Newer targets

WITH CLOSE TO 1.5 lakh cases within city limits and an additional 1.8 lakh in the extended metropolitan region, Mumbai's fight with Covid-19 has been a staggering one. Every day, the city reports between 1,100 and 1,300 new cases and nearly 50 people die from the virus. In many ways, Covid-19 has exposed the dream city's vulnerabilities.

In the initial months after the first case was recorded in the city on March 11, Mumbai scrambled to hold together its shaky health infrastructure. It battled lack of medical equipment, dearth of frontline health workers in leading public hospitals, a huge migrant crisis, food shortage in high-density areas, the threat of transmission in slums, sudden transfers of municipal commissioners, undercounting of deaths, and frequently changing testing policies that were sometimes at variance with ICMR guidelines.

“I think Mumbai took a long time to take decisions and decentralise the control of Covid-19,” says Sayli Mankikar, senior fellow at Observer Research Foundation. “It was too little too late when it began. But after Iqbal Chahal (current municipal commissioner) took over [in early May], a new protocol was put in place, which worked. I feel we need to innovate and disrupt further.”

In the six months since the first case, Mumbai has created temporary medical infrastructure and has contained transmission in Dharavi and other high-density areas through an aggressive ‘test, trace, track and treat’ policy. But the city is now tackling three immediate problems—containing the infection spread in non-slum, high-rise areas; arresting the growing number of critical patients; and bringing down an ever-increasing fatality rate.

“The best part of Mumbai's fight is that 80 per cent of the non-health care responsibility has been handled by the non-profit sector and activist citizens,” says Shishir Joshi, founder of the non-profit Project Mumbai. “The state busied itself with catering to the shortages in basic health care infrastructure. There was a complete breakdown in communication from the authorities and the excuse that the virus [gave] us no time to prepare does not hold ground in a mega-city like Mumbai. It only brings into focus the 25 years of incompetence of the municipal government in power.”

However, a Brihanmumbai Municipal Corporation official, on the condition of anonymity, said: “The BMC has left no stone unturned in its efforts to contain the transmission of the virus in the city; Dharavi is the best example of it. And if we have a high number of infections, we also have an equally high number of those who have recovered and have been discharged from hospitals. The recovery rate stands at 81 per cent. So, one only needs perspective to analyse the work done by the corporation.”

As of now, Mumbai’s fatality rate stands at 5.3 per cent, which is higher than the state (3.2 per cent) and national average (1.8 per cent). Late admissions to hospitals and infrequent check-ups of patients at home have contributed to the high mortality, say experts. The aim is to bring it below 3 per cent.

To do this, the BMC has urged private hospitals to refer critical patients to civic-run Covid-19 health centres and major hospitals. This is part of the civic body's 'Mission Save Lives', a nine-point strategy launched on June 30, which aims to reduce fatalities through video surveillance of patients and mandatory audit of every death.

“More than half of all fatalities have been among those under the age of 60, which is very high in comparison to most countries,” says Dr Murad Banaji, a mathematician at Middlesex University London who works in disease modelling. Examining the sero-survey that detected 57 per cent infection in high-density slums across three wards, including Dharavi, Banaji says that it is likely that there were over 50,000 infections in the city by the end of March. “The spread in Mumbai was quite rapid in the slums between late March and early April,” he says. “The report was a shock even for researchers. What we missed is that there was a slow ongoing spread in housing societies as well. The reason for the slow decline in the cases in Mumbai is that we still have spread in housing societies.”

Currently, the BMC is looking after discharged patients through 'Mumbai Maitri', a dedicated remote-monitoring set-up that has trained health care workers calling home-quarantined patients and doing regular follow-ups. Around 20 lakh citizens in the city have completed their quarantine; more than 1.5 lakh are currently under home quarantine.

Convinced that Dharavi is flattening the curve, the BMC has decided to shut down the jumbo facilities created to tackle the pandemic there. The citizens, however, see a sense of fatigue among those in-charge. “I feel everyone has given up, really,” says a 23-year-old woman in Dombivli. “My relative who tested positive some time back has not received a single call from the authorities asking how he is feeling post-Covid-19.”

Mankikar, however, says: “Mumbai is in a much better situation and the administration has got a stronger grip on all the services. Our numbers are still high but we have at least sorted issues in the high-density areas. We still have a long way to go to completely open up, but we are inching closer to that goal.”