Decoded: What is the 'Mumbai Model' of Covid management that court lauded?

With over 56,000 active Covid-19 cases, Mumbai counts as amongst the worst affected cities in the country. But on Wednesday the municipal administration of Mumbai came in for praise from the Supreme Court while it was hearing a matter on oxygen shortage in Delhi.
 
“Municipal Corporation of Greater Mumbai (MCGM) has done a remarkable job. Without any disrespect to the Delhi government, can it take a leaf out of Mumbai’s experience in maintaining oxygen supply and its optimum utilisation?” a bench of Justices D Y Chandrachud and M R Shah remarked.
 
The second wave in Delhi has been far more severe and its daily Covid-19 case count has been more than Mumbai’s in April.

 

So what is the ‘Mumbai Model’ of Covid management that the court lauded?
 
The biggest challenge that the people of Delhi have faced in the second wave is the availability of beds, oxygen and medication. While Mumbai faced the same problems last year, it was better prepared this time around.
 
Last April, the MCGM created Jumbo Covid-19 centres that offered a buffer capacity over and above the existing public and private health facilities. Civic officials realised its need given the city’s population density — families using common bathrooms were susceptible to infection. The jumbo facilities have also acted as intermediate facilities between the critical care ICUs and Covid-19 care centres. Anticipating a second wave, their capacity is being ramped up and 4,000 additional beds have been added, Additional Municipal Commissi­oner Suresh Kakani said.

 
In terms of policy, while last year Municipal Commissioner I S Chahal adopted the “Chase the virus” programme to track and test Covid-19 suspects, this year it is aggressively following “Chase the patient”’ programme for triaging and treatment of Covid-19 positive individuals. Twenty-four-hour war rooms have been set up in each of the 24 civic wards. These war rooms manned by municipal teachers and doctors carry out tasks like assessing a Covid-19 patient’s condition (asymptomatic, mild, severe) and allotting hospital beds among others.
 
In the first two weeks of April, however, there were challenges in bed allotment but those have now been sorted, civic officials say. During the first wave of the pandemic last year, Covid-19 prevalence was mostly in the slum areas, while now cases are higher among middle-income and posh localities. Everyone was looking for beds in private hospitals and beds in public hospitals were going vacant.

 
Last month, the MCGM also teamed up with private hospitals for setting up Covid-19 facilities in five-star hotels. Covid-19 patie­n­ts who no longer required a hospital bed were allowed treatment in step-down facilities in two five-star hotels, thus easing the hospital bed situation further.
 
“It is a well-oiled model, which was tested last year and is being replicated this year,” said Shashank Joshi, a doctor who is a member of Maharashtra government’s Covid-19 task force.
 
How has Mumbai managed the situation better as compared to Delhi?
 
According to Joshi, Mumbai’s response to the second wave has been more organised and coordinated. But the city has its own challenges, he added. “We are not here to compare and contrast. We have our battles to fight,” he said.

 
A step that Mumbai hospitals implemented on the task force’s recommendations was ways to optimise the use of oxygen. “We issued guidance to stop the use of high-flow nasal cannulas and focus more on bipaps. The idea was to conserve oxygen and avoid wastage without compromising patients’ lives,” Joshi said.
 
Regular stakeholder consultations, adherence to common treatment protocols and tie-ups between Jumbo Covid-19 centres and large hospitals helped. Also, curbs were introduced in Mumbai in early April with the shutting down of malls, restaurants and cinema halls. The restrictions were tightened and fresh orders issued twice last month, restricting public movement and reducing fresh Covid-19 cases. On Wednesday, Mumbai reported 3,882 fresh Covid-19 cases.

 
How has Mumbai kept its oxygen supply steady?
 
Mumbai’s current daily medical oxygen requirement is around 240 metric tonnes and it is sourced from tanks in major hospitals and refilling plants on the outskirts of the city. Storage tanks of 13,000-26,000 litres were installed in the past few months. The MCGM now plans to set up two refilling plants in Mumbai in view of the shortages. With these two plants, oxygen cylinders from Mumbai would not need to be taken to plants outside the city. The civic body is also planning to set up oxygen production plants in 12 municipal hospitals to take care of future requirements.

 
Last month, the corporation also framed procedures to prevent oxygen-related emergencies. These were issued after the authorities had to shift 168 patients from six hospitals due to oxygen shortage on April 18. Refill cycles of hospitals have been mapped, instructions laid down to give advance orders to suppliers and the entire process is monitored by a control room.
 
What more needs to be done in Mumbai?
 
While Mumbai is still not out of the woods and with the possibility of a third wave looming large, its local administration cannot rest easy. While the jumbo Covid-19 centres have offered buffer capacity, there is still a shortage of ICU beds. The civic body is working to add more ICU beds in the city and is also planning paediatric beds and creches.