COVID-19 Update

Maharashtra: Shift in focus

Print edition : August 14, 2020

A volunteer health worker using a smart helmet equipped with a thermo-scan sensor to check the body temperature of residents in Mumbai on July 21. Photo: INDRANIL MUKHERJEE/AFP

As the rise in infections seems to have plateaued in Mumbai, the Maharashtra government turns its attention to the rest of the Mumbai Metropolitan Region and districts where the virus is active.

After almost four months of what he describes as “mind-numbing, heart-rending” work, a senior Brihanmumbai Municipal Corporation (BMC) official, who requested anonymity, says he has a flicker of hope. “No one can say that the end is near. We may have to live with this virus for years. After more than three months of tackling it and working closely with doctors, there is no longer any shame or sense of failure in admitting that we really don’t know what’s happening. It has been a constant learning and unlearning process for us,” says the official. But what does seem to be clear, though this too he states with caution, is that “the rise in infections seems to have plateaued in Mumbai around early to mid July”.

Despite this note of optimism, Mumbai continues to be the worst affected Indian city, with 1,00,350 cases and 5,650 deaths as of July 18. The optimism stems from the fact that there has been a drop in the number of new cases in the city, from 1,400 a day in late June to 1,200 in mid July. The recovery rate has also increased from 50 per cent on June 22 to 70 per cent on July 18. The official says, “We see sudden surges and now realise that these will keep happening because people are dropping their caution. After the lockdown was eased there was a surge. Then people were reminded of the seriousness of the situation and things calmed down a bit. But this will keep happening. No one will stay indoors all the time. On the whole, barring a few pockets, Mumbaikars acted responsibly during the worst days. We’re just asking that the basics of hygiene and physical distancing be maintained.” Another official who commented on the situation says, “It’s time for citizens to realise that this is everyone’s battle. If you don’t exercise caution you’re likely to get infected.”

‘Self-inflicted problem’

Dr Jawahar Mukhtiyar, a well-known physician, agrees with it, saying the spread of the virus is a “self-inflicted problem”. The city continues to have containment zones, and a large number of them are in the economically privileged areas. Take the example of the BMC’s most privileged A Ward in south Mumbai. Within A Ward is the Churchgate-Marine Drive area, a prime locality with homes of the well-heeled, senior bureaucrats, Ministers and old-timers in the city. Yet this area has more than 40 per cent of the cases in A Ward.

Dr Mukhtiyar, who lives and practices in the area, says people have behaved in an “undisciplined and irresponsible manner. They think they are invincible and that bad things only happen to others.” He recounts instances of people celebrating weddings and birthdays and an entire family using one member’s essential services pass to move around the city. “The domestic help is made to sleep in common passages and use common toilets. There is no social distancing whatsoever when they sleep on the landings.”

Rohini Char, a Churchgate resident, bemoans the “stupidity of people who have been holding card parties and calling relatives home thinking that just because they are family they are safe.” Though the BMC has sealed the buildings with positive cases, Dr Mukhtiyar says, “The BMC can seal a building but we need common sense and that’s in short supply.”

Mumbai Metropolitan Region

While areas of Mumbai continue to see increases in the number of cases, the government’s focus has shifted to the Mumbai Metropolitan Region (MMR), Pune, Pimpri-Chinchwad, Nashik, Aurangabad, Solapur, Jalgaon and Akola. All these areas have shown a spike in cases, and this is being attributed to the lifting of travel restrictions.

As of July 20, the eight civic bodies that make up the MMR—Thane, Kalyan-Dombivli, Bhiwandi-Nizampur, Mira-Bhayandar, Vasai-Virar, Navi Mumbai, Panvel and Ulhasnagar—contributed 30 per cent of the total cases in the State. Over the last four weeks, these areas have seen a threefold rise in the number of cases. Poor medical infrastructure has resulted in high mortality and poor control of the virus. After Mumbai, it is Pune that has about 1,000 new cases a day and then comes Kalyan-Dombivli with 470 cases a day.

There are fears that with the upcoming Ganpati festival, the virus will spread to the Konkan region. Every year a few lakh people return home to the Konkan for the festival. This year will probably be no exception though strict guidelines have been issued by the government for the festivities.

On July 17, Chief Minister Uddhav Thackeray held a video conference with the Collectors of Ratnagiri, Sindhudurg and Raigad districts and told them to restrict the celebrations and follow the guidelines of Mumbai’s Ganesh mandals. A maximum height of four feet has been set for statues of the deity and only one public idol per municipal ward will be permitted, that too with stringent instructions about physical distancing. There will be no processions and the idols will have to be immersed in ponds created at the respective sites.

The government’s thrust on testing continues. The BMC official says,“Mumbai is a good example that ramped-up testing works. Dharavi’s ‘chase the virus’ strategy worked well. But we have to remember that there was great support from the people. Apply the same strategy across the State and a semblance of control will be established. It is important to have this sense [of control]. It gives confidence to everyone.”

Increased testing

The number of daily tests in Mumbai has increased from 4,408 in June to 5,326 until July 18. But it is considered inadequate since the Test Positivity Rate (TPR) of 21.7 per cent is still too high given the World Health Organisation’s (WHO) standard of 5 per cent. At present, for every 100 people tested 21 are positive. But there has been a slight improvement from June when the TPR was 28 per cent.

If the TPR is over 5 per cent, it could be an indicator of community spread and of the inadequacy of the testing being done. To lower the TPR, the testing rate needs to be increased. But the BMC says it is close to saturation point and needs private laboratories to take on more of the burden.

Without actually saying it, the BMC wants everyone to have themselves tested. While this is probably an effective control measure, the biggest hurdle is the cost, Rs.2,800 per test, something people will not consider spending on until they show symptoms. In any case, for this to be a solution, a large majority will have to opt for testing. And even if people are willing to have themselves tested, there are only 48 laboratories in the State that are accredited with the National Accreditation Board for Testing and Calibration Laboratories. There is a move to widen this and allow laboratories that have doctors with MD in Pathology and 10 years’ experience to also carry out the tests. If this comes through then the number of laboratories in Mumbai alone will jump from 17 to 2,000.

To some extent the delay in allowing private laboratories to test has contributed to the spread. It was only on July 7 that the BMC did away with the insistence on a doctor’s prescription. Until then even high-risk contacts of positive patients were tested only after nine days of quarantine.