Test of leadership

With more than 60 per cent of Maharashtra’s COVID cases in Mumbai, the government is scrambling to expand the public health care system in the city.

Published : Jun 04, 2020 16:33 IST

Mumbai city slowly coming back to normal at the start of Lockdown 5.0 on June 1.

Mumbai city slowly coming back to normal at the start of Lockdown 5.0 on June 1.

After two months of relatively sound leadership, Chief Minister Uddhav Thackeray needs to steady his nerves even more as Maharashtra opens up after the lockdown. This is the moment the Bharatiya Janata Party (BJP) has been waiting for. Over the last many weeks, the party has kept up a steady political pressure against the ruling coalition, the Maha Vikas Aghadi (MVA), and especially against the Chief Minister.

It is no secret that Nationalist Congress Party (NCP) leader Sharad Pawar has been the guiding force in the six-month-old MVA, which consists of the Shiv Sena, the NCP and the Congress. He engineered the unusual alliance with the three parties, worked out a deal where Uddhav Thackeray would be the Chief Minister and Ajit Pawar of the NCP the Deputy Chief Minister, and after that went on to lead the government from behind the scenes.

The BJP has ridiculed the Chief Minister for being a puppet, but the more accurate assessment is that Uddhav Thackeray has shown a least expected but warmly welcomed maturity in listening to experienced advice. His willingness to learn and discuss is completely against the widely understood “constitution” of his party, but it is this very difference that has earned him praise from Shiv Sena detractors.

This is a testing time for Uddhav Thackeray and for his government because the staggered manner in which the State is being opened up could offer the BJP a last-ditch attempt to try and discredit the MVA. The BJP is waiting for a nervous Uddhav Thackeray, who is inexperienced in active politics and policy decision-making, to bungle. They also know that he would hate to be ousted from his post because it would be a feather in the BJP’s cap.

But the BJP is fully aware that it is up against a formidable adversary in the form of Sharad Pawar. He has been persistent about opening up key areas of activity so that the economy can be kickstarted. But Uddhav Thackeray has resisted this. A mid-level bureaucrat in Mantralaya, requesting anonymity, said that the Chief Minister was “desperately worried” about the spread of infection if he opened up the State and the “impact it would have on his government politically”.

The bureaucrat said that so far decision-making had not been difficult because there was “little option but to lockdown”, but now, with the need to open up again, the government needed to “consult varied experts right from doctors to trade associations” to understand the “dynamics of the State and how to go about getting back to normal”. He said the coordination required to get “Mumbai and the State moving again” was not yet in place.

In a similar vein, a Pune Municipal Corporation official, also speaking on condition of anonymity, said, “We are trained for this sort of administration. Now we have to put it into place.” He said ideally small hubs of commerce needed to be opened up and they should become like isolation facilities in themselves. For instance, workers in a factory should be checked for the virus and those free of it would have to live and work in the factory for whatever period was required. The factory owner would be responsible for their board and lodge. The plan sounds feasible, but even the official has doubts whether it will be put into operation. Mumbai is called the COVID hotspot of the nation, with 62 per cent of all cases reported in the State being from the city. It also has the highest number of deaths in the country. Rising numbers and the certainty of an extension of the fourth lockdown led to restlessness, which was freely expressed on social media.

On May 23, the Maharashtra Police issued a prohibitory order which banned any criticism of the State’s decisions. It threatened action against anyone for posts that may create “mistrust towards government functionaries and their actions” in fighting the virus and causing panic and confusion or targeting any specific community. The gag order must also be seen in the context of the BJP’s constant attack on the MVA, especially on social media. This has ranged from calling for Uddhav Thackeray’s resignation to an outright call for Governor’s rule.

The condition of the public health system in the State, especially in Mumbai, has been dragged into full public view by the coronavirus. This remains the actual crux of the issue, and the political game that is being played around it is just shadow boxing.

Focus on Mumbai

Trying to address this, Brihanmumbai Municipal Corporation (BMC) Commissioner Iqbal Singh Chahal said he was focussing on beefing up public health care infrastructure. He said testing and the number of ambulances had been increased and a more proficient helpline had been instituted. He said the administration was aggressively “chasing the virus”. He was referring to increased testing, which would naturally show a rise in the numbers. Chahal said that until May 27 more than 1.7 lakh people had been tested in the city. The positivity rate has been 18 per cent and 15,800 of the active cases in Mumbai are asymptomatic. Whether or not these people were in self-quarantine was not known.

Sticking to the same script, Uddhav Thackeray said on television that the State had increased its number of COVID-19 test laboratories from two in March to 72 on May 27. He said the State-level task force of 11 expert doctors had set a protocol on treating the patients. “We have succeeded in bringing down the COVID-19 fatality rate to 3.3 and the recovery rate to 31 per cent. The doubling time for the number of patients has increased from three days in April to 14 days in May end,” he said.

Chahal said Mumbai had 75,000 hospital beds of which 44,000 were in dedicated COVID hospitals, dedicated COVID health centres, and COVID Care Centres that are meant for mild and asymptomatic patients (a BMC press note of the same date said there were only 18,000 beds for COVID cases). The Commissioner said the city would have 1,50,000 beds by June 15.

Chahal also raised a point of concern. Hospitals were working with 40 per cent or less of their staff. The reality is that there are hundreds of health care workers who just cannot get to work because they stay in far-off suburbs. This is one example of the poor coordination the bureaucrat spoke of. “We obviously can’t open up the suburban train network fully. But we can selectively run trains and allow only essential services personnel to use them just like it was done with the BEST [public bus network].”

While the Chief Minister has asked the Railway Ministry to start some suburban trains, the silence from the Centre is reminiscent of early April when he had asked for trains to repatriate people to their home States. The Centre had refused and the migrant worker matter exploded into a crisis where the State had to bear the blame.

The problems of doctors, nurses and other hospital staff have never been a priority. In the early days of the virus, nurses were sent with only a cotton mask to examine potential coronavirus cases. Even after the pandemic declaration, health care workers have not received regular access to personal protective equipment (PPE), masks or gloves. They have been subjected to social ostracism, with some housing societies refusing to let them back even to claim their possessions.

On May 6, the Directorate of Medical Education and Research called on the services of the city’s 25,000 licensed private doctors, saying all those under 55 would have to work for two weeks in COVID hospitals or lose their licence. The offer of insurance and payment for their time did little to lessen the anger at the diktat, but the BMC says 3,700 doctors have joined active duty and 570 of these doctors are reportedly willing to work in four of the dedicated jumbo COVID hospitals.

Then the BMC turned its attention to private health care facilities. On May 19, they were threatened with criminal action if they failed to restart their hospitals, clinics or nursing homes. This was after they had been forced to close down just weeks earlier. The move was a precursor to demanding the reservation of 100 beds in private hospitals for coronavirus patients, including 10 ICU beds. On May 21, the BMC capped hospitalisation charges and took over 80 per cent of the beds in private hospitals. On May 25, Kerala was asked to send medical personnel for a 600-bed COVID hospital in Mumbai.

More is yet to come. State Chief Secretary Ajoy Mehta said initial projections saw 1.5 lakh cases by the end of May in the State. But on May 27, he said, “We won’t reach anywhere close to that number.” He said as on that date, “nearly 66 lakh people, or 6 per cent of the State population, have been screened by 16,000-plus squads”. He further said the doubling of cases had now gone up to 14 days.

The monsoon will bring its share of seasonal ailments such as dengue and malaria. The curve is still rising and, by all accounts, the spike is expected around July.

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