On the mend

The Brihanmumbai Municipal Corporation begins aggressive testing after achieving some success in containing the spread of the virus in densely populated localities.

Published : Jun 27, 2020 11:59 IST

Essential services workers waiting for a local train at Mumbai’s CSMT station on June 19.

Essential services workers waiting for a local train at Mumbai’s CSMT station on June 19.

Ever since the first COVID-19 case in Mumbai was detected on March 11, more than 100 days ago, there are signs that the city may no longer be the coronavirus capital of the country. Delhi is fast catching up as the number of positive cases in the National Capital Region continue to rise.

With a spike in the number of cases in Delhi, it was inevitable that comparisons would be drawn between the two cities. As of June 24, Delhi had over 70,000 positive cases as opposed to Mumbai’s 69,528. With testing ramped up in both metropolitan cities, the number of cases has been oscillating back and forth. But while Delhi had a test positivity rate of 16.7 per cent, Mumbai’s was higher at 23.2 per cent. Essentially this means that the rate of viral transmission is higher in Mumbai. The possible reasons for this are that the population density of Mumbai is higher than Delhi’s; the virus has been entrenched in the city for a longer period; and Mumbai has more number of densely populated slums. As on June 24, Mumbai recorded 3,964 deaths and Delhi 2,365.

Following the encouraging results achieved in Dharavi and Worli village after they were sealed to contain the spread of the virus, the Mumbai civic administration has adopted a more aggressive tactic of “chasing the virus” to break the chain of transmission. Areas with many positive cases are sealed or isolated, after which cases are tested, treated and quarantined, if needed. Dharavi and Worli were among the first areas to be sealed to contain the spread. The uncompromising protocols adopted in these localities helped bring down the number of cases.

The Brihanmumbai Municipal Corporation (BMC) is cagey about declaring the status of the virus in the city. Categories such as peaked and plateaued have been applied and later disproved. So, the administration now prefers to say that things are stable enough for parts of the city to be partially opened for Maharashtra’s Mission Begin Again programme. As of June 24, 765 areas and 6,116 buildings were sealed in the city.

The coronavirus infection seems to have moved northwards of the city towards the suburbs of Andheri, Malad, Mulund, Dahisar, Borivali and Kandivali, which have seen a spike in cases. In order to combat this, the BMC has initiated a rapid action plan called Mission Zero. The civic body has organised 50 ambulance clinics with a team of doctors to carry out door-to-door screening especially in densely populated areas such as slums. The health staff will check for fever, co-morbidities and collect swabs. This initiative is expected to help in quicker detection of COVID and subsequent adoption of protocols. The medical teams aim to screen at least 10,000 houses in every municipal ward. Mission Zero also envisages that slum toilets be cleaned and sanitised at least five times a day.

One criticism of the city’s handling of the COVID situation was the distribution of beds for patients. In the first week of June, the Municipal Commissioner I.S. Chahal, in a note to his colleagues, said: “We have started decentralised COVID bed allotment at all 24 Ward War Rooms of MCGM from 8th June onwards. This process starts at 8 am sharp & finishes by 12 noon. We have named it as *CHASE THE PATIENT POLICY* conceived by Hon’ble CM, for BMC.” Under the new policy all labs had been directed to “share reports only & only with BMC at 7am daily”. The earlier practice had been the normally acceptable one of informing the patients directly but the BMC decided to change this.

As per the new rule, the BMC would inform the person who tests positive. Chahal wrote: “No direct message now goes to patient from lab, unlike earlier & then our medical teams visit the patient at his residence, examines him & allots the bed/hospital before leaving patient’s premises…. The patient is properly counselled while we break the news of COVID positivity to him.”

The reason for formulating the new procedure was to reduce the stress for families who mostly had to go from hospital to hospital to seek allocation of bed for the patient. Chahal felt that the centralised system would guarantee beds to patients in need of treatment, prevent bed allocation to those whose symptoms could be handled with home quarantine and take the load off the central control room that works 24x7. The control room number, 1916, used to be flooded with calls seeking beds and, not knowing the severity of the case, the operators were bound to direct the patients or their families to various hospitals.

Under the new system only those who require COVID care support would be sent to hospitals. The initial doubts that the system was violating patient privacy were soon dispelled when it was realised that more beds were being freed up and those with relatively mild symptoms were not subjected to potential hospital-related infections. The new system has freed up more than 6,000 beds in the city.

In order to speed up testing, the State government ordered one lakh rapid antigen test kits from the South Korean company, SD Biosensor, which have been approved by the Indian Council of Medical Research. This antibody kit is used on a suspected patient’s nasal swab to detect the presence of viral proteins that are an indicator of a positive case. The results are obtained within 30 minutes. Although less sensitive than the RT-PCR tests (reverse transcription polymerase chain reaction, which is the gold standard for testing), these have the advantage of speed and are expected to scale up Mumbai’s testing from 4,500 tests a day to 6,000. Delhi, by comparison, is testing upwards of 15,000 people a day.

Mumbai’s doubling rate is now 36 days; the BMC wants to increase this to 50 days. The doubling rate indicates the spread of the virus in terms of days. A higher doubling rate means less spread. At the beginning of June, it was 24.5 days. Dharavi’s is 42 days. The national average is 16 days.

On June 24, Mumbai’s recovery rate stood at 53 per cent; about 2,434 patients had recovered and had been discharged. The death rate has by and large been steady or has risen on a low curve. So, while new cases are being detected, the positive indicators bolster Chahal’s optimism that “Team BMC is fully geared up to effectively confront Covid-19”.

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