The national capital recorded over 3,000 new cases of the coronavirus disease (Covid-19) for the first time since June 26 on Sunday, as per the Delhi government’s daily health bulletin.
Despite a dip in tests — to 36,046 on Sunday from 38,895 the day before, the city added 3,265 cases of the infection. A bulk of the tests on Sunday were performed using the less-sensitive rapid antigen method — a trend that has persisted in the Capital since they were introduced in June
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The Delhi government last month said it aims to increase testing to 40,000 a day.
The increase in the number of cases also resulted in a bump in the single-day positivity rate to 9.03%, as compared to the 8.68% rate recorded over the last week.
The week before that, the average daily positivity rate stood at 8.66%, and just 6.85% two weeks ago.
After seeing a decrease in the number of new cases in the first two weeks of August — with just 652 cases recorded on August 16, Delhi started seeing an increase in the number of new cases and the positivity rate from the third week of the month.
“Not just the number of cases, but the positivity rate has also increased in the city, indicating an increase in the transmission of the virus,” said Dr Lalit Kant, former head of the department of epidemiology at the Indian Council of Medical Research (ICMR).
Dr Puneet Mishra, professor of community medicine at the All India Institute of Medical Sciences (AIIMS), said, “Its not just the numbers. We have to look at micro-level data to see whether the new cases are being reported from. From what I have seen so far, most of the cases are being reported from southwest and south Delhi now. In June, when there had been a surge in the number of cases, most new infections were being reported from central Delhi, from areas such as Chandni Mahal. This implies that the virus is now in transmission in areas where the infection had been low earlier.”
He also said, “People have now become more relaxed or fatigued, and are not following simple preventive measures such as wearing masks in public places, maintaining social distance, and washing hands frequently. This has also led to an increase in transmission of the virus.”
Delhi has also seen an increase in the absolute number of deaths, which has gone up from a low of eight in one day on August 16 to 29 reported on Sunday. On average, 20 people died of the infection every day in the city over the last one week.
Despite the increase in the number of deaths, the surge in testing has resulted in a declining case fatality ratio (CFR) — the fraction of deaths among those who test positive.
Delhi’s CFR stood at 2.39% as on Sunday, the lowest since May 31. The highest CFR in Delhi was recorded on June 16 — 4.11% — when Delhi reconciled the number of deaths, adding 437 deaths in a day to the total toll.
“Even though the number of cases is going up, the mortality is likely to remain almost the same. This is because the doctors have a better understanding of the disease, the treatment protocols have been standardised, and there are more options for treatment such as plasma therapy and drugs like remdesivir. Also, with beds and infrastructure in place, people are being motivated to get admitted even when the disease is not very serious for better monitoring and management in case the condition deteriorates,” said Dr Neeraj Gupta, professor of pulmonology at Safdarjung hospital.
“The only way I see the mortality going up is if our ICUs and isolation beds start running full and we are not able to admit patients early on. The case fatality ratio in Delhi is higher than the national average perhaps because people from neighbouring states also come to Delhi for treatment,” he said.
The country’s average CFR stands at 1.7%.
The other reason for the low mortality rate, experts suggest is that many asymptomatic and mild cases are also being detected.
“Not only the number of tests have gone up since June, the criteria has also been relaxed and the government has now allowed testing on demand. People are now being motivated to get tested. This also means we are detecting many more asymptomatic and mild cases that were not being diagnosed back then. This also means the proportion of those tested who will have severe disease will be lower, and so will be the deaths,” said Dr Mishra.