Covid-19: Consistency is key in managing a pandemic, says NMMC chief

When Mumbai was in the midst of the first Covid19 wave the neighbouring Navi Mumbai a counter magnet for the megalopolis was facing an even deadlier threat from the virus With its test positivity rate reaching 50 per cent and mortality rate going up to 3 per cent the highest in the entire country Navi Mumbai was struggling to battle the Covid19 storm Amidst this crisis 38yearold Abhijit Bangar was appointed as the new commissioner of the Navi Mumbai Municipal Corporation NMMCBangar and his staff all in PPE suits seen during a surprise visit to a Covid19 quarantine centre in CIDCO Exhibition Centre to check if patients were satisfied with the facilities available thereA 2008 batch IAS officer Bangarrsquos unique initiatives not only helped contain the first wave but also helped the city limit the surge during the second wave Taking just one weekly off in the last 10 months Bangar along with his team has managed to restrict the cityrsquos positivity rate to 12 per cent in the second wave NMMC has also tested more than 50 per cent of the residents for the virus In an interview with midday the city chief discusses the strategies adopted by him which were effective in stemming the tide of the disease in Navi MumbaiWatch videoWhen you took charge as NMMC chief in July 2020 what was the situation like in Navi MumbaiI joined the NMMC on July 14 2020 The next three months were tough in terms of Covid19 management Though the number of patients was 350 to 400 per day in terms of statistics there were two issues Our case positivity rate CPR was as high as 50 per cent Second was the case fatality rate CFR which was 2 to 3 per cent At the time NMMC didnrsquot even have its own lab and was totally dependent on private labsSoon after you took over you implemented unique initiatives such as lsquoBreak the Chainrsquo and mobile test vans What were the outcomes of thoseAs the CPR was high I realised the infection chain had to be broken To break the infection chain there was no alternative but to ldquotest trace and isolaterdquo and for that I needed some infrastructure Within two days of taking over as NMMC chief I started free antigen tests at the four NMMC hospitals and 23 health centres We also ramped up our testing infrastructure getting our own lab which started processing more than 1000 samples every day To ensure more tests were being done we launched six mobile test vans which were also available on call Any housing society could book these vans for testing This reduced the fear and stigma among citizens about Covid19Watch videoWas Navi Mumbai ready for the pandemicTo manage any pandemic we need testing and isolation infrastructure While NMMC managed to get its lab in August 2020 in the middle of the first wave we still needed to get enough beds Beds are usually of three typesmdashnormal beds for asymptomatic patients oxygen beds for moderate symptomatic patients and ICUventilator beds for serious patients We had normal beds but were falling short of oxygen and ICU beds When I joined there were only 83 oxygen beds We slowly increased it to 2200 beds and later managed to get a total of 3000 beds with the help of private hospitals We also got 500 ICU beds out of which 230 were that of the corporationrsquos But just having beds isnrsquot enough For instance if we have 1000 beds in a corporation out of which 900 belong to private hospitals not everyone will be able to afford it Thatrsquos why we had to enhance the corporationrsquos facilities We even focused on increasing our oxygen and ICU beds and purchased 120 oxygen cylinders which helped us during the second waveYou initiated an analysis of every Covid19 death in the corporation area How did it help in managing the mortalityCritical patient management is most important when handling a pandemic We began with analysis of each and every death occurring in the city We collected data on the number of deaths where they happened and the reasons for the deaths There were many factors responsible such as age comorbidities etc But after we analysed this data we realised that lsquotimersquo also played a critical role If patients are administered medicines at the right time and given the right kind of treatment there is always a high chance of saving them Even today death audits are carried out daily Regular sessions with our task force which in turn coordinates with general physicians at various hospitals in the city have helped us refine our treatment protocols too Today we are definitely in a better position to handle the second waveNavi Mumbai has a population of around 15 lakh with a diverse demography it is also home to the APMC market and other major corporate hubs What were your priorities when you started planning for the pandemicWhen we think of Navi Mumbai demographically it has various characteristics There are slum pockets and gaothans then the CIDCO nodal areas highrises and of course APMC market and the area around it We had to look at growth of cases in all the three regions separately While there were cases in the slums the nodal areas and highrises were a bigger problem All the corporate hubs were shut so that was taken care of However the APMC market posed a peculiar problem right from the beginning The market which provides vegetables and fruits to the entire MMR region receives more than 1000 trucks daily and sees a footfall of nearly 30000 to 40000 people Before my appointment there was a lot of hue and cry about whether the APMC market should work as there were infections among mathadi workers and shop owners It had to be shut for a week too If you see the market itrsquos jampacked with shops in close proximity So we began staggering the inward flow of trucks to avoid crowding while unloading Since APMC runs 247 we also started a dedicated testing centre that worked round the clock This has not happened anywhere else Workers who feel they have Covid19 symptoms can go and get tested for free here At one point we did around 3000 tests in a single day I personally visited APMC several times without prior noticemdashsometimes even at midnightmdashto check whether our system was in placeBangar speaking with a member of the health staff at a quarantine centreTurbhe like Dharavi is a densely populated locality But the area reported very low number of Covid19 cases How did you manage itCovid19appropriate behaviour in slums and gaothans was a challenge Fortunately again rampant and random testing not just of symptomatic but of asymptomatic patients and doortodoor survey helped What we observed in Turbhe and other slums was that people responded to the messages given out by the corporation We carried out activities on a masslevel with the help of local representatives and urban primary health centres In the second wave as well we continued the doortodoor survey Every house in this area was visited by our health workers every 15 days In any pandemic management consistency is the key Thatrsquos what we did in Turbhe Another problem was that home isolation wasnrsquot possible for Turbhersquos residents and so anyone who tested positive for Covid19 had to be taken to an institutional quarantine centre Generally there is a negative mindset about corporation or government facilities In order to combat that perception we followed the highest standards at these centres in terms of cleanliness housekeeping and catering That way people didnrsquot hesitate to avail the facilityDuring the second wave the NMMC isolated every positive person above 50 Did it put a strain on the systemWe made some significant observations about the second wave Our daily cases started increasing from February 10 but the rate at which the cases rose was not that high On March 15 we reported 136 cases After that the cases almost doubled every day By April 4 we had hit a peak reporting 1441 cases While observing the increasing trend we realised that the case fatality ratio hadnrsquot changed At the time there was a feeling within the administration as well as doctors that this wave had bigger numbers but lesser fatalities We soon realised that this wasnrsquot the case There had been a gap of three to four weeks between the peak of daily cases and rise in fatality We found patients were getting more critical in the third and fourth week of March This put a strain on all the hospitals During this time we observed that 80 to 85 per cent of the fatality was from the age group of 50 Also after midMarch we found that many patientsrsquo oxygen saturation had dropped to 60 to 70 per cent These patients needed to be sent to an ICU facility To avoid these scenarios we started asking our heads at the primary health centres to isolate the 50plus age group patients If somebody refused we made sure their physician or general practitioner maintained a record of the personrsquos vital parameters We started taking feedback from doctors as well We also sought a list of patients coming to them with Covid19 or influenzalike symptoms These patients were then traced Another trend that was observed during the second wave was that people would try and bypass this system out of fear that they would be taken into an isolation centre They would just do the HighResolution Computed Tomography HRCT test another way of determining the presence of the viral infection in the body bypassing the regular antigen and RTPCR testing protocol Hence we reached out to diagnostic centres carrying out HRCTs and took reports of the patients from them This helped reduce the number of cases Our dedicated call centre which at one point was receiving around 25 distress calls for ICU beds is now barely getting any callsSome of the other stringent measures you adopted included penalising housing societies whose residents violated quarantine rules and raids on morning walkers and night crawlersThe corporation and police are working round the clock to contain the virus but there are a handful of people who donrsquot follow rules They had to face the music We did fine some housing societies Rs 10000 as a first offence but after that many started stringently following orders Several citizens too had developed a false sense of relief after the cases started dipping in the first week of April Despite the curfew theyrsquod go for morning or evening walks We formed teams to get hold of these violators They were asked to take an antigen test right then and an FIR was also lodged against them This was needed because unless citizens follow rules the efforts of any corporation will go in vainAs far as citizens are concerned what more can they do to help the administrationCitizens tend to have this mindset that corporations are unprofessional inaccessible and inefficient I donrsquot blame them for having such an opinion because bureaucracy works in a typical way which we describe as redtapeism However I must mention that we have received a good response from citizens They have reciprocated to all our ideas and that has been a gamechanger We want to keep this relationship goingNMMC has been reaching out to citizens on WhatsApp Facebook and Twitter as wellPassing on accurate information to citizens is important especially because of the kind of misinformation they are being bombarded with We created a comprehensive dashboard which is updated from time to time We have also floated helplines and email IDs to help citizens and upload the daily COVID19 report on our website But we also felt the need to tap Facebook and Twitter If a government body keeps updating its citizens with accurate and timely information there wont be any unrest or state of confusionNMMC elections were due last year but it had to be differed due to the pandemicElected representatives have an important role in our society They understand the pulse of our society Though no fresh elections were conducted many local representatives joined hands with the NMMC It helped us function effectively Wersquove all been working nonstop Of course it takes a toll on onersquos mental and physical wellbeing But we had to rise to the challengeCOVID19 caseload in NMMC436683Total number of RTPCR tests done480968Total number of antigen tests done94688Total number of cases88960Total recovered1431Total number of deaths4277Total number of active cases Data as of May 75037Case positivity rate CPR in Navi Mumbai before Bangar took charge1237CPR in Navi Mumbai as of May 2020