How Mumbai raced to add more beds than patients after its June unlocking

Nearly half the bed capacity lies unutilised now

Bed capacity was showing signs of strain when Mumbai began lifting its lockdown in early June. The government seems to have added them at a faster pace than occupants, since.

Nearly 80 per cent of the 16,197 available beds in Mumbai were already occupied when unlocking began, according to Municipal Corporation of Greater Mumbai (MCGM) data of June 3. The latest occupancy numbers suggest that nearly half its current bed capacity lies unoccupied (see chart 1).

Joy Chakraborty, Hinduja Hospital chief operating officer and the chairman (healthcare) at the Confederation of Indian Industry (CII) Western Region said that a fall in new case additions had helped ease the pressure for hospital beds in Mumbai. He added that the doubling rate in Mumbai is now over 70 days. "The recovery rate is good too. On the whole, we are in a better situation than June-July. Addition of jumbo centres in BKC (Bandra-Kurla Complex),...(and the Bombay Exhibition Center)...along with decentralisation of war rooms...have contributed significantly," he said.

Multiple media reports suggested that people had trouble finding beds earlier. Such reports became rare as days went by. The government also moved to let more patients recover at home in a bid to keep beds available only for the critically ill.

Avinash Supe, former dean of King Edward Memorial (KEM) Hospital, and a member of the state’s task force on Covid-19 said that the pressure on hospital beds is definitely easing, but there are still around 20,000 active patients in the city. "The demand for tertiary care beds thus remains, and so does the demand for ICUs (Intensive Care Units)," he said. Supe, however, pointed out that the wait time for beds is much lower now. Someone could now get a bed within a few hours or the same day and preferably in his vicinity. Even government hospitals like KEM, which have around 450 beds, now have around 100 beds or so available roughly. The situation, however, is dynamic and keeps changing daily.

Shortage of ventilators has been a problem in many global cities. Ventilator capacity appears to have more than doubled in Mumbai over the last two months. It rose from 442 on June 3rd to 1035 now (see chart 2). Nearly all ventilators were occupied at one point. The situation seems to have improved now, with more than 16 per cent unused as per the latest data.

Doctors also say that that being ahead on clinical management decisions helped.

"Mumbai took some of the clinical management decisions ahead of the country. That is because it always had a high number of patients," said Supe.  Anti-inflammatory drug Tocilizumab was tried in Nair Hospital much earlier than the rest of India. Mumbai has also used the steroid Dexamethasone in the casualty ward stage. Whenever patients come and are waiting for oxygenation and admission, they are put on Dexamethasone.

Dr Behram Pardiwala, principal investigator of the plasma trial at Wockhardt Hospital elaborated that that the initial treatment for hospitalised patients is usually steroids when oxygen saturation is not normalising and pulse rate and inflammation markers are high.

If steroids do not make much of a change, then the doctors deliberate on the next line of therapy with medicines like Tocilizumab or Remdesivir In some cases a clinician may decide to give blood plasma upfront, right after they see the patient did not improve even after steroids.

The government is said to be preparing for the possibility of a second wave. The next phase of unlocking, where malls and market complexes are also allowed to open, began on August 5.