Fast vaccination is key: Time for Mumbai to turn into Singapore?

While most countries are reimposing tighter restrictions Singapore has gone the other way saying it will stop counting daily Covid cases do away with contact tracing lift restrictions and only monitor large gatherings as it prepares to unlock As cases continue to come down in Mumbai and the clamour for relaxations grows what is the way forward for our city We asked expertsMunicipal Commissioner Iqbal Singh Chahal had told the media last month that the Mumbaimodel would be to have faster vaccination to avert a third wave which could cost the city above Rs 8 billion just to run its temporary hospitals midday asked several experts for their views on whether Mumbairsquos administration could look at similar measureslsquoDepends on mutationsrsquoDr Subhash Salunkhe epidemiologist and advisor to the Maharashtra government on Covid19 management said we will have to learn to live with the virus ldquoEventually Covid19 is going to be an endemic virus and we have no alternative but to learn to live with it It will have to be handled with both vaccine and by following Covid19 appropriate behaviourrdquo he saidDr Salunkhe said that at this juncture the city needs to follow strict surveillance and vaccination program ldquoWe need to have strict measures where a suspected person is tested quickly and public health measures follow The other is mass vaccination At least 70 per cent to 75 per cent of our population has to be vaccinated so that the virus gets less opportunity to mutaterdquo he said He said if we donrsquot get virus mutations in next few months and the third wave doesnrsquot arrive while we manage to vaccinate more than 7537 of the population we will be in a better position by next year endlsquoBe very carefulrsquoDr Santosh Bansode head of the department Emergency Medicine Wockhardt hospital Mumbai Central said the biggest challenge in unlocking Mumbai is its dense population and that officials should be very careful But he agreed that we should not panicldquoThe last time we unlocked the city faced a huge waverdquo he said ldquoSo this time we must open places one by one for a fixed period of one month while keeping others locked If we open all shops and hotels full time we should observe figures for one month If they are the same or fall we can move to malls theatres and again observe for a month Public transports should be unlocked last But the key to all this is increasing the speed of vaccinationrdquolsquoAbandon lockdownsrsquoDr Wiqar Shaikh professor of Medicine Grant Medical College and Sir JJ Group of Hospitals said a model like Singaporersquos requires stringent quarantine measures and as new variants spread will probably be impossible to maintainAlso Read Second wave brought a mental health tsunami with it Mumbai psychiatristsldquoThe pandemic will abate sooner or later but Covid will never go awayrdquo he said ldquoThe Singapore roadmap aims to turn Covid into something less threatening like influenza or chickenpox This is a bold plan and can be adopted by countries that wish to return to normalcy and resume travel and tourism It will also help citizens to get back to normal life after 18 months of restrictionsrdquoThe key Dr Shaikh said is that Singapore will continue with an aggressive vaccination programme but Covid testing will be restricted to large gatherings and travellers from abroadWhat Mumbai should do1 Continue to vaccinate but at a much faster pace2 Continue to ramp up medical facilities particularly in rural areas3 Open high schools colleges and professional institutions Primary schools can wait4 Open malls shops theatres parks religious places etc5 Allow large gatherings with appropriate Covid19 testing6 Abandon lockdowns which prevent the development of natural herd immunity Certain places in India even Mumbai reported fewer cases compared to others So it is possible that such places have already developed herd immunitylsquoWonrsquot work herersquoTop virologist Dr Jacob John said the key is a health management system with real time information on all infectious diseases particularly flu and India doesnrsquot have such infrastructureldquoFollowing Singapore is out of questionrdquo he said ldquoThe second key here is immunisation rate Any region where twothirds or more adults are fully vaccinated can return to normalcy and Covid can be just another disease under surveillance But again India does not have such a system despite repeated recommendationsrdquoHe said after the Surat plague the Ramalingaswami Committee recommended casebased allcasesurveillance mdashevery doctor reporting every case of notified diseases the same day as it is suspected in any patient to a district public health officer by simple electronic or postal reporting Singapore and Hong Kong have such a system but India does notldquoFrom early 2020rdquo said Dr John ldquoit was clear that after the pandemic burns out the infection will settle down as ldquoendemicrdquo Risk of death will remain for atrisk groups If they can be given two doses of vaccine plus a booster life can be back to prepandemic daysrdquolsquoLearn but adaptrsquoDr Kedar Toraskar critical care specialist Wockhardt Hospital and member of State Task Force said while Singapore is a wellorganised country with a small geographical area and tiny population Mumbai canrsquot be compared to itldquoBut some salient features could to be looked intordquo he said ldquoSingaporersquos model is worth looking at but we need to adapt it as per the local scenario We also need to understand that implementation will be importation Unlocking is an art and it has to happen in a controlled manner We have to make sure there are no new outbreaks We have to understand that the Covid19 virus is dynamicrdquolsquoWait till OctoberrsquoDr Subhash Hira Professor of Global Health University of WashingtonSeattle said the 18 millionstrong Mumbai Metropolitan Region is a good candidate to apply a cautious roadmap provided people participate in Covid19 control measuresldquoSometime in September or October 70 per cent of Mumbairsquos adult population will be vaccinated If citizens adhere to proper facial masking sanitisation and distancing the city could look at fewer restrictionsrdquoHe said officials need to prepare a plan to bring Mumbai back to normalcy at minimal cost with measurable targets and output indicators ldquoFor example the city needs to mobilise and train energetic CBOs and NGOsrdquo he said ldquoThe city should to be divided into lsquogridsrsquo each municipal ward can be divided into four to five grids each headed by a civic public health officer and assisted by local CBOs and NGOsThey can work with social workers and report to the wardrsquos assistant municipal commissioner Phasewise each week wards can open up with most functions markets and activities except schools sensitive noncompliant settings and foreign travel There will of course be disruptive forces in each ward that need to be managedrdquoHe expects nasal vaccines to get DGCI clearance by March 2022 after which it can be delivered to children and adolescents Once more than 70 per cent of children and adolescents get vaccinated they can go back to schools and colleges This he said is easier said than done considering the group comprises almost 40 per cent of cityrsquos population ldquoPost June 2022 unrestricted international travel could resumerdquo he said18No of months for which restrictions have been in place for Mumbai70Percentage of the population that needs to be vaccinated for the city to be fully unlocked