A short thread on why Mumbai is currently under severe stress at the moment

A colleague's mother had to be admitted to a private hospital in Khar - she had become weak and wasn't responding, was unconscious. (1/n)

She was diagnosed with encephalitis. After 2 days, results said that she was COVID-19 positive.
Now, the private hospital was NOT a COVID centre. So my colleague was asked to shift her to one. (2/n)

He used the BMC helpline and registered. It took them over 24 hours to find a ICU bed for her. Given her condition, she needed more aggressive treatment.

A smart ambulance driver told my colleague that although they are saying you have a bed you may not. Please check. (3/n)

The ambulance guy told him that he has been seeing this happen for the last 3-4 days where critical patients are not getting beds. And patients often deteriorate in the ambulance itself as people move from one hospital to another.
So my colleague calls up the govt hospital.(4/n)

The hospital says - yes the BMC may have told you a bed is available but there isn't. :-/
So my friend and his ailing mom are stuck in the private hospital.
The private hospital is restless - they want them to leave soon.
(5/n)

Her treatment is on - so that's not a bad thing.
There is no cure for COVID anyway - they had to move because the hospital they were in was not a COVID one.
So the process is on to find a ICU bed somewhere in Mumbai. Other private hospitals too expensive (6/n)

So he has to figure a govt hospital. The bill for 3 days at the current private hospital was already well in excess of INR 2 Lacs. Now the private hospital they were in also trying to find them a bed. Few more hours pass. (7/n)

Finally, there is a bed available in the same govt hospital which had refused earlier in the day. So my colleague confirms multiple times asking if he should come because you don't want to reach there and be told that its not available. They say come. (8/n)

Now, the ambulance takes its own sweet time to reach (possibly because there is a huge demand). Late in the night they reach the govt hospital - they are told no bed available. ICU bed had to be given to someone else they say. There was no communication error for sure this time

Now, the critical patient is in the ambulance in no man's land. Old private hospital has given discharge. No ICU bed in the govt hospital. Option give - admit to general ward and we start treatment. My colleague is confused - should he go back to the private place? (10/n)

After some deliberation, and realising that the oxygen in the ambulance will also be exhausted, he decides to admit her in the general ward. At least the treatment for the brain inflammation will continue - This is 1.30 am.
At 4.30 am she passes away. (11/n)

After 2 months of a stringent lockdown, we aren't prepared. A lot of vulnerable patients are not going to make it. Doctors, hospitals, nurses, ambulance operators, police - everyone is under severe stress. And this isn't going to go away anytime soon. (12/n)

The heartbreaking thing is the exploitation in the middle of all this. From PPE to Medical equipment to hospital admissions - people are profiteering without any remorse. A South Mumbai hospital has apparently presented a INR 19 Lac bill for a 3 day admission for COVID. (13/n)

There is no accountability. BMC, State government, Central government - everyone is to blame. People are responsible too. Those who asked for fake certificates to prevent quarantine, those who hid their exposure to positive patients. We are quite a mess. (14/n)

Not going to disclose the identity of the family - please don't reach out to me for that. Just leave everyone alone. Take care of your loved ones. Follow social distancing. Wear masks. Wash hands. Educate people around you. Contribute where you can. (15/n)

Mom passed away at 4.30 am. He is not home yet (it's 6 pm) There is a queue where they are doing the last rites. (16/n)

What we need right now is suspension of self-interest even if temporarily to come out of this. Also, unity of purpose. It sounds idealistic but can't think of another way. As someone who has been distributing meals on the road I'm aware of issues with loss of livelihood as well.

We cannot stay locked down forever. And we cannot let people die either. Science, Management and Politics - everyone needs to come together. There are things that can be avoided. Let's do them. (18/n)

Also believe that the government alone cannot manage this. Citizens will have to do things - more than usual. Donating to a few NGOs is not enough. (19/n)

When things are better, hope we use this opportunity to completely reboot and build a world class health care system in our country. It is possible - both education and health require solutions at scale. We have never invested enough in them. Just check union budgets of last 25y

We have always lived with a scarcity mindset. Make quality super exclusive - e.g. from hospital beds to medical seats. People spend 0.5 Crores to become a doctor often. Add our 'jugaad' mindset to it and we have recipe for disaster.

Digitization of health records, real-time monitoring of health capacity, building infrastructure for scale. Investing in human capital that will manage that scale. There are so many areas we need to work on. It requires intent. I'm hoping this tragedy forces us to fix these.

Few things I've realized :
1) While the virus doesn't discriminate it has an uneven impact. Labourers, poor will suffer more - with no fault of theirs
2) Workers of certain industries far more affected than others - the response by the system hasn't been targeted accordingly

3) People on the frontline need rest. Police, Doctors, Nurses, Cleaners, Those performing last rites cannot be exposed to the virus constantly. Even the young among them at risk. Most studies point to extent of exposure as an important metric. No rest means low immunity.

4) Ramping up ICU beds capacity is important but so is development of systems/technology to help people get medical consultation online so that they don't crowd hospitals.

5) Hunger is a real problem. I had started something called as #1000mealchallenge. Since then, I have come across tens of NGOs and citizen groups helping and feeding people. I estimate that everyone put together serve about 45-50k meals daily in Mumbai. Not enough.

The pandemic has only exposed so many of our underlying issues. I have a feeling that 45-50k meals served by private groups and citizens may not be enough even if there was no pandemic.

6) We need to permanently upgrade quality of life and infra for our blue collared workers - from labourers, household help, service personnel. May mean remaining housing. May also mean spreading out the city. Forcefully work on reducing density.

7) Need a in-depth labour movement study within India. One of the reasons no one really predicted plight of labourers and this mass movement back is because we have never tracked this or focused on living conditions in metros. This crisis should lead to new socio-economic studies