Mumbai may have 45,000 to 46,000 cases by May-end, projects BMC chief
The city’s newly elected Brihanmumbai Municipal Corporation (BMC) chief IS Chahal speaks to HT on the plan to curb the spread of Covid-19 in Mumbai. Excerpts:
What is your assessment of Mumbai’s performance in managing the pandemic so far?
We are putting in our best. Standard operating procedures are already in place. Ward officers are the backbone of the system. I sat with them for a good 10 hours. People have worked hard and should get due credit for the work they did in the past 50 days.
I have told my officers that if Mumbai has 14,000+ cases, and active cases are only around 11,000+, there is no need to feel demoralised. Look at our testing. Maharashtra has carried out 2.30 lakh tests, of which 1.25 lakh are from Mumbai only, which is 33% of the testing in the country. Mumbai has carried out 9,000 tests per million, compared to Delhi’s 4,000 tests per million. These things have not happened automatically. Of course, there are some bottle necks, which we are trying to resolve.
What are the bottlenecks you have identified?
We started from contact-tracing. How do you identify contacts and quarantine them? In slums, how do you quarantine high-risk contacts? We have deliberated on how to increase the ratio of contacts traced from 1:3 to 1:10. That is, for every one positive patient, trace up to 10 high-risk contacts, instead of the current average of three. We are deliberating on how to make contact-tracing more accurate.
Equally important is filing data on the ICMR website. When I joined, it showed only 54% contact-tracing, when we had done 98%. In the past five days, the contact-tracing went to 76%, just by updating the official data. When the Centre sees this, they underestimate Mumbai’s work, [that too] just because the data is not updated. There will be no compromise on data filing.
Will you replan the way containment zones are monitored?
Yes. I am rationalising the number of containment zones. A population of 5,000 to 6,000 is apt for one containment zone. However, in Mumbai, every building is one containment zone. The so-called 2,800 containment zones in Mumbai looks frightful. But 1,153 are standalone buildings, with one Covid-19 case. The number of containment zones, 2800, which is rising rapidly everyday, scares people. Manning these containment zones is also a waste of police manpower. When I joined on Friday, I saw 250 zones were created in a single day on Thursday. When I went into the details, I found that 50 cases have led to 50 containment zones. One containment zone for one case. This has led to panic. I have drafted a proforma for management committees of these buildings. While health workers can go there, take out comorbid people and disinfect the building, the society will have to ensure no one goes in and out of the building. Self-management of containment zones is necessary. It will reduce the number of containment zones by half.
What about the testing protocol?
I have announced a new testing policy. There were a lot of ambiguities. For example, if there is an elective surgery, should you do a Covid-19 test or not? When should a pregnant woman get a Covid-19 test done? If someone is going through dialysis, what is the procedure?
What other changes will be made?
I am making standard operating procedures for everything. We have 307 flu clinics (fever clinics) and we want to impose ‘military-type’ discipline there. I have drafted a format which says when you [the doctor at the clinic] recommend someone’s test, you will have to certify that he is symptomatic, and that he has not been given any treatment, any paracetamol. It is not your business to prescribe treatment. You have to certify that you are following ICMR guidelines while prescribing tests. If anyone is found violating this, their licence will be cancelled. Tomorrow no one can accuse us and say we were trying to curb a patient’s symptoms by giving medicines. I have issued vertical orders for tasks given to all officers. Everyone should know who should do what. If a municipal commissioner is in-charge of Mumbai and all its aspects, a ward officer can be in-charge of his ward in the same way.
What is the worst-case scenario expected for Mumbai?
I am projecting 23,000-odd active cases in Mumbai by May 21-23. This month, the total may reach 45,000-46,000 cases. When I joined last Friday, the doubling rate was eight days. As of Tuesday evening, it has become 10.9 days, so almost 11 days. I have 14,900 cases, but active cases are 11,500 after deleting cases of discharges and deaths. That is how we are calculating the cases for Mumbai.
Is Mumbai prepared to handle it?
At least 60-65% of those quarantined are in our Covid Care Centres (CCC), where we have 35,000 beds. The remaining 40% are in health centres and hospitals [(dedicated Covid health centres (DCHC), and dedicated Covid hospitals (DCH)]. The capacity of our DCHC and DCH is 4,200 beds. Presently, 400 beds are vacant.
The BMC has planned that 200 beds will be added from the government’s side daily. We are also going for jumbo ICUs now at SevenHills hospital, BKC grounds, JJ Hospital and St George hospital. Private hospitals have promised me they will create additional beds for Mumbai. With all this, Mumbai can jump to 8,000 beds very fast, and be ahead of the Covid-19 outbreak’s pace.
Moreover, I am trying to enhance beds at CCCs as well. Today I am visiting NCSI dome, where we are establishing a 50-bed ICU, which can be scaled up to 200 beds. Similarly, beds at the BKC grounds are reaching 1,000. At BKC grounds, I plan to put 300 ICU beds and make it into a DCHC.
When will Mumbai flatten the curve?
The lockdown is a very good decision. Our cases are 14,000+, and our doubling rate is 10 days. This rate will remain only if Mumbai gets 1,400 cases in one day, but instead we are getting 600 to 700 cases. So Mumbai may touch the doubling rate of 14 in 3-4 days. The moment that happens, even if it happens in seven days, by May 20 or 21, Mumbai can compete with the 14-day cycle, due to the new discharge policy of the Government of India. If some patients can get discharged on the 7th or 8th day or the 10th day and the doubling rate is touching 14, it will show a downward curve.
In another scenario, some of these patients will still take a maximum of 14 days to be discharged and because the doubling rate is projected to be 14, another person will come to occupy the same bed in 14 days. Bed management will stabilise. By May 31, the doubling rate can go up to 17 or 18 and the battle is almost won.
How long can the lockdown practically last?
I am very open to kickstarting the economy of the city, but we have to be very wise while doing it. Yesterday, I opened the entire diamond market of Mumbai. In the diamond market, where there is very limited labour and specialised labour, and there are ₹5,000-crore exports waiting to happen, opening up the market can be beneficial. Next, I will look at Nariman Point. But none of these can happen at the cost of spreading Covid-19. If I feel something is going to spread Covid-19, like opening a wine shop with long queues, then I am not going to change that till the end of May.
Do you think there will be a situation where you may have to take a stance contradictory to the state or Centre, like it happened with opening of liquor shops?
I have already discussed this with the chief minister and chief secretary of Maharashtra. I have said I will take the government into confidence before taking any decision for Mumbai. Once we announce a decision on BMC level, it shall not be changed.
What is your assessment of Dharavi?
When I was in Dharavi, I asked the ward officer to show me a map of Dharavi, and show me in colours where all the virus has spread. I was surprised to see there are no Covid-19 cases in 80% of Dharavi. There has to be a difference between a containment zone in Dharavi and in a posh 30-storey building in the rest of the city. They cannot have the same parameters.
How challenging is this posting?
I was monitoring Covid-19 at state level for the past 50 days. I got associated with Covid-19 [management work] on March 21, when the Maharashtra government announced the lockdown.
The chief minister made me in-charge of monitoring the entire state, my Google drives are filled with 34 collectors and 27 municipal commissioner’s data, monitoring their contact-tracing efforts, containment zones and hospital categories. I was doing all of this for the entire state. In April, I made the hospital management plan – CCCs, DCHCs, and DCHs for the state. When I joined the BMC, I was already 45 days into the fight.
How prepared is Mumbai to handle the monsoon?
Every week, once or twice I am going to inspect the nullahs and Mithi river. At Mithi, instead of eight hours, dredging is happening for 16 hours. The road work was suffering due to lack of labour. We now have a software that will estimate how much cement is needed for any stretch of road. I have asked them to use the software and make payments, so dozens of people don’t have to stand on the road taking measurements for work to commence. The work will speed up.