The second wave of the Covid pandemic in our country exposed the worst among us but many a time also highlighted some of our best. Therefore, in April, when Mumbai first started recording more than 7000 daily new cases reaching up to 11,200 cases on April 4, and then was able to slowly decline to around 2000 cases, all eyes turned to Mumbai.
Currently, the Covid positivity rate in Mumbai is around 6% while the doubling rate has improved to 170 days and the recovery rate reached 92%. The number of active cases has declined from almost 92,000 to around 37,000. Everyone wanted to know how this turnaround was achieved. India’s apex court lauded this staggering performance and recommended New Delhi to replicate the ‘MUMBAI MODEL’.
The nitty-gritty of managing state resources to confront any epidemic usually boils down to the District Magistrates (Collectors) and Commissioners who are usually drawn from our elite corps of IAS officers. The Municipal Commissioner of the Brihanmumbai Municipal Corporation (BMC), Iqbal Singh Chahal, the architect of Mumbai’s fight against Covid became the darling of the media and the face of this dramatic turnaround. Chahal is a 1989 batch IAS officer of Maharashtra cadre and is widely credited to have kept the virus in check, ever since he took charge as BMC Commissioner in May 2020.
PROACTIVE APPROACH
The proactive approach of Mumbai, spearheaded by Chahal was on full display for those who might want to know how India’s commercial capital handled the oxygen crisis engulfing the entire nation. The total installed oxygen capacity of Maharashtra is around 1200 MT. By the first week of April, the state had more than 6 lakh positive cases that were consuming around 950 MT. With these trends and estimates, it was predicted that oxygen consumption might reach 1700 MT. Immediately; the central government was approached with a request of allocation for an additional 500 MT.
They realised that the additional allocation of oxygen would be coming from Haldia, West Bengal and it would hence entail a time of around 8 days for the tankers to reach Mumbai. Therefore, again in coordination with the Cabinet Secretary, the source of procurement was changed from Haldia to Jamnagar, Gujarat (Reliance Industries) that entailed a travel time of a mere 16 hours. Thus, the challenge of oxygen supply to Mumbai was handled with deftness and intelligence and hence the city was spared of catastrophic scenes of patients dying in critical care units of hospitals due to the lack of oxygen supply.
Once, such a situation did arise, but it was again tackled by the BMC Commissioner smartly and swiftly. On the night of April 16, the BMC was informed around midnight that six hospitals were running out of oxygen. The lives of around 168 patients hung precariously. It was decided that instead of trying to arrange for oxygen tankers to those hospitals (for which there was no time left), 150 ambulances would be deployed between 1 am and 5 am; all patients were safely shifted to the state-managed Jumbo Covid Centres which had the required oxygenated beds.
DECENTRALISATION AND PROCESS-DRIVEN MANAGEMENT
Mumbai has a population of 1.25 crores. The city was divided into 24 Covid response “war rooms”. They were empowered, autonomous and connected to a central command and control office. The other dramatic decision that the BMC has taken is the complete takeover of hospital bed allocation. Hospitals in Mumbai cannot admit any Covid patient by themselves. It is all done by the BMC.
The bed allocation is done based on the concept of medical triage, a process of sorting people based on their need for immediate medical treatment as compared to their chance of benefiting from such care. Triage originated in World War I. Wounded soldiers were classified into one of three groups: those who could be expected to live without medical care, those who would likely die even with care, and those who could survive if they received care.
Each war room has adequate staff and telecom infrastructure to handle thousands of calls. Outgoing calls are made to positive patients undergoing home quarantine and treatment. Enquiries are made about their health status. Incoming calls to the war room helpline are catered to by doctors and trained coordinators. The medical history of the patient is solicited to check comorbidities, blood pressure and saturation levels. If the patient does not have an oximeter, a healthcare worker is sent on location to collect the reading. Based on the SpO2 levels, the patients are directed to the Covid Care Centres or hospitals with ICU facilities.
Each of the 24 war rooms has exclusive access to a ‘BMC Bed-Tracker’ website that reflects the bed availability in real-time along with capacity and occupancy. Beds are categorised as ICU Beds, Regular, Paediatric ICU, Neonatal ICU, Normal Beds, Quarantine for Suspect, Isolation for Positives, Pregnancy and Others (Cancer & Dialysis). There is also data about O2 Beds and Ventilators that is a subset of ICU and Normal Beds.
AGGRESSIVE TESTING
Early detection of those infected with the virus and their isolation is the key to beating the spread of new cases. Even as early as February 2021, we were carrying out 63 tests per detected case (on an all-India basis). This daily testing has declined to 4.5 tests per each detected case. The average daily test positivity rate has risen from 8.5% during the first wave to 22.8% when the daily new cases count reached 4 lakhs.
The WHO advises keeping testing aggressively until positivity rates reach below the 5% level. However, this can bring bad publicity for governments and hence we saw many state governments fudging data by avoiding aggressive testing. Mumbai was an exception to this trend. In an interview with the Indian Express, Chahal said: “When the pandemic started, I immediately told my team that we must double up testing. And very soon, we started doing testing in shopping malls, railway stations, airports. At one point, we reached 56,000 tests in a single day.
“Then, I started getting complaints from people that it is taking two-three days for the test reports to come. I immediately conducted a Zoom meeting with CEOs of all the 55 labs in Mumbai. They said that they were carrying out 8,000 to 10,000 tests every day for corporates. I stopped corporate testing about three weeks ago. We must give top priority to a symptomatic person who needs treatment immediately, rather than having mass testing on a cosmetic basis. When corporate state testing stopped, our average came down from 55,000 to about 44,000 tests. From April 1 to 30, we did about 12.9 lakh tests, 67% of them RT-PCR unlike all other cities. But when our positivity rate fell from 31% in the first week of April to single digits, the demand has reduced.”
Everyone acknowledges that we are not out of the woods yet but probably the worst is behind us as far as the second wave is concerned. “Mumbaikars” are famous for their hardworking nature, resilience to calamities and ability to bounce back from disasters. No wonder, the world keeps saying, “Salaam Mumbai”.