Iqbal Singh Chahal recounts night of April 16-17 “that changed us forever”, explains how he made oxygen shortage “history” in Mumbai, lists lessons for Delhi, including not pressuring hospitals to increase beds, and lays out plans for “vaccination tsunami”. Session was moderated by National Editor (Mumbai) Nirupama Subramanian
NIRUPAMA SUBRANIAN: You said that the intervening night of April 16-17, when as many as 168 patients were evacuated in an emergency operation from six civic hospitals in Mumbai, as one of the most difficult nights of your career. Why did you feel that way?
The issue of oxygen first came up at a meeting around the first week of April. It was mentioned that Maharashtra’s total installed oxygen capacity is roughly 1,200 MT, which included industrial, non-Covid and Covid use. By April 4-5, the state’s six lakh positive cases had started consuming almost 950 MT of oxygen. In our meeting it was projected that by April 15-20, our consumption may go up to 1,700 MT. That is when the alarm bells went off. We realised that even if we stop all industrial operations as well as non-Covid oxygen use, we still can’t manage beyond 1,200 MT of oxygen… So we requested the Government of India to give us an additional allocation of 500 MT. About 150-200 of this additional allocation was coming from Haldia in West Bengal, and for the tanker to reach Mumbai, the turnaround time was around eight days.
In the midst of these talks, on the intervening night of April 16-17, I was informed around midnight that six hospitals were running out of oxygen. There were 168 patients there… So between 1 am and 5 am, we deployed 150 ambulances and brought these patients to our jumbo Covid centres. Fortunately, we had 3,600 empty beds, of which 850 were oxygenated beds. I was so relieved that no lives were lost.
After the operation, I couldn’t sleep at all, and around 7 am I sent messages to top functionaries of the Government of India, including the Cabinet Secretary, Home Secretary, Health Secretary… I sent another set of messages to top eight leaders of Maharashtra, starting with the honourable CM. I said, this is not the end of the problem and this may happen again.
Within 15-20 seconds, I had an incoming call coming from the Cabinet Secretary, Rajiv Gauba. He told me, tell me what you want… I said we have to import oxygen into the state. I told him that we can’t manufacture oxygen at such short notice and that the turnaround time for oxygen coming from Haldia was around eight days… I worked under Gauba sir when I was joint secretary in the Ministry of Home Affairs… I told him that Reliance Industries was just 16 hours away from Mumbai, in Jamnagar, and oxygen tankers can come from there every night. He said that such an allocation cannot be made just for one city. I told him that he can allocate it to Maharashtra and I will make sure that it comes to Mumbai city only… And then 125 MT of oxygen was allocated to us from Jamnagar. The same evening, tankers started moving and now the problem (of oxygen) has virtually become history in Mumbai because of great help from the Government of India.
NIRUPAMA SUBRAMANIAN: So, would you say that Mumbai is now self-sufficient in oxygen?
Unfortunately, outside Mumbai, in the rest of Maharashtra, cases are not coming down. Mumbai is only 17% of the state’s population, and the demand (for oxygen) from other parts has not reduced.
After the April 16-17 incident, the state government created emergency systems. The FDA (Food and Drug Administration) Commissioner was given charge of allocating and organising seamless distribution (of oxygen). Only oxygen availability is not the issue, the bigger issue is optimal utilisation and proper channelising. That is why a team was created under the FDA, which has district collectors, divisional commissioners, BMC commissioner, and other commissioners… The team is functioning very well. So we are in good situation, but in 10-15 days, when cases start coming down further in the state too, we will become a little more comfortable. Now, stress is there.
SHUBHAJIT ROY: While you reached out to top bureaucrats and ministers after the April 16-17 incident, don’t you think there should be an institutionalised mechanism to address such issues?
I agree with you… In the first week of April, our crisis management team started discussing the oxygen crisis. It had started to build up but nobody knew that things were going to happen so fast and suddenly… In Mumbai, we have established six emergency stock points, which function 24/7 and store about 50 MT of oxygen each. Each point services four wards (there are 24 in Mumbai)… Now, if anybody gets an SOS call, they have to forward it to the ward officer, which is then sent to the deputy commissioner in charge of one of the six emergency points. And then, in two-three minutes, tankers start moving with supplies… We have learnt from our experiences, and our crisis management team continues to add on new activities to the mechanisms.
MALLICA JOSHI: Delhi has been experiencing oxygen shortage for over three weeks now. What could be the reason behind this sustained crisis?
In oxygen management, there are five areas which need to be taken care of. First is availability of stock and dedicated supply. Like from the moment an oxygen tanker leaves the manufacturing unit, it should be clear where it is going, and who is going to take custody of the tanker… Second… what is happening in many cities, including Mumbai, is that when the Covid pressure builds up, the administration tells the hospitals to add on beds. They don’t realise that the capacity of installed oxygen tanks is limited, and has a turnaround time of 24 hours.
At a meeting of Delhi government and Central officials on Wednesday, I said that this is the single biggest reason why SOS calls are coming… I said if you want to increase beds like Mumbai, don’t pressurise the hospital… What we did was to have more beds at jumbo centres which also have higher oxygen capacity. Now, we are building oxygen plants there as well to have in-house oxygen manufacturing for the jumbos. It will be implemented in the next three-four weeks. We have seven jumbos with 9,000 beds and another four are coming up with 6,500 beds. And, 70% the beds will be oxygen beds. So I told the government of Delhi that make sure that hospitals should not be forced to add on beds because that leads to crisis.
The third issue is of leakage of oxygen. So you should have emergency stock. We have the six points in Mumbai… So emergency stock can be rushed in time. The fourth point is related to our state taskforce which is headed by Dr Sanjay Oak and has many eminent doctors. I asked them to give us a protocol for oxygen consumption. They said saturation level should not be maintained beyond 94, and we circulated the protocol to all of Mumbai’s 176 hospitals. There is no need for saturation of 97-98.
And lastly, they (the task force) also said that high-flow nasal oxygen is a guzzler. You should not blindly give it to everybody just because it’s available. It should be used as a last resort. We also told hospitals that you should do your daily oxygen consumption audit — what was the per bed ratio — and try to reduce it by 5%. The government of Delhi agreed that high-flow oxygen is a guzzler and that they will revisit it.
ANANT GOENKA: During the second surge, there has been a lot of Centre-state blame game over oxygen supply etc. How can we solve this?
Let me make it very clear that the kind of stories that we hear is not fact. Most of these talks happen at a bureaucratic level. So when we are talking to our colleagues in the Government of India, they are like batchmates, one batch above or below… Nobody found the Government of India not willing to help us. Even they have their own issues… As we are learning, even they were learning. So no such friction was there… For instance, when I requested the Cabinet Secretary to airlift (oxygen), he said we are looking into that but some issues are coming up. Later on I realised that you can’t lift up a full tanker, it can explode.
ANANT GOENKA: So the Centre-state differences never came in the middle of work?
I don’t believe in that.
ANANT GOENKA: Did Maharashtra dismantle its infrastructure too quickly after the first wave?
We had built eight jumbos in Mumbai and except the one at Race Course, the remaining seven were kept intact. The one at Race Course was in a low-lying area and got flooded during the monsoon. Also, since June it had zero occupancy. After it got flooded, I took a meeting and said that if the centre got flooded in the future, there may be two feet of water under beds, and so it’s better to get rid of the jumbo.
ANANT GOENKA: Are you confident that if in the future the crisis deepens, the systems that you have built and the relationships that you have established with oxygen companies such as Linde and Inox will hold up for Mumbai, and we will have enough oxygen supply?
Incidents like what happened on April 16-17 have changed us forever. For example, 15 days ago, we issued tenders for creating in situ oxygen generation plants at the seven existing jumbos and the four new jumbos. These 11 jumbos will have 15,000 beds, 70% of which are oxygenated. They will have 1,400 ICU beds. We will not need even one cubic meter of oxygen to be imported into the premises. All of this will become a reality by May 31 and our oxygen requirement (from other sources) may come down by 60% and we won’t have to tell the state government to give us oxygen.
ANANT GOENKA: Are you prepared for the third and fourth wave?
Absolutely. I have no doubt in my mind that a third wave is going to hit us sometime in June and July, maybe later. We are already preparing for that. That’s why we started building four brand new jumbos in Mumbai 15 days ago. It will take our dashboard from 22,000 beds to more than 30,000 in a month’s time. Our ICU beds have been ramped up from 1,500 to almost 3,000. We are trying to bring that up to 4,000 by June. These preparations are primarily meant to confront the third wave, whenever it comes. I hope I’m proven wrong, but we are prepared for it.
TABASSUM BARNAGARWALA: Is the spread of the virus in slum areas a concern in the third wave? In the last three sero surveys, we have seen that the antibody percentage has been declining in the slum population, which had been severely affected in the first wave.
The first sero survey which we did in last July-August, showed that people in the slums had immunity of 57% while those in non-slum areas had just 12%. By the second sero survey, it had come down to 45% in the slum areas. And in the latest sero survey, which we did about 10 days ago, it had come down to 41.5%. However, the immunity in non-slum areas has grown from 12% to 28.5%. This, coupled with our vaccination drive — we have already done 26 lakh vaccinations in Mumbai — will cover up for that reduction in immunity.
We have drawn-up very ambitious plans for vaccination. I always tell my team that we will get a big tsunami of vaccinations done, but the only issue is availability. The CM has assured me that Mumbai will get the best possible help… On May 1, we had 63 government vaccination centres and 73 in private hospitals. The private hospital number will go up to 150 soon… They are already on our dashboard and we are working with them.
The Government of India has also said that from May 1 if you can get an ambulance linked, then you can go for corporate drives. So we are now requesting lakhs of corporates, housing societies, thousands of workplaces to sign MoUs with any of the 150 hospitals and then apply online and get clearance within a few minutes… Basically, whichever hospital you are going to tie-up with, they need to park an ambulance in your office building, they need to get staff and vaccines, and you have to give them space to vaccinate everybody. For instance, we vaccinated all 1,100 people at the Bombay High Court last week in a day. So that is the plan, to have thousands of such places for vaccinations… I am making a very low and safe estimate, but in this manner we can do nearly 2,00,000 vaccinations per day. We have roughly 90 lakh people in the city in the 18-plus category, which means 1.8 crore doses. Of this, we have already covered 25 lakh… So if we do 2 lakh per day, 60 lakh in a month… In 75 days, I can cover 1.5 crore doses. It will all depend on how forthcoming people are.
Now the only issue is that of vaccine availability. I have requested the CM to get us 60 lakh vaccines per month… I think by May 20, the picture on availability of vaccine will become quite clear. And if we are able to procure stock, I can assure you that before the next wave, we will try to vaccinate everybody in Mumbai.
VANDITA MISHRA: Would you agree that for those who are not meeting this crisis in the ways that you seem to be doing, the question of accountability, which is not just political accountability but also bureaucratic accountability, needs to be raised?
I have been very lucky in many ways. First, I got a CM, who gave me such a free hand that virtually I can take any decision. This is not available to my colleagues in many other cities. Secondly, when I joined the BMC last May, I told my team that this virus is not going to go away soon. We have to be ready for a long battle, maybe for one, two or three years. And that is where we started building systems…and now the systems are on autopilot. Today, whether we get 2,000 or 5,000 or 10,000 cases, it makes no difference. The systems just work. No phone call comes to me….
…We were also the first city in the country to ban direct sharing of Covid positive report by the lab to patients… They shared the report at 7 pm… Hearing the news, there were panic calls and scrambling for beds. There were thousands of phone calls on one single helpline number, collapsing the central control room… Patients not running for hospitals beds also helped us control the spread of the virus. Otherwise, a single patient would have infected 200 more in his/her hunt for hospitals beds….
MANRAJ GREWAL SHARMA: Don’t you think states should institutionalise the best practices of other states to fight the virus?
I agree with you. But pandemics come once in 100 years and when this pandemic came, all of us were unprepared. It was hands on learning. Different people learned it in different ways. Now I say that there is no point in reinventing the wheel. For example, six months ago, my batchmate in Karnataka called me to understand what ward war rooms are, how they function, how our ambulances move… Now those things are being applied in Bengaluru… But it is up to the district collectors, municipal commissioners of states and how they react to it… Till two months ago, I used to get calls from my colleagues in the Government of India, asking why only Maharashtra has Covid. And they would laugh at us. I would tell them (my colleagues), “Sabka number aane wala hai. (Everyone will face the crisis)… It’s a pandemic. It is going to spread everywhere.” If someone is laughing at us, how do I share my model with them?… When calamity hits, there is no time to learn, you don’t have time to copy models.
ZEESHAN SHAIKH: Why are testing numbers seeing a dip in Mumbai?
When the pandemic started, I immediately told my team that we must double up testing. And very soon, we started doing testing in shopping malls, railway stations, airports… At one point, we reached 56,000 tests in a single day. Then, I started getting complaints from people that it is taking two-three days for the test reports to come. I immediately conducted a Zoom meeting with CEOs of all the 55 labs in Mumbai. They said that they were carrying out 8,000 to 10,000 tests every day for corporates. I stopped corporate testing about three weeks ago. We must give top priority to a symptomatic person who needs treatment immediately, rather than having mass testing on a cosmetic basis… When corporate state testing stopped, our average came down from 55,000 to about 44,000 tests. From April 1 to 30, we did about 12.9 lakh tests — 67% of them RT-PCR unlike all other cities… But when out positivity rate fell from 31% per cent in the first week of April to single digits…the demand has reduced.
DEEPTIMAN TIWARY: What do you think of Centre’s oxygen allocation?
Let me answer this question in a very strong manner. The Government of India should not be blamed at all. If anybody has to be blamed, it is states. I’ll tell you why. As far as Maharashtra is concerned, we have been very honest with the figures. We were putting out figures of over 60,000 new positives every day, when the whole country was laughing at us. Many states of India were not even ready to admit how many cases they have. How does Centre allocate to them? One of our neighbouring states had 6,000 cases when we had 60,000 cases. But I’m sure if they had tested properly, they would also have 60,000 cases… Now, how does Centre allocate them equal amount of oxygen like us? So, when states have only 1,000 or 2,000 cases, their allocation will be very poor. If allocation is poor, people are going to suffer… Our CM has been telling me right from the day I joined, that if there are deaths, don’t be shy of reporting them.
NIRUPAMA SUBRAMANIAN: Do you think a lockdown is effective in breaking the chain of transmission?
In Mumbai and in Maharashtra, the lockdown has been very different and there are a couple of reasons for that. For example, last time we had a lockdown from March 25 to May 14… But this time we cannot stop the vaccination drive. Last week, we vaccinated 75,000 people per day in the lockdown. Secondly, a lot of people would joke with me that in Mumbai’s lockdown everything is open — taxis are plying, airports are working… But still with this kind of lockdown, we have been able to bring down our positivity rate. That means even this kind of lockdown is working… I am a very firm believer of decentralisation… If Mumbai achieves a 6-7% positivity rate, then why should it suffer a national lockdown? Lockdown has to be left to states… A decentralised lockdown, varying from state to state, would be a better option.
SANJANA BHALERAO: How is the BMC planning to tackle Covid during the monsoon?
Last time, we had a harrowing time. We had floods, cyclones threats… four-five feet water at Nariman Point… One day, on September 13, we had a power outage… The pandemic was also there. So, after the monsoon, in the first week of October, the CM told us, ‘Instead of starting to prepare for the monsoon in March-April, this year you start right away.’
Mumbai is a saucer-shaped structure with many spots which are below sea level. When the rain starts and there is high tide, we have a couple of gates in Mumbai which we shut down. Once shut, we can’t open the gates in high tide…So in high tide it (Mumbai) is virtually a saucer where no rainwater can go into the sea. It has to be collected within the geographical area of Mumbai.
Now, in this saucer-shaped structure, we identified 385 spots which are traditionally flooding spots. So under team BMC, we appointed 385 engineers as mentors on October 15. One engineer for one flood spot. And we gave him one month’s time and asked him to come up with an out of the box solution for that particular saucer depression. A lot of solutions were proposed. And in December, we started tendering for these ideas. We made a Rs 600 crore plan to mitigate flooding of these areas. On February 20, work orders were issued and work started happening in these areas. We expect to complete the work by May 31.
YOGESH NAIK: Despite the caseload declining in Mumbai, why is the death rate increasing?
In Mumbai, a day after the second wave started, on February 11, our dashboard showed 3.31 lakh cumulative Covid-19 cases. Last week, we had about 6.6 lakh cases, which means that the net addition has been 3.48 lakh in the last 85-90 days. Now, out of this 3.48 lakh new Covid-19, the actual number of deaths as per our dashboard is 2070… Now, if you divide 2070 with 3.48 lakh, our mortality comes to 0.5%. Now, this is one of the lowest mortality rates you will find anywhere in India or abroad… We have 2,800-plus people in our ICUs. These patients have been there for three-four weeks. The normal turnaround time in the ICU is at least three weeks, if not more. So many of the patients who were admitted earlier, may be passing away now. That is why there’s a mismatch between the new cases and death figures… But, we had a meeting with the task force a few days ago. They gave us a patient protocol, which I have sent to our 176 hospitals yesterday, and we also have the ‘Save Lives’ mission, which is dealing with measures to reduce death rate. So, we are very closely monitoring the mortality rate. If you still see figures of the last 30 days, you will see that although Mumbai constitutes 17-18% of Maharashtra’s population, the deaths are not above 7-8% of the state.
SRIRAM VEERA: As you were trying to save lives, there were elections going on in the country, the Kumbh Mela was taking place in the middle of a raging pandemic…
Well, I wouldn’t make a comment that will be misread. I will only say that as far as Maharashtra is concerned, Mumbai is concerned we have been successful in avoiding all such events. Eid festival is going on and we have a virtual lockdown, everything is closed. During Diwali, not a single cracker was burst. People are also very disciplined here, they listen to us. It’s a pandemic, it doesn’t differentiate between any caste or religion or race. Everybody must be very careful.
JAYPRAKASH S NAIDU: Recently we saw that 276 rail passengers who had arrived in Mumbai from eight states tested positive for Covid-19. Are we looking at increasing testing of passengers in the future?
Last week, we issued orders that passengers coming in trains from West Bengal, Uttarakhand, apart from Delhi, Gujarat, Rajasthan, Goa, Kerala (which were already on the list), will be screened. We are the only airport in the country where passengers coming from 74 countries are also being put in institutional quarantine after RT-PCR tests. So, with our available manpower and resources, I can assure you that we are trying our best.
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