Thread alert. Mumbai's #COVID19 story: A 1hr long video interview of @mybmc's IS Chahal with Dr Shashank Joshi and Dr Harish Shetty. Key takeaways from this @OneMDHealth video:

The change in BMC since March? Decentralize and empower wards, enlist interns from across Mah’s 50 medical colleges (raise stipends to 50K from 11K, free stay in 4/5-star Mumbai hotel) to manage ward level war room. 800 doctors, interns, signed up and put to training.

BMC got 500 buses to function as ambulances (alum sheet to separate drivers, PPE kits under driver seats), got 60 mini BEST buses to function as stretchers. Parked 10 ambulances in 24 wards.

So each ward became a separate unit with doctors, ambulances, telephone operators, etc. Got IT experts to bring hospitals onto a dashboard, cleaned up data of tested people.

IT system separates patient list as per wards, data appears in individual ward war room. So on daily basis you can see 1500 patients across 24 wards. Then doctors start allocating beds as per asymptotic and symptomatic. The system works.

He cites ICMR guideline of 11 May that fever clinics and doctors will prescribe testing only for symptomatic cases. BMC was testing 3600-4000 people per day and almost 40% (1300-1600) were coming positive - these 1300-1500 would need hospital beds because all are symptomatic.

But today after BMC “scrapped prescriptions” (not sure what this means) on 3rd July, BMC is getting 1000-1200 cases/day with almost 80% asymptomatic. So we need only 150 hospital beds versus 1500 beds previously.

So from 1500/day hospital admissions a month ago, today we have 150/day hospital admissions. We have 7100 beds lying empty in hospitals (with oxygen, ICU) today. Today, regular hospitals are not COVID centers, not quarantine centers, they’re actual hospitals.

In summary: Previously there were 1300-1500/day positive cases from 4000/day tests, today 1000-1200 positive cases from 7000-8000/day tests. "7600/day tests, only 170/day going to hospitals. Let people decide gravity."

BMC has 5 tools: testing, tracing, tracking, quarantine and treatment. World over the debate is on vaccine and drugs. Everyone talking about last stage....

...But Mumbai has focused on surveillance and home to home visits. *Till now, 1.71cr Mumbaikars have been visited and surveyed at home, in the last 110 days.*

68% (?) people in Mumbai lives in slums which is more than 10m to 12m population. 8000-strong MoH+NGOs staff visited them. BMC testing was focused only on suspected cases, symptomatic cases were hospitalized, high mortality rate is now becoming comfortable.

Of the 100,000 strong BMC staff, almost 40K-50K would be in slums along with medical staff, ward officers. BMC never focused on vaccines, they focused on surveillance and treatment. BMC worked on the basics not on expensive medicines.

On mortality rate: first reason: mortality rate in Mumbai jumped from 2.9% early on to nearly 6% due to cleaning up of reporting and data updating. Last 25 days of July, mortality is 3.5-4% and coming down.

Second reason: Mumbai includes MMR. Whenever anyone gets serious there, they drop them in Mumbai (Sion, KEM, Nair), BMC cant say no to them. Death certificates are issued at place of death.

So we might have 4000 people who died in Mumbai of critical condition, brought here (from MMR) in last stages. 54% deaths at Sion Hospital are of non-MCGM area, all cremated in Mumbai.

From 9% in April we are down now on mortality rate and by 15th Aug we will further improve.

There was an idea to make one IAS officer in charge of one hospital. IS Chahal opposed the idea. There was an NYT article stating that Mumbai’s health infra was collapsing. He (ISC) showed it to CEOs of private hospital.

He told these CEOs that this NYT news will mess up your plans of medical tourism. He imposed caps on treatment 1 July to 31 August. That’s how got private hospitals on board.

When ISC joined, Mumbai's doubling rate was 9 days, now it’s 64 days. Places like Bandra, doubling rate is 135 days. We need less than 200 beds/day to take care of Covid in Mumbai in a population of 20m.

And now, the important part for the future...

We are so comfortable that everything can be opened. But the issue is MMR and Pune, where things are not satisfactory. If we open trains and people from there come in, things going bad can’t be ruled out.

"The day MMR gets to our situation, I’ll be the first person to recommend to hon CM to open up everything."

At this point, someone complained on FB Live and Dr Shetty actually read out the complaint to ISC! The complaint (a common one, we all hear of this) was of non-availability of hospital beds and sky-high private bed cost. Here's ISC's response.

We've been publicizing this - walk in admissions across 5000 beds in facilities like NESCO Goregaon, NSCI Dome, etc Appeal to every Mumbai + Mumbaikar - take a taxi and walk into these facilities, no questions asked, bed is waiting for you.

And this is my favorite part right at the end because it has to do with us entitled privileged people who are now officially the problem...read this..

Mumbaikars must use masks, keep social distancing, even if you’re in a gated community, with its own walking facilities. 80% cases today are from gated communities, only 20% from slums.

"It is an embarrassment that slum people are showing us the way and we’re not able to follow that."

If high rise buildings behave properly our cases can drop to 200/day from 1000/day. Look at the contribution of our slum dwellers and look at their discipline. And compare that to high rise dwellers who are contributing 80% positive cases today.

Finish. This 1hr long interview hasn't been fully reported in the press. I just watched it and my already high respect for @mybmc @CMOMaharashtra @MumbaiPolice and everyone at the frontline has gone up higher. Do watch the video please.