With a recovery rate of 94% and a death rate of 0.6%, which is among the lowest in the world, Mumbai is being hailed as a successful COVID-19 containment model across the globe. The city looks like an island of hope amidst a sea of despair. Let’s admit it, this wasn’t a fluke. It is but an outcome of sheer planning, intelligent foresight, prompt action, dynamic and daring leadership and surplus finances. It is based on a hub and spoke model, which keeps the public sector at the heart of the functioning. “Chase the virus and chase the patient” policy has been their overarching strategy.
Here we deconstruct the ‘Mumbai model of managing the Second Wave of Covid’.
The principle of decentralisation
The Brihanmumbai Corporation (BMC) employed the principle of decentralisation and abolished the centralised BMC control room. In its place, 24 ward war rooms were established with their own control room for each ward. Each war room was provided with 30 telephone lines, 10 telephone operators, 10 doctors with medical support staff and 10 ambulances.
Public-Private sector collaboration
Another feature of the Mumbai Model is the facilitation of a world-class, real-time, integrated dashboard of 172 hospitals from both the public and private sector put together. It includes 35 major private hospitals of Mumbai like Lilavati, Breach Candy, Hinduja, Nanavati. It also roped in 98 smaller hospitals, nursing homes and all the government hospitals. The BMC Commissioner, Iqbal Singh Chahal, considers the dashboard as the greatest blessing to the strategy. In an interview by Barkha Dutt on Mojo Story, he expressed, “I salute the private sector of Mumbai which, unlike any city of India, surrendered 80% of their beds and 100% ICU’s to BMC”. The cherry on the cake is that the conscientious private sector charged government prices even at a cumulative loss of 700 crores (Source: Print) for its once in a lifetime crisis.
The doctors and medical staff at the respective wards were responsible for examining the test reports, allocating the beds through the dashboard and providing ambulance support. BMC stationed 240 doctors and supporting staff to monitor the war rooms. It was an impromptu idea of the Commissioner to invite medical college interns from across Maharashtra. The young boys and girls were paid handsome stipends of Rs 50,000 a month. They were given 5-star accommodation within walking distance. These newly assigned interns were working 24×7 in 3 shifts. The result is what everyone is now talking about.
Chasing the patient
A unique aspect of the strategy was that BMC abolished the system of disclosing the positive test reports directly to the patients to avoid panic. All the test reports were sent to BMC headquarters that were then split across the 24 wards. The list of nearly 10,000 cases came down to almost 400 per ward. To just 50-40 reports per doctor each day. The BMC Commissioner explained to The Print, “on an average there are 80% asymptomatic cases. So each doctor would have to allot only 5 beds per day. The remaining 40 asymptomatic cases were home quarantined and individually called by doctors 5 times a day to check on temperature and oxygen levels. In case they didn’t have the equipment, field officers would visit them to record all parameters. If they developed any symptoms, they were picked from their residence, allotted the bed and moved to the hospital.”
The idea was also to relieve the hospitals from all other roles, except treatment. In this way, the entire process was streamlined. It saved Mumbai from undue delays at hospitals gates and widespread panic and chaos among the public, which was sadly witnessed in the case of Delhi.
A seamless transportation network
To ease the public transportation, BMC refurbished 800 SUV’s and turned them into ambulances. BMC used Uber’s software platform to track and manage these ambulances.
A separate dashboard for crematoriums
The BMC asked IIT, Mumbai to create an online dashboard for all the 47 crematoriums across the city. It provided half-hour slots to the family of the deceased to bid farewell with dignity and relative privacy. It prevented the harrowing of corpses at crematoriums.
Massive infrastructure augmentation
Currently, the city has a total bed capacity of 30,255, out of which 7,897 oxygen beds and 653 ICU beds are available. During the first wave itself, Mumbai had established 7 jumbo centres across the city. These were built, with well-equipped with oxygen supplies and ICU beds, on open grounds and at vacant halls.
In January, after the first wave subsided, NESCO, one of the jumbo facilities, had only 3 beds occupied in its over 2500 bed capacity. However, anticipating the second wave, the authorities took the wise decision of not dismantling the jumbos. Also, jumbos admit the patients even if they do not have a positive test report or had a swab test done. This made them the handiest and accessible walk-in facilities for the common man while easing the burden on city hospitals. The facility has to date been availed by more than 20,000 people.
Instilling confidence among employees
The nature of the job makes the employees of a municipal corporation highly susceptible to the virus. Considering this fact, the BMC decided that in case any of its 1 lakh eight thousand employees dies during the pandemic, the family will be given a cash compensation of 50 lakhs from BMC coffers and an assured job to the next of kin. This made the employees feel supported, confident and taken care of. (Source for Stats: The Print)
Though Mumbai is a city, its health budget of 4600 crores is higher than most states. It gave the corporation enough room to manoeuvre.
Oxygen- optimum usage, buffer stocks, seamless distribution
BMC installed nearly 24 Liquid Medical Oxygen (LMO) tanks in its COVID-19 facilities, more than half of which remained unused during the first wave. But it came in handy when the second wave hit the city and the need for oxygen and oxygenated beds increased drastically.
During the second wave, The Covid Task Force of Maharashtra created a 4 point SOP for hospitals to optimise oxygen usage. The BMC chief was quoted by The Free Press Journal, “Optimum utilisation of available oxygen supply and the stock has been our trick. Seamless distribution and creation of buffer stock, along with the BMC’s ability to pull together its existing resources has led to make oxygen shortage a non-problem.”
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What is Mumbai’s plan for the third wave?
BMC is constructing 4 new jumbo facilities. Each has 2000 beds (As per their interview with Print, it had 70% oxygen beds, 200 ICU beds and 100 cubicles for paediatric cases). Each will have an in-house oxygen generation plant to eliminate the dependence on external sources for oxygen supply. The existing jumbos are also being upgraded to have in-house oxygen generation.
To conclude, Mumbai Model is a successful pandemic containment strategy and a remarkable model in public administration. As urged by Justice Chandrachud, the rest of the country should improvise their strategy taking a cue from Mumbai’s experience.