Mumbai/New Delhi: Two of India’s most important cities — national capital Delhi and financial capital Mumbai — have borne the brunt of the Covid-19 pandemic, with both registering over 1 lakh coronavirus cases. But what sets them apart is their approach towards data.
While Mumbai routinely puts all its Covid-related data out there, free for perusal by the public and experts, the same can’t be said of Delhi.
Not only does Mumbai have a detailed dashboard with information about all its 24 administrative wards, the daily bulletins issued by the Brihanmumbai Municipal Corporation (BMC) run into multiple pages, offering granular data.
Delhi has a Covid-19 dashboard as well that offers some statistics but is more in the nature of a directory, which lists the phone numbers and addresses of labs, hospitals etc, and the guidelines people need to follow. The daily Delhi bulletin is barely a page long, and has grown increasingly sparse since the initial days of the pandemic, when it used to offer a much more detailed picture.
Experts stress the importance of releasing detailed data, describing it as key to gauging the true situation on the ground.
Dr Dileep Mavlankar, director at the Delhi-based Indian Institute of Public Health, said data in public health is like a thermometer, or any other diagnostic tool, and helps devise strategy for further treatment.
“Maintaining data is as important as a CT scan for a patient or following up of a temperature of a person. If temperature goes up, it means something is wrong, if it goes down, it means things are working,” he added.
“If there is no accurate reliable data, experts will be unable to develop a strategy to counter this pandemic. The more granular data there is, the better.”
Mumbai vs Delhi
Mumbai has so far recorded 1,14,287 Covid-19 cases, with 87,074 recoveries, 20,569 active cases and 6,350 deaths as of Friday. In Delhi, there have been 1,35,598 Covid-19 cases, with 10,705 active cases, 1,20,930 recoveries, and 3,963 deaths.
As of 1 June, Delhi was issuing detailed bulletins that offered a break-up of positive cases (active and recovered), patients admitted in various hospitals and Covid care centres, age break-up, and cumulative tests conducted. On some days, the details of pending lab reports were also provided. However, even these lacked district-wise data.
Now, all the bulletin offers is the number of positive cases (total and daily update), the number of beds — occupied and vacant — at Covid-19 facilities, and the number of tests conducted. On some days in May and June, no health bulletin was issued at all.
The dashboard at DelhiFightsCorona.in opens with a smattering of statistics like the number of active cases, deaths, recoveries and testing rate. Further in, you can check the availability of beds at different hospitals and the areas earmarked as containment zones, but there’s little other data on the trends of the disease in the national capital.
The Mumbai dashboard at stopcoronavirus.mcgm.gov.in/key-updates-trends, meanwhile, provides granular data under several verticals — number of high-risk, symptomatic, asymptomatic and critical patients in each of the city’s 24 wards, total active cases, deaths, positivity rate, and ICU beds available in hospitals, contact-tracing done in the last 24 hours (the number of contacts traced, and, if they have tested positive, how many of them are in home and institutional quarantine), tests conducted, lab reports pending, containment zones declared, and building/areas sealed.
The BMC started work on the dashboard in May and it became functional on 7 June.
Although charts with these data points are fed into the dashboard, the BMC also issues a very comprehensive health bulletin daily that has details on deaths, number of cases, overall growth rate of infection, doubling rate, and availability of hospital beds.
Mumbai working with ward-level war rooms
Technology and discipline are the two key drivers of Mumbai’s data management.
Mumbai has been able to manage its voluminous data by dividing it into multiple verticals, each of which is looked after by two people. There are 24 separate ward-level war rooms, managed by technical and data experts.
Every morning, the main war room at the BMC downloads the data of positive cases from the ICMR website, where it is uploaded by different labs. An algorithm then sorts this data by pincode, and ward-wise data is subsequently dispatched to the 24 wards for follow-up.
“The ward-level war rooms… are manned 24 hours (a day) by three different teams that comprise resident doctors, medical students, teachers and some other staff,” Mumbai Municipal Corporation (BMC) Additional Municipal Commissioner Ashwini Bhide said.
“Once the ward receives the list, they call up people who have turned positive to ask how they are feeling. If they are unwell, they are referred to hospitals, if they are asymptomatic, the team visits and checks them with oximeters (devices that check oxygen levels in the blood stream) and then decides if they should be shifted to hospital or allowed to stay in home isolation,” she added.
Having these war rooms has helped Mumbai streamline data, she said.
“Initially, there was no system in place to collect the information coming from all hospitals. Later on, we identified these verticals and decided the ownership of each so that there is accountability. The person responsible for data on tests owns that vertical. The one responsible for data on deaths or active cases makes sure that is updated,” Bhide added.
“After sorting these verticals, we then had a horizontal pipeline connecting all these to a central system, which can go directly in the dashboard,” she said.
What has aided Mumbai’s approach is streamlining data input. To avoid confusion, the authorities equipped testing labs and hospitals with a template for data submission into the ICMR portal.
“Earlier reports didn’t include phone numbers, addresses, they only had names, and it created too much confusion. We then created a standard Google form with all the required heads, which the labs and hospitals now fill,” Bhide said.
In Delhi, there is no dedicated centralised war room. The district magistrates of its 11 districts have been managing data with the help of chief district medical officers.
Accredited social health activists (ASHAs) collect patient details (age, symptoms, gender etc) from the ground and pass them on to the medical officers concerned, who then share the data with the DMs.
“There has been no centralised system for data from day one and the health department is dependent on data sent by DMs,” a DM told ThePrint.
Some districts like South Delhi have a dedicated war room, where data from the area is collected and uploaded on a Covid portal. However, the portal can only be accessed by government officials.
ThePrint made several attempts through calls and texts to get a comment for this report from Delhi Director General of Health Services Nutan Mundeja, Health Minister Satyendar Jain, and the office of Health Secretary Padmini Singla, but hadn’t received a response until the time of publishing.
A proper format to avoid confusion
The Mumbai dashboard also offers real-time data on status of critical, symptomatic and asymptomatic patients, another function performed by the ward-level war rooms that constantly track patients’ treatment.
“The patients keep moving. Some asymptomatic patients go to Covid care centres. If they get critical, they are shifted to dedicated Covid hospitals. Some are sent home. All this is tracked by our ward-level teams and the numbers updated regularly,” Bhide said.
No such information is available in Delhi. According to Bhide, the system they have devised has also helped them plug holes in data.
“When we started this ward-level system, we could track all hospitals closely and found that a lot of deaths were not being reported. That is also because of the pending documentation. Now, all hospitals have been given a Google form and a death summary format,” Bhide said.
Covid fatality figures in Delhi, meanwhile, have been under a cloud since May, with discrepant figures coming from funeral homes, municipal agencies and the Delhi government giving rise to allegations that the latter may be under-reporting deaths.
Speaking to ThePrint off the record, Delhi government officials have denied the charge, blaming the mismatch on the time it takes for the figures to be tallied and verified by the audit committee. Even so, no effort has been made to streamline the flow of data. As recently as 17 July, there was a discrepancy of 500 between the data of civic agencies and that of the Delhi government.
On 2 July, ThePrint had reported discrepancies in the data for Mumbai Covid deaths released by the Maharashtra government and the BMC too, but the state data was just off by two.
Tracking the availability of beds
The absence of real-time data on the availability of hospital beds initially proved a huge challenge in Mumbai as it found itself overwhelmed by coronavirus, but the BMC has since addressed this concern.
“There are two things we track — existing beds getting filled and beds being added. Everything has to go on the dashboard every day,” Bhide said. “This also is done on a ward level, where a close watch is kept on beds occupied, available in Covid care facilities. All this information comes from all wards on a daily basis and is updated in real time,” she said.
It was with a similar intention that the Delhi government launched an app — Delhi Corona — in June that seeks to offer real-time updates on bed availability, but the portal has courted allegations of mismatch since day one.
‘Cleaned up the mess’
In order to set up its war rooms, Mumbai engaged private players like PwC.
To reach their current level of transparency, Bhide said, they had to overcome several hurdles. “We have evolved. Initially, we were not sure about our own data. Lab data was not proper, addresses were wrong. We have cleaned up the mess,” she said.
“There are some issues that crop up even now, but we take all suggestions and incorporate them,” she added.
Transparency, Bhide said, is important for their own growth.
“Numbers do not lie. Maintaining clear data is important for us, so we know where the shoe is pinching. Without this, we would not have been able to control the situation or solve issues,” she added.