Turning the tide: Is Mumbai ready for the next wave?
‘Turning the Tide: Is Mumbai Ready for the Next Wave?’ traces the intricacies of managing the Covid-19 pandemic in the city. It captures lessons and learnings from existing innovations and hurdles encountered during the first two waves of the pandemic and presents factors to reimagine Mumbai’s response to a potential third wave.
MumbaisS unique health service delivery system is led by the Municipal Corporation of Greater Mumbai (MCGM) and aided by a robust private hospital network. The Covid-19 pandemic forced the Mumbai health system to undergo rapid adaptation and transformation to combat its impacts. The city’s first case was recorded in March 2020, and its first wave peaked in September 2020 and flattened by January 2021. A second wave hit in March 2021, peaking in April. Based on past pandemic patterns, the findings of Mumbai’s four rounds of sero-survey, and global examples, the possibility of the third wave cannot be ruled out. While vaccination is the only viable solution to this crisis, only 13.7% of Mumbai’s above-18 population has been fully vaccinated and about 38% has received the first dose (as of July 7, 2021).
The city’s estimated adult population is over 9 million. The report looks at the specifics of the first and second wave, detailing lessons learnt from issues related to oxygen, and medicine supply and vaccination.
It also considers hidden groups—migrants, crematorium and graveyard staff, and ASHA workers—who bore the brunt of the crisis. Further, it details other crucial aspects of Covid-19 management—technology and the associated challenges; the importance of the Mumbai Metropolitan Region (MMR) in fortifying the city; and learnings from global successes in pandemic handling.
The character of Mumbai’s second wave differed greatly from the first. Infections moved from the slums, such as Dharavi (which was badly impacted in the first wave), to more affluent areas; hit the younger population; and spread faster, leading to oxygen and medicine shortages. The circulation of new variants and a drop in social vigil fueled the second wave
‘Turning the Tide’ is an attempt to complement the existing research in dealing with the pandemic. Deliberations with over 20 government, medical, tech and media experts, along with a study of media reports and government communication formed the basis of this analysis. Important learnings were also drawn from the MCGM’s June 2021 report titled ‘Principles of Medical Management of COVID-19: The MCGM Experience’ that acts as a guide for medical practitioners involved in pandemic management.
The first and second waves
The character of Mumbai’s second wave differed greatly from the first. Infections moved from the slums, such as Dharavi (which was badly impacted in the first wave), to more affluent areas; hit the younger population; and spread faster, leading to oxygen and medicine shortages. The circulation of new variants and a drop in social vigil fueled the second wave. In addition to physical health infrastructure, the handling of the pandemic revolved around two aspects—testing, tracing, tracking, quarantine and treatment; and setting up decentralised digital ward-level ‘war rooms’ for hospital bed and patient management (in what came to be known as the Mumbai model).
The vaccination imperative
Vaccination is the most critical aspect of the fight against Covid-19. The inclusion of private hospitals in the vaccination programme has improved Mumbai’s inoculation capacity. On June 28, 2021, Mumbai vaccinated 1,80,821 individuals, the highest single-day count.
Reliable digital pillar
Handling the third wave will require the construction of a more comprehensive information pipeline with a thrust on:
Technology solutions that focus on legacy infrastructure to reach every citizen and empower on-ground response personnel with accurate information
‘Phygital’ technology responses in line with governance mechanisms
Beefing up existing disaster management protocols
MMR and the pandemic
Given the deep economic integration of Mumbai in the MMR, any flattening of the curve in the city can only be in conjunction with similar efforts in the whole MMR. About 700,000 people from the MMR enter Mumbai daily for work. Most of this ‘to and fro’ travel happens by local trains that could become a ‘super spreader’ of the virus. The MMR saw high infection rates during the previous Covid-19 waves, contributing about 35% to Maharashtra’s caseload and deaths.
Global examples can provide insights on vaccination and transportation strategies for pandemic management. For instance, while Mumbai followed the age-based national guidelines for vaccination, an area-based strategy (as seen in Toronto, Canada) could prove just as successful. Similarly, the concept of digitally verifiable vaccine records and passports, versions of which are now being tried across the world, could be beneficial in Mumbai.
Preparing for the third wave
Data suggests that barring the brief periods when Covid-19 infections spiked, Mumbai managed the pandemic with relative success on the back of strong leadership, quick decision-making, and innovative strategies. Nevertheless, to prepare for a third wave, certain interventions should be considered:
A Mumbai+ plan
The MCGM can adopt a ‘Mumbai+’ approach for vaccinations and reopening the city. A special MMR task force of health experts, administrators, transport specialists and spatial planners should be able to drive this plan to ensure a uniform vaccination and unlock schedule.
The migrant strategy
A ‘city migrant policy’ is the need of the hour. Such a policy should begin with creating a database of migrants, their state/city/town/village of origin and job description. The civic body could set up migrant resource centres to register them, and link and track the health, housing and livelihood needs of the migrant’s family
While the MCGM has prioritised their vaccinations, it is also important to provide the hidden frontline workers—such as ASHAs and crematorium and graveyard workers—enough financial protection through health and life insurances from the state government.
A dedicated campaign to appoint citizens, including the youth, as ‘Covid champions’ can ensure some adherence to Covid-19 appropriate behaviour in all public spaces.
Disaster management protocols
The newly-created standard operating procedures for the pandemic at the municipal headquarters and ward levels need to be instituted. An alternate workforce creation system should be initiated where a new batch of people from within the administration and outside (teachers, bank staff and citizen volunteers) are repurposed in emergencies like a pandemic.
The phygital approach
Machine learning and artificial intelligence must be used to produce modelling patterns and forecast surges in caseloads. But these digital tools have limitations and involve several variable human factors. Therefore, a ‘phygital’ approach (digital tools plus on-ground implementation and monitoring) must be considered to supplement the use of innovative technologies.
Early health warning system
Real-time data on emerging diseases must be tracked and a robust warning system established to help the MCGM respond more quickly in the event of another disease outbreak.
(The study has been authored by Sayli Udas Manikikar)