First, some projections. By the end of this month, going only by the rise in new cases since June 8, when Unlock 1.0 came into force, the number of coronavirus disease (Covid-19) cases in Mumbai would be 80,000; 100,000 in New Delhi and 71,000 in Chennai, which officials of all three metropolises agree, would greatly test their health infrastructure.
The unlock guidelines, crucial to restart economic activities and prepare the country to learn to live with Covid-19, has led to a spurt in cases in most states. Mumbai, Delhi and Chennai however, account for more than half of the total cases in the country today. These cities are among the 65 most critical Covid-19 affected districts in the country, according to the latest analysis of the health ministry shared with state governments.
The Brihanmumbai Municipal Corporation (BMC), which is handling Covid-19 cases in the Mumbai, estimates that if the same pace of increase continues, the business capital of the country will have around 80,000 cases by the end June and over 100,000 by mid July.
Suresh Kakani, BMC’s additional municipal commissioner, said that the numbers have stabilised in the past month. But that doesn’t mean they’re not large enough to cause concern: in the past month, Mumbai has seen a daily addition of anywhere between 1,000 to 1,700 cases. [June 16 fell short of the lower end of that range by 19 cases.] “The numbers have stabilised for now, but we cannot estimate saturation point. We will have to wait for one more week,” he said. On Friday, Mumbai’s case count was 64,139 (1264 fresh cases), and 3425 deaths (114 new deaths). The mortality rate in the city was 5.33%. The BMC officials said assuming that 1,500 cases are reported in the city every day for another 12 days, the city will have 81,000 cases by June end.
To cope with the increase in cases, the BMC has set up 90 clinics in areas where the concentration of cases is highest, such as Dharavi, Worli Koliwada, Mankhurd and Govandi, and also stepped up screening efforts in other areas by setting up additional 400 fever clinics. “We have conducted over 2.69 lakh tests, and are maintaining daily number of tests being conducted at 4,500 to 5,000. In the last one week, we have touched the 5,000-mark on June 12 and June 16. Our capacity is to conduct around 7,000-8,000 tests daily,” Kakani said.
The high number cases doesn’t indicate that the city has reached its peak, experts said. Thus, the city must prepare for the eventuality that it hasn’t.
Dr Siddarth Paliwal, a city-based private health consultant said, “In the last one month capacity of the medical health infrastructure has doubled, and the cases have risen from around 15,000 to 60,000. We will have to scale up at a much faster rate, if we are of the belief that the peak in Mumbai has yet not arrived.” He added that the occupancy rate of the ICU beds and ventilators was above 90% on any given day.
Chennai, by comparison, has fewer cases than Mumbai, but it accounts for 70% of the total cases in Tamil Nadu. The state government, on June 15, announced a complete lockdown starting Friday and till the end of the month in Chennai and three adjoining districts, Chengapattu, Thiruvallur and Kancheepuram. The lockdown was enforced after there was a steady rise in cases, an increase in deaths and lack of public cooperation in maintaining social distancing and wearing masks.
After the first case was reported on March 24, by June 7 — a day before Unlock 1.0 was to start — Chennai had 22149 out of the state’s 31667 cases. Ten days later, Chennai breached the 35000-mark while Tamil Nadu crossed the 50000-mark. This month, the state has reported more than 1,000 new cases everyday with Chennai accounting for most of them. In the first week of May state-run Tamil Nadu Dr MGR Medical University projected that Chennai would have roughly 71000 cases by June-end and 150,000 cases by the second week of July. However, this forecast may change with the imposition of the 12-day lockdown.
“Rather than focussing all resources on 1 million people in the containment zones, the city now has to control its entire population of 8 million,” said a member of the task force constituted to recommend ways to control spread of Covid-19, who was not willing to be named.
To deal with the increase in cases, Chennai has prepared a micro-level plan for each of 200 wards in the city with an assistant engineer in-charge at each ward. The Chennai municipal corporation is conducting door-to-door surveys for its 8.4 million population and has set up more than 400 fever camps and 10 mobile sample collection centres.
“We need a maximum of 30,000-35,000 beds to manage our peak,” city corporation commissioner G Prakash had announced on June 7. He added that 20000 additional staff nurses and 2,000 paramedics were appointed in June for Chennai and its three neighbouring districts.
There is no clear data of daily testing figures in Chennai, but it is roughly pegged at 5,000. According to the health bulletin released on June 19, 160,000 samples have been tested in the city so far. Tamil Nadu, which was testing around 18,000 samples a day has ramped up testing to 25,000 daily in the past three days alone. However, experts say that to assess and control the spread of the disease, Chennai alone needs to test at least 10,000 people per day.
“We began easing lockdown norms since May but did not significantly ramp up testing in Chennai or plan an aggressive containment strategy to restrict the cases geographically,” said a member of the government-appointed medical expert panel quoted above. As of June 19, Tamil Nadu has tested 789, 408 individuals, which is 71,725 more than the people Maharashtra has tested and 60% more than Gujarat’s test numbers.
“For this lockdown to be effective, we need aggressive testing and early isolation of people with symptoms and their contacts. If a person starting to show symptoms is isolated within 3 to 4 days, the transmission can be cut by half,” says Dr Prabhdeep Kaur, a member of the government appointed expert medical panel and deputy director, National Institute of Epidemiology.
In Delhi, the average daily increase of confirmed cases has grown by 9% against 6% daily average for the 11 days prior to Unlock 1.0. On June 9, the Delhi government had projected that the total Covid cases (including recoveries) would be around 1,00,007 by June 30 and 2,24,537 by July 15.
Even though the fatality rate (the number of people who succumbed to the virus) is at 5.5% now, versus 3.7% prior to June 8, the recovery rate has improved from 27% to 49% in the 11-day period. Delhi is conducting more tests than before and as on June 19, it has conducted 15,400 tests per million with positivity rate of 31%, up from 7% on May 17.
To cope with the anticipated increase in cases, the Delhi government plans to have 80,000 beds by end of July from the present 10,889. The government has identified 40 hotels (4,628 beds) and 77 banquet halls (11,229 beds) that are being turned into Covid care centres (to add 15,800 beds immediately), said Delhi chief minister Arvind Kejriwal. In addition to this, the city government is planning to build the country’s biggest Covid Care Centre at a religious institute in South Delhi Bhati area, which will add 10,000 more beds in the city. Besides, 50 train coaches with 800 beds have also been readied by the northern railways for Delhi.
Will these cities cope with the rise cases remains to be seen, but they are bracing for impact.