{"id":50501,"date":"2021-06-22T16:30:35","date_gmt":"2021-06-22T15:30:35","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50501"},"modified":"2021-06-25T12:29:25","modified_gmt":"2021-06-25T11:29:25","slug":"anita-jain-covid-19-in-india-and-the-mumbai-model","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/","title":{"rendered":"Anita Jain: Covid-19 in India and the Mumbai model\u00a0"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The Supreme Court of India <\/span><a href=\"https:\/\/www.newindianexpress.com\/nation\/2021\/may\/06\/covid-19-supreme-court-appreciatesmumbai-model-asked-delhi-and-centre-to-take-a-look-at-it-2298984.html\"><span style=\"font-weight: 400\">recently praised &#8220;<\/span><i><span style=\"font-weight: 400\">The Mumbai Model&#8221;<\/span><\/i><\/a><span style=\"font-weight: 400\"> in responding to the second wave of covid-19 and asked other Indian states to draw from its experience.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In early to mid-April, the state of Maharashtra and its capital Mumbai were at the epicentre of the covid-19 pandemic contributing nearly 30-50% of all cases across India. The number of cases has now dipped even as the disease has spread more widely across the country. Lockdown measures were enforced from mid-April with cases peaking at <\/span><a href=\"https:\/\/www.ndtv.com\/india-news\/mumbai-reports-over-11-000-coronavirus-cases-in-a-day-for-the-first-time-2406045\"><span style=\"font-weight: 400\">over 11,000 each day in <\/span><\/a><span style=\"font-weight: 400\">Mumbai<\/span><span style=\"font-weight: 400\">. Hospitals were quickly overwhelmed. The public had to source everything themselves including treatments for covid-19, oxygen cylinders, and hospital beds. Most people in the city will have received a distress call from a covid-affected family.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In a matter of a few days however, single-point helpline numbers were being circulated for any covid-related query or requirement. The city is administratively divided into wards. <\/span><a href=\"https:\/\/theprint.in\/health\/inside-a-mumbai-covid-war-room-16-staff-phones-that-ring-every-minute-eat-when-you-can\/648182\/\"><i><span style=\"font-weight: 400\">The Mumbai Model<\/span><\/i><\/a><span style=\"font-weight: 400\"> focused on decentralising the covid-19\u00a0 response with ward-level triage, supervision, and contact tracing. Each ward has a covid \u201cwar room\u201d and response team with a single helpline number to respond to queries. The ward control room is equipped with dashboards for live tracking and allocation of hospital beds. These became the first point of contact for patients trying to find an available hospital bed near their residence without having to shuttle between hospitals. This helped avoid delay, deterioration, and further transmission. Patients are triaged over the phone based on severity so only patients with moderate or severe disease were hospitalized. After a brief oxygen shortage crisis, prompt guidelines were issued to hospitals across the state on when to use oxygen and when to avoid using high flow nasal oxygen. This was backed by continuous audit of oxygen consumption and identifying sources for oxygen supply. Hospital bed turnaround times were closely managed with decisions on discharge or transfer to covid care centres once the patient had stabilised. Strict guidelines were enforced for labs to issue covid-19 test reports within 24 &#8211; 48 hours for early detection and isolation. Covid positive reports were not handed directly to the patient, rather these were routed through the municipal office who contacted the patient to discuss next steps.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Early on a Saturday morning, we received a phone call from the local ward office informing us that one in our family had tested positive. The caller did a risk assessment asking for exposure, symptoms, age, and comorbidities and accordingly advised hospital admission. We assured them that we would be able to manage our relative at home under medical supervision and that we have enough space for isolation. They agreed to let us proceed. Within an hour, we had a local ward official at our door. She inquired about symptoms in all family members and put stamps on our hand declaring dates until when we would be under quarantine. She checked and documented the pulse oximeter reading for the patient. In another hour we had a garbage cleaner wearing personal protective equipment (PPE) at our door to collect our garbage in a biomedical waste bag separate from the rest of the building. He handed us bags for the next day and this continued for the entire quarantine period. He was followed shortly by a team to sanitize the entire premises. Home-based testing was available with prompt online reporting of test results by labs.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Annual work performance reviews have a rating for going \u201cabove and beyond\u201d the objectives of the role. Each one of the people who helped us went above and beyond their duties. Fellow doctors have mentioned how the municipal ward offices have responded promptly to requests to transfer covid patients to designated public hospitals. At a children\u2019s shelter that I oversee, after the first covid case was detected, the local ward arranged testing for all staff and kids and sanitization of the premises the very next day. The centre was quarantined and further cases have been smoothly transferred for testing and admission at designated covid care centres. If you have ever lived in India, you would know that not much moves without multiple calls and appeals. We are mighty impressed by the change and the seriousness of action. No one is cutting corners.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The response system put in place has merits, but is certainly not foolproof. There have been shortages, lapses, delays, and needless loss of life. As <\/span><a href=\"https:\/\/timesofindia.indiatimes.com\/city\/bengaluru\/bengaluru-adopts-mumbai-model-to-reduce-delay-in-treatment\/articleshow\/82492859.cms\"><span style=\"font-weight: 400\">more cities in India adopt the Mumbai Model<\/span><\/a><span style=\"font-weight: 400\"> for the covid-19\u00a0 response, quicker sharing of lessons and resources will help put up a unified front to continue to counter the pandemic in the country. The state of Kerala has done well to <\/span><a href=\"https:\/\/www.theweek.in\/theweek\/current\/2021\/04\/29\/how-kerala-managed-to-have-zero-covid-19-vaccine-wastage.html\"><span style=\"font-weight: 400\">reduce vaccine wastage<\/span><\/a><span style=\"font-weight: 400\">. Boosting the vaccination drive is a crucial priority over the coming months as well as disease surveillance and response as lockdown restrictions are eased.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Honest, responsive, and forthright leadership at each level will be critical. Not a day goes by without people questioning whether this second wave could have been prevented, or the impact reduced by earlier and more responsive action. There is still more to be done and a long way to go.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Anita Jain<\/strong> is a family doctor in Mumbai and clinical editor with The BMJ.\u00a0<\/span><\/i><\/p>\n<p><em><strong>Competing interests<\/strong>: none declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Supreme Court of India recently praised &#8220;The Mumbai Model&#8221; in responding to the second wave of covid-19 and asked other Indian states to draw from its experience. In early [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":50220,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5720,447],"tags":[],"class_list":["post-50501","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anita-jain","category-india"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Anita Jain: Covid-19 in India and the Mumbai model\u00a0 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Anita Jain: Covid-19 in India and the Mumbai model\u00a0 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The Supreme Court of India recently praised &#8220;The Mumbai Model&#8221; in responding to the second wave of covid-19 and asked other Indian states to draw from its experience. 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(Editors note image depicts death)Health workers carrying dead bodies of coronavirus disease victims, outside the mortuary of LNJP Hospital. India has recorded 21.512 M total cases, 17.629 M recovered and 4,210 deaths due to coronavirus disease. Delhi government Lok Nayak Jai Prakash Narayan Hospital (LNJP), is one of the largest facilities for coronavirus disease (Covid-19) patients. 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In early [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2021-06-22T15:30:35+00:00","article_modified_time":"2021-06-25T11:29:25+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2021\/05\/India_delhi_doctors_covid.jpg","type":"image\/jpeg"}],"author":"julietwalker","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"julietwalker","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/"},"author":{"name":"julietwalker","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/373707d32533c2cbca204980b8cd3493"},"headline":"Anita Jain: Covid-19 in India and the Mumbai model\u00a0","datePublished":"2021-06-22T15:30:35+00:00","dateModified":"2021-06-25T11:29:25+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/"},"wordCount":872,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2021\/05\/India_delhi_doctors_covid.jpg","articleSection":["Anita Jain","South Asia"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/","url":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/","name":"Anita Jain: Covid-19 in India and the Mumbai model\u00a0 - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2021\/05\/India_delhi_doctors_covid.jpg","datePublished":"2021-06-22T15:30:35+00:00","dateModified":"2021-06-25T11:29:25+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/22\/anita-jain-covid-19-in-india-and-the-mumbai-model\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2021\/05\/India_delhi_doctors_covid.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2021\/05\/India_delhi_doctors_covid.jpg","width":540,"height":350,"caption":"2FM6HTT New Delhi, India. 06th May, 2021. (Editors note image depicts death)Health workers carrying dead bodies of coronavirus disease victims, outside the mortuary of LNJP Hospital. India has recorded 21.512 M total cases, 17.629 M recovered and 4,210 deaths due to coronavirus disease. Delhi government Lok Nayak Jai Prakash Narayan Hospital (LNJP), is one of the largest facilities for coronavirus disease (Covid-19) patients. 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