Why Mumbai has scary coronavirus figures

'It is a bigger challenge for Mumbai because we have a dense population and people are staying in very, very small rooms.'
'So even if there is one case, then it can spread to you know, four or five people are staying together.'

As of 8 am on Monday morning, Mumbai reported 406 cases of COVID-19.

Twenty-nine new cases, and counting, were found in the last 24 hours.

And the city has recorded some 30 dead.

The congested, closely-packed city has many grim hot spots and the BrihanMumbai Municipal Corporation releases lists daily, on its Twitter account, of details of new cases.

Dr Daksha Y Shah is one of the protectors of our city, working tirelessly around the clock, in her special capacity, with her team and her able seniors, to hold the tidal wave back.

Deputy Executive Health Officer for the Municipal Corporation of Greater Mumbai, Dr Shah is also the city TB officer and has navigated Mumbai through tuberculosis, H1N1 and malaria crises.

She tells Vaihayasi Pande Daniel/Rediff.com about the progress Mumbai is making on different fronts to halt the march of COVID-19.

What is the situation in Mumbai presently? Has the lockdown helped as expected?

Now, it is too early to say whether the lockdown has helped, but obviously our testing facilities have really gone up like anything.

Can you quantify that?

We have done more than 10,000 tests in Mumbai alone. Definitely the more you test, the more you diagnose.

And are you going to be able to scale testing up further?

Yes, I think right now we're working at the full capacity.

So that's like a how many tests, roughly, per day? Or is that hard to say?

Per day, I won't be able to say because I think in one particular lab, they are doing more than 200 in a day. I think different, different labs are doing say up to 300 to 400 also.

We have around 10 labs and some have capacity of a 100 also, some are capacity of 50.

We have activated our home collection team. So we don't want all the people to come to the centres and raise the transmission.

Suppose a patient has been identified as a positive and he is in an isolation center, and for testing his close contacts, we send the teams to the homes and then we bring the samples to the labs. And then if anyone is positive, we isolate and the rest is home-quarantined.

So that's how our strategy is.

Are you seeing a lot of asymptomatic people?

Yes, we do see around 30 per cent patients who are asymptomatic and a lot of them are from the contacts itself.

We are doing very rigorous contact tracing. We are identifying the patients among the contacts also. A lot of positives are among the contacts.

Do you still need to scale up the testing more? Are you looking for more testing facilities or more test kits?

If a kind of rapid test which is available (it would help).

The thing is the PCR test (polymerise chain reaction) takes a little more time and looking at the lockdown, a lot of our technicians are finding it difficult to reach and you know, so many other factors.

And PCR is a very advanced test and so it requires that technical capabilities to conduct PCR.

So definitely, some simpler test, if it is approved, would be really good

It's too early to say but are there any signs of the curve flattening? Any positive signs?

I wouldn't be able to say right now. We are testing so many so our numbers are going up.

I would say that we are into the fourth week right now. And we have reported 300 plus cases in Mumbai. So...

Maharashtra Health Minister Mr (Rajesh) Tope spoke about extending the lockdown.
For Mumbai, wouldn't it be good to extend the lockdown? What is your feeling?

Yeah, it should be extended.

But I think the (city's) people also should be equally kind of, you know, (willing to) participated in it. Like it's very difficult for people in Mumbai to sit at home.

It would be kind of important. I'm sure there are so many technical experts who are advising the government and they'll take those decisions,

But from like a from a medical point of view?

I would say yes, it would be advisable.

The high-risk individuals should be taken care of. At least they should not roam around. We know that they capture infection fast and they are at the high risk even of mortality.

It will be really important that the whole group of high-risk people they are quarantined.

But the problem is that if the younger people, with no risk, go out in a family then they bring it back to the high-risk members. So that means the whole group/unit -- the young and old -- in a high-risk family should stay home?

Yes, they go out and they come back and (bring) some infection. That's also there.

So it has to be done for certain family units?

Yes.

So it should be a lockdown for a little extended time, but I don't know how that will affect the economy and all other things.

What are the challenges of containment and protecting slum areas?

It is a bigger challenge for Mumbai because we have a dense population and people are staying in very, very small rooms.

So even if there is one case, then it can spread to you know, four or five people are staying together, as compared to the other countries, where there is possibility of having a separate rooms or even in the non-slum areas there.

So, definitely that's going to be a challenge, within the slum areas.

So the task for Mumbai is much more difficult?
I'm sure there are, sort of, parallels in New York or China. But Mumbai is really unique.
Is it much more difficult to identify potential carriers for every positive case in Mumbai?

See right now, at least for every positive contact, we are testing all the immediate contacts, like high-risk contacts. And the other contacts we are home quarantining.

In slum areas, suppose we identify a patient and we put them in an isolation ward, but then if their other contacts have to be home-quarantined it's not possible for them to remain in the home. Then we are actually shifting them to some lodge and some hostels.

This is the whole exercise that we have undertaken. If it is not possible for them to remain in the slum areas, we give them an alternate, much more spaced-out accommodation.

This is an important step which we are taking. Like we are allowing people to go and stay in better, less crowded facilities.

Are you taking lessons from any other place, which may have had similar challenges, like maybe in China. Or for Mumbai, the situation being so unique, there's no nobody to take lessons from?

We are looking at you know, some of the digital technology where we are kind of defining the containment zone then we are also trying to see if we can track the people.

Of course, right now there's a lockdown, so people should not go out and should not go out of the quarantine. But this kind of technology also could be used.

I've seen the use of booths. So now, I think, in one or two labs, were establishing the booth for collection of the throats swab. So the patient doesn't have to travel much. Even within the hospital it's been made a little easier for the collection of the throat samples.

And many new (types of) technology and diagnostic kits are on the way, I guess.

I heard that in China they have given some wristbands and everything.

But of course, right now, I believe, a lot of our home quarantined are not coming out. We are enforcing them with the police.

If there are people who are seen going around and they are not listening to the home quarantine, then we also have police teams who are helping us and we are taking measures to ensure that they remain in the houses.

What is it that the city's people are not yet understanding about this virus and what are some of the signs that show that people are understanding the situation?

See the people are aware. It's not that they're not aware.

But it's kind of a casual attitude, you know, like: 'Okay, nothing is going to happen, nothing like that to us'.

And sometimes it is, you know, the tiredness of just sitting at one place, not working and then just having this media bombardment all the time. They get affected and they want to go out and have some fresh air and all that.

Multiple factors for why people may not take it seriously.

Overall, I see that people have understood the severity and all.

But there are still few people, or I would say, a lot of people who have who have not taken it seriously.

In the beginning, there was a lot of talk about this virus mainly seriously affecting older people or people with existing pre-existing conditions. But as this illness has continued and spread around the world, a lot of young people have fallen prey and died. Not just, say smokers, but young, healthy people.

This is a virus infection. So you are going to get infected.

That again is a research question. What has gone wrong and whether (the virus) is changing.

I would not be able to comment as a physician, because I am more into administration.

But, of course, the virus might be behaving differently.

In Mumbai, do our frontline doctors have enough personal protective equipment (PPE)?

As of now, in all our isolation centres, we do have sufficient PPE equipment and a lot of the material has been acquired. We are procuring definitely.

We have a different department which is doing all this work. We are procuring and it's on the way and it is in process.

But right now in Kasturba hospital (central Mumbai), which is a major isolation facility we have all the PPE kits and other isolation facilities and masks and kits available.

What is your area of concern in this battle against the pandemic? And this is probably the worst thing that you have ever seen in your life, right?

I have seen H1Ni (bird flu) outbreak and some malaria outbreaks.

I have yet to see anything more than that.

I really hope it does not go to the level, like what I am looking at in New York and all that.

So this has not been worse than the H1N1 and the malaria outbreaks you have seen?

Not yet. Of course, we don't want to progress to that level.

And what is your area of concern?

Concern is, of course, I would say, for manpower.

And exhaustion. Amongst the medicals, the para-medicals and the administrators because a lot of, many challenges will come up if it goes more.

What is your day like? What time do you begin and when do you end and what are your hours like.?

I begin at nine and I end at nine or maybe sometimes -- yesterday I came home at 11.30 pm.

We work more than 12 hours, maybe 15 hours. And in the middle of the night there are many calls. The whole health department.

Not only the health department. The engineering department. A lot of people of the administrative category. All are working hard.