Ward-level warfare rooms, dashboard for beds, constant oxygen provide — Mumbai’s civic physique put in place a slew of techniques to deliver down the Covid curve. Chahal, a 1989-batch IAS officer, has been on the centre of that course of since he took cost
as BMC Commissioner in Might final 12 months
NIRUPAMA SUBRAMANIAN: You mentioned that the intervening evening of April 16-17, when as many as 168 sufferers have been evacuated in an emergency operation from six civic hospitals in Mumbai, as probably the most troublesome nights of your profession. Why did you’re feeling that means?
The difficulty of oxygen first got here up at a gathering across the first week of April. It was talked about that Maharashtra’s complete put in oxygen capability is roughly 1,200 MT, which included industrial, non-Covid and Covid use. By April 4-5, the state’s six lakh constructive instances had began consuming virtually 950 MT of oxygen. In our assembly it was projected that by April 15-20, our consumption might go as much as 1,700 MT. That’s when the alarm bells went off. We realised that even when we cease all industrial operations in addition to non-Covid oxygen use, we nonetheless can’t handle past 1,200 MT of oxygen… So we requested the Authorities of India to provide us an extra allocation of 500 MT. About 150-200 of this extra allocation was coming from Haldia in West Bengal, and for the tanker to succeed in Mumbai, the turnaround time was round eight days
Within the midst of those talks, on the intervening evening of April 16-17, I used to be knowledgeable round midnight that six hospitals have been working out of oxygen. There have been 168 sufferers there… So between 1 am and 5 am, we deployed 150 ambulances and introduced these sufferers to our jumbo Covid centres. Fortuitously, we had 3,600 empty beds, of which 850 have been oxygenated beds. I used to be so relieved that no lives have been misplaced.
After the operation, I couldn’t sleep in any respect, and round 7 am I despatched messages to high functionaries of the Authorities of India, together with the Cupboard Secretary, House Secretary, Well being Secretary… I despatched one other set of messages to high eight leaders of Maharashtra, beginning with the honourable CM. I mentioned, this isn’t the tip of the issue and this may occasionally occur once more.
Inside 15-20 seconds, I had an incoming name coming from the Cupboard Secretary, Rajiv Gauba. He informed me, inform me what you need… I mentioned we now have to import oxygen into the state. I informed him that we are able to’t manufacture oxygen at such quick discover and that the turnaround time for oxygen coming from Haldia was round eight days… I labored below Gauba sir after I was joint secretary within the Ministry of House Affairs… I informed him that Reliance Industries was simply 16 hours away from Mumbai, in Jamnagar, and oxygen tankers can come from there each evening. He mentioned that such an allocation can’t be made only for one metropolis. I informed him that he can allocate it to Maharashtra and I’ll be sure that it involves Mumbai metropolis solely… After which 125 MT of oxygen was allotted to us from Jamnagar. The identical night, tankers began shifting and now the issue (of oxygen) has just about turn out to be historical past in Mumbai due to nice assist from the Authorities of India.
NIRUPAMA SUBRAMANIAN: So, would you say that Mumbai is now self-sufficient in oxygen?
Sadly, outdoors Mumbai, in the remainder of Maharashtra, instances should not coming down. Mumbai is barely 17% of the state’s inhabitants, and the demand (for oxygen) from different components has not diminished.
After the April 16-17 incident, the state authorities created emergency techniques. The FDA (Meals and Drug Administration) Commissioner was given cost of allocating and organising seamless distribution (of oxygen). Solely oxygen availability just isn’t the problem, the larger challenge is perfect utilisation and correct channelising. That’s the reason a staff was created below the FDA, which has district collectors, divisional commissioners, BMC commissioner, and different commissioners… The staff is functioning very effectively. So we’re in good scenario, however in 10-15 days, when instances begin coming down additional within the state too, we’ll turn out to be just a little extra snug. Now, stress is there.
SHUBHAJIT ROY: Whilst you reached out to high bureaucrats and ministers after the April 16-17 incident, don’t you assume there must be an institutionalised mechanism to handle such points?
I agree with you… Within the first week of April, our disaster administration staff began discussing the oxygen disaster. It had began to construct up however no one knew that issues have been going to occur so quick and out of the blue… In Mumbai, we now have established six emergency inventory factors, which perform 24/7 and retailer about 50 MT of oxygen every. Every level companies 4 wards (there are 24 in Mumbai)… Now, if anyone will get an SOS name, they should ahead it to the ward officer, which is then despatched to the deputy commissioner answerable for one of many six emergency factors. After which, in two-three minutes, tankers begin shifting with provides… We’ve got learnt from our experiences, and our disaster administration staff continues so as to add on new actions to the mechanisms.
MALLICA JOSHI: Delhi has been experiencing oxygen scarcity for over three weeks now. What may very well be the rationale behind this sustained disaster?
In oxygen administration, there are 5 areas which should be taken care of. First is availability of inventory and devoted provide. Like from the second an oxygen tanker leaves the manufacturing unit, it must be clear the place it’s going, and who’s going to take custody of the tanker… Second… what is going on in lots of cities, together with Mumbai, is that when the Covid stress builds up, the administration tells the hospitals so as to add on beds. They don’t realise that the capability of put in oxygen tanks is restricted, and has a turnaround time of 24 hours.
At a gathering of Delhi authorities and Central officers on Wednesday, I mentioned that that is the single largest motive why SOS calls are coming… I mentioned if you wish to enhance beds like Mumbai, don’t pressurise the hospital… What we did was to have extra beds at jumbo centres which even have larger oxygen capability. Now, we’re constructing oxygen vegetation there as effectively to have in-house oxygen manufacturing for the jumbos. It is going to be applied within the subsequent three-four weeks. We’ve got seven jumbos with 9,000 beds and one other 4 are developing with 6,500 beds. And, 70% the beds can be oxygen beds. So I informed the federal government of Delhi that be sure that hospitals shouldn’t be pressured so as to add on beds as a result of that results in disaster.
The third challenge is of leakage of oxygen. So you must have emergency inventory. We’ve got the six factors in Mumbai… So emergency inventory will be rushed in time. The fourth level is expounded to our state taskforce which is headed by Dr Sanjay Oak and has many eminent docs. I requested them to provide us a protocol for oxygen consumption. They mentioned saturation degree shouldn’t be maintained past 94, and we circulated the protocol to all of Mumbai’s 176 hospitals. There isn’t a want for saturation of 97-98.
And lastly, they (the duty pressure) additionally mentioned that high-flow nasal oxygen is a guzzler. You shouldn’t blindly give it to all people simply because it’s out there. It must be used as a final resort. We additionally informed hospitals that you must do your each day oxygen consumption audit — what was the per mattress ratio — and attempt to scale back it by 5%. The federal government of Delhi agreed that high-flow oxygen is a guzzler and that they may revisit it.
ANANT GOENKA: Through the second surge, there was plenty of Centre-state blame recreation over oxygen provide and many others. How can we resolve this?
Let me make it very clear that the type of tales that we hear just isn’t reality. Most of those talks occur at a bureaucratic degree. So after we are speaking to our colleagues within the Authorities of India, they’re like batchmates, one batch above or beneath… No one discovered the Authorities of India not keen to assist us. Even they’ve their very own points… As we’re studying, even they have been studying. So no such friction was there… As an example, after I requested the Cupboard Secretary to airlift (oxygen), he mentioned we’re trying into that however some points are developing. Afterward I realised which you can’t raise up a full tanker, it will possibly explode.
ANANT GOENKA: So the Centre-state variations by no means got here in the midst of work?
I don’t imagine in that.
ANANT GOENKA: Did Maharashtra dismantle its infrastructure too rapidly after the primary wave?
We had constructed eight jumbos in Mumbai and besides the one at Race Course, the remaining seven have been stored intact. The one at Race Course was in a low-lying space and obtained flooded throughout the monsoon. Additionally, since June it had zero occupancy. After it obtained flooded, I took a gathering and mentioned that if the centre obtained flooded sooner or later, there could also be two ft of water below beds, and so it’s higher to do away with the jumbo.
ANANT GOENKA: Are you assured that if sooner or later the disaster deepens, the techniques that you’ve constructed and the relationships that you’ve established with oxygen firms reminiscent of Linde and Inox will maintain up for Mumbai, and we can have sufficient oxygen provide?
Incidents like what occurred on April 16-17 have modified us endlessly. For instance, 15 days in the past, we issued tenders for creating in situ oxygen technology vegetation on the seven current jumbos and the 4 new jumbos. These 11 jumbos can have 15,000 beds, 70% of that are oxygenated. They are going to have 1,400 ICU beds. We won’t want even one cubic meter of oxygen to be imported into the premises. All of this can turn out to be a actuality by Might 31 and our oxygen requirement (from different sources) might come down by 60% and we gained’t have to inform the state authorities to provide us oxygen.
ANANT GOENKA: Are you ready for the third and fourth wave?
Completely. I’ve little doubt in my thoughts {that a} third wave goes to hit us someday in June and July, possibly later. We’re already getting ready for that. That’s why we began constructing 4 model new jumbos in Mumbai 15 days in the past. It would take our dashboard from 22,000 beds to greater than 30,000 in a month’s time. Our ICU beds have been ramped up from 1,500 to virtually 3,000. We are attempting to deliver that as much as 4,000 by June. These preparations are primarily meant to confront the third wave, each time it comes. I hope I’m confirmed mistaken, however we’re ready for it.
TABASSUM BARNAGARWALA: Is the unfold of the virus in slum areas a priority within the third wave? Within the final three sero surveys, we now have seen that the antibody share has been declining within the slum inhabitants, which had been severely affected within the first wave.
The primary sero survey which we did in final July-August, confirmed that folks within the slums had immunity of 57% whereas these in non-slum areas had simply 12%. By the second sero survey, it had come all the way down to 45% within the slum areas. And within the newest sero survey, which we did about 10 days in the past, it had come all the way down to 41.5%. Nevertheless, the immunity in non-slum areas has grown from 12% to twenty-eight.5%. This, coupled with our vaccination drive — we now have already finished 26 lakh vaccinations in Mumbai — will cowl up for that discount in immunity.
We’ve got drawn-up very bold plans for vaccination. I all the time inform my staff that we are going to get a giant tsunami of vaccinations finished, however the one challenge is availability. The CM has assured me that Mumbai will get the absolute best assist… On Might 1, we had 63 authorities vaccination centres and 73 in non-public hospitals. The non-public hospital quantity will go as much as 150 quickly… They’re already on our dashboard and we’re working with them.
The Authorities of India has additionally mentioned that from Might 1 if you may get an ambulance linked, then you possibly can go for company drives. So we are actually requesting lakhs of corporates, housing societies, 1000’s of workplaces to signal MoUs with any of the 150 hospitals after which apply on-line and get clearance inside a couple of minutes… Principally, whichever hospital you’ll tie-up with, they should park an ambulance in your workplace constructing, they should get workers and vaccines, and you must give them area to vaccinate all people. As an example, we vaccinated all 1,100 individuals on the Bombay Excessive Courtroom final week in a day. So that’s the plan, to have 1000’s of such locations for vaccinations… I’m making a really low and secure estimate, however on this method we are able to do almost 2,00,000 vaccinations per day. We’ve got roughly 90 lakh individuals within the metropolis within the 18-plus class, which implies 1.8 crore doses. Of this, we now have already lined 25 lakh… So if we do 2 lakh per day, 60 lakh in a month… In 75 days, I can cowl 1.5 crore doses. It would all depend upon how forthcoming individuals are.
Now the one challenge is that of vaccine availability. I’ve requested the CM to get us 60 lakh vaccines per thirty days… I believe by Might 20, the image on availability of vaccine will turn out to be fairly clear. And if we’re capable of procure inventory, I can guarantee you that earlier than the following wave, we’ll attempt to vaccinate all people in Mumbai.
VANDITA MISHRA: Would you agree that for individuals who should not assembly this disaster within the ways in which you appear to be doing, the query of accountability, which isn’t simply political accountability but additionally bureaucratic accountability, must be raised?
I’ve been very fortunate in some ways. First, I obtained a CM, who gave me such a free hand that just about I can take any choice. This isn’t out there to my colleagues in lots of different cities. Secondly, after I joined the BMC final Might, I informed my staff that this virus just isn’t going to go away quickly. We’ve got to be prepared for a protracted battle, possibly for one, two or three years. And that’s the place we began constructing techniques…and now the techniques are on autopilot. Right now, whether or not we get 2,000 or 5,000 or 10,000 instances, it makes no distinction. The techniques simply work. No cellphone name involves me….
…We have been additionally the primary metropolis within the nation to ban direct sharing of Covid constructive report by the lab to sufferers… They shared the report at 7 pm… Listening to the information, there have been panic calls and scrambling for beds. There have been 1000’s of cellphone calls on one single helpline quantity, collapsing the central management room… Sufferers not working for hospitals beds additionally helped us management the unfold of the virus. In any other case, a single affected person would have contaminated 200 extra in his/her hunt for hospitals beds….
MANRAJ GREWAL SHARMA: Don’t you assume states ought to institutionalise the most effective practices of different states to combat the virus?
I agree with you. However pandemics come as soon as in 100 years and when this pandemic got here, all of us have been unprepared. It was fingers on studying. Completely different individuals realized it in several methods. Now I say that there isn’t any level in reinventing the wheel. For instance, six months in the past, my batchmate in Karnataka known as me to grasp what ward warfare rooms are, how they perform, how our ambulances transfer… Now these issues are being utilized in Bengaluru… However it’s as much as the district collectors, municipal commissioners of states and the way they react to it… Until two months in the past, I used to get calls from my colleagues within the Authorities of India, asking why solely Maharashtra has Covid. And they’d chuckle at us. I might inform them (my colleagues), “Sabka quantity aane wala hai. (Everybody will face the disaster)… It’s a pandemic. It’s going to unfold in every single place.” If somebody is laughing at us, how do I share my mannequin with them?… When calamity hits, there isn’t any time to study, you don’t have time to repeat fashions.
ZEESHAN SHAIKH: Why are testing numbers seeing a dip in Mumbai?
When the pandemic began, I instantly informed my staff that we should double up testing. And really quickly, we began doing testing in buying malls, railway stations, airports… At one level, we reached 56,000 checks in a single day. Then, I began getting complaints from folks that it’s taking two-three days for the take a look at stories to come back. I instantly performed a Zoom assembly with CEOs of all of the 55 labs in Mumbai. They mentioned that they have been finishing up 8,000 to 10,000 checks each day for corporates. I ended company testing about three weeks in the past. We should give high precedence to a symptomatic one who wants remedy instantly, fairly than having mass testing on a beauty foundation… When company state testing stopped, our common got here down from 55,000 to about 44,000 checks. From April 1 to 30, we did about 12.9 lakh checks — 67% of them RT-PCR in contrast to all different cities… However when our positivity price fell from 31% within the first week of April to single digits…the demand has diminished.
DEEPTIMAN TIWARY: What do you consider Centre’s oxygen allocation?
Let me reply this query in a really robust method. The Authorities of India shouldn’t be blamed in any respect. If anyone needs to be blamed, it’s states. I’ll inform you why. So far as Maharashtra is anxious, we now have been very trustworthy with the figures. We have been placing out figures of over 60,000 new positives each day, when the entire nation was laughing at us. Many states of India weren’t even able to admit what number of instances they’ve. How does Centre allocate to them? One among our neighbouring states had 6,000 instances after we had 60,000 instances. However I’m certain if they’d examined correctly, they’d even have 60,000 instances… Now, how does Centre allocate them equal quantity of oxygen like us? So, when states have just one,000 or 2,000 instances, their allocation can be very poor. If allocation is poor, individuals are going to undergo… Our CM has been telling me proper from the day I joined, that if there are deaths, don’t be shy of reporting them.
NIRUPAMA SUBRAMANIAN: Do you assume a lockdown is efficient in breaking the chain of transmission?
In Mumbai and in Maharashtra, the lockdown has been very totally different and there are a few causes for that. For instance, final time we had a lockdown from March 25 to Might 14… However this time we can not cease the vaccination drive. Final week, we vaccinated 75,000 individuals per day within the lockdown. Secondly, lots of people would joke with me that in Mumbai’s lockdown the whole lot is open — taxis are plying, airports are working… However nonetheless with this type of lockdown, we now have been capable of deliver down our positivity price. Meaning even this type of lockdown is working… I’m a really agency believer of decentralisation… If Mumbai achieves a 6-7% positivity price, then why ought to it undergo a nationwide lockdown? Lockdown needs to be left to states… A decentralised lockdown, various from state to state, could be a greater possibility.
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