Model that helped Mumbai tide over 2nd wave

From being the epicentre of the Covid-19 pandemic to being hailed nationally for its containment model, Mumbai has come a long way

From being the epicentre of the Covid-19 pandemic to being hailed nationally for its containment model, Mumbai has come a long way. The city with a population of over 20 million had only 10% vacant beds in hospitals and Covid jumbo care centres in the first week of April. Now, over 60% of the beds are empty in the city. To achieve the ‘Mumbai model’, the Brihanmumbai Municipal Corporation (BMC) had to take multiple initiatives not only to handle shortage of beds, but control the mortality rate, and ensure timely supply of oxygen and medicines to the infected patients.

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In April, when the second wave of the pandemic was at its peak, the country’s financial city recorded more than 10,000 daily cases thrice. But now, the daily average has come down to around 2,000 cases. The BMC has garnered quite a lot of praise from across the nation. The Supreme Court not only applauded the management of medical oxygen supply in Mumbai, but also recommended that the Delhi government replicate the “Mumbai model” to fight the pandemic.

On April 1, Mumbai had 50,055 active patients who were on Covid-19 treatment. The number has now fallen to 27,649. This stands a 45% fall in the total active cases.

Strengthened health infrastructure

On April 1, Mumbai had 15,971 beds in 97 dedicated care centres and hospitals. Of this, only 4,160 beds were available. The city had 1,805 beds for patients on Intensive Care Units (ICU), but 139 of them were available. Of the 1,143 ventilator beds, only 82 were empty.

By April 15, the number of total beds was raised to over 20,000, which included ICU and ventilator beds. Along with focusing on strengthening the health infrastructure, the BMC also had to chalk out plans and initiatives to deal with shortage of beds, which could have increased the fatality rate.

“When the pandemic curve flattened post November 2020, we used some Covid-19 beds for patients with non-Covid infection. As soon as the number started soaring again, we upgraded our facilities. Initially, we had a limited number of ICU beds which were increased within a fortnight,” Suresh Kakani, additional municipal commissioner, health. “Almost 40% Covid Care Centre (CCC) were activated and the remaining were kept on standby,” he added.

Patients were, however, still struggling to find beds in hospitals and jumbo centres. Private hospitals were instructed to use 80% beds for Covid care. So, acting on war footing, the BMC standardised the system.

“We decentralised ward war rooms (24) and each were instructed to manage their own geographical areas. It was mandatory for beds to be allotted only through these war rooms. Hospitals were directed not to allow direct or walk-in admission. The individual wards were responsible for contact tracing, isolation, identifying high-risk contacts,” said Dr Rahul Pandit, a member of the state task force for Covid-19.

The availability of beds was made public through a live bed tracker in both public and private hospitals across the 24 wards. In fact, all wards were provided with their individual ambulances to save time in commute.

“Many a times, patients would keep waiting for a bed of the hospital of their choice which often delayed their treatment. When this Standard operating procedure (SOP) was started, it helped channelise the admission process,” said Bhagyashree Kapse, ward officer of R/C that covers Borivali.

Private laboratories were even instructed not to inform the infected patients directly. “We were instructed to share the list of infected patients directly with the war rooms. Officials from the war rooms would individually contact the patients and arrange for beds as per their health parameters,” said a senior officer from a laboratory.

These on-ground initiatives helped curb shortages of beds like witnessed in the first wake of the pandemic. At present, the city has 22,077 beds in the dedicated care centres and hospitals. As many as 13,704 beds are available. The number of ICU beds has increased to 2,867. Out of this, 532 beds are vacant.

If an infected patient was asymptomatic, they were advised to isolate at home. In case, if they didn’t have equipment to check temperature or oxygen levels, the field officers visited them to record all parameters. All elderly above 50 years or people with comorbidities like diabetes, tuberculosis, cancer among others were isolated in CCC nearby.

Early detection, isolation and treatment

The Opposition criticised the civic body for conducting fewer tests, alleging it led to infected people spreading the virus to others. Till March 21, the civic body was conducting around 18,000 tests daily on an average. But from March 22, the BMC started increasing the testing to over 40,000 daily.

“We were instructed to test as many people as possible. It was in two ways— the floating population of people in bus stands, markets, and malls were tested with a rapid antigen test (RAT) which gave results within 30 minutes. While the stationed population like shopkeepers, residents were tested with RT-PCR. This helped in early detection, isolation and treatment,” said Kakani. In April, on an average, the civic body was conducting over 45,000 tests daily.

In fact, anticipating a shortage, the BMC had floated a tender procuring 2 lakh vials of Remdesivir.

During the first wave of novel coronavirus last year, Mumbai’s oxygen requirement was approximately 210 metric tonnes which rose to 270 metric tonnes post March, when the city’s active cases surged to 90,000. The BMC initiated ‘Mission Mode’ under which all oxygen manufacturers and distributors were instructed to provide adequate oxygen supply in civic and private hospitals across Mumbai. The details of the supply and stock were maintained through a centralised Google Drive document around-the-clock.

“During the first wave, we had realised the importance of oxygen so we installed nearly 24 Liquid Medical Oxygen (LMO) tanks. But due to lower demand, half of them remained unused which we became helpful in the second wave when the cases increased drastically,” added Kakani.

In the first wave, due to the national lockdown, the footfall of non-Covid patients fell by 80% so the private and major civic-run hospitals had enough beds for Covid-19 patients. However, in the second wave, with the relaxation of the lockdown, the hospitals were reeling under the pressure of both Covid and non-Covid patients. Thus, the jumbo covid care centres also played a major role in the second wave.

Talking about it, Dr Neelam Andrade, dean of NESCO jumbo Covid care centre in Goregaon said, “So far, we have treated around 21,000 patients. We have 413 pipelines for oxygen. Along with that, we have over 200 ICU beds. In the month of April, there was a huge load of patients. We also provided counselling to the patients to help them with their mental health.”

Getting ready for the third wave

State health minister Rajesh Tope has already declared a possible third wave after September. As a precautionary measure, the BMC has decided to add 5,000 more beds for Covid-19 patients. In addition to this, three major jumbo centres will be set up, which will cater to over 2,000 patients. These centres will also have ICU beds.

But the main priority would be to ramp up the mass immunisation programme. The civic body, which is expecting to get the vials next month, wants to inoculate over 1crore people within two months.

“If we are expecting a third wave post September, it is imperative that we vaccinate as many people as possible. Along with elderly, we also want to inoculate the younger population who possibly would be more affected in the next wave. We are just waiting for the vials before we could reboost the immunisation programme,” said Kakani. Just like decentralisation of the war rooms, the BMC has plans to bifurcate the vaccination as per wards. “Citizens would get vaccinated as per their individual wards, which will help control crowding and smoothen the process,” he added.