21 December,2021 08:17 AM IST | Mumbai | Ankita Mishra
Workers refill oxygen cylinders at a private gas company in Mahalakshmi. Pic/Ashish Raje
After battling a devastating first wave of the coronavirus outbreak, Mumbai, as the rest of the country, started the year 2021 with a hint of normalcy. The Covid-19 restrictions were eased and it appeared that the city was on its way to flatten the curve.
With the onset of the second wave, however, Mumbai touched a few grim milestones. It not only logged 88,710 Covid-19 cases in March, 475 per cent higher than February, but its positivity rate too hit 20-24 per cent, from an average of 8-9 per cent in the preceding months.
The surge in cases strained the already-burdened health infrastructure, as the city fell short of oxygen, beds and life-saving drugs. At that time, Mumbai had 11,082 oxygen beds, 2,861 ICU beds and 1,444 ventilator beds. There were 21,717 beds for moderate to critical patients and 25,365 beds for patients who were asymptomatic or had mild symptoms. With 15 per cent of the patients requiring oxygen, these facilities were proving to be inadequate. The state then was producing around 1,200 tonnes of oxygen, of which nearly 950-1,000 tonnes was being utilised daily, but as the cases continued to spike, the demand increased.
Shortage of oxygen cylinders in the Vasai-Nalasopara-Virar areas also led to COVID-19 deaths. Pic/Hanif Patel
During this time, the city also witnessed the horrors of hospital fires. At least 11 people died and 10 others were injured after a fire broke out at a private Covid-19 hospital in Bhandup West on March 26. On April 23, a fire broke out at an ICU of the Vijay Vallabh Covid care hospital in Virar, killing 15. Five days later, at least four persons died in a fire at a non-Covid healthcare facility in Thane.
The rising cases of mucormycosis or black fungus worsened the situation and caused several casualties---128 between February and June alone. The city was not only treating its own patients, but also tending to black fungus patients from different parts of the state.
From being under immense strain, Mumbai emerged as a role model for others to emulate with its effective handling of the Covid crisis.
A defining moment came on the intervening night of April 16-17, when BMC commissioner Iqbal Singh Chahal received distressed calls about oxygen shortage from six civic hospitals. In an overnight rescue operation, lives of 168 patients were saved after they were transferred from the hospitals to jumbo centres in cardiac ambulances.
The incident though was a reminder of what may lie ahead. Working on a war-footing, the Brihanmumbai Municipal Corporation (BMC) not only appointed teams for coordination between oxygen suppliers, hospitals and assistant municipal commissioners to ensure seamless oxygen supply, it also sought a protocol for oxygen consumption from the state's COVID-19 task force. The ward-level teams were tasked with moving surplus oxygen from one site to another. The screening, tracking and isolation to restrict transmissibility too were ramped up.
Around March Mumbai had 11,082 oxygen beds, 2,861 ICU beds and 1,444 ventilator beds. Pic/ Nimesh Dave
Dr Sanjith Saseedharan, Consultant & Head Critical Care, SL Raheja Hospital, says, "The 4T model that involved Tracing (including door-to-door screening), Tracking, Testing and Treating was key to restricting the second wave. Also, the effective training of junior staff in the public health sector went a long way in achieving this goal, considering the population in Mumbai."
Mumbai Police introduced a colour-coded sticker system in April for smooth functioning of vehicles engaged in essential services, but it was later discontinued. Pic/ Nimesh Dave
To cope with the crisis, the city also rapidly added beds to its field hospitals, turned top-tier private hospitals into Covid-care centres and 800 vehicles into ambulances. Dr Saseedharan says, "The masterstroke was the decentralisation of the central war room into multiple ward-wise war rooms. The telephonic follow-up of patients isolated at home also played a big part in keeping things under control."
Among other unique measures, Mumbai Police introduced a colour-coded sticker system in April for smooth functioning of vehicles engaged in essential services, but it was later discontinued owning to the confusion it caused and re-introduction of the e-pass system.
The result of successful resource management and real-time monitoring was that Mumbai saw the positivity rate drop to 6 per cent by May and 1.79 per cent in the first week of July.
These efforts alone though could not combat the swift rise in infections. "We needed to chase the virus," said Chahal.
A proactive approach focused on 55 slums, including Asia's largest, Dharavi, where a strict lockdown was accompanied by aggressive sanitisation of public toilets, mass screening and a huge volunteer effort to ensure that nobody went hungry.
Mumbai logged 88,710 Covid-19 cases in March, 475 per cent higher than February. Pic/ Syed Sameer Abedi
All positive test reports in the city were routed through âwar rooms' manned by doctors who would triage cases and decide where to send the patient, irrespective of "whether he is a minister, a big shot or a slum dweller," the BMC chief said.
Healthworkers conduct door-to-door screening in Dharavi slum. Pic/AFP
A decision that proved to be more crucial was to not dismantle the infrastructure put in place during the first wave of the pandemic. "There would have been chaos if we hadn't kept jumbo COVID centres (field hospitals), oxygen beds, ICU beds ready before the start of second wave," Mayor Kishori Pednekar said in May.
Dr Rahul Pandit, who is a member of the national and state Covid-19 taskforce, says, "The âMazha Kutumb Mazhi Zavabdari' drive (My family, my responsibility) to reach out to people and sensitise them on the Covid-appropriate behavior proved to be effective. As part of the programme, extensive screening and vaccination camps were organised along with public awareness outreaches in every slum area."
Amid a nationwide oxygen shortage in May, the apex court lauded Mumbai for its oxygen management and asked Delhi to take note of it. "Bombay Municipal Corporation has done some remarkable work and, not disrespecting Delhi, but we can maybe see what was done by BMC," Justice DY Chandrachud said, taking note of the submissions of Solicitor General Tushar Mehta that Mumbai managed with 275 MT of oxygen even when the active cases crossed 92,000.
On December 13, the Bombay High Court too said Maharashtra was "one of the pioneers" in successfully tackling the Covid crisis.
As the number of fresh cases receded and those vaccinated rose, the state government resumed local train services for the fully vaccinated from August 15. Close to 2.3 million people boarded the local trains on the first day of restart. Setting a milestone, Mumbai also became the first district in the country to complete one crore vaccinations against Covid-19, on September 4.
On December 4, a 33-year-old marine engineer from Kalyan-Dombivli was found to be the first patient Omicron in Maharashtra. The state's Omicron tally stood at 54 as on December 19.
Mumbai became the first district in the country to complete one crore vaccinations against Covid-19 on September 4. Pic/ Pradeep Dhivar
Dr. Lancelot Pinto, Consultant Pulmonologist and Epidemiologist at P.D Hinduja Hospital & MRC, Mahim, says, "The Omicron variant, which has been reported with increasing frequency to cause breakthrough infections, can cause a third wave, but the healthcare system may not get burdened to the same extent, as a majority of Indians have antibodies, either from vaccination or past infection". Whether the antibodies will last without a booster dose remains to be seen," he adds.
Dr Pandit says, "The risk of third wave certainly exists. If people do not follow Covid-19 norms, then the third wave is inevitable. Therefore, maintaining Covid-19-appropriate behavior is a must."
