As the temperature plummets and air pollution rises to dangerous levels, the Indian capital Delhi will fight the winter battle in the Covid-19 cases.
More than 8,500 cases were confirmed in the city on Wednesday alone, its daily record.
It also added 85 deaths in one day, exceeding 7,000 in total.
The sharp rise in cases after months of loneliness has also put pressure on hospitals - more than half of the available beds are already occupied.
Chief Minister Arvind Kejriwal has written a letter to the federal government seeking more beds in government hospitals amid mounting public pressure.
8..6th and counting, India is currently the second largest case in the world. But it has been on a downward trend since mid-September: despite testing continuing, the daily case count dropped from a low of about 100,000 to a low of 37,000.
Daily national numbers hover between 40,000-50,000 - India reported about 48,200 cases on Wednesday
But Delhi has seen a worrying trend in the last few weeks, with more new cases being reported than any other state. The capital has so far confirmed only 450,000 cases, of which about 42,000 are active.
According to experts, large parts of northern India are exposed to the winter season and dangerously high air pollution.
The growing number is also consistent with the busy festival season in India, with Hindus celebrating Diwali this week. Delhi has banned the sale and use of fireworks and officials have strengthened the need for social distance, but the scenes of crowds in the city's markets have become frightening. Officials have found high positivity rates among shoppers in some ancient markets, which are at risk of becoming hotspots.
"My two elderly patients had to wait for more than 20 hours to get to bed," said Dr Joyta Basu, a doctor in Delhi.
As many as 8,600 of the 16,573 covid beds in public and private hospitals in Delhi were filled up by Wednesday evening, according to the government's Corona app. But more worryingly, inexperienced beds are more rare in intensive care units (ICUs) - only 176 beds with ventilators and 338 beds without ventilators are available.
Doctors say the epidemic is spreading to the city's hospitals, where free beds are being filled in a minute.
According to the application, thousands of beds remain free in government-run hospitals. But at least 24 private hospitals do not have empty beds and less than 50 of the 80 private hospitals listed on the app are available.
But many who can afford private healthcare will not choose to go to a public hospital in India, where the quality of infrastructure is often poor. India has an exceptional record in public health, spending about 1% of its GDP.
Dr Randeep Guleria, director of India Institute of Medical Sciences, one of the largest public hospitals in India, told local media that the number of patients admitted to hospitals would increase.
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Air quality monitors show that the level of pollution is 14 times higher than the World Health Organization's (WHO) safe level.
Another concern is that in cold climates, general immunity is reduced regardless of one's age or suitability, said Prof. Dr. Krishna Kumar, Chairman, Public Health Foundation, Delhi-based think tank. That is what Srinath Reddy has said.
Cold weather is even more hospitable for viruses, whose survival time increases in dry and cold air, he said.
Add pollution to this scenario, and it’s “double whammy,” he added, as cold air means pollutants stick to it longer.
Studies from around the world have linked air pollution to the number and death of ovida covid-19 cases. A Harvard University study has shown that an increase of just one microgram per cubic meter in PM2.5 - dangerously small pollutants in the air - is associated with an 8% increase in covid-19 mortality.
A second Cambridge University study found a link between the severity of Covid-19 infection and long-term exposure to air pollutants, including nitrogen ides, car exhaust fumes, or burning fossil fuels.
"We have to keep our fingers crossed," said Professor Reddy. He added that Delhi was initially tense when the case was registered in April.
European countries, such as France and Italy, which caught the headlines at the beginning of the epidemic for rising cases, were hit hard during the harsh winters in January and February.
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