Understanding Mumbai’s downward Covid-19 trend
Amidst an explosive second wave of the pandemic, the number of Covid-19 cases in Mumbai has started showing a gradual, downward trend. From touching a single day high at 11206 cases in the first week of April, the daily case count dropped to 3999 on Tuesday. But this comes with an all-important caveat: The number of tests has declined from 51263 on April 7 to 30428 on April 27. What’s more, the number of deaths has gone up and so has the Case Fatality Ratio (CFR) --- the daily CFR on April 7 was 0.23%; on Tuesday, it was 1.47% --- and, significantly, hospitals across the city are yet to record a reduction in demand for beds.
“The lockdown-like measures have definitely worked in the city, but this is also a typical trend in the pandemic waves. You record a sudden surge and then a slump,” said Dr Avinash Supe, member of the task force of Covid-19 deaths. He said that Mumbai’s situation is expected to stabilise by May 15.
RISE IN DEATHS
In the first week of April, Mumbai’s daily case average stood at 9737. In the following week, the daily average dropped slightly to 8879 and to 8074 in the third week. In the ongoing fourth week of the month, the daily case average has further declined to 5628. On the other hand, the number of deaths has shown a rise. In the first week of April, the average daily deaths were 23. In the fourth week, the daily average is 68. To be sure, the overall CFR has declined marginally between April 7 and April 27, from 2.45% to 2.03%.
“The deaths that we are recording now are of people who have been hospitalised when the number of cases was high,” said Supe. “In this wave, we have seen few deaths within a day or two after hospitalisation. Almost 80% of people who have succumbed have battled the virus for a week or two a week in the hospital.”
The declining trend in cases is yet to reflect as the demand for beds in city hospitals has not gone down as yet. The civic-run 1,850-bedded SevenHills Hospital, which is an exclusive Covid-19 facility, continues to have full occupancy. “We are still admitting anywhere between 150 to 200 patients every day,” said Dr Maharudra Kumbhar, an officer on special duty at the Seven Hills Hospital. “The reduction in daily demand for beds would be a fair parameter to analyse the situation. But we haven’t experienced any reduction as yet,” he said.
“The occupancy in our centres remains full,” said Dr Prince Surana, who runs a 75-bed Covid-19 hospital in Chembur and a 50-bed one at Malad. Both the hospitals have 100% occupancy. “The number of calls asking for beds may have slightly reduced, but the demand for Intensive Care Unit beds and ventilator beds remains the same,” he said.
At the NESCO facility in Goregaon, all the 200 ICU beds were full. Of the 2015 ward beds, 1426 were occupied.
“We have been admitting 220 to 250 patients daily and the number of admissions has not come down as yet,” said Dr Neelam Andrade, dean of the facility. Another 1,500 beds including 700 beds will be added to this centre on Wednesday. According to Andrade, the demand continues to be high for oxygen and ICU beds.
On Tuesday, 1,096 oxygen beds and 51 ICU beds were available in the city, according to the BMC’s dashboard.
SLUMP IN TESTS, NOT JUST ON WEEKENDS
This indicates that reports about Mumbai turning a corner are premature. But the biggest indicator for this is that the city is now testing fewer people.
A state-wide curfew is underway since April 14, and on April 21, the state announced stricter curbs on movement of ordinary citizens. One of the reasons for this downward trend, experts say, is that laboratories are flooded with samples; many only provide home sample collection appointments with a five-to-six-day lag. Doctors say that a large number of patients in the city were prescribed chest CT scans (to detect infection in the lungs), as they could not get appointments for RT-PCR swab tests.
“The number of tests may fluctuate, and the numbers drop on weekends. But Mumbai has not reduced the tests drastically,” said Dr Rahul Pandit, a critical care physician at Fortis Hospital and a member of Maharashtra’s Covid-19 task force.
However, the numbers don’t bear this out.
The average daily tests in Mumbai in the first week of April were 46,315. The average improved slightly to 49,582 in the second week and again dropped to 45,829 in the third week. There has been a steady downward trend in testing in the city: starting April 22, the number of tests has ranged from 41,826 to 30,428 (April 27). Typically, daily tests fall during the weekend. For instance, on April 18 (a Sunday), 36,556 tests were conducted, and on the following day, 45,350 tests were conducted. By comparison, the number of tests conducted in Mumbai on Sunday (April 25) was 28,328.
According to Pandit, the daily cases in Mumbai are likely to plateau and stabilise in another two weeks. “But we can’t let our guards down. Covid appropriate behaviour is essential and the number of tests should not decrease at any cost,” he said. Experts have also pointed that aggressive vaccination will help in controlling the third wave of the pandemic.