Even with rising number of deaths, they look like this right now:
As a result, the Delhi government has imposed a Rs 2,000 fine on anyone caught without a mask, and ordered greater surveillance at markets. But it may be too little too late.
Patient profile: With people—especially the young—circulating freely, the virus has spread to more vulnerable groups. A leading Delhi doctor says his hospital is treating far more serious cases—and the death rate is very high among those with diabetes and obesity. Also, the patients this time around are older:
“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.”
Overwhelmed hospitals: While there is no data to confirm this, it doesn’t take a rocket scientist to connect the lack of emergency resources to a rising death toll. On November 4, there were zero ICU beds with ventilators available. The government has been making noises about making arrangements for 5,000 extra beds for weeks now—but they are nowhere in sight. Last week, the government ordered 42 private hospitals to reserve 80% of their ICU beds and 60% of normal beds for COVID cases—which will add a measly 260 ICU beds with ventilators.
Delaying care: These shortages are made more dangerous by Delhi-walas who are not seeking proper care in time. As one doctor told Quint:
“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.”
The bottomline: The rising death should hardly come as a surprise to anyone. What is shocking is the total unpreparedness of the Delhi government—which continues to cling to a declining daily case tally for comfort, even as hospitals and crematoriums struggle to cope.
Reading list
The Wire has a long analysis of why our death tally is flawed. Quint has the reasons why the number is ticking up. We offered the most detailed overview of the link between Covid and pollution back in October. This Times of India op-ed offers a scathing assessment of Kejriwal’s performance.