Mumbai struggles to tackle increasing number of COVID-19 cases

healthworker-salil Representational image | Salil Bera

On May 6, a notification signed by Dr T.P. Lahane, director, Medical Education and Research (Mumbai) was forwarded to all private medical practitioners in Mumbai by the Maharashtra Medical Council. Invoking the Epidemic Diseases Act, the Disaster Management Act and the Maharashtra Essential Service Maintenance (Amendment) Act the notification read, “Your expert services are required for the prevention and treatment of COVID-19 patients at least for 15 days. You shall, therefore, convey your willingness and place of choice where you would like to render your services.”

This order comes in the wake of rising concern about the shortages facing the BMC (Brihanmumbai Municipal Corporation) in the areas of health infrastructure, particularly concerning the availability of doctors, beds in hospitals, ICUs during the ongoing pandemic caused by the novel coronavirus. Around 25,000 private medical practitioners in Mumbai have been asked to report to the hospitals treating COVID-19 patients with immediate effect. Those failing to report to the assigned hospital will face action, including revocation of the license to practice, the notification stated.

Speaking to THE WEEK over the phone, Dr Lahane said, "This is specifically for those doctors who own private clinics. We want them to come forward on humanitarian grounds and help us handle a huge number of cases that are currently being witnessed in the city."

As of May 6, the number of COVID-19 infected patients crossed the 9,000 mark in Mumbai alone, with more than 350 deaths. This is a crucial time when everyone is expected to be chipping in. Doctors from private hospitals too, are coming forward to fill in the gaps.

Many private doctors had shut their clinics fearing they would contract the virus if they treat COVID-19 patients. A doctor who practices in Prabhadevi spoke to THE WEEK on the condition of anonymity. "I have been asked by the secretary of the society on whose premises I have my dispensary, to not entertain any COVID-19 patients at all. Accordingly, I have to refer them to public setups."

However, Maharashtra Medical Council president Dr Shivkumar Utture makes it clear that the need for doctors will be acutely felt in the coming days as the number of COVID-19 positive cases in Mumbai can go up to a shocking 75,000. "It is the question of the shortage of doctors to work in COVID hospitals. Majority of these COVID hospitals are public and municipal hospitals with a few private setups. Now as the number of cases goes on increasing the corporation has in advance decided to ramp up the facilities and to attend to patients in these, we need more doctors," said Utture.

Chief Minister Uddhav Thackeray had recently tweeted about the 1,000-bed capacity COVID-19 hospital being built at Mumbai's posh Bandra-Kurla Complex. The hospital is being constructed by the Mumbai Metropolitan Region Development Authority (MMRDA) at a sprawling ground in the BKC and will serve as a major isolation facility for non-critical COVID-19 cases.

Early last month, the NSCI was the city's first sports facility to be turned into a quarantine centre for asymptomatic contacts of COVID-19 patients. Yet, with an increase in testing capacity, the number of cases are rising in the city and the state, the state government is requesting hospitals, institutions, and buildings under the management of the railways, Mumbai Port Trust, Indian Army, Navy and other Central government undertakings to make their facilities available across Maharashtra.

"This is to make sure there is the availability of ICU beds and isolation centres as a part of preparedness," tweeted CMO Maharashtra on May 6.

Yet, it is true that even after it was reported that some patients fro Tata Memorial Hospital and KEM hospital had to share space under a flyover, for the lack of beds inside hospitals, there remains a lack of a centralised database on the availability of beds for coronavirus patients in the city.

As of on May 6, in dedicated COVID-19 hospitals such as Nanavati, Saifee and HBT Trauma and in COVID Health Centres, such as KEM Hospital, Seven Hills hospital, Nair hospital, Kasturba Hospital, HBT Trauma Care in Jogeshwari, Bhabha Hospital and BPT Hospital in Wadala, on an average three ICU beds are available, while the rest are occupied. Additionally, as per BMC orders, all private hospitals need to reserve 20 per cent of their beds for poor patients who have tested positive for the novel coronavirus and that the BMC will bear the cost of the treatment as per the rates set by the state government.

According to reports, additional municipal commissioner (health) Suresh Kakani said that this was done because the beds in public hospitals were filling up fast and then as the option remains to go to the private hospitals, the latter must not overcharge poor patients. "Considering that it takes at least two weeks of occupancy of an ICU bed by a COVID patient, the need for more beds is acute. But it is not just a shortage of beds. Healthcare personnel too, the city will need desperately for all the new patients who will come in and for all those new facilities that will be set up. Also, what about the additional beds and other facilities required for the treatment of non-COVID patients who are finding themselves neglected anyway,” asks Dr Anant Bhan, a researcher on global health and policy.

Pharma companies are at the forefront of making available existing drugs to hospitals, especially BMC hospitals to see if they work on COVID-19 patients. For instance, Kiran Mazumdar Shaw's Biocon provided immunomodulatory drug 'Itolizumab,' which will be used by BMC hospitals to treat extremely critical COVID-19 cases as seen from the recovery of two patients from Nair hospital earlier this week. Cipla's Tocilizumab is also being tested. This will help in preventing the rising number of COVID-19 deaths in the city, which have been observed to be taking place within a day or two of the patient being brought to the hospital.

Dr Hemant Deshmukh, dean at Mumbai's BMC-run KEM hospital whose 35-year-old patient became the first in the state to receive Biocon manufactured Itolizumab—used for treating psoriasis, a skin condition—by way of infusion, said, "It is important to get the right treatments for critically ill COVID-19 patients and these are welcome measures."

But even as drug trials remain underway, the BMC is busy procuring oxygen cylinders to cater to a high number of symptomatic patients, who will be admitted soon. Portable ICU units and 100 beds in open areas of the NSCI stadium are also being set up.

Predicting that the number of cases will touch 75,000 mark by the end of this month and 80 per cent of them report as asymptomatics, it will only be a small number of critical patients whom it will have to treat with oxygen support and ventilators.

"Sourcing them in advance will help in ensuring that patients with low blood oxygen levels don't die due to a lack of oxygen support. We now have beds with oxygen support at Bombay Exhibition Centre (2000), 1000 at BKC, 500 at NSCI and 300 in Andheri," said a BMC official.