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Monday, July 04, 2022

How Mumbai tackled the rising curve

Since the second wave of Covid-19 began in February, Mumbai’s success in flattening the curve is being attributed to a timely lockdown, aggressive testing and effective triaging system.

Written by Laxman Singh , Sanjana Bhalerao | Mumbai |
Updated: May 2, 2021 7:37:36 am
Andheri, Jogeshwari, COVID-19, coronavirus cases in Mumbai, mumbai covid-19 cases, mumbai news, indian expressCovid-19 vaccination drive underway at Bandra Kurla Complex (BKC) Jumbo Hospital in Mumbai. (Express Photo: Pradip Das)

The Brihanmumbai Municipal Corporation (BMC) on Friday released figures that showed that Mumbai’s daily positivity rate had dropped from a high of 20.8 per cent in the beginning of April to 9.9 per cent by the end of the month. A declining positivity rate suggests that the number of infections in the city is decreasing.

Since the second wave of Covid-19 began in February, Mumbai’s success in flattening the curve is being attributed to a timely lockdown, aggressive testing and effective triaging system. At 11,573, after touching the highest single day fresh cases on April 3, the city has been recording less than 4,000 daily cases in the last week.

Experts believe that mobility restrictions imposed on the people, coupled with BMC’s ability to pull together all of its resources, has helped the city tide over the crisis.

Not shutting down field Covid-19 centres

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BMC officials believe their decision to not dismantle Covid-19 centres after the first wave ebbed last year was crucial in being able to handle the second wave. Last December, when daily Covid-19 cases had declined to 300-400, Additional Municipal Commissioner Suresh Kakani had decided to maintain the facilities till March 31, 2021.

For better management of facilities, BMC had categorised beds into active, buffer and reserve. While facilities kept in buffer could be activated within two to three days, those in reserve could be made operational in a week.

In February and March, when the number of cases started to rise, we managed to re-start the facilities in the minimum possible time, said Kakani. Officials said the number of beds was increased from 12,000 to 23,000 within four to six weeks.

Also, the number of ICU beds went up from 1,500 to 2,800.

Dr Shashank Joshi, a member of Maharashtra’s Covid Task Force, praised BMC’s decision of not dismantling the Covid-19 centres. “Couple of things worked for Mumbai. BMC did not dismantle makeshift jumbo facilities like BKC. When the tsunami (second wave) hit us, it changed its geographical location. The first wave came from the slum population, now it is predominantly coming from high-rises and housing societies. Now, demand for treatment in private hospitals has increased,” he added.

“Around the first week of April, we were facing a similar situation as Delhi is currently witnessing. But what BMC did was it rapidly ramped up the beds… it added 3,000 beds in a few days, easing the pressure on the existing private healthcare care sector,” said Joshi.

War Rooms

The BMC’s 24 ward-level war rooms set up for bed management in hospitals has helped in setting up one of the most effective triaging system in the country, ensuring systematic allotment of beds and preventing people from running from one hospital to another as was the case during the first wave. Joshi said the war rooms were a key management strategy.

“It eased out anxiety experienced by patients while hunting for beds. The main thing in the Mumbai success story has been its war rooms. All 24 wards have war rooms, with ward officers, who were given power equivalent to the municipal commissioner,” he added.

For better coordination between the 24 war rooms and jumbo care facilities in terms of bed allotment, BMC had set up 10 inspection teams and arranged ambulances for each ward to facilitate examination of those testing positive and seeking hospitalisation.

After the civic body received a report from the labs, the concerned ward war room informed the patient. Depending upon symptoms, the person was either asked to undergo home quarantine or a team was sent to home to take the patient to a quarantine centre or hospital.

Testing facility ramped up

As the second wave hit, BMC ramped up testing facilities in the city. By March 1, BMC was conducting about 20,000 daily tests. The number increased at the end of March to about 40,000 tests.

On April 12, Mumbai conducted the highest number of tests in a single day. In April, the city’s daily positivity rate was consistently around 20 per cent with the highest positivity rate of 27.94 per cent recorded on April 4.

“During the first wave, Mumbai could not perform more than 18,000 to 20,000 tests a day. With great difficulty, we ramped up testing to around 40,000 to 50,000 a day. This stretched the lab infrastructure but we still managed to increase the number of daily tests performed. The number did fluctuate but was not drastically reduced. The number of tests being conducted will depend on how many people are showing symptoms,” said Joshi.

Questions, however, are being raised about the decrease in the number of daily tests being conducted at present. The number has declined from 51,319 on April 3 to 43,525 on April 29. Typically, daily tests have fallen over the weekend. On all four Sundays in April, the number of daily tests remained below 40,000, with the lowest (28,328) on April 25.

“Mumbai is the only city where we don’t need a doctor’s prescription to undergo Covid test. Less testing means recovery is good and people are not falling sick,” said Dr Gautam Bhansali of Bombay hospital.

Effective lockdown-like curbs

Officials said that action against people not following Covid-19 norms, random testing and effective control of lockdown-like curbs led to a decline in daily cases.

“Initially, we took several actions against individuals and buildings not following guidelines. This forced people to take the guidelines seriously. Also, we ensured aggressive testing in markets, shops and public places. But with the curbs imposed, these places are not open and hence, no tests are taking place there. With the lockdown-like restrictions, we managed to break the chain of infection,” said Dr Bhupendra Patil, BMC Medical Officer of Health, M West ward (Chembur).

T ward (Mulund) Assistant Municipal Commissioner Kishor Gandhi said that timely imposition of curbs helped in decreasing the number of cases. From 550 cases daily during the peak, the number has dropped to 100, he added.

“One of the main reasons for a dip in the positivity rate is the restrictions, as it prevented contact among people. During the first phase, more cases were recorded in slums and we had to reach out to them to undergo tests. Now, more cases are coming from non-slums areas and people are themselves going for tests. This trend has helped in putting less burden on the health infrastructure, as many can stay in isolation at their own homes,” said Gandhi.

The way ahead

While the numbers seem to suggest that Mumbai is on the path to recovery, experts have a word of caution: it is too early to let the guard down.

“There are two current concerns: to make intensive care and critical care beds available to those who need them and lower the mortality rate. The biggest challenge is to contain asymptomatic cases. Therefore, we should strictly self-isolate. And when we unlock, ensure strict adherence to Covid-19 rules,” said Joshi.

After the first wave, even when the rest of the country was reporting hardly any new cases, Mumbai was registering 400 to 500 cases a day. In Mumbai, there is some endemic degree of Covid.

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