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Delhi, Mumbai among 15 places that account for over 60% of India’s COVID-19 cases

Delhi and 14 districts across the country account for over 60% of all Covid-19 cases reported in India, according to data from the federal think tank NITI Aayog, whose chief executive officer Amitabh Kant says diligent monitoring, and aggressive testing, treating and containment are required to check the spread of the disease.

Delhi, which has 11 districts, account for 12.62% of all cases in the country as of Monday. Mumbai and Indore feature among the list of the 14 other districts. “Our job is to present the nationwide picture, but it is the state governments that have to take strong, ruthless containment measures, more testing, isolation, and treatment in order to bring the number of cases down,” Kant said. 

“These are the 15 places that have reported more than 1% of India’s cases and it is here that we have to flatten the curve to win the fight against the virus,” said Kant. There are 33 other districts that have reported over 100 cases each so far, he said.

Along with the data, NITI Aayog also presented a weekly trend of the number of cases, which shows that most of the states with these 15 high-case burden areas have started showing a decline other than Maharashtra and Delhi.
“However, it is not enough to show a decline over one week, this has to be consistent for three to four weeks to be a correct indication of a downward trend. This is the reason I have also put up Kerala’s trends, which has shown week on week constant decline. We must learn from what Kerala did,” said Kant.
Most of the 15 places referred to by the NITI Aayog are big cities such Mumbai, Delhi, Chennai, Hyderabad, and Ahmedabad. Experts believe this is mainly due to density of the population in these cities and testing bias.
These cities account for a big chunk of cases reported from their respective states – Mumbai accounts for 33% of cases in Maharashtra; Ahmedabad accounts for 66% of the cases from Gujarat, Indore accounts for 49.5% cases in Madhya Pradesh, and Hyderabad accounts for 55.6% of the cases in Telangana.

“If you see the bigger cities, the population is dense leading to a faster spread of infectious diseases like Covid-19. Also, when it comes to testing, we have a track record of testing more in the urban areas – it was true for H1N1 pandemic, it happens for routine infections like typhoid and even lifestyle diseases like diabetes. Unless the sample has been selected statistically to represent both rural and urban population, we cannot say that the infection is not being reported from rural areas,” said Dr. T Jacob John, professor emeritus and former head of virology department at Christian Medical College, Vellore.
In Delhi too, the district with the highest number of cases are those with a high proportion of slums and resettlement colonies.

“The analysis by NITI Aayog is wrong in considering Delhi as one whole. It is not that entire Delhi is reporting high number of cases, but certain districts are. And, if you closely look at the districts where this is happening, there are slums and resettlement colonies where maintaining social distancing is not possible,” said Dr Jugal Kishore, head of the department of public health at Safdarjung Hospital.

Experts say that it is community engagement rather than enforced lockdowns that can help bring down the number of Covid-19 cases.
“Just locking down a street or a colony when positive cases are reported is not the solution. If people continue meet each other within the containment areas, the number of cases will rise. What we need to do is engage with the community, make them stakeholders, make them responsible for ensuring social distancing and other measures,” said Dr Kishore.

Dr John cited the example of Kerala, where health authorities were quarantining all those who travelled to the state, whether from abroad or other parts of the country.
“Maybe the government should have gone into communities like Dharavi in Mumbai and explained about the disease, asked them to start wearing masks a month ago. This would have slowed down transmission in the communities where social distancing might not always be possible.

Cities like Ahmedabad where the population density is lower can still implement these measures, but for bigger cities like Delhi and Mumbai, all the government can do is fire-fight now.”

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