In May this year, Iqbal Singh Chahal took charge as commissioner of the Brihanmumbai Municipal Corporation (BMC) amid the ongoing Covid-19 pandemic. Chahal has delivered promising results, lauded especially for controlling the spread of virus in the city’s slums. Aggressive contact tracing and quarantining of suspected cases has helped, Chahal says, adding that the BMC plans to do about 12,000-14,000 coronavirus tests per day in the next month. Edited excerpts:
Q. Is Mumbai out of Covid-19 danger yet?
If we compare the situation of Municipal Corporation of Greater Mumbai (MCGM) exactly a month back, on June 30, we had 76,000 cumulative cases and today we have 1,10,000...so we added about 1,100 cases every day on average. But the number of active cases a month back was 28,000, and today it has gone down to 20,000. If we also look at the rate of infection (one person infecting other people), it was 1.5 percent last month and yesterday, for the first time, we touched 0.97 percent (overall Mumbai average). These facts are quite reassuring.
Q. Can you tell us about the implications of the Sero-survey?
The Sero-survey has been very heartening, in fact I'm grateful to NITI Aayog and Tata Institute of Fundamental Research (TIFR), who joined hands with us for it. We found that 57 percent people have developed antibodies in the slums of Chembur, Matunga and Dahisar. In Mumbai, since 55 percent people live in slums, a huge population has developed this... we're very close to herd immunity. According to World Health Organization (WHO), when 60 percent people have developed antibodies herd immunity sets in.
Q. How much should daily cases fall further to say that Mumbai is out of the woods?
On July 1, when 1,100 to 1,200 cases came, we were doing only 3,600 to 3,700 tests every day. On July 30, 11,000 people were tested. We have increased our testing rate by three times. A few days ago, the number of cases also fell from 1,100 to 700.
Q. Mumbai Metropolitan Region (MMR) (Kalyan, Dombivli, Thane, Mira road, Bhayandar etc) are still worries; how are you tackling this?
Our infection rate is below one percent in MCGM; if MMR was not around us, I can assure you that we would've opened up everything today. MCGM has a population of around 20 million. MMR comprises eight different municipal corporations starting from Vasai, Virar, Mira Road, Bhayandar; then we have Thane, Navi Mumbai, Panvel, and these account for another 20 million people.
Things over there not satisfactory. The case load and infection rate is very high, which is why we're not opening up. The moment we start trains, they will begin from MMR-Kalyan, Satara, Nalasopara, Vasai or Virar, and we will have almost 6 million people who travel to and fro...that's the reason we're not opening up fully.
Q. What plans to further scale testing in Mumbai?
We plan to do about 12,000 to 14,000 tests per day in the next month. We have enough hospital beds; for example, on July 30, more than 14,000 beds were lying vacant in hospitals. This doesn’t include quarantine beds and Covid care centres, which have full-fledged beds complete with doctors, oxygen and ICUs. When I took over in May, we only had 3,700 hospital beds in Mumbai; today, we have 23,000. About 5,000 beds are occupied by MCGM patients and we are also accommodating almost 3,000 patients from MMR who come in critical condition to our special hospitals.
Q. What are the lessons for the BMC and public health policy from this pandemic?
When I joined BMC on May 8, we took a major policy shift in our strategy. We decided not to follow other countries where everyone is only talking about vaccine, medicine and trials. I wanted my team to focus on fundamental surveillance, and we moved to that. We went house to house and reached 1.81 crore people; we deployed almost 10,000 health workers and 50,000 BMC employees roaming around in slums and containment zones. This surveillance helped us pick up people who were co-morbid, who were suspects and unwell. We moved 1.3 lakh people into institutional quarantine. We monitored them for 10 days, sanitised their homes and sent them back after 10 days. This strategy is not followed by the US or Canada. It has worked well for us.
Q. How are you controlling the number of fatalities?
In the beginning of June, one of the major hospitals in Mumbai reported 17 deaths on the same day, which was hard to digest. It struck me that after one falls sick, most of the population won’t go to a Breach Candy hospital but to a nearby clinic or nursing home. Nursing homes were confused about treatment; it took long for them to refer patient to bigger hospitals. These nursing homes are not supposed to admit critical Covid-19 patients.
On June 8, I gave an ultimatum to hospitals in Mumbai and asked them to declare undeclared deaths in 48 hours else under the Epidemic Diseases Act their license shall be cancelled. Between June 11 and 15, 862 deaths were reported; these were deaths from March-April-May.
I went to the chief minister with these numbers, and he said let’s be transparent and declare everything irrespective of the mortality rate. On June 16, our mortality rate shot from 2.9 to almost 7 percent. On July 29, this 7 percent has come down to 5.6 percent. In fact, when Washington Post did research in India, they said that only Mumbai has transparency of mortality. This is the reason for our higher mortality rate.
Q. What are your impressions on people from the slums versus people from high-rises in terms of their reactions to the virus?
I salute people living in the slums, they are so disciplined. When we visited their houses, they opened their homes to us and cooperated thoroughly. Cases have drastically gone down in slum areas. People from upper and middle class still need to become more responsible—80 percent of our cases out of 1,100 per day are coming from these buildings. This is consistent since 25 days, which is why we are appealing to high-rise buildings to learn from slums, whether they like it or not. At least for the sake of their families. Not stepping out of the house without a mask should become a practice, along with maintaining social distancing and sanitising everything.
Q. What are the plans for opening up?
On June 29, during our cabinet meeting with Chief Minister (CM) Uddhav Thackeray, he mentioned that we should bury the word ‘lockdown’ and from now on, should only talk about Mission Begin Again. If MCGM wouldn't have been affected so much by MMR, I can assure you everything could've easily opened up.
Q. What is the capacity creation in case of second wave?
When the pandemic hit us in March, we only had 3,700 hospital beds and 271 ICU beds. From 271 we've gone to 1,700 plus ICU beds and 23,000 hospital beds. Our doctors and BMC workers are quite experienced enough now to face the pandemic. If the second wave comes, we're fully prepared. Having said that, the CM said we shouldn't be complacent and I fully agree with that.