Mumbai needs a lot better planning to handle Covid

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Published: May 25, 2020 12:20 AM

It is short of hospital beds, but better planning—and good forecasting—would prevent the panic being seen today

Patients who get better should be moved from hospitals to quarantine facilities as promptly as possible, and vice versa for patients who need greater medical intervention.

The good news first: Despite the surge in Covid-19 infection levels in Mumbai, and a much higher real number that only aggressive levels of testing will reveal, Mumbai may just be able to scrape through by creating enough hospital and doctor capacity to take care of the problem.

The bad news: With very little forecasting, the city looks quite unprepared, and that is causing the panic. With no transparent and efficient hospital bed-management-system in place, patients don’t know which hospital to go to, and that is compounding the panic. And when, as now, public hospital beds run out, the city taking over 80% of the beds in private hospitals only adds to the panic since it looks like a knee-jerk reaction.

Given how most of the data for infections in India—and Mumbai is no different—is marred by the lack of sufficient testing, a big problem the city faced was that there wasn’t enough data to make a reasonable forecast of the future path of the infection. Indeed, while there is no data on the number of tests done in Mumbai, a colleague—Ishaan Gera—found that the ratio of new infections to new tests was a whopping 19.3 in Maharashtra over the last four days versus 13.3 at the end of the third lockdown and 9.6 at the end of the second lockdown; given Mumbai accounts for 61% of Maharashtra’s infections, it can safely be assumed this applies to Mumbai as well. With such a jump, mere extrapolation of past data—the doubling rate of X days has now fallen to Y days, or narratives along those lines—serves no real purpose.

One group of people, working with doctors and others dealing with the infection, has created a model where Mumbai essentially tracks New York in that, it too has around 15,000 infections per million population at the peak. Though their growth trajectories look remarkably similar (see graphic), it is easy to dismiss the comparison as fanciful since, right now, Mumbai has just around 2,000 infections per million people.

But, apart from the growth trajectories looking remarkably similar and Mumbai’s infection levels rising dramatically of late, the fact is that the publicly available data simply doesn’t add up. Mumbai’s current hospitalisation rates are too high—as are the death rates—and both suggest that the level of infection is being under-reported due to lack of testing. Once the number of infected rises, the hospitalisation and death rates will automatically reduce.

The important thing, however, is that even if the numbers are correct—if they are not, then it is even better—Mumbai may just about be able to manage. According to this analysis, the infection peaks in around 4-5 weeks. At the peak, with around 2 lakh active cases—and a total of 3 lakh cases—Mumbai needs 29,000 hospital beds, 9,600 ICU beds, around 155,000 isolation beds, and 28,000 doctors. Government hospitals have just around 10,000 beds, but the private hospitals have some 25,000 or so beds (another 12,000 are in clinics so small that it makes little sense to use them); so the city will probably be short by 5,000-10,000 beds.

The government, for its part, is trying to create fresh capacity. A total of 63,000 isolation beds have been created in hotels, schools, marriage halls, stadiums and other large spaces. While more are in the pipeline, home quarantining can also take care of a large part of the burden—wherever the infected have a separate bathroom, they can be home quarantined, with doctors and health workers checking on them regularly. Apart from taking over 80% of private hospital beds (there is a downside to this, though), the government has brought in 1,100 doctors from other parts of the state, and private sector doctors have also been conscripted, as it were, into the Covid-19 fight.

So, why is there such a panic? Though the city may just be able to scrape through, there is a clear shortage of beds and doctors. Adequate planning and proper forecasting could have prevented this since some field hospitals could also have been created.

Ideally, since it is clear it is the private sector that has the bed capacity, and the doctors, the government needed to be working in partnership with it to see how, and when, to bring on fresh capacity—say, 5,000 beds by May 1, 15,000 by May 15, etc. Instead, it chose to simply commandeer the rooms. Also, it is difficult to understand why such draconian price controls have been imposed. How can a deluxe room at a Breach Candy cost the same as one at some third-rung hospital? More important, how does it help subsidise the non-poor so dramatically when it also hits at the hospital’s viability?

While this is not something too many will worry about in the middle of a pandemic, what the government urgently needs to do is sit with the private sector and create a top-notch bed management system. Patients who get better should be moved from hospitals to quarantine facilities as promptly as possible, and vice versa for patients who need greater medical intervention; this alone can augment capacity by 10-15%. Ideally, there should be a public dashboard so patients can know which hospital to go to, hospitals and administrators can keep tabs on shortages of PPE, oxygen cylinders, ventilators, etc. In the case of PPE, for instance, some of those donating these to hospitals found that while a few hospitals were complaining of shortages, the reality was they had not come to the central dispatch centres to pick up their quotas. Even now, if more information is made public, it will both help planning, as well as calm some of the panic.

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