Covid-19: Consistency is key in managing a pandemic, says NMMC chief

Taking charge as NMMC chief in the middle of a Covid-19 storm in July 2020, Abhijit Bangar tells mid-day how he used the lessons from last year to plan ahead, ramping up bed-oxygen-testing infra, which helped Navi Mumbai see itself through the second wave

When Mumbai was in the midst of the first Covid-19 wave, the neighbouring Navi Mumbai, a counter magnet for the megalopolis, was facing an even deadlier threat from the virus. With its test positivity rate reaching 50 per cent, and mortality rate going up to 3 per cent, the highest in the entire country, Navi Mumbai was struggling to battle the Covid-19 storm. Amidst this crisis, 38-year-old Abhijit Bangar was appointed as the new commissioner of the Navi Mumbai Municipal Corporation (NMMC).

Bangar and his staff, all in PPE suits, seen during a surprise visit to a Covid-19 quarantine centre in CIDCO Exhibition Centre, to check if patients were satisfied with the facilities available there

A 2008 batch IAS officer, Bangar’s unique initiatives not only helped contain the first wave, but also helped the city limit the surge during the second wave. Taking just one weekly off in the last 10 months, Bangar, along with his team, has managed to restrict the city’s positivity rate to 12 per cent in the second wave. NMMC has also tested more than 50 per cent of the residents for the virus. In an interview with mid-day, the city chief discusses the strategies adopted by him, which were effective in stemming the tide of the disease in Navi Mumbai.

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When you took charge as NMMC chief in July 2020, what was the situation like in Navi Mumbai?
I joined the NMMC on July 14, 2020. The next three months were tough in terms of Covid-19 management. Though the number of patients was 350 to 400 per day, in terms of statistics there were two issues. Our case positivity rate (CPR) was as high as 50 per cent. Second was the case fatality rate (CFR), which was 2 to 3 per cent. At the time, NMMC didn’t even have its own lab and was totally dependent on private labs.
 
Soon after you took over, you implemented unique initiatives, such as ‘Break the Chain’ and mobile test vans. What were the outcomes of those?
As the CPR was high, I realised the infection chain had to be broken. To break the infection chain, there was no alternative, but to “test, trace and isolate”, and for that I needed some infrastructure. Within two days of taking over as NMMC chief, I started free antigen tests at the four NMMC hospitals and 23 health centres. We also ramped up our testing infrastructure, getting our own lab, which started processing more than 1,000 samples every day. To ensure more tests were being done, we launched six mobile test vans, which were also available on call. Any housing society could book these vans for testing. This reduced the fear and stigma among citizens about Covid-19.

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Was Navi Mumbai ready for the pandemic?
To manage any pandemic, we need testing and isolation infrastructure. While NMMC managed to get its lab in August 2020, in the middle of the first wave, we still needed to get enough beds. Beds are usually of three types—normal beds for asymptomatic patients, oxygen beds for moderate symptomatic patients, and ICU/ventilator beds for serious patients. We had normal beds, but were falling short of oxygen and ICU beds. When I joined, there were only 83 oxygen beds. We slowly increased it to 2,200 beds, and later, managed to get a total of 3,000 beds, with the help of private hospitals. We also got 500 ICU beds, out of which 230 were that of the corporation’s. But, just having beds isn’t enough. For instance, if we have 1,000 beds in a corporation, out of which 900 belong to private hospitals, not everyone will be able to afford it. That’s why we had to enhance the corporation’s facilities. We even focused on increasing our oxygen and ICU beds, and purchased 120 oxygen cylinders, which helped us during the second wave.
 
You initiated an analysis of every Covid-19 death in the corporation area. How did it help in managing the mortality?
Critical patient management is most important, when handling a pandemic. We began with analysis of each and every death occurring in the city. We collected data on the number of deaths, where they happened, and the reasons for the deaths. There were many factors responsible, such as age, comorbidities etc. But, after we analysed this data, we realised that ‘time’ also played a critical role. If patients are administered medicines at the right time and given the right kind of treatment, there is always a high chance of saving them. Even today, death audits are carried out daily. Regular sessions with our task force, which in turn coordinates with general physicians at various hospitals in the city, have helped us refine our treatment protocols, too. Today, we are definitely in a better position to handle the second wave.

Navi Mumbai has a population of around 15 lakh with a diverse demography; it is also home to the APMC market and other major corporate hubs. What were your priorities when you started planning for the pandemic?
When we think of Navi Mumbai demographically, it has various characteristics. There are slum pockets and gaothans, then the CIDCO nodal areas, highrises, and of course APMC market and the area around it. We had to look at growth of cases in all the three regions separately. While there were cases in the slums, the nodal areas and highrises were a bigger problem. All the corporate hubs were shut, so that was taken care of. However, the APMC market posed a peculiar problem right from the beginning. The market, which provides vegetables and fruits to the entire MMR region, receives more than 1,000 trucks daily, and sees a footfall of nearly 30,000 to 40,000 people. Before my appointment, there was a lot of hue and cry about whether the APMC market should work, as there were infections among mathadi workers and shop owners. It had to be shut for a week too. If you see the market, it’s jam-packed with shops in close proximity. So, we began staggering the inward flow of trucks to avoid crowding, while unloading. Since APMC runs 24/7, we also started a dedicated testing centre that worked round the clock. This has not happened anywhere else. Workers, who feel they have Covid-19 symptoms, can go and get tested for free here. At one point, we did around 3,000 tests in a single day. I personally visited APMC several times, without prior notice—sometimes even at midnight—to check whether our system was in place.

Bangar speaking with a member of the health staff at a quarantine centre

Turbhe like Dharavi, is a densely populated locality. But, the area reported very low number of Covid-19 cases. How did you manage it?
Covid-19-appropriate behaviour in slums and gaothans was a challenge. Fortunately, again rampant and random testing, not just of symptomatic, but of asymptomatic patients, and door-to-door survey helped. What we observed in Turbhe and other slums was that people responded to the messages given out by the corporation. We carried out activities on a mass-level with the help of local representatives, and urban primary health centres. In the second wave as well, we continued the door-to-door survey. Every house in this area was visited by our health workers every 15 days. In any pandemic management, consistency is the key. That’s what we did in Turbhe. Another problem was that home isolation wasn’t possible for Turbhe’s residents, and so, anyone who tested positive for Covid-19, had to be taken to an institutional quarantine centre. Generally, there is a negative mindset about corporation or government facilities. In order to combat that perception, we followed the highest standards at these centres, in terms of cleanliness, housekeeping and catering. That way people didn’t hesitate to avail the facility.

During the second wave, the NMMC isolated every positive person above 50+. Did it put a strain on the system?
We made some significant observations about the second wave. Our daily cases started increasing from February 10, but the rate at which the cases rose was not that high. On March 15, we reported 136 cases. After that, the cases almost doubled every day. By April 4, we had hit a peak, reporting 1,441 cases. While observing the increasing trend, we realised that the case fatality ratio hadn’t changed. At the time, there was a feeling within the administration, as well as doctors, that this wave had bigger numbers, but lesser fatalities. We soon realised that this wasn’t the case. There had been a gap of three to four weeks between the peak of daily cases and rise in fatality. We found patients were getting more critical in the third and fourth week of March. This put a strain on all the hospitals. During this time, we observed that 80 to 85 per cent of the fatality was from the age group of 50. Also, after mid-March we found that many patients’ oxygen saturation had dropped to 60 to 70 per cent. These patients needed to be sent to an ICU facility. To avoid these scenarios, we started asking our heads at the primary health centres to isolate the 50-plus age group patients.  If somebody refused, we made sure their physician or general practitioner maintained a record of the person’s vital parameters. We started taking feedback from doctors as well. We also sought a list of patients coming to them with Covid-19 or influenza-like symptoms. These patients were then traced. Another trend that was observed during the second wave was that people would try and bypass this system, out of fear that they would be taken into an isolation centre. They would just do the High-Resolution Computed Tomography (HRCT) test, [another way of determining the presence of the viral infection in the body], bypassing the regular antigen and RT-PCR testing protocol. Hence, we reached out to diagnostic centres carrying out HRCTs and took reports of the patients from them. This helped reduce the number of cases. Our dedicated call centre, which at one point was receiving around 25 distress calls for ICU beds, is now barely getting any calls.

Some of the other stringent measures you adopted included, penalising housing societies whose residents violated quarantine rules, and raids on morning walkers and night crawlers.
The corporation and police are working round the clock to contain the virus, but there are a handful of people, who don’t follow rules. They had to face the music. We did fine some housing societies Rs 10,000 as a first offence, but after that many started stringently following orders. Several citizens too, had developed a false sense of relief, after the cases started dipping in the first week of April. Despite the curfew, they’d go for morning or evening walks. We formed teams to get hold of these violators. They were asked to take an antigen test right then, and an FIR was also lodged against them. This was needed, because unless citizens follow rules, the efforts of any corporation will go in vain.
 
As far as citizens are concerned, what more can they do, to help the administration?
Citizens tend to have this mindset that corporations are unprofessional, inaccessible, and inefficient. I don’t blame them for having such an opinion, because bureaucracy works in a typical way, which we describe as red-tapeism. However, I must mention that we have received a good response from citizens. They have reciprocated to all our ideas, and that has been a game-changer. We want to keep this relationship going.
 
NMMC has been reaching out to citizens on WhatsApp, Facebook and Twitter, as well. 
Passing on accurate information to citizens is important, especially because of the kind of misinformation they are being bombarded with. We created a comprehensive dashboard, which is updated from time to time. We have also floated helplines and email IDs to help citizens, and upload the daily COVID-19 report on our website. But, we also felt the need to tap Facebook and Twitter. If a government body keeps updating its citizens with accurate and timely information, there won't be any unrest or state of confusion.
 
NMMC elections were due last year, but it had to be differed due to the pandemic. 
Elected representatives have an important role in our society. They understand the pulse of our society. Though no fresh elections were conducted, many local representatives joined hands with the NMMC. It helped us function effectively. We’ve all been working non-stop. Of course, it takes a toll on one’s mental and physical well-being. But, we had to rise to the challenge.

COVID-19 caseload in NMMC

4,36,683
Total number of RT-PCR tests done

4,80,968
Total number of antigen tests done

94,688 
Total number of cases

88,960 
Total recovered

1,431 
Total number of deaths

4277 
Total number of active cases  

(Data as of May 7)

50%
Case positivity rate (CPR) in Navi Mumbai before Bangar took charge

12%
CPR in Navi Mumbai as of May 2020

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