April 16 was arguably the most devastating day for India with respect to COVID-19 cases. We recorded 2,17,353 cases in a single day and people suffered due to insufficient resources such as hospital beds, medicines and oxygen. Mumbai painted a similar picture, but the only difference was in how it dealt with the crisis.
That day Brihanmumbai Municipal Corporation (BMC) commissioner Iqbal Singh Chahal was under tremendous pressure after he received frantic calls from six civic hospitals that informed him about depleting oxygen supplies post-midnight. Chahal sent cardiac ambulances to the hospitals and transferred 168 patients to the city’s Jumbo COVID-19 care facility. He told The Indian Express that they were able to save all of these critical patients.
He further added that the evacuation operation that took place between 1 and 5 am helped the BMC gauge the upcoming situation. The very next day, he circulated a protocol on oxygen supplies to all 176 hospitals in the city. Meanwhile, he told the Central government to assign oxygen cylinders from Reliance Industries in Jamnagar instead of Haldi, which would otherwise take 8 days.
On the night of April 17, 24 hours after the evacuation operation, the city, with a population of 12.3 million, was equipped with 125 metric tonnes of oxygen. This was only one of the many proactive steps that Mumbai has taken to cope with the crisis.
Last week, the Supreme Court lauded the methods adopted by Mumbai and even asked municipal corporations of other states, including Delhi to follow a similar model.
The daily positivity rate stands at 6% as of May 12. This is a 22% drop since early April. Here’s what helped the financial capital of India control the spread of the deadly disease.
The Mumbai Model
The BMC created SOS teams to decentralise the COVID-19 monitoring and management process. Each team is in contact with hospitals under their jurisdictions. These teams primarily ensure enough oxygen supply in each facility by either transporting surplus oxygen from one hospital to another, or restricting hospitals from admitting patients beyond their capacity.
Last year, after the first wave, the BMC upgraded the centres with 24 Liquid Medical Oxygen (LMO) tanks after realising the importance of oxygen. Half of the unused LMOs came in use during the second wave.
“We were not sure if the LMOs would be used. But we took the bold decision of building them, and that saved us during the second wave,” additional municipal commissioner P Velrasu, told Hindustan Times.
In addition to this, hospitals were warned against excessive use of high-flow nasal oxygen and promoted non-invasive ventilation instead. This way, the city judiciously used 270 metric tonnes of oxygen when the active cases were around 80,000 around May 10. According to Al Jazeera, Delhi had a similar number of cases and double the oxygen amount around this time, but the situation in the capital remained severe.
H.J Doshi Ghatkopar Hindu Mahasabha Hospital informed BMC around 5PM that their oxygen supply was running short.
Quick action was initiated upon receiving the info and oxygen was delivered in less than an hour & half.
— माझी Mumbai, आपली BMC (@mybmc) April 21, 2021
This kind of a decentralised system is also working in ‘War Rooms’ or centres where school teachers, social workers, medical interns, health experts and officials work in shifts to operate 24/7 helpline numbers for the 24 wards of the city. Each war room has 30 telephone lines that help callers with finding beds.
Every day, the war rooms sort through and segregate 10,000 COVID-19 test results as per each ward, thereby uncomplicating the allocation process. They also look after updating ten dashboards as per the information received from private and public hospitals.
Workers in the war rooms follow a triage system and allot beds as per the severity and chances of recovery of the patient, instead of on a first-come first-serve basis. In case callers are unsure of their condition, the nearest health workers visit the patients.
Once the bed is allocated, the information is relayed to ambulance services. Close to 800 SUVs were refurbished into makeshift ambulances to transport patients. Also, a software platform created with Uber helps in coordination.
The BMC has taken over 80% of beds in private hospitals to add them to the dashboards. This helps in a faster allocation of ICU and oxygenated beds. Besides, the total number of beds was increased by 1.5 times to deal with the raging second wave. Not dismantling the jumbo centres after the first wave has also proved to be beneficial for the city.
The BMC also heavily depended on the data to identify hotspots and restrict movements accordingly.
“We closely monitored the rise and fall of cases in wards and intensified our activities accordingly,” said Shah. “For example, when R Central (Borivali) and G South (Worli, Lower Parel) wards were reporting more cases, we directed the medical officer to intensify contact tracing, testing, and micro containment zones [in these areas],” Dr Daksha Shah, deputy executive health officer of BMC told HT.
To deal with the third wave, the city will soon launch three field hospitals with a focus on ICU and oxygenated beds, and each hospital will get its own oxygen plant instead of depending on cylinders, according to Additional Municipal Commissioner Suresh Kakani.
Edited by Divya Sethu