Ever since the first Covid case was detected in Mumbai in mid-March this year, the city got into the news for all the wrong reasons. It appeared that the offensive march of Covid was relentless. The pandemic spread like wildfire in the months of March and April. The well-known slums of Mumbai like Dharavi, Deonar, Bainganwadi, Govandi, Ghatkopar and Worli-Koliwada were on fire. The death rate touched 8% of cases detected, and it was speculated that the city would see innumerable deaths.
In the first week of May, a few bodies were seen on the streets and road dividers. The situation seemed visibly out of control. Social media was flooded with videos of bodies on the road and stacked in public hospitals next to patients undergoing treatment. The Government of India’s Covid Monitoring Team visited Mumbai on May 5 expressing fears that there was mismanagement and the infection was likely to explode leading to thousands of fatalities. Some critics even raised the demand of handing over Mumbai to the Army.
Panic gripped the city as it became the country’s most-talked-about hotspot. It was in this scenario that I took over on May 8 as Mumbai’s Municipal Commissioner. Early morning, on the very next day, I walked into the Covid ICUs of the municipal hospitals to take stock of the desperate ground reality; and we followed it up with a four-kilometre long-march through the containment zones of Dharavi to understand the situation prevailing in the slums.
From first-hand experience, we identified four pillars on which the Covid fight would stand: testing discipline, need of ambulances, ensuring availability of Covid beds and an abundant number of trained doctors/paramedics. The focus was on testing, tracing, tracking, quarantine and treatment. In the next 10 weeks, the Municipal Corporation of Greater Mumbai (MCGM) ensured a multifold increase in the city’s health infrastructure. The number of Covid beds rose from 3,700 on May 8 to 22,300, while the number of ICU beds jumped up to 1,957 from just 480 with a manifold increase in ventilator beds.
It was made mandatory that Covid test results would be available within 24 hours. Thousands of health workers entered the slums and containment zones for door-to-door surveillance and focused testing. More than one million RT-PCR tests (which is the gold standard) were conducted in the city. There was a tenfold increase in the ambulances from 80 to 826, and these were at hand by making them accessible on the Uber platform and on-call free of cost. More than 1,000 doctors and paramedics were hired under the banner of ‘Covid warriors’ from among retired government doctors.
Around 900 intern MBBS students were deployed to manage the 24-hour war rooms, one in each municipal ward, fully equipped with ambulances, doctors and paramedics round the clock. The Covid fight was decentralised with each of the 24 wards of Mumbai acting independently. An innovative and extremely aggressive ‘Chase The Virus’ policy was implemented effectively and lakhs of high-risk contacts were physically shifted from the slums and put in institutional quarantine zones to prevent spread and disconnect them from the virus.
As many as 48,000 institutional quarantine beds were created. Our decentralised hospital bed management system, with ‘Chase The Patient’ Policy, proved to be a game changer in the allotment of beds to Covid patients. These could be tracked real-time on online dashboards. Senior IAS officers were appointed in various hospitals to supervise the operations. Mumbai became the first city in India to fully regulate Covid beds in 35 major and 73 other private hospitals at government rates through a single online dashboard. And it was implemented with an iron hand.
A world-class online platform for dialysis management for Covid patients was implemented; Mumbai was the first city to set up centrally air-conditioned jumbo field hospitals with ICU and dialysis beds (nine of them); walk-in facilities of beds for suspected Covid patients were created all over the city to treat suspected patients without test reports; and dashboards were created for hospitals to monitor the crematorium status.
For hospitalised patients, ‘Mission: Save Lives’ was successfully implemented to reduce the mortality rate to under 2% from the earlier 8%; and compensation of `50 lakh was provided for deceased municipal and BEST transport staff not covered under the Government of India Insurance Scheme. The outreach programme too worked wonders. The ‘My Family My Responsibility’ campaign was implemented for two months where more than 12,000 health workers reached out to 3.5 million families to ensure health check-ups.
The city was painted red with the slogan ‘No-Mask-No-Entry’ on thousands of hoardings and bus stops, buses and taxis. The campaign also included a deterrent and more than 5 lakh people were fined for not wearing masks. iPads were distributed to admitted Covid positive patients with Wi-Fi facilities for interaction with their relatives.
The results proved our success. As on 24 November 2020, the total active cases fell to 9,770 (the lowest ever). On December 1, the city recorded fewer than 10 Covid deaths, the lowest since May 1. The doubling rate increased to 218 days, the rate of infection fell to 0.3% and the monthly mortality rate came down to 2%, with 92% of Covid patients discharged. Despite the recent festivals of Dussehra and Diwali, the Covid situation has not deteriorated.
Team MCGM has risen to the occasion. But there is no room for complacency as the war against Covid is far from over. However, we can take heart that the city has arrested the pandemic, making Mumbai one of the safest metropolises in the country.
I S Chahal (is.chahal66@nic.in)
Municipal Commissioner, MCGM, Mumbai