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NEW DELHI - COVID-19 cases are surging to record highs in India's capital, New Delhi, even as they drop sharply in the rest of the country.
Moreover, doctors say the pandemic is extracting a heavier toll in the city as air pollution levels spike dangerously, making its 20 million residents more vulnerable to the virus. Large numbers of people, many without masks, packing markets and celebratory gatherings during the recent Hindu festive season have also raised concerns about the spread of the infection.
Authorities are flying in doctors and paramedics, increasing the number of intensive care beds, and ramping up testing and tracing as the twin health emergencies overwhelm hospitals.
Studies indicate dirty air can increase the severity of COVID-19 infections. Delhi recorded 131 deaths Wednesday, the highest so far on a single day.
Doctors say air pollution affects the immune system, making people more vulnerable to infections, particularly respiratory infections.
"It has been seen that pollution can increase COVID-19 infections and deaths by about 9 to 10%, in some studies they have even gone up to 15%," according to Suranjit Chatterjee, senior consultant of internal medicine at New Delhi's Indraprastha Apollo Hospital.
Authorities acknowledge that the city's hazardous air poses a risk to the city during the pandemic.
"Pollution is coming. The sky is filled with smoke and this is worsening the situation with coronavirus," Delhi's chief minister, Arvind Kejriwal, said this month as he launched a campaign to control pollution levels that included measures such as spraying water to control dust levels.
Delhi has now counted over half a million cases out of the nearly 9 million in India, the world's second-worst affected nation.
As the city witnesses its worst phase of the pandemic, authorities have lowered the number of people allowed at marriage ceremonies from 200 to 50,and are considering shutting down markets in areas that are emerging as COVID-19 hotspots.
"The way the numbers are going up, it might be difficult for the Delhi health care system to handle it, even though it is the best in the country," Chatterjee said.
The toxic haze enveloping Delhi has been a huge disappointment for a city that saw clear blue skies and clean air during a months long lockdown earlier this year.
However, environmentalists say the return of the hazardous pollution was inevitable, as economic activity resumes because little has been done to eliminate the main sources of pollution.
These include construction dust in a city of an ever-swelling population, smoke from fires set to crop stubble in neighboring states at this time of the year and the 10 million vehicles in Delhi's streets. Falling temperatures and still air in winter keep the emissions hanging low over the city.
"You need to address these issues 365 days a year and find systemic, long-term solutions," said environmentalist Vimlendu Jha, founder of Swechha, a nonprofit that works on environmental and youth issues.
"For example," he said, "the first thing we need to do is improve our public transport infrastructure and incentivize public mobility rather than private mobility."
Construction sites, however, are humming, the streets are crammed with vehicles, and markets are open in a city where lockdown measures have been lifted to restore livelihoods, as India reels under its worst economic downturn in decades because of the pandemic.
On several days this month, Delhi's air pollution hit the "severe" category - days when particulate matter considered most harmful to human health spikes to over 30 times the safe limits set by the World Health Organization.
"Linkages between environment and health needs to be paramount and needs to be hammered down, but a lot of time our politicians and our state is in denial that pollution kills," Jha said.