Iqbal Singh Chahal, BMC commissioner; Image: Punit PARANJPE/AFPDespite the initial chaos, the ‘Mumbai model’ of Covid-19 management worked well in the face of the surging second wave and earned praise from the Supreme Court as well. Planning, delegation and launching the right initiatives, like 24x7 war rooms equipped with doctors and trained staff, worked well in the favour of Brihanmumbai Municipal Corporation (BMC). But the BMC isn’t looking to be complacent, instead it has already started preparing for the third wave by setting up more jumbo centres, and training paediatricians, since children are expected to be more vulnerable to the third wave. In a freewheeling conversation with Forbes India, BMC Commissioner Iqbal Singh Chahal talks about learnings from previous waves, opening up of local trains, vaccination plans for slum-dwellers and tackling the next wave with monsoon setting in. Edited excerpts:Q. How is the BMC planning to scale up infrastructure as experts suggest the third wave will mostly impact children?
The doctors in our task force advised me that a third wave could hit us by July-end or early-August and we need to be prepared for that. Chief Minister Uddhav Thackeray had called for a meeting in early-May where it was decided that Mumbai will construct four new jumbo centres, the primary reason being that last time, although we confronted the virus very well, we've had a lot of stress on ICUs.
We started constructing these jumbos from May 15. The tenders were put in place and workers were hired only last week. We’re building these along with Mumbai Metropolitan Region Development Authority (MMRDA). The plan is to have a 2,000-bed jumbo in Malad with 70 percent oxygen beds, and with learnings from the problems with oxygen supply last month, we’re going to have in-built oxygen generation plants in each of them so that we don't need to import oxygen. It will also have 200 ICU beds and 400 cubicles. These cubicles are designed keeping children in mind; in case they’re admitted their mothers can be with them in that cubicle. Other jumbos are being set up at Worli racecourse, Kanjurmarg and Sion. These 6,500 bed facilities [combined] will have 1,000 cubicles, 800 ICUs [200 each] and oxygen beds.
BMC is responsible for the Worli Racecourse jumbo and we have opened it last week. Unlike other jumbos, we didn’t need any approvals or permissions to build this because HDFC Bank’s Deepak Parekh funded it under the bank’s CSR project and provided Rs 45 crore for it. About three weeks ago, our CM called a virtual meeting of 660 paediatric doctors of Maharashtra. The senior doctors from the task force addressed this meeting to sensitise them and make them aware of the threats of the paediatric wave. These doctors were further requested to spread the word to the family doctors of kids all over the state. We also created a paediatric task force to brief the family physicians with the do's and don'ts. This task force is also preparing a patient treatment protocol on what needs to be done if the child is under home quarantine or in the hospital.
Q. We saw many SOS requests coming from Mumbai for beds, oxygen, medicines and other medical facilities…did BMC anticipate the second wave or was it caught by surprise?
Not at all. We had seven jumbos with 9,200 beds and after Diwali our cases started falling. From December till early February, we saw a huge decline in the number of cases. Still, we didn’t shut any of the jumbos, they were all functional. Not a single staff was removed. This is the proof that we anticipated the second wave. Q. Mumbai was one of the first cities to keep cases under control. The SC also praised the Mumbai model of oxygen management. Can you delve deeper into it because all administrators were dealing with such a crisis for the first time?
Between March and December 2020, nobody knew what oxygen shortage or oxygen requirement is. But Maharashtra was one of the first states which started feeling the pinch. Early April, the CM held a meeting and it was brought to our notice by the health department that Maharashtra produces 1,200 tonnes of oxygen (including industrial use, and Covid and non-Covid use), and that in the first week of April, 950 tonnes were already being consumed just by Covid-19 patients. It was also flagged that the way the graph is increasing, our oxygen consumption may touch 1,600-1,700 tonnes only for Covid-19 patients by April-end. Since Maharashtra cannot produce more than 1,200 tonnes, we had to import 500 tonnes. Unlike other states, we raised this issue with the government of India and started importing. Now the problem was these places were far away and the oxygen transportation was taking a lot of time. That’s when we started realising the importance and the shortage of oxygen and how it can create a havoc.
It was a stressful situation when the cases shot up in rural Maharashtra. On April 17, when 168 patients were lying in six of our BMC hospitals, including 34 in the ICU, we got a message at midnight that in next two hours these patients can die because oxygen is running out. That night we carried out a major operation and moved these patients to the jumbo centres. But this was a temporary solution and we badly needed oxygen. That is when we got allocation from Reliance Industries in Jamnagar. After April 17, till today, we haven’t had a problem of oxygen. The reason why the Supreme Court appreciated our oxygen management was because of various reasons. We put up emergency oxygen stocking points, and we strictly warned all the hospitals to not add oxygen beds without the BMC’s notice—if they did so, their licence would be cancelled. In other states like Delhi, they were forcing the hospital to increase oxygen beds because they didn’t want to see patient lying on the floor without realising that they are creating another problem. Our emergency stocking points at six places in Mumbai had 50 tonnes of oxygen. The task force also gave a couple of standard operating procedures (SOPs) to save oxygen. They suggested the oxygen saturation level of patient should be 94 not 98. No patient will die if his oxygen saturation levels are 93-94. This single suggestion suddenly decreased our oxygen requirement by 10 percent. We also banned elective surgeries, which can wait for a month or two, till the Covid-19 cases comes down. This also helped us in saving oxygen. BMC Commissioner (L) talks with his colleagues in the disaster management room at their headquarters in Mumbai; Image: Punit PARANJPE / AFP Q. Opening up is a tricky proposition… the moment you open up, cases may also rise. How do you find the middle ground in ensuring business is not affected and people also do not contract the virus?
I always request our citizens with folded hands that please adopt Covid-appropriate behavior. I also appreciate them because, this year, Mumbai never went beyond 11,000 cases in a single day, unlike Delhi which went to 27,000 on a single day. The only reason was that in Mumbai 27 lakh people were fined for not wearing masks in public spaces. We charged them mere Rs 200, but collected Rs 54 crore between November and January. We collected 25,000 fines in a day. Around 50,000 police constable were deployed on the roads. Even Pune went to 15,000 cases in a day, even though Pune’s population is just one-fourth of Mumbai. If every citizen takes a vow that he will not come out in public without a mask, the third wave can disappear. Even though we’re doing much better now, we are not going to open everything. I have a very clear view that instead of inviting another wave and then having a lockdown, it is far better to go in a graded manner. Q. Trains are the lifeline of Mumbai. It is the mode of travel for a majority of the working population. Are there any plans to open them for the public soon?
We will start with ladies only. Because, first, their number is less in comparison to men, around 25 lakhs. The moment we open up for men, this number shoots up to 50 lakh-plus. Our plan is that, maybe, from first week of July, we will try with the ladies and slowly move on, because trains can be super spreaders as people stay shoulder to shoulder. Experts are warning us that we have to weigh the pros and cons before we start the trains, so we will have to be very careful with this.
Q. At various times during the second wave, we saw states blaming the Centre for various things, including shortage of vaccines. Did Maharashtra not get adequate help? The population of Mumbai is roughly 16 million. We are doing about 70,000 to 90,000 vaccinations per day. So far, more than 42 lakh people have been vaccinated and we may be number one in the country in terms of the percentage of vaccinated people. We cannot complain when we are first in the country in the vaccination drive. I'm very happy to say that Mumbai will have a distinct advantage over others other cities in the country because the government of India has allowed 25 percent procurement for private hospitals. A few days ago, 97,000 vaccinations were done out of which 77,000 were done by private.
Q. What’s the plan to vaccinate people is slum areas or those who are underprivileged?
We have elected 224 representatives known as nagarsevaks, who work with the BMC. They are geographically well distributed, covering every nook and corner. We have opened 227 BMC-owned vaccination centres, one in each constituency. Roughly, we have 70,000 population in every such nagarsevak constituency. This way, we will ultimately cover each and every human in the slums also.
Q. Have you noticed vaccine hesitancy in the city? If yes, what is the civic body doing to convince people?
Before the second wave came, hesitancy was there. But, once the second wave hit the country, there was a clamour for vaccine. We saw huge queues outside vaccination centres. The only good thing about second wave is that it has made the hesitancy disappear in bigger cities like Mumbai. But smaller villages are still hesitant due to superstitions in some religious communities. We spoke to their saints, and asked them make videos and circulate in their community. I have also developed a script which will be given to some of the top Bollywood personalities and I shall request them to broadcast it in their own communities. More than anything, the real issue is availability of vaccines. Hesitancy is not an issue anymore.
Q. Now, there is going to be a dual challenge: Covid and the monsoon… we’ve already seen what a couple of rainy days did to the city. As Mumbai slowly opens up, is the BMC ready to ensure there won’t be monsoon woes (flooding etc) when they commute?
Let me assure you that, from July 1, there will be no waterlogging in the Hindmata and Gandhi Market areas, from where 90 percent of the flooding coverage emerge. We started preparing for flooding from October itself and we’ve spent Rs 140 crore to build huge underground tanks, one under the Pramod Mahajan Garden and another in the St Xavier’s ground. We are connecting them with 1.5 km pipeline, and pressurised pumps would throw water into those tanks to be later pumped into the sea.