“ Entire families in hospital after coronavirus outbreak ”

On October 14, Farah Husain, an intensive care specialist at Delhi’s largest Covid-19 hospital, breathed a sigh of relief.

“After four grueling months for healthcare workers at dedicated Covid hospitals, India has the lowest daily increase in new cases,” she tweeted.

Barely a month later, Dr Husain looks melancholy. “I really thought we had passed it. Now we are facing the intensity of a winter coronavirus outbreak,” she told me.

Doctors fear Delhi could become the epicenter of the first wave of winter infections in India.

The capital has so far added more than 128,000 cases since the beginning of November. On November 12, it registered 8,593 cases, the highest rate in one day since the start of the epidemic. Delhi now registers more cases per day than any state. Its total number of cases has exceeded 500,000.

Delhi reported 131 deaths from Covid-19 on Wednesday, the highest toll in a day. To date, more than 8,300 people have died from the infection. The test positivity rate is worrying 12% and more than three times the national average.

Not surprisingly, hospitals are inundated with patients and intensive care beds fill up quickly.

“People are having trouble finding beds. Even I can’t find a bed for my friends or family, it’s so bad, ”Dr Harjit Singh Bhatti, consultant at Manipal Private Hospital in Delhi, told me. All 75 Covid-19 beds and 10 intensive care beds at his hospital are full. My colleague, Vikas Pandey, who went to admit a relative to a leading private hospital, found there was a ‘waiting list’ of 250 patients for Covid-19 beds. “It’s worse than summer. It’s crazy,” he said.

The boom was sparked by the opening of offices, factories and markets, and the intensification of social exchanges during a busy festival season. It has also been exacerbated by the drop in temperatures and the increase in air pollution.

The 2,000-bed Lok Nayak Jai Prakash Narayan Hospital (LNJP) in Delhi, where Dr Husain looks after a 60-bed Covid-19 intensive care unit, is teeming with patients.

The story continues

Many of them are given oxygen and given antivirals, steroids, plasma, blood thinners, and steroids to stop the infection before it gets serious. Doctors say there may be fewer deaths overall than in the summer, but fear that many patients who have recovered from the disease will soon be struggling with ‘long Covid’, affecting everything from breathing, brain, heart and cardiovascular system to kidneys, intestine, liver and skin.

Doctors say the outbreak is both similar and different from the summer outbreak.

“Patients are coming in clusters this time. We are seeing families and friends being infected and hospitalized with the virus after attending frequent and repeated indoor festivals and gatherings,” Dr Husain said. “I have had a married couple or a mother and her son admitted to intensive care with the infection at the same time.”

Doctors are also reporting an increase in the number of younger patients this time around.

About 70% of critically ill patients are over 55, but Dr Husain says “a lot of patients” are between 25 and 45 years old. “Almost a third of my patients belong to this age group. They also report high viral loads, which hints at repeated exposures to infected people, ”she adds.

“Young people feel invincible and they come out and mingle. I believe a lot of these young adults are the archetypal super-spreaders.”

During the summer outbreak, doctors were less prepared to deal with the disease. Many critically ill patients have died within days in intensive care. Thanks to advances in medicine and clearly defined treatment protocols, these patients now have a much better chance of being cured. But they also take longer in intensive care, resulting in fewer ICU vacations.

Frontline health workers are exhausted. Doctors working in many public hospitals work 15-day shifts and quarantine themselves for a week in a hotel or facility before returning to work after taking a Covid-19 test. Many have not returned home for weeks.

They also handle a deluge of phone calls and consultations from panicked people. “I get over 50 calls a day from people asking where to find beds, what to do, and asking about symptoms. And the calls come from all over town, ”says Dr Bhatti.

Read more stories by Soutik Biswas

While thousands of patients stay at home and seek treatment through video consultations, many are also rushing to hospitals because they don’t know how to cope at home. “I see patients who say they cannot read a pulse oximeter [which measures oxygen saturation and pulse rate]. More and more people now benefit from private health insurance. They arrive in hospitals with mild to moderate symptoms, ”explains Dr Bhatti.

Very few Delhiians want or can afford to return to summer lockdown, where people have stayed at home and businesses and schools have been closed, vacations postponed and livelihoods lost. The outbreak was somewhat muffled in late September for a fortnight, and many believed the virus was gone. “The pandemic has never really disappeared. It has always been present in hospitals,” an intensive care intensivist told me, who preferred not to be named.

The Delhi government has increased the penalty for not wearing a mask to 2,000 rupees ($ 26; £ 20). There is talk of adding intensive care beds in hospitals and care facilities. Private hospitals have been asked to preserve 80% of their beds for patients with Covid-19, a move that could once again block elective surgeries and prevent patients with other conditions from obtaining beds. The government is considering closing markets and limiting the number of guests allowed to weddings. Doctors and paramedics are flown to Delhi from other parts of the country to build capacity.

“We’re still riding the peaks in the middle of the first wave. Aside from the brief respite, the infection never really subsided. People thought it was, and now we’re back to square one, ”says Dr Husain.

Shadab Nazmi Graphics

What should I know about the coronavirus?

Follow Soutik on Twitter