The Brihanmumbai Municipal Corporation has been meeting the second wave of the COVID-19 challenge on a war footing. Sonam Saigal reports on how the civic body learnt lessons from the first wave and adopted a decentralised approach which is showing results slowly but surely
Mane works at a disaster control room, or ward ‘war room’, in Mumbai, where she answers distress calls from those showing symptoms of COVID-19 or from their families and diligently notes down their details.
The job is hectic. On May 13, Mane answered 23 phone calls on one of the 15 lines in the ‘war room’ at ‘E’ ward. “The first thing I do when I answer a call is to take down the contact number of the person calling in case the line gets disconnected,” she says.
Mane says the nature of calls has changed over time. “Earlier, we used to get a lot of queries on the availability of beds and ambulances. Now, most of the people calling are in isolation at home. They ask about garbage disposal because the society does not collect their garbage. I take down their name, number, address and enter all this into a register. Then I contact the waste management department. The next day, I follow up to check if the garbage has been picked up,” she says.
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Mane sometimes gets unusual requests. “The other day, I got this call asking for a banner for a society. The BMC (Brihanmumbai Municipal Corporation) puts up banners at buildings after it declares them as ‘containment zones’. [When five people test positive for COVID-19 in a building, it is labelled a containment zone.] The secretary of the building called saying a stray dog tore off the banner. So, we arranged for the banner to be put up again,” she says.
Mane is one of the over thousand staff members working at Mumbai’s ‘war rooms’. The financial capital struggled during the initial phase of the first COVID-19 wave with only one central BMC helpline. It quickly learnt that decentralisation was the best way to tackle the unfolding challenge. With the help of private hospitals, the police, educational institutions, industry and others, the BMC, the richest civic body in the country, has been meeting the new wave of the COVID-19 challenge on a war footing. And the results are slowly but surely showing, with many praising what it now being referred to as the ‘Mumbai model’. After a record number of daily cases on April 3 (11,163), Mumbai has been recording a steady dip since then, with 1,657 daily cases on May 14.
Mumbai, the hotspot
Soon after Mumbai recorded its first COVID-19 case in March 2020, and cases climbed to 17, the Maha Vikas Aghadi government, a coalition of the Shiv Sena, Congress and the Nationalist Congress Party, declared COVID-19 an epidemic and invoked the Epidemic Diseases Act of 1897. On March 13, 2020, the State government shut down theatres, gyms, swimming pools and public parks; barred social, religious and political events; requested private employers to ensure that employees work from home wherever possible; and advised people against visiting malls, hotels, restaurants and other crowded places. On March 20, when cases reached 52, Chief Minister Uddhav Thackeray announced that all workplaces, excluding essential services and public transport, in certain pockets of Maharashtra would be shut till March 31. He then imposed a complete lockdown as cases continued to increase. Despite these measures, Mumbai soon became a hotspot for COVID-19 cases. By May 8, it had recorded 12,142 COVID-19 cases. The BMC looked like it was losing the battle against the virus.
Mahesh Narvekar, chief officer of the BMC’s disaster management cell, recalls how stressful the job was back then. He says the central control room (number 1916) buckled under the pressure of calls during the first wave of COVID-19. “As 75% of the staff tested positive, there were very few people to take the calls, let alone address the queries of those desperate people who were calling,” he says. “I appointed some contractual call operators but they were new and didn’t have any domain knowledge.” Staggering under the weight of cases and deaths, the city looked like it was on the brink of a disaster.
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Back then, there were only 40 ambulances for COVID-19 patients and four hearses to carry dead bodies, Narvekar says. “The backlog of dead bodies was 100-150. These bodies were just lying in morgues. We didn’t have any vehicles to carry the bodies,” he recalls.
Today, the BMC has 675 ambulances and 400 hearses.
Chasing the virus
With its back to the wall, the BMC began to fight back during the first wave. A new BMC Commissioner, Iqbal Singh Chahal, who was Principal Secretary in the Urban Development department, was appointed to lead the fight on May 8, 2020. Chahal was chosen despite having had no experience in municipal administration. He recalls the day he received the order as being “very scary”. “That day there were reports of a body found on the road near Dadar, another body found in an autorickshaw in Parel, and another on the divider at Dharavi,” he says.
Chahal immediately called all the 120 heads of departments of the BMC, 24 ward officers, 24 wards in-charge of health, deputy commissioners, additional commissioners and joint commissioners for a physical meeting. “We have to chase the virus,” he told them. The BMC soon launched the ‘Chase the Virus’ campaign and began to aggressively test, trace and isolate. As part of this campaign, 15 close associates of every COVID-19 positive patient were compulsorily institutionally quarantined. In addition, community leaders were appointed to provide information to people about co-morbidities, facilities being provided at institutional quarantine facilities, clinic timings, and so on.
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Chahal led from the front. He conducted a 5.5 km march at Mukund Nagar in Dharavi along with 50 BMC officers. The officials checked the hygiene conditions in the slums and distributed packets of food. “The BMC planned to visit all the containment zones across various slums in Mumbai because 95% of the cases were in the slums,” says Chahal. The civic body’s aim was to go from house to house, test, quarantine those who were found positive, and move their family members and neighbours to the 47,000 rooms that were made available through 187 hotels in Mumbai.
It was an onerous task. “We started shifting close to 30,000 people a week,” says Chahal. At the same time, BMC officials started sanitising the homes of those who had tested positive and kept constant checks on those who had been quarantined to see if they had developed any symptoms. “Those who developed symptoms were taken to hospitals. Else, they were sent back to their sanitised homes,” says Chahal. The BMC moved over 1.5 lakh people in this way in Mumbai through the first wave.
At first no one wanted to be whisked away to these facilities. “But by word of mouth, people came to know about these facilities. They understood that people were being looked after well. And that broke the initial reluctance among people; they voluntarily agreed to move,” he says.
Chahal says he visited 55 slums in Mumbai. Thousands of health workers, who feared visiting containment zones earlier, visited the slums too. “This was in the second week of May. We quickly arrested the spread of the virus. In July, the World Health Organization praised our efforts in Dharavi,” says Chahal.
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Getting the largest slum of Asia in order was never going to be an easy task. Sanitation and hygiene are the first casualty in a slum of Dharavi’s size. “We entered public toilets in Dharavi and found that 200 people were sharing one toilet. Each public toilet had 20-25 seats. We ordered that the toilets be sanitised every two hours. That is being done even today. This is how we destroyed the virus in public toilets,” Chahal says.
Role of community leaders
These initiatives were not foolproof. To ensure that instructions were being followed by BMC employees, community leaders were roped in to keep frequent checks on them. Each of the community leaders was given a mobile phone and was connected to the control rooms. These leaders were asked to check whether BMC health workers were going door to door checking people’s temperatures, conducting tests, and checking for co-morbidities, or whether they were just filling up documents at the exit gates of the containment zones. They were asked to report to the BMC if the toilets were not sanitised. They were asked to check whether personal protective equipment kits were being used by healthcare workers and whether people in the neighbourhood had developed symptoms like diarrhoea or eye problems. In addition to this, they monitored the quality of the food packets being distributed by the BMC. This was micro-management and yet a decentralised operation that was put in place by the Mumbai civic authority.
It was also important to take care of the BMC employees, says Chahal. “More than 100 BMC employees had died between March and April 2020, and they did not come under the Government of India’s insurance scheme for frontline healthcare workers. For example, safai karamcharis and bus drivers of BEST buses who were ferrying doctors were not in the category of frontline workers,” he says. In mid-May, the families of all BMC employees who died of COVID-19 became entitled to receive ₹50 lakh as compensation. The announcement galvanised the staff. The BMC has paid ₹150 crore as compensation to the families of the bereaved employees.
Inside the ‘war rooms’
The BMC also launched another campaign called ‘Chase the Patient’ where it asked people to get tested and admitted in hospitals if they had symptoms of COVID-19. Each of the 24 wards in Mumbai got a ‘war room’, its own dedicated line, and a COVID-19 dashboard that was uploaded on a daily basis. The dashboard gives information on the number of positive cases, active cases (symptomatic and asymptomatic) and number of patients discharged. The ‘war rooms’ are active 24X7 with staff working in three shifts. Each shift has at least one doctor on duty to advise patients. These ‘war rooms’ have been especially useful during the second wave.
The ‘war room’ of K (West) ward is associated with 12 hospitals and two COVID-19 Care Centres for asymptomatic patients. Dr. Hameen Yadnyeshwari, the in-charge there, says the ‘war room’ has eight doctors who work in three shifts, along with five BMC employees who take queries and make arrangements to sanitise the homes of COVID-19 patients. “We also have 10 teachers who receive calls and five teachers who make calls after they receive the final list of COVID-19 patients,” says Yadnyeshwari. “When the second wave started around mid-February this year, the number of cases started rising to 50, 60 even 80 in a ward as opposed to 20,30 that we saw last year. That is when we knew the second wave was here. We began to increase the number of beds in private hospitals and non-COVID-19 hospitals. We also added oxygen beds to COVID-19 care centres.”
Today, calls are largely about vaccination. In K(West) ward, Deepa Raut, who teaches science to students of Class 8 at a BMC-run school in Juhu, has been attending to several of these anxious calls. “On May 13, I received 12 calls and all of them were vaccination-related. We assure them that we are there to help them. We tell them that the BMC is coming up with more vaccination centres and vaccines, and that the problem will be resolved soon,” she says.
Involving private hospitals
An operation of this scale could not have been possible without the involvement of private hospitals. The chief operating officers of 35 private hospitals including Breach Candy Hospital, Lilavati Hospital, Nanavati Hospital, Wockhardt Hospitals and Hiranandani were brought in. A BMC order stated that 80% of the total beds and 100% of ICU beds in private hospitals shall be kept reserved only for COVID-19 patients referred by ward ‘war rooms’. In order to augment ambulance capacity, 800 Tata Sumo and Toyota Innova cars available with the BMC were converted into ambulances. Fifty mini buses were converted into ambulances with stretchers and Uber was roped in to make available its fleet of cars and buses.
Institutions were also roped in. IIT Bombay developed a web page called covidialysis.in. This gives information to COVID-19 patients about slots available for dialysis. Aggressive measures were put in place for those not observing COVID-19 protocols. The BMC has collected ₹50 crore as fines from people so far.
Giant COVID-19 Care Centres were created at the Bandra Kurla Complex, NESCO in Goregaon and the National Sports Club of India at Worli. These have a total capacity of 78,000 beds and are centrally air conditioned. The BMC also ensured that patients could keep in touch with their families through iPads.
Preparing for the worst
Eight jumbo isolation centres were set up across the city last year. Except one which did not have a single patient, all of them were kept intact, says Chahal. “We kept the beds, equipment and oxygen support which were not used in the first wave. All that is now being utilised at the new centre which we are building right opposite the Mahalaxmi Racecourse,” he says.
As expected, Mumbai was badly hit by the second wave. Maharashtra is the worst-affected State this year too, accounting for more than a quarter of the cases in the country. Fatalities too have been high. And despite efforts, there have been alarms about shortage of oxygen. Chahal recalls one particularly difficult night: “On April 16 midnight, I learnt about shortage of oxygen. In the morning, I texted Cabinet Secretary Rajiv Gauba and told him that we need to import oxygen. He put me in touch with Dr. Guruprasad Mohapatra, Secretary in the Department for Promotion of Industry and Internal Trade. I said it would take eight days for oxygen to reach Mumbai from Haldia, West Bengal, and asked if oxygen tankers could come from Jamnagar, just 16 hours away. He arranged for it. A disaster was averted.”
But as a result of this combined and sustained effort over months, there have been no SOS calls for beds in Mumbai during the second wave. Dr. Mangala Gomare, executive health officer of BMC, in her affidavit before the Bombay High Court said, “The BMC’s COVID-19 Response War Room Dashboard uploaded every day at 5 pm contains all the essential information about total active cases — symptomatic as well as asymptomatic active cases.”
“In all the dedicated COVID-19 hospitals, healthcare centres and ‘jumbo’ COVID facilities, a nodal officer has been appointed to update the data at regular intervals. The same information is available to the disaster management cell as well as the ‘war rooms’ and the administrators of each ward. Therefore, for effective bed management, real-time information is available with the ‘war rooms’ of each ward,” said Dr. Gomare.
“Each ward war room has a mobile medical team which is deployed in case there is a serious emergency. The team provides temporary medical care while shifting the patient to the nearest hospital. The patients who are advised home isolation are regularly called on their mobile phones on the third, fifth, seventh and 10th day. The ward ‘war rooms’ in coordination with health officers follow up with patients and allot beds on the same day,” said Gomare.
Dr. Manoj Joshi, Dean of BYL Nair Hospital, says it was very difficult to put the plan in place. “Following the lockdown, the challenge was to provide transport for healthcare workers coming from outside Mumbai like Vasai-Virar, Nala Sopara, Panvel, Badlapur and Kalyan. We managed this for thousands of healthcare workers. We looked after their needs. As canteens were not open, food was provided either by corporates or by hotels,” says Joshi. More than 50% of healthcare workers including doctors, resident doctors, nurses and support staff stayed at hotels, says Joshi.
At the same time, strict action was taken against those who did not come. “We served them notices, handed out punishment. We tried to remove some, threaten some. But that is how they all resumed work. It was through reward and punishment,” says Joshi.
Going beyond duty
The ‘Mumbai model’ would be incomplete without the mention of the Mumbai Police which has lost 115 of its personnel to COVID-19 till date. “The first wave was tough. People did not understand the gravity of the problem, and were not willing to listen. So, tough measures had to be taken in some areas and this put a lot of policemen at risk,” says a police officer who worked in Dadar and Worli Koliwada, which were among the worst affected areas in Mumbai when COVID-19 was at its peak. “But people have been much more cooperative since then,” he says.
Hemant Nagrale, the Mumbai Police Commissioner, says the role of the police is multifaceted during a pandemic. “We need to maintain the lockdown, deploy our officers on the road and in busy areas like markets. We need to issue e-passes to facilitate travel in cases of death, marriage or any medical emergency after permission is granted by the local authority.” The Mumbai Police have also had to man buildings where people have been quarantined to ensure that nobody leaves or enters the building. “We have deployed officers at vaccination centres and COVID-19 wards so that the vaccination process goes on smoothly and there are no stampedes,” he says.
The police are also required at crematoriums for unclaimed bodies. “A head constable, Gyandeo Ware, has cremated 50 bodies. All of them had COVID-19. The police have to take the bodies from the hospitals or morgues and cremate them. It is not their duty, but they have done this as a humane gesture,” he says.
The ‘Mumbai Model’ is being replicated in other districts. “This model is being implemented with local variations in rural areas. Cases are coming down in Nagpur and Pune. We have increased testing in many rural areas. We are also trying to increase the availability of beds and oxygen according to the needs,” says Maharashtra Chief Secretary Sitaram Kunte.
Despite the fact that Mumbai’s daily positivity rate was as low as 7% on May 10 as compared to around 25% in the first week of April, it cannot afford to relax. “As we anticipate a third wave, there are two challenges that we envisage: cases may originate from the rural areas of Maharashtra and that wave may affect the younger population more,” says Kunte. The challenges keep piling on, but “we are preparing for them,” he says.
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