As the number of COVID-19 positive cases in Mumbai increases by the day, state health officials and the Brihanmumbai Municipal Corporation (BMC) are trying to end a barely concealed standoff over how to prevent the contagion from spreading further in the city. Of 416 cases till Thursday, Mumbai contributed to more than 50 per cent burden at 235 cases. State officials told The Indian Express that while Pune and Pimpri-Chinchwad have managed to contain the spread, Mumbai had “failed” in proper contact tracing of COVID-19 case.
After multiple complaints from state officials, Chief Secretary Ajoy Mehta visited the BMC headquarters on Tuesday and held a meeting with all ward officers. This was followed by a visit by Health Minister Rajesh Tope. A plan for containment in Mumbai has been drawn up. The civic body has now started following a more aggressive protocol of cluster containment in over 190 areas in Mumbai now.
Analysis of BMC data shows the number of sporadic cases rose from two people on March 28, to six on March 29 and 11 on March 30. These people neither had a travel history nor contact with confirmed cases indicating possibility of community transmission.
As per protocol, each local area must form a committee of three officers to counsel and contact trace confirmed COVID-19 patients. Each civic corporation is supposed to fill a form giving details of high risk and low risk contacts of each patient, suspected duration of exposure and areas visited by the patients.
State public health department said they received no information on a single COVID-19 case from BMC until Tuesday. When contacted Dr Satish Pawar, from Directorate of Health Services, said, “BMC is the only corporation in state that has not filled information on IDSP (integrated disease surveillance programme) portal.” IDSP portal is a central database that maintains information on each COVID-19 case.
BMC has acted on its own, deviating from state and central guidelines in some cases, official said. The circular issued by the Mumbai civic commissioner on March 30 disallowing burial of dead bodies contradicting central guidelines which permits burials, is one such instance, an official said. A BMC ward officer said civic staff has not been trained well in handling the outbreak. “They lack the skill to convince and counsel confirmed cases to give detailed history of the people they met,” the officer said. In the initial days when new cases emerged in Mumbai, low risk contacts were only advised home quarantine, but no mechanism to monitor them was in place.
Pune, Sangli and Pimpri-Chinchwad Municipal Corporation (PCMC), on the other hand, have taken an aggressive approach to contact trace. The public health department said these corporations remained in touch with the department.
“We knew if a patient tests positive, he would be in shock and not properly answer our questions. So even before the test results came, our doctor conducted a detailed interview to get a list of all people they met. If they tested positive, within hours all these contacts were reached out,” said Dr Pawan Salve, additional medical officer, PCMC.
State officials said BMC had gaps in contact tracing and did not communicate to the department its containment measures and testing to the state portal. In some cases testing of close contacts was delayed even as government guidelines require immediate isolation and testing of close contacts. A 40 year old woman died in KEM hospital on March 28, her husband and son’s swabs were collected from their home only on March 30.
In another case, when a 68 year old domestic help from the central suburbs tested positive on March 18, her son said he was only questioned for 15 minutes about basic movement of the woman. The woman had bathed in a public toilet but no attempts to trace other women who used the bathroom were made. “BMC asked us to go to hospital ourselves for test. No transport was provided,” the son said.
An infected person, according to WHO, can transmit virus to people within one metre range. BMC officials said in Mumbai the population density is higher (26,453 per sq km according to environment report 2018-19) and contact tracing becomes challenging. Civic officials said they were also asked to fill separate forms of confirmed cases by BMC and state government. Following a meeting with state government on Tuesday, a common form has now been prepared. “We have found several instances of cluster transmission in Mumbai, the cluster containment plan has been implemented now. House to house survey has been immediately started. We will see the results in next few days,” said Anup Kumar Yadav, director of National Health Mission, Maharashtra.
BMC has also been asked to modify its approach. Now a constable is stationed near a building where a person has been home quarantined to ensure compliance. In D ward, after a COVID-19 case reported she went to buy vegetable in local market, the entire market was sealed this week. “These measures should have been taken earlier. We are trying to do damage control,” a civic official said.
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