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Friday, 08 May 2020 00:00
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With close to 30% of India’s Covid-19 deaths coming from Mumbai, and the city contributing to a fifth of the country’s total infections, a team of doctors and epidemiologists led by the health ministry’s joint secretary Lav Agarwal has been dispatched there to suggest a future course of action; Agarwal is the face of the country’s Covid-19 battle and holds a daily briefing on it.

After Tamil Nadu which added 771 cases, Mumbai added the most Covid-19 cases with 769 infections on Thursday. Mumbai’s total cases rose to 10,714 on Thursday, while India’s rose to 52,952. While the team will assess the situation, a more worrying issue facing the country’s financial capital is that its health infrastructure simply cannot cope with the strain. The city is trying to prepare 75,000 isolation beds by the end of the month, in keeping with a projection of the likely cases.

Isolation facilities are also being readied at the Mahalakshmi racecourse, and the Nehru planetarium, the MMRDA grounds in Bandra Kurla, among others. Perhaps Mumbai will have to consider the new central guideline that allows home treatment for the infected.

Since the shortage extends to doctors and nurses as well, the state has asked 25,000 medical practitioners in the city to report to hospitals treating Covid-19 cases; if they don’t, their licences will be revoked. The city has also allowed officials to take over private hospitals and clinics if the need arises. A report of the city’s medical infrastructure on the state government’s website (https://arogya.maharashtra.gov.in/pdf/covidupload39.pdf) has details as of April 26, and the picture it paints is of a city bursting at the seams (see graphic). At an overall level, Mumbai has 20.3% of the country’s infections but just 2.3% of its ICU beds and 0.8% of its ventilators.

As a result, the Kokilaben Hospital, for instance, has a demand for nearly six times the number of beds it has, it is around 4.5 times in the case of Lilawati hospital. The pressure is less in the case of ventilators, but here too, demand outstrips supply – the Kasturba hospital has a demand that is 1.7 times its capacity though, at the level of the city, just 5% of the ventilator capacity is being used. This explains all the stories of patients being turned away from hospitals that various newspapers increasingly report.

While Maharashtra appears to be adequately equipped to handle the crisis, the report makes it clear the problem is that while the capacity is evenly spread across the state, the infection is mostly centred in Mumbai; over two thirds of the state’s cases are in Mumbai but just two percent of the state’s isolation beds are here, three per cent of the quarantine beds, 15% of the ICU beds and seven percent of the PPE equipment. As a result, the Wadia hospital, the report says, had no PPE at all on April 26, nor something as basic as N-95 masks. Some testing facilities are, similarly, operating at 3-4 times their capacity.

And, most worrying, with the cases piling up so fast – cases were doubling every 11.6 days at the time of the lockdown, but this is now up to 9.8 already – the level of tracing of contacts is slipping badly. According to the report, contact-tracing had taken place for just 54% of the infected in Mumbai versus 61% in the case of Pune; it was an even lower 49% for Thane.


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