Mumbai's COVID-19 battle: Factors that the city is grappling with to overcome the pandemic

As India's recovery rate increases to 48.2%, its financial capital - Mumbai, fights Coronavirus (COVID-19) with its tally soaring towards the 50,000-mark. Mumbai's civic body- Brihanmumbai Municipal Corporation, which is leading the city's COVID-19 battle has seen a major reshuffle in its management - Iqbal Chahal replacing Praveen Pardeshi as its Commissioner on May 9, amid lockdown. Mumbai currently has  45,854 cases with 18,797 recovered and 1518 deaths, as of June 5, 2020.

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What are the top factors affecting Mumbai's COVID battle?

Stagnated testing

As revealed by BMC COVID-19 response war room's report, Mumbai's testing rate has been erratic through May 2020. While it started 4087 samples on May 1, there were dips on several days to as low as 2359 samples to finally reaching 3748 samples on June 4. Though Mumbai claims to have the highest tests per million with 16,593 samples, its positivity rate also stands at 20.71% - the highest. 

In comparison, Tamil Nadu has tested 16,323 samples per million with a positivity rate of 5.01%. Curiously, while Mumbai has kept its testing rate constant inspite of increasing cases, Maharashtra itself has increased its testing rate from 7,237 samples per day to 14,504 tests by May 31, as per reports. Mumbai has also failed to put a cap on testing by private labs inspite of the Supreme Court's directive.

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Bed availability on paper, patients complain of unavailability

The BMC has announced the construction of several jumbo facilities for mild/asymptomatic patients. As per BMC's own report, BMC has 7168 such beds of which 4589 are already occupied. On the other hand, BMC has 3087 beds for patients with moderate symptoms or co-morbidities - of which 2907 are already occupied. For critical patients, BMC has 6195 beds of which 5731 beds are already full.

While the BMC's helpline 1916 has a feature to know about bed availability, there have been reports of several patients, unable to procure a bed due to 'unavailability of beds on an urgent basis'. This has led to deaths of some patients as they succumb to low oxygen levels, waiting for a bed. The other issue faced by many patients is the lack of ambulance services. While BMC has time and again claimed that there are adequate ambulances, reports state that there are only 100 state-run ambulances available and private hospitals' ambulance services are exorbitant.

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Lack of medical staff, doctors

The entire COVID crisis has put a massive strain on India's public health sector. According to an early study in April, it was found that 80% of India's initial COVID cases were handled by government hospitals, as the private hospitals were reluctant to enter the fray due to state govt restrictions, testing rate cap, ICMR's stringent guidelines etc. Mumbai, which has seen a steady rise in the number of cases, has been experiencing an acute shortage of nurses, doctors and  Class IV staff - ward boys, cleaners, labourers. On request from the state government, Kerala has sent a team of 50 doctors and 100 nurses, who will arrive at the city's Seven Hills hospital.

Recently, KEM hospital's nurses protested demanding a separate ward for infected colleagues and shorter shifts, after a there was a delay in finding a bed for a KEM nurse who was infected while caring for a patient. Reports also state that lack of Class IV staff is affecting cleaning of wards,  getting samples, X-rays, scans. On analysing deeper, reports state that 'nearly 40% Class IV posts are vacant'. The shut down in public transport has also affected commuting of staff - particularly Class IV, most of whom live far away from the city, state reports.

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Constant change in policy

While Mumbai had initially seen a stringent containment policy as cases rose with BMC sanitising premises, sealing buildings, stationing a dedicated police officer, and BMC officer at a 'containment zone', the containment policy took a drastic shift with a change in management. Suddenly, Mumbai's containment zones were dropped from 2,800 to 743,  by excluding sealed buildings and chawls, which will be self-managed by the society. The reduced number of containment zones highly frees up the city's zones under the current lockdown- which is limited only to containment zones.

BMC has also changed its testing guidelines time and again. After ICMR's revised guidelines, BMC  revised COVID-19 testing criteria, differing from the ICMR, by excluding asymptomatic high-risk persons from testing, quarantining them instead. Later, on May 28, BMC increased its testing scope by allowing  COVID-19 swab test for symptomatic cases without a public or a private doctor’s prescription. Moreover, ICMR too changed its discharge policy, allowing moderate cases to be discharged without a test if no fever is seen for 3 days, boosting India's recovery rate.