Fast vaccination is key: Time for Mumbai to turn into Singapore?

A large crowd gathers at the weekly bazaar at Kandivli on Wednesday, some minus face masks. Pic/Satej Shinde

While most countries are reimposing tighter restrictions, Singapore has gone the other way, saying it will stop counting daily Covid cases, do away with contact tracing, lift restrictions, and only monitor large gatherings, as it prepares to unlock. As cases continue to come down in Mumbai, and the clamour for relaxations grows, what is the way forward for our city? We asked experts.

Municipal Commissioner Iqbal Singh Chahal had told the media last month that the Mumbai-model would be to have faster vaccination to avert a third wave, which could cost the city above Rs 8 billion just to run its temporary hospitals. mid-day asked several experts for their views on whether Mumbai's administration could look at similar measures.

‘Depends on mutations'

Dr Subhash Salunkhe, epidemiologist and advisor to the Maharashtra government on Covid-19 management, said we will have to learn to live with the virus. "Eventually Covid-19 is going to be an endemic virus and we have no alternative but to learn to live with it. It will have to be handled with both vaccine and by following Covid-19 appropriate behaviour," he said.

Dr Salunkhe said that at this juncture, the city needs to follow strict surveillance and vaccination program. "We need to have strict measures where a suspected person is tested quickly and public health measures follow. The other is mass vaccination. At least 70 per cent to 75 per cent of our population has to be vaccinated so that the virus gets less opportunity to mutate," he said.

He said if we don't get virus mutations in next few months and the third wave doesn't arrive while we manage to vaccinate more than 75% of the population, we will be in a better position by next year end.

‘Be very careful'

Dr Santosh Bansode, head of the department, Emergency Medicine, Wockhardt hospital, Mumbai Central, said the biggest challenge in unlocking Mumbai is its dense population and that officials should be very careful. But he agreed that we should not panic.

"The last time we unlocked, the city faced a huge wave," he said. "So, this time we must open places one by one for a fixed period of one month while keeping others locked. If we open all shops and hotels full time, we should observe figures for one month. If they are the same or fall, we can move to malls, theatres and again observe for a month Public transports should be unlocked last. But the key to all this is increasing the speed of vaccination."

‘Abandon lockdowns'

Dr Wiqar Shaikh, professor of Medicine, Grant Medical College and Sir JJ Group of Hospitals, said a model like Singapore's requires stringent quarantine measures and, as new variants spread, will probably be impossible to maintain.

Also Read: Second wave brought a mental health tsunami with it: Mumbai psychiatrists

"The pandemic will abate sooner or later, but Covid will never go away," he said. "The Singapore roadmap aims to turn Covid into something less threatening like influenza or chicken-pox. This is a bold plan and can be adopted by countries that wish to return to normalcy and resume travel and tourism. It will also help citizens to get back to normal life after 18 months of restrictions."

The key, Dr Shaikh said, is that Singapore will continue with an aggressive vaccination programme, but Covid testing will be restricted to large gatherings and travellers from abroad.

What Mumbai should do:

1 Continue to vaccinate, but at a much faster pace
2 Continue to ramp up medical facilities, particularly in rural areas
3 Open high schools, colleges and professional institutions. Primary schools can wait
4 Open malls, shops, theatres, parks, religious places, etc.
5 Allow large gatherings with appropriate Covid-19 testing
6 Abandon lockdowns, which prevent the development of natural herd immunity. Certain places in India, even Mumbai, reported fewer cases compared to others. So, it is possible that such places have already developed herd immunity.

‘Won't work here'

Top virologist Dr Jacob John said the key is a health management system with real time information on all infectious diseases, particularly flu, and India doesn't have such infrastructure.

"Following Singapore is out of question," he said. "The second key here is immunisation rate. Any region where two-thirds or more adults are fully vaccinated can return to normalcy, and Covid can be just another disease under surveillance. But again, India does not have such a system despite repeated recommendations."

He said after the Surat plague, the Ramalingaswami Committee recommended case-based all-case-surveillance - every doctor reporting every case of notified diseases the same day as it is suspected in any patient, to a district public health officer, by simple electronic or postal reporting. Singapore and Hong Kong have such a system but India does not.

"From early 2020," said Dr John, "it was clear that after the pandemic burns out, the infection will settle down as "endemic". Risk of death will remain for at-risk groups. If they can be given two doses of vaccine plus a booster, life can be back to pre-pandemic days."

‘Learn, but adapt'

Dr Kedar Toraskar, critical care specialist, Wockhardt Hospital and member of State Task Force said while Singapore is a well-organised country with a small geographical area and tiny population, Mumbai can't be compared to it.

"But some salient features could to be looked into," he said. "Singapore's model is worth looking at but we need to adapt it as per the local scenario. We also need to understand that implementation will be importation. Unlocking is an art and it has to happen in a controlled manner. We have to make sure there are no new outbreaks. We have to understand that the Covid-19 virus is dynamic."

‘Wait till October'

Dr Subhash Hira, Professor of Global Health, University of Washington-Seattle, said the 18 million-strong Mumbai Metropolitan Region is a good candidate to apply a cautious roadmap provided people participate in Covid-19 control measures.

"Sometime in September or October, 70 per cent of Mumbai's adult population will be vaccinated. If citizens adhere to proper facial masking, sanitisation, and distancing, the city could look at fewer restrictions."

He said officials need to prepare a plan to bring Mumbai back to normalcy at minimal cost, with measurable targets and output indicators. "For example, the city needs to mobilise and train energetic CBOs and NGOs," he said. "The city should to be divided into ‘grids'; each municipal ward can be divided into four to five grids, each headed by a civic public health officer and assisted by local CBOs and NGOs.

They can work with social workers and report to the ward's assistant municipal commissioner. Phase-wise, each week wards can open up with most functions, markets, and activities, except schools, sensitive non-compliant settings, and foreign travel. There will, of course, be disruptive forces in each ward that need to be managed."

He expects nasal vaccines to get DGCI clearance by March 2022, after which it can be delivered to children and adolescents. Once more than 70 per cent of children and adolescents get vaccinated, they can go back to schools and colleges. This, he said, is easier said than done, considering the group comprises almost 40 per cent of city's population. "Post June 2022, unrestricted international travel could resume," he said.

18
No. of months for which restrictions have been in place for Mumbai

70
Percentage of the population that needs to be vaccinated for the city to be fully unlocked