Decentralisation and planning helped Mumbai fight the second COVID-19 surge

Mumbai was hit hard by the second wave of the COVID-19 pandemic in March 2021, with the city recording a record high positivity rate of 20-24%, from an average of 8-9% in the preceding months.

Within a month, the positivity rate declined to 6% by 12 May 2021, and further to 1.79% in the first week of July. Multi-pronged strategies such as the decentralisation of the response, efficient resource management, leveraging of technology for rapid information dissemination and real-time monitoring enabled the city administration to stem the surge.

The Municipal Corporation of Greater Mumbai (MCGM) decentralised its central war room structure and created 24 peripheral control rooms in all the 24 wards for localised COVID-19 response. Patient admissions were mandated only through the war rooms, which enabled equitable access to hospital beds as per the availability in civic hospitals, dedicated COVID health centres (DCHCs), and private hospitals. This prevented overwhelming of the health facilities and optimised utilisation of critical medical supplies.

Mr. Iqbal Singh Chahal, who took over as Commissioner of BMC in May 2020, said that the creation of ward war rooms, 24X7 monitoring of patients, and maintaining COVID-19 facilities set up to respond to the first wave were crucial in the second wave response. “The system was on auto-pilot this time,” Mr Chahal added.

The MCGM had created five Jumbo COVID-19 Centres to respond to the first wave. These Jumbo COVID Centres were not dismantled even when cases declined at the end of 2020. Following the launch of the COVID-19 vaccination drive on 16 January 2021, a part of these facilities were turned into vaccination centres. Since January, more than 600 000 vaccine doses have been administered at the 55 session sites at the Jumbo COVID-19 centres.

 

The vaccination teams were trained by WHO officers, UNDP teams and MCGM medical officers. These Jumbo COVID Centres have become popular vaccination sites as there is ample parking space, and the waiting and observation areas are spacious.

When the second wave hit the state in 2021, the bed capacity at the Mulund Jumbo COVID Centre was increased to accommodate additional patients, while the other four Jumbo COVID centres also continued vaccination drive and COVID-19 management.

“In Mumbai, 69 dedicated COVID health centres were reopened in April 2021 and the WHO team assessed 19 of these facilities based on WHO’s standard assessment checklist. The findings were shared with the Mumbai Executive Health Officer for necessary actions. To support the surge response, WHO officers also conducted infection prevention and control trainings for more than 250 health care workers (including staff and medical officers) in five batches,” shared Dr Vivek Pardeshi, Surveillance Medical Officer, WHO India.

Multi-layered monitoring of the vital parametres of critically ill patients is done 24×7 through a war room within the Jumbo COVID Centres. This serves as a second wall of safety and empowers the medical team to provide efficient and quality care. Senior engineers have been deputed at all Jumbo COVID Centres to ensure seamless supply of electricity and oxygen. Inventory management ensured availability of the critical medical supplies for emergencies.

The civic authorities are looking ahead and have begun preparing for a potential third wave by building three additional Jumbo COVID Centres in the eastern and western suburbs of Mumbai, which will add 5 300 more beds, with 70% oxygen beds to the existing inventory. The aggressive testing policy continues to track super spreaders and conduct random sample collection at malls, gardens and public places. The target is to increase the testing to at least 40 000 per day or more. The preparedness strategy includes opening additional vaccination centres, deputing of marshals in the field to ensure adherence of COVID-19 appropriate behaviours, and data-driven policy decision-making.

The “Mumbai model” has showcased that optimum utilisation of resources through inventory management, decentralisation of responsibilities and response, and a robust real time monitoring system can flatten the COVID-19 curve and save hundreds of lives.