Mumbai shows the way

The Brihanmumbai Municipal Corporation makes efforts on a war footing to control COVID-19 spread with good results, but rural Maharashtra sees a rise in cases.

The Brihanmumbai Municipal Corporation’s COVID-19 awareness campaign in Mumbai on April 8. Thanks to the measures undertaken by the civic body, the number of cases, which had peaked in early April, gradually levelled out.

As realistic and accurate figures of COVID-19 cases emerged from the rest of India, attention drifted slightly from Maharashtra and specifically Mumbai, which had been the focus of the second wave of infection amid accusations of mismanagement. Chief Minister Uddhav Thackeray in his addresses to the people maintained just one line of response: “People [read Prime Minister Modi] can say what they like; we know what we are facing and we know we are handling it in the best way possible given the resources allotted to Maharashtra by the Centre.”

This statement has now been validated by the Supreme Court of India. On May 4, Justice D.Y. Chandrachud, hearing a COVID-related petition, observed that the Centre and the Union Health Secretary should talk to Mumbai’s Municipal Commissioner, I.S Chahal and learn some lessons from the way the Brihanmumbai Municipal Corporation (BMC) has been handling the crisis. Earlier, the Nagpur bench of the High Court of Bombay advised the Nagpur Municipal Commissioner and District Collector to adopt the Mumbai model of pandemic management.

As Maharashtra was under the pressure of a heavy caseload, an impression was created that the State government was reactive and lacked a plan. Mumbai had reported 5,000-odd cases on March 31, but on April 1 the city registered 8,000 fresh cases. The surge continued until mid-April with the highest single-day spike of 11,163 cases on April 4.

The administration realised that the State’s consumption of medical oxygen would soon surpass its installed production capacity. The crisis peaked quickly but was not prolonged thanks to the BMC’s forethought. COVID-19 cases in the city slowly levelled out.

Decentralisation of response

The Mumbai model is essentially decentralisation of the COVID response by establishing ‘war rooms’ in every corporation ward. Chahal, who was appointed in May 2020, first changed the COVID testing protocol by disallowing laboratories from sharing the “positive” test report directly with the patient. The laboratories were told to inform the BMC which in turn would notify the patients and counsel them about the precautions needed to be taken. The new protocol came in for criticism.

But the new order immediately established some control. The BMC allocated hospital beds to prevent a rush to obtain admission to hospitals. In a further refinement of the bed management system, it advocated home quarantine to patients with mild infection thereby preventing unnecessary exposure in hospitals and saving beds for extreme cases.

Chahal altered the role of the BMC’s central control room. Instead of dealing directly with the public, it now became an internal disseminator of information. The BMC created disaster control rooms for each of the city’s 24 wards, with each having a COVID response war room.

The central control room sorted the 10,000-odd lab reports received every day and sent them to the respective war rooms for response. Each of the 24 war rooms are staffed with medics and medical support staff working on shifts round the clock. In addition to handling calls from the public, every day the war rooms put out information about the number of beds available. At the peak of the crisis, the BMC requisitioned the services of 172 major hospitals across the city apart from that of smaller ones and nursing homes. Students from medical and nursing schools were also roped in. The government put a cap on COVID treatment in all hospitals. With the presence of doctors in control rooms, some semblance of order was restored with hospitalisation advice given to a small percentage of those who tested positive. Ward-level teams met patients to ascertain whether they could be home quarantined or hospitalised and would require intensive care or oxygen support. Such measures helped reduce the burden on the system.

Although there was a control over hospitalisation, citizens had the option of going to any of the city’s seven COVID care centres and admitting themselves.

The BMC also requisitioned more than 800 SUVs and converted them into COVID ambulances.

Planning for a third wave

The State government is planning for a likely third wave of the virus. In Mumbai, facilities that had been shut down at the beginning of the year have been reopened making available more than 5,000 beds. Four more COVID jumbo centres are getting ready. These will be managed by five-star hospitals in order to encourage patients belonging to the higher economic bracket to use them and not demand hospital space.

The decision to import vaccines played a big role in Mumbai’s plans to control the spread of the virus. The BMC issued a global expression of interest to procure one crore vaccines. It is hoping for bids from Pfizer, Sputnik, Moderna and Johnson and Johnson. The State government gave the green signal to float the tender within 24 hours with a May 18 deadline for application from prospective suppliers.

The exercise is expected to cost the Shiv Sena-controlled BMC around Rs.400 crore, but the goodwill the BMC will enjoy is likely to pay off during the election to the civic body due in February 2022. The opposition Bharatiya Janata Paty (BJP) is in a bind. It cannot raise objections to the plan to import vaccines, although it knows the initiative will increase the stature of the Shiv Sena-led coalition government. The Shiv Sena will derive political mileage from its initiatives and retain its hold over the civic body.

So far, 25 lakh doses of vaccine have been administered in Mumbai. Door-to-door vaccination is planned in cooperation with housing societies. Vaccine shortage is the main problem facing Mumbai and Maharashtra which is why the State has not been able to sustain vaccinations for the 18-44 age group.

The focus was on Mumbai so far, at the cost of the rest of the State, especially rural Maharashtra. In the first week of May, 20 districts reported a rise in COVID cases, making the government enforce an eight-day lockdown in some of them.

For the Uddav Thackeray government the war continues on many fronts. It has to fend off the BJP which is smarting under the Shiv Sena’s decision to walk out of their three-decades-long alliance following a disagreement over the chief ministerial post. The BJP-Shiv Sena alliance won the Assembly election in October 2019, but the partners fell out when the Sena insisted on keeping the Chief Minister’s post and rejected the BJP’s suggestion to share it on a rotational basis. Bolstered by the offer of support by Sharad Pawar’s Nationalist Congress Party (NCP) and the Congress, the Shiv Sena severed its ties with the BJP and formed the government.

The BJP has not given up its efforts to harry and harass the government. Petty but dangerous politics have been played in the distribution of vaccines, medicines, personal protection equipment, gloves, masks and medical oxygen. There are rumours that there could be an attempt to remove Chahal from the post of BMC Commissioner, and destabilise the efficient COVID management system.