New Delhi: As Maharashtra slowly eases out of the two-month lockdown, civic and health officials are scrambling to ramp up health facilities in case of a fresh wave of Covid-19 infections amid several reports of patients making a run for hospital beds.
The ‘unlockdown’ has seen people step out for walks, non-essential shops open up for business and private offices resume functioning with up to 10 people.
However, what can complicate the crisis is the annual onset of Mumbai’s infamously harsh monsoon, during which floods submerge the city, bringing with it a horde of ailments such as malaria, dengue and leptospirosis.
Mumbai plans to add over 8,000 beds in June with the Brihanmumbai Municipal Corporation (BMC) setting up ‘jumbo’ field hospitals across the city. Simultaneously, it is boosting public hospital infrastructure to ensure almost 6,500 Covid beds for critical patients, and roping in private hospitals to add to the city’s Covid care capacity.
Chief Minister Uddhav Thackeray, who rolled out ‘Mission Begin Again’ on 31 May, said the state is either at the peak or nearing a peak in the number of Covid-19 cases being recorded.
As of Friday morning, Maharashtra reported 77,793 cases, the country’s highest tally.
Of these, India’s financial capital accounts for 44,704 cases, about 60 per cent of the state’s case load. The city reported 25,141 active cases as of Thursday evening.
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About 70 per cent of the positive cases are asymptomatic, while 1,465 patients have died.
Manisha Mhaiskar, principal secretary on special deputation to the BMC, told ThePrint, “The idea is to keep the superstructure ready and then take a call on when and how to commission it as per requirement.”
Ramping up health infrastructure
With the situation in Mumbai continuing to snowball, reports of patients having to run from hospital to hospital in search of a bed, especially ICU beds, have emerged.
Ashwini Bhide, additional municipal commissioner, eastern suburbs, said, “Yes, there was some confusion earlier. Patients were not getting admission without a Covid test. But, now we have suspect wards in all BMC hospitals. Some issues still remain, especially in private hospitals, but these are being ironed out.”
Through April and May, the BMC aggressively worked on expanding the capacity of dedicated Covid hospitals as well as other large hospitals such as King Edwards Memorial and Sion Hospital that partially cater to Covid patients.
Currently, public hospitals have 6,495 beds available for serious Covid patients, up from just 1,969 as of 15 April. Of these, 696 are ICU beds. Apart from these, the BMC also has a dedicated Covid health centre for the less serious cases.
Mhaiskar said adding capacity to these hospitals in a short span of time with a virus on the loose was a challenging exercise.
“One worker tested positive, and then the others ran away. We have had labourers, plumbers running away. Moreover, the chief engineer in charge of all the civil works himself tested positive,” she said.
Besides these, the civic body will soon have 8,729 Covid care beds in what it calls ‘jumbo’ facilities — large field hospitals with general wards, ICU beds and oxygenated beds. These facilities, located in places such as Bandra Kurla Complex, Dahisar, Mulund, and Mahalaxmi Racecourse, are being completed in phases, with some already commissioned for use.
As of 11 am Thursday, Mumbai had a total of 9,292 Covid beds for the critical as well some less severe Covid cases, including those at private hospitals. Of these, 94 per cent are occupied. The current ICU bed capacity for Covid patients available with the BMC across the main hospitals, field hospitals and private hospitals is 1,100, of which 98 per cent are occupied. Also, 93 per cent of the 457 ventilators available are currently in use.
Another 29,400 beds are available for the mildly symptomatic or asymptomatic patients. These also act as step down facilities for hospitals, where a recovering patient is shifted to free up a much-needed hospital bed, or step up facilities for the quarantine centres. Of these, 7,120 beds have been activated for use so far, with 63 per cent of them currently being in use.
The BMC also has a network of quarantine centres for high-risk contacts of those testing positive. As of now, about 28,657 such persons are being quarantined here. Overall, more than 86,000 high-risk contacts have been housed in these centres so far, according to data from the civic body.
Nodal civic officer at private hospitals to ensure beds
Along with beds in the public sector, the civic body is banking on a sizeable chunk of beds in private hospitals. Last month, the state government ordered private hospitals to reserve 80 per cent of their beds for Covid as well as non-Covid patients who will be treated in accordance with government guidelines.
However, with there still being complaints of patients being denied beds, or made to wait for long hours, State Health Minister Rajesh Tope paid surprise visits to four large private hospitals in the city — Jaslok, Lilavati, Hinduja and Bombay Hospitals, which were later served show-cause notices for violating government guidelines.
“The minister started his visits at 10 pm on Monday night and was at these hospitals till 2 am. There were several issues. At some places, accurate information about beds available was not displayed, government rates for these beds were not displayed. Patients had to wait in queues despite beds being available. We hope to iron out these issues by keeping a stricter watch,” an official from the minister’s team told ThePrint.
The state cabinet also decided to appoint a nodal officer from the BMC at these private hospitals to ensure the municipal corporation gets the requisite 80 per cent beds as and when they are free.
Bhide said, “In every ward, we hope to find one or two private hospitals and add a hundred regular beds and 20 ICU beds.” There are 24 administrative wards in the city.
“The advantage of private hospitals is that they come with manpower. In case of the public sector facilities we are creating, we have to also separately focus on getting enough manpower to run them,” Bhide said.
The hustle for manpower
Setting up more beds is an important step, but the BMC also needs to reorganise its medical staff to dedicate more personnel for Covid cases. For this, it is also conducting special recruitment drives.
Suresh Kakani, additional municipal commissioner, said, “We have a list of about 1,700 people. The recruitment drive is underway. We are also getting medical staff from green zones, where there aren’t as many cases, to work in Mumbai.”
He added the jumbo facilities are such that the requirement of medical staff is at the minimum. “We have created booths. The doctor can sit on the other side and monitor patients’ health through pulse oxygenators and interact with them through a telecom,” Kakani said.
The state government is also tapping medical colleges and getting final-year students to work in Mumbai’s Covid facilities.
Disinfecting toilets, door-to-door inspections
To prepare for monsoon-related ailments, which show symptoms similar to Covid-19, hospitals have been asked to stick to their standard protocol — take the number of cases for dengue, malaria and leptospirosis in their worst year until now and get the required infrastructure ready based on those requirements.
Ward-level officials are overseeing door-to-door inspections for these diseases, combing slums for any still-water accumulation, and ensuring toilets are being disinfected every two hours and so on.
Kiran Dighavkar, assistant municipal commissioner for the G North ward, one of the worst affected by Covid-19, said, “We have been working on smoothening the processes of detecting Covid positive patients, contact tracing and so on such that we want the whole system to run on an auto-pilot mode. The focus is now on preventing large numbers of other seasonal diseases.”
Officials to wait and watch impact of ‘unlockdown’
Mumbai reported its first coronavirus case on 11 March. By mid-April, the doubling rate of cases was around seven days, i.e., the total number of cases were doubling by the week. By 31 May, the number of cases had reached 38,442 with 20,845 active cases and a doubling rate of about 14 days.
Kakani said the doubling rate has now further slowed down to 20 days for the entire city and even above 30 days for severely affected wards such as G North, which includes the sprawling slum of Dharavi.
Officials say the number of new positive cases seems to have plateaued with about 1,200 to 1,400 cases every day. The average growth rate for seven days until 3 June was 3.62 per cent. The corresponding figure for seven days till 22 May was 6.61 per cent.
While most agree that Mumbai is either at its peak or not far from it, there’s caution in their optimism.
“The city is opening up after a long lockdown,” Kakani said. “We will have to watch the situation for a week to see the impact.”
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