File image: Medics sit inside a vaccination room during a nationwide dry run of COVID-19 vaccine delivery systems, at a temporary vaccination centre in Mumbai, India on January 8, 2021. (Image: Reuters/Niharika Kulkarni)
Brihanmumbai Municipal Corporation (BMC) Commissioner Iqbal Singh Chahal spoke to the Indian Express about how Mumbai beat the oxygen shortage and the slew of other measures it has taken to counter a potential third wave of COVID-19.
Chahal believes lockdowns should be left to states and that states should adopt best practices from other states that have managed to tackle the crisis instead of 'reinventing the wheel'.
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Here are the key highlights:
>> On oxygen supply: Chahal said the issue first came up in the first week of April when Maharashtra’s total installed oxygen capacity (including for medical and industrial purposes, and for COVID and non-COVID treatment) was judged to be 1,200 metric tonne (MT).
By April 4 and 5 the state’s six lakh cases had alone begun consuming 950 MT of this capacity and in meetings on April 15-20 projected requirement of oxygen of up to 1,700 MT. It was understood that this could not be met by diverting industrial oxygen towards healthcare and a request for allocation of 500 MT extra oxygen was made to the Centre. The 150-200 MT being sourced from Haldia (West Bengal) had a turnaround time of eight days.
On the night of April 16, Chahal was informed that six hospitals with 168 patients were running out of oxygen and deployed 150 ambulances to transfer these patients to the state’s jumbo COVID centres which had 3,600 empty beds, including 850 oxygenated ones.
“I was so relieved that no lives were lost…. (and) sent messages to top government functionaries … notifying them that … this may happen again.”
He said the Cabinet Secretary Rajiv Gauba responded immediately and said the oxygen can be diverted from Reliance Industries’ Jamnagar plant which is 16 hours away from Mumbai. And thus 125 MT from the plant was allocated to Maharashtra.
>> On the need for an institutionalised mechanism to address oxygen shortage instead of reaching out to bureaucrats: Chahal said while initially, no one knew the shortage would build up this fast and sudden, Mumbai has now set up six emergency stock points, each storing 50 MT oxygen each and servicing four wards each – this stock is dispatched within 2-3 minutes of an SOS.
“We have learnt from our experiences, and our crisis management team continues to add on new activities to the mechanisms,” he added.
>> On Delhi’s oxygen shortage situation and lessons to be learnt: Chahal advised five areas of focus –
(1) Availability and dedicated supply of oxygen – clear instructions on roles and responsibilities,
(2) Not pressuring hospitals to add beds – this because the oxygen supply remains constant regardless of the number of beds, but instead build oxygen plants or in-house oxygen manufacturing for jumbo centres,
(3) Ensure no leakage of oxygen – have emergency stock which can be deployed for emergencies,
(4) Have a protocol for oxygen consumption – for example, the protocol in Mumbai’s 176 hospitals was that saturation level should not be maintained beyond 94.
He also added that the use of high-flow nasal oxygen should be used as a “last resort” – this because it is a “guzzler”, and they should instead maintain an audit to reduce the ratio per bed by 5 percent.
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>> On Centre-state blame game: Chahal said “stories are not fact as most talks happen at bureaucratic level and with colleagues who are like batch mates”.
>> On confidence about systems built now will last for future requirements: Chahal said tenders have been issued for situ oxygen generation plants at the city’s seven jumbo centres and four new jumbos by May 31. He added: “We will not need even one cubic meter of oxygen to be imported into the premises … and we won’t have to tell the state government to give us oxygen.” He added that requirement from other sources will reduce by 60 percent.
>> On preparation for a third and fourth wave of COVID-19 cases: Chahal was of the opinion that a third wave “is going to hit us sometime in June or July” and the four new jumbos are part of the prep. “These preparations are primarily meant to confront the third wave, whenever it comes. I hope I’m proven wrong, but we are prepared for it,” he added.
>> On vaccinations in Mumbai: Chahal said they have “drawn up very ambitious plans” but the issue is availability. He added that the city can give nearly 200,000 vaccinations per day and requires around 1.8 crore doses to vaccinate everyone in the 18+ age group – provided people turn up for vaccinations.
He added that he spoke to Chief Minister Uddhav Thackeray for 60 lakh vaccines per month and said this would be “quite clear” by May 20.
>> On bureaucratic accountability: Chahal noted he has a “CM who gave me such a free hand” which is not available to colleagues in other cities. He added that when he joined the BMC last year the plan to combat the virus was for 2-3 years.
>> On learning and adopting ‘best practices’ from other states: Chahal said he feels states should institutionalise methods that worked in other places instead of “reinventing the wheel”. He gave an example of a batchmate in Karnataka who called to understand what war rooms are and how they function and has applied this in Bengaluru.
>> On the effectiveness of lockdowns: Chahal pointed out that the lockdowns in Mumbai and Maharashtra have been different because vaccination has to continue and the point is to reduce the positivity rate.
“… this kind of lockdown is working… I am a very firm believer of decentralisation… If Mumbai achieves a 6-7 percent positivity rate, then why should it suffer a national lockdown? Lockdown has to be left to states… A decentralised lockdown, varying from state to state, would be a better option,” he added.Follow our full COVID-19 coverage here