Ward-level war rooms, dashboard for beds, constant oxygen provide — Mumbai’s civic body place in spot a slew of systems to bring down the Covid curve. Chahal, a 1989-batch IAS officer, has been at the centre of that procedure due to the fact he took charge
as BMC Commissioner in May last year
NIRUPAMA SUBRAMANIAN: You mentioned that the intervening evening of April 16-17, when as a lot of as 168 patients have been evacuated in an emergency operation from six civic hospitals in Mumbai, as one of the most complicated nights of your profession. Why did you really feel that way?
The challenge of oxygen 1st came up at a meeting about the 1st week of April. It was talked about that Maharashtra’s total installed oxygen capacity is roughly 1,200 MT, which incorporated industrial, non-Covid and Covid use. By April 4-5, the state’s six lakh positive instances had began consuming practically 950 MT of oxygen. In our meeting it was projected that by April 15-20, our consumption could go up to 1,700 MT. That is when the alarm bells went off. We realised that even if we quit all industrial operations as effectively as non-Covid oxygen use, we nevertheless cannot handle beyond 1,200 MT of oxygen… So we requested the Government of India to give us an added allocation of 500 MT. About 150-200 of this added allocation was coming from Haldia in West Bengal, and for the tanker to attain Mumbai, the turnaround time was about eight days
In the midst of these talks, on the intervening evening of April 16-17, I was informed about midnight that six hospitals have been operating out of oxygen. There have been 168 patients there… So among 1 am and 5 am, we deployed 150 ambulances and brought these patients to our jumbo Covid centres. Fortunately, we had 3,600 empty beds, of which 850 have been oxygenated beds. I was so relieved that no lives have been lost.
After the operation, I couldn’t sleep at all, and about 7 am I sent messages to best functionaries of the Government of India, like the Cabinet Secretary, Home Secretary, Health Secretary… I sent one more set of messages to best eight leaders of Maharashtra, beginning with the honourable CM. I mentioned, this is not the finish of the dilemma and this could take place once more.
Within 15-20 seconds, I had an incoming contact coming from the Cabinet Secretary, Rajiv Gauba. He told me, inform me what you want… I mentioned we have to import oxygen into the state. I told him that we cannot manufacture oxygen at such brief notice and that the turnaround time for oxygen coming from Haldia was about eight days… I worked beneath Gauba sir when I was joint secretary in the Ministry of Home Affairs… I told him that Reliance Industries was just 16 hours away from Mumbai, in Jamnagar, and oxygen tankers can come from there every single evening. He mentioned that such an allocation can’t be made just for one city. I told him that he can allocate it to Maharashtra and I will make sure that it comes to Mumbai city only… And then 125 MT of oxygen was allocated to us from Jamnagar. The similar evening, tankers began moving and now the dilemma (of oxygen) has practically turn out to be history in Mumbai since of terrific enable from the Government of India.
NIRUPAMA SUBRAMANIAN: So, would you say that Mumbai is now self-enough in oxygen?
Unfortunately, outdoors Mumbai, in the rest of Maharashtra, instances are not coming down. Mumbai is only 17% of the state’s population, and the demand (for oxygen) from other components has not lowered.
After the April 16-17 incident, the state government developed emergency systems. The FDA (Food and Drug Administration) Commissioner was provided charge of allocating and organising seamless distribution (of oxygen). Only oxygen availability is not the challenge, the larger challenge is optimal utilisation and right channelising. That is why a group was developed beneath the FDA, which has district collectors, divisional commissioners, BMC commissioner, and other commissioners… The group is functioning really effectively. So we are in excellent scenario, but in 10-15 days, when instances commence coming down additional in the state as well, we will turn out to be a small more comfy. Now, anxiety is there.
SHUBHAJIT ROY: While you reached out to best bureaucrats and ministers following the April 16-17 incident, do not you believe there must be an institutionalised mechanism to address such challenges?
I agree with you… In the 1st week of April, our crisis management group began discussing the oxygen crisis. It had began to make up but no one knew that factors have been going to take place so quick and suddenly… In Mumbai, we have established six emergency stock points, which function 24/7 and retailer about 50 MT of oxygen every single. Each point services 4 wards (there are 24 in Mumbai)… Now, if anyone gets an SOS contact, they have to forward it to the ward officer, which is then sent to the deputy commissioner in charge of one of the six emergency points. And then, in two-3 minutes, tankers commence moving with supplies… We have learnt from our experiences, and our crisis management group continues to add on new activities to the mechanisms.
MALLICA JOSHI: Delhi has been experiencing oxygen shortage for more than 3 weeks now. What could be the purpose behind this sustained crisis?
In oxygen management, there are 5 places which have to have to be taken care of. First is availability of stock and committed provide. Like from the moment an oxygen tanker leaves the manufacturing unit, it must be clear exactly where it is going, and who is going to take custody of the tanker… Second… what is taking place in a lot of cities, like Mumbai, is that when the Covid stress builds up, the administration tells the hospitals to add on beds. They do not realise that the capacity of installed oxygen tanks is restricted, and has a turnaround time of 24 hours.
At a meeting of Delhi government and Central officials on Wednesday, I mentioned that this is the single largest purpose why SOS calls are coming… I mentioned if you want to raise beds like Mumbai, do not pressurise the hospital… What we did was to have more beds at jumbo centres which also have larger oxygen capacity. Now, we are creating oxygen plants there as effectively to have in-residence oxygen manufacturing for the jumbos. It will be implemented in the next 3-4 weeks. We have seven jumbos with 9,000 beds and one more 4 are coming up with 6,500 beds. And, 70% the beds will be oxygen beds. So I told the government of Delhi that make sure that hospitals must not be forced to add on beds since that leads to crisis.
The third challenge is of leakage of oxygen. So you must have emergency stock. We have the six points in Mumbai… So emergency stock can be rushed in time. The fourth point is connected to our state taskforce which is headed by Dr Sanjay Oak and has a lot of eminent medical doctors. I asked them to give us a protocol for oxygen consumption. They mentioned saturation level must not be maintained beyond 94, and we circulated the protocol to all of Mumbai’s 176 hospitals. There is no have to have for saturation of 97-98.
And lastly, they (the process force) also mentioned that higher-flow nasal oxygen is a guzzler. You must not blindly give it to everyone just since it is accessible. It must be made use of as a last resort. We also told hospitals that you must do your everyday oxygen consumption audit — what was the per bed ratio — and attempt to cut down it by 5%. The government of Delhi agreed that higher-flow oxygen is a guzzler and that they will revisit it.
ANANT GOENKA: During the second surge, there has been a lot of Centre-state blame game more than oxygen provide and so on. How can we resolve this?
Let me make it really clear that the type of stories that we hear is not reality. Most of these talks take place at a bureaucratic level. So when we are speaking to our colleagues in the Government of India, they are like batchmates, one batch above or below… Nobody located the Government of India not prepared to enable us. Even they have their personal issues… As we are understanding, even they have been understanding. So no such friction was there… For instance, when I requested the Cabinet Secretary to airlift (oxygen), he mentioned we are seeking into that but some challenges are coming up. Later on I realised that you cannot lift up a complete tanker, it can explode.
ANANT GOENKA: So the Centre-state variations never ever came in the middle of work?
I do not think in that.
ANANT GOENKA: Did Maharashtra dismantle its infrastructure as well speedily following the 1st wave?
We had constructed eight jumbos in Mumbai and except the one at Race Course, the remaining seven have been kept intact. The one at Race Course was in a low-lying location and got flooded in the course of the monsoon. Also, due to the fact June it had zero occupancy. After it got flooded, I took a meeting and mentioned that if the centre got flooded in the future, there could be two feet of water beneath beds, and so it is improved to get rid of the jumbo.
ANANT GOENKA: Are you confident that if in the future the crisis deepens, the systems that you have constructed and the relationships that you have established with oxygen organizations such as Linde and Inox will hold up for Mumbai, and we will have sufficient oxygen provide?
Incidents like what occurred on April 16-17 have changed us forever. For instance, 15 days ago, we issued tenders for making in situ oxygen generation plants at the seven current jumbos and the 4 new jumbos. These 11 jumbos will have 15,000 beds, 70% of which are oxygenated. They will have 1,400 ICU beds. We will not have to have even one cubic meter of oxygen to be imported into the premises. All of this will turn out to be a reality by May 31 and our oxygen requirement (from other sources) could come down by 60% and we will not have to inform the state government to give us oxygen.
ANANT GOENKA: Are you ready for the third and fourth wave?
Absolutely. I have no doubt in my thoughts that a third wave is going to hit us sometime in June and July, perhaps later. We are currently preparing for that. That’s why we began creating 4 brand new jumbos in Mumbai 15 days ago. It will take our dashboard from 22,000 beds to more than 30,000 in a month’s time. Our ICU beds have been ramped up from 1,500 to practically 3,000. We are attempting to bring that up to 4,000 by June. These preparations are mostly meant to confront the third wave, anytime it comes. I hope I’m established incorrect, but we are ready for it.
TABASSUM BARNAGARWALA: Is the spread of the virus in slum places a concern in the third wave? In the last 3 sero surveys, we have seen that the antibody percentage has been declining in the slum population, which had been severely impacted in the 1st wave.
The 1st sero survey which we did in last July-August, showed that people today in the slums had immunity of 57% even though these in non-slum places had just 12%. By the second sero survey, it had come down to 45% in the slum places. And in the most current sero survey, which we did about 10 days ago, it had come down to 41.5%. However, the immunity in non-slum places has grown from 12% to 28.5%. This, coupled with our vaccination drive — we have currently accomplished 26 lakh vaccinations in Mumbai — will cover up for that reduction in immunity.
We have drawn-up really ambitious plans for vaccination. I constantly inform my group that we will get a major tsunami of vaccinations accomplished, but the only challenge is availability. The CM has assured me that Mumbai will get the ideal doable help… On May 1, we had 63 government vaccination centres and 73 in private hospitals. The private hospital quantity will go up to 150 soon… They are currently on our dashboard and we are working with them.
The Government of India has also mentioned that from May 1 if you can get an ambulance linked, then you can go for corporate drives. So we are now requesting lakhs of corporates, housing societies, thousands of workplaces to sign MoUs with any of the 150 hospitals and then apply on the web and get clearance inside a couple of minutes… Basically, whichever hospital you are going to tie-up with, they have to have to park an ambulance in your workplace creating, they have to have to get employees and vaccines, and you have to give them space to vaccinate everyone. For instance, we vaccinated all 1,one hundred people today at the Bombay High Court last week in a day. So that is the strategy, to have thousands of such locations for vaccinations… I am generating a really low and secure estimate, but in this manner we can do almost 2,00,000 vaccinations per day. We have roughly 90 lakh people today in the city in the 18-plus category, which implies 1.8 crore doses. Of this, we have currently covered 25 lakh… So if we do 2 lakh per day, 60 lakh in a month… In 75 days, I can cover 1.5 crore doses. It will all rely on how forthcoming people today are.
Now the only challenge is that of vaccine availability. I have requested the CM to get us 60 lakh vaccines per month… I believe by May 20, the image on availability of vaccine will turn out to be fairly clear. And if we are in a position to procure stock, I can assure you that prior to the next wave, we will attempt to vaccinate everyone in Mumbai.
VANDITA MISHRA: Would you agree that for these who are not meeting this crisis in the approaches that you appear to be performing, the query of accountability, which is not just political accountability but also bureaucratic accountability, requires to be raised?
I have been really fortunate in a lot of approaches. First, I got a CM, who gave me such a no cost hand that practically I can take any selection. This is not accessible to my colleagues in a lot of other cities. Secondly, when I joined the BMC last May, I told my group that this virus is not going to go away quickly. We have to be prepared for a extended battle, perhaps for one, two or 3 years. And that is exactly where we began creating systems…and now the systems are on autopilot. Today, irrespective of whether we get 2,000 or 5,000 or 10,000 instances, it tends to make no distinction. The systems just work. No phone contact comes to me….
…We have been also the 1st city in the nation to ban direct sharing of Covid positive report by the lab to patients… They shared the report at 7 pm… Hearing the news, there have been panic calls and scrambling for beds. There have been thousands of phone calls on one single helpline quantity, collapsing the central handle room… Patients not operating for hospitals beds also helped us handle the spread of the virus. Otherwise, a single patient would have infected 200 more in his/her hunt for hospitals beds….
MANRAJ GREWAL SHARMA: Don’t you believe states must institutionalise the ideal practices of other states to fight the virus?
I agree with you. But pandemics come after in one hundred years and when this pandemic came, all of us have been unprepared. It was hands on understanding. Different people today discovered it in distinct approaches. Now I say that there is no point in reinventing the wheel. For instance, six months ago, my batchmate in Karnataka known as me to fully grasp what ward war rooms are, how they function, how our ambulances move… Now these factors are getting applied in Bengaluru… But it is up to the district collectors, municipal commissioners of states and how they react to it… Till two months ago, I used to get calls from my colleagues in the Government of India, asking why only Maharashtra has Covid. And they would laugh at us. I would inform them (my colleagues), “Sabka number aane wala hai. (Everyone will face the crisis)… It’s a pandemic. It is going to spread everywhere.” If a person is laughing at us, how do I share my model with them?… When calamity hits, there is no time to find out, you do not have time to copy models.
ZEESHAN SHAIKH: Why are testing numbers seeing a dip in Mumbai?
When the pandemic began, I straight away told my group that we have to double up testing. And really quickly, we began performing testing in buying malls, railway stations, airports… At one point, we reached 56,000 tests in a single day. Then, I began finding complaints from people today that it is taking two-3 days for the test reports to come. I straight away carried out a Zoom meeting with CEOs of all the 55 labs in Mumbai. They mentioned that they have been carrying out 8,000 to 10,000 tests every single day for corporates. I stopped corporate testing about 3 weeks ago. We have to give best priority to a symptomatic individual who requires remedy straight away, rather than possessing mass testing on a cosmetic basis… When corporate state testing stopped, our typical came down from 55,000 to about 44,000 tests. From April 1 to 30, we did about 12.9 lakh tests — 67% of them RT-PCR as opposed to all other cities… But when our positivity price fell from 31% in the 1st week of April to single digits…the demand has lowered.
DEEPTIMAN TIWARY: What do you believe of Centre’s oxygen allocation?
Let me answer this query in a really powerful manner. The Government of India must not be blamed at all. If anyone has to be blamed, it is states. I’ll inform you why. As far as Maharashtra is concerned, we have been really truthful with the figures. We have been placing out figures of more than 60,000 new positives every single day, when the complete nation was laughing at us. Many states of India have been not even prepared to admit how a lot of instances they have. How does Centre allocate to them? One of our neighbouring states had 6,000 instances when we had 60,000 instances. But I’m sure if they had tested adequately, they would also have 60,000 cases… Now, how does Centre allocate them equal quantity of oxygen like us? So, when states have only 1,000 or 2,000 instances, their allocation will be really poor. If allocation is poor, people today are going to suffer… Our CM has been telling me correct from the day I joined, that if there are deaths, do not be shy of reporting them.
NIRUPAMA SUBRAMANIAN: Do you believe a lockdown is powerful in breaking the chain of transmission?
In Mumbai and in Maharashtra, the lockdown has been really distinct and there are a couple of factors for that. For instance, last time we had a lockdown from March 25 to May 14… But this time we can’t quit the vaccination drive. Last week, we vaccinated 75,000 people today per day in the lockdown. Secondly, a lot of people today would joke with me that in Mumbai’s lockdown every little thing is open — taxis are plying, airports are working… But nevertheless with this type of lockdown, we have been in a position to bring down our positivity price. That implies even this type of lockdown is working… I am a really firm believer of decentralisation… If Mumbai achieves a 6-7% positivity price, then why must it endure a national lockdown? Lockdown has to be left to states… A decentralised lockdown, varying from state to state, would be a improved selection.