4 months on, med infra in good health?

While the period helped Mumbai prepare for more Covid cases, experts say testing still needs boost

MUMBAI: While the city remained on its toes through the four months of lockdown, as the case count crossed 1.04 lakh and toll crossed 5,800, it managed to ramp up its health infrastructure in the period, according to both Brihanmumbai Municipal Corporation (BMC) and experts. The latter, however, feel the city still needs to boost the testing numbers.

HOW IT ALL BEGAN

As the first case was detected in mid- March, BMC and the state urged citizens to work from home and shut gyms and restaurants on March 13. On March 19, BMC said non-essential shops will be opened on odd and even days, but three days later, the state announced a lockdown, a day before the nationwide lockdown, allowing only essential shops to remain open for two months.

The first relaxation came in the form of opening of electrical and hardware shops, considering the complaints from essential businesses that electrical appliances had developed a snag and had to be fixed. Later, wine shops were opened in the first week of May owing to revenue deficit. However, they were shut on May 5 owing to violation of social distancing norms. On May 8, the state transferred BMC chief Praveen Pardeshi to the urban development department, making 1989 batch Indian Administrative Services (IAS) officer Iqbal Singh Chahal the new commissioner. In mid-may, Chahal allowed home delivery of liquor with help of e-commerce websites. On June 2, BMC allowed re-opening of parks and playgrounds for physical activity, non-essential shops to remain open on odd and even days and private offices to work with 10% strength as part of Mission Begin Again. In the last week of June, BMC allowed reopening of salons and beauty parlours, and reopened hotels from the second week of July.

HEALTH INFRA

In the initial phase of lockdown, the major challenge for BMC was to create health infrastructure and scale up testing and tracing. BMC went from having sole Kasturba Hospital to isolate Covid-19 patients in March to more than 22,000 beds to handle critical cases and additional 74,000 beds in quarantine centres to isolate high-risk contacts and those

having mild symptoms.

According to data from the state health department, Mumbai recorded 151 positive cases and seven deaths as of March 31, which went up to over 6,000 cases and 250 deaths by the end of April. By the end of May, Mumbai had over 39,000 cases and over 1,200 deaths that went up to over 77,000 cases and over 4,500 deaths by the end of June. As of July 22, Mumbai had over 1.04 lakh cases and over 5,800 deaths. In the past 51 days after relaxations, 61,186 cases have been reported in the city. In this period, the fatality rate increased to 5.68% from 3.25%. One of the reasons is the addition of 1,500 deaths by BMC after reconciliation of figures. In this period, the recovery rate of the city, too, went up to over 70%,

from 40%.

BMC currently has 17 private labs in addition to the government labs, where daily collection of samples has gone up from 100 in March to 7,000 samples in July. The first 1 lakh mark of testing samples was crossed on May 6, followed by crossing the 4 lakh mark on July 14. As of July 21, BMC had tested 4.50 lakh samples.

In this span of four months, BMC undertook several measures to liberalise testing policy, from initially allowing only symptomatic patients and highrisk symptomatic patients. On June 23, BMC announced that it was procuring 1 lakh rapid antigen kits. On July 7, BMC announced a protocol that allowed everybody to get tested without any prescription.

DOWNWARD CURVE

Several areas like Worli, Dharavi, Mankhurd, Govandi, Byculla, Mumbai Central and Mazgaon that were earlier known as hotspots are now showing signs of improvements. According to the data for the past one month, 50% cases are from suburban areas namely Dahisar, Borivali, Kandivli, Malad, Andheri, Bhandup, Mulund, etc. BMC said cases in these areas have increased owing to aggressive screening and testing in these areas. On the other hand, daily cases in the earlier hotspots have gone down. Experts claim to conclude that the curve is going downwards or flattening in certain areas of the city, BMC needs to release area-wise testing data.

Siddarth Paliwal, a private health consultant from Mumbai, said, “Area-wise testing data will help analyse and comment on why a particular area may be seeing more or less cases.”

BMC said the focus now is on detecting cases from high-rises, considering post relaxations people have started going out, allowing house helps, electricians, mechanics in their house. Dr Shashank Joshi, an expert member of Maharashtra’s Covid-19 task-force, said, “This virus has taught us a lot of things in four months. It started to spread from those who were coming from abroad initially from where it spread in the densely populated slum population. Post relaxations, it has gone towards high-rises, where maximum cases are being reported currently.”

BMC in the last two months has also announced several initiatives such as ‘Chase the virus’ that involves aggressive screening and tracing maximum highrisk contacts behind every positive case, followed by ‘Mission Zero’ that involved aggressive screening, tracing and testing in areas that have high growth rate. Other initiatives include ‘Mission Universal Testing’ that involves changing testing protocols from time to time to ‘Mission Save Life’ to change treatment protocols to bring down the fatality rate.

DID LOCKDOWN HELP?

Madhav Sathe, former professor of microbiology at Nair Hospital, said, “Globally, the first four to six weeks of lockdown are very useful, and subsequent relaxations give a much better picture when it comes to the number of cases. We can’t imagine the situation without lockdown in a city like Mumbai. The lockdown gave a buffer period for the authorities to tackle and handle the pandemic, and Mumbai did very well at scaling up health infrastructure, however, it was not done in the Mumbai Metropolitan Region (MMR) and rest of Maharashtra. In Mumbai, 6,000 RT-PCR tests are being done daily, by now, this number should have been around 12,000 to 15,000 tests daily. In MMR and Thane, the tests are fewer.” Dr Shashank Joshi from Maharashtra’s Covid-19 task force said, “We might have lost economically, but we can’t afford to not have a lockdown. We have much better health infrastructure. Testing should have been liberalised earlier. We also had citizens who did not follow lockdown. We could have tackled the issue of migrant labourers earlier.”

Going ahead, there will be a staggered re-opening, civic officials said. Suresh Kakani, additional municipal commissioner of BMC, last week told HT, “We are planning to reopen restaurants in the coming days. Theatres, malls might be reopened in a staggered manner. The monsoon will be crucial. We have to control cases considering we can’t eliminate them until the vaccine arrives”

Chahal in an interaction with HT last week had said, “Mumbai does not have a lockdown in the real sense anymore. If you leave aside malls, every shopis opening. On an average, we have one crore people on the road every day, so it can’t be called a lockdown.”