War rooms, field hospitals helped Mumbai in battle of Covid second wave: Officials

A system of ward-level `war rooms' where hospital beds are allocated by civic officials and the decision not to dismantle field hospitals were key to Mumbai's success in tackling the second wave of Covid-19 pandemic, officials believe.

As much of the country is reeling under an unprecedented surge in cases, the "Mumbai model" has drawn appreciation even from the Supreme Court.

Since May 1, Mumbai is reporting less than 4,000 cases every day, a significant fall from over 8,500 cases a day in the first week of April. On April 4, the city logged 11,163 cases, the highest so far. On May 6, it recorded 3,056 cases.

To be sure, the financial capital of the country is still reporting more cases daily than the peak of 2,848 cases recorded on October 7 during the first wave last year.

But there is no shortage of hospital beds and oxygen for patients, civic officials claimed.

On Wednesday, the Supreme Court lauded the efforts of authorities to ensure adequate oxygen supply in Mumbai.

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"Bombay Municipal Corporation is doing some great work, with no disrespect to Delhi. What they are doing, how they are managing, we can learn from them.

"I also understand that Maharashtra also produces oxygen which Delhi cannot do," said a bench headed by Justice D Y Chandrachud, hearing pleas on the dire situation in Delhi.

As the second wave began, the Brihanmumbai Municipal Corporation focused on testing, contact tracing and treatment besides ensuring that people followed guidelines.

But the decision not to take down the infrastructure put in place during the first wave proved to be more crucial.

"There would have been chaos if we hadn't kept jumbo Covid centres (field hospitals), oxygen beds, ICU beds ready before the start of second wave," said Mayor Kishori Pednekar.

Additional Municipal Commissioner Suresh Kakani, who insisted that jumbo centres should not be dismantled till March 31, said the BMC was ready for a new surge.

"The whole system -- oxygen, catering, house keeping, doctors and nurses -- was in place at jumbo centres," he said.

The civic body continued to augment availability of oxygen and ICU beds and medicine stocks, he said.

"This is why the BMC had sufficient stock of Remdesivir when everywhere there was a shortage," Kakani said.

The number of beds was doubled from around 12,000 to 24,000 within a month when cases began to rise in February. At present, Mumbai has 31,695 Covid-19 beds, including 12,754 oxygen beds and 2,929 ICU ones.

There is no shortage of medical oxygen in the city now, but there were some scary moments when on the night of April 16-17 the BMC had to shift 168 Covid-19 patients from six civic hospitals as oxygen supply ran out.

Learning a lesson, it started monitoring the movement of oxygen cylinders from plants to hospitals in real time.

"We have now deputed six officers at control rooms to ensure seamless supply of oxygen. There is also a monitoring committee headed by a deputy commissioner," Kakani added.

During the first wave, the BMC set up a `war room' in each of the 24 wards to guide patients. Thanks to this system, people are not needed to run from one hospital to another in search of beds, as allocation of beds is done by war room officials.

Municipal commissioner Iqbal Singh Chahal said during a recent interview to the Indian Express that war rooms, dashboards for bed management, prohibition of release of test report directly to patients and the decision not to dismantle jumbo Covid facilities proved useful.

The system is on "auto pilot" now, he said.

"When I joined, we did not have a dashboard, our control room operators used to check with individual hospitals if a bed is available," he said.

After the April 17 incident when oxygen in six hospitals ran out, the BMC sought a protocol for oxygen consumption from the Maharashtra government's Covid-19 task force.

It was decided that oxygen saturation level need not be maintained beyond 94 per cent, high-flow nasal oxygen should not be used indiscriminately, and there should be an oxygen consumption audit, Chahal said. The protocol was conveyed to all 176 hospitals in the city.

Mayor Pednekar said the BMC also focused on setting up oxygen plants. "We didn't rely only on oxygen cylinders, but we set up liquid oxygen plants. Because of this, not a single person died due to lack of oxygen," she said.

Chief Minister Uddhav Thackeray's decision to enforce fresh lockdownalso helped, she noted.

The civic body has already started preparing for the possible third wave of the pandemic, she said.

The number of jumbo Covid facilities will be increased from nine to 15, including dedicated facilities for children and the disabled, Pednekar said.

"Jumbo centres, dashboard, oxygen supply and all other things worked effectively. Their effectiveness was visible in last three-four weeks. This infrastructure needs to be maintained because one can not predict if Covid-19 has run its course or not," said Dr Om Shrivastava,an infectious diseases expert who is a member of the state task force.