Mumbai has reported 15,581 COVID-19 cases as of May 13, accounting for 60% of cases in Maharashtra and 20% of India’s total. Maharashtra has had 25,922 cases, even as two other states--Gujarat (9,267) and Tamil Nadu (9,227)--are nearing the 10,000 mark.

The island city now has had five times the number of cases detected in Thailand (3,017), which recorded the first case outside China on January 13, and 29 times the cases reported in Kerala (534), the first Indian state to report a COVID-19 case, way back on January 30.

Mumbai, home to more than 12.8 million people, had reported its first COVID-19 case on March 12. It took 51 days for Mumbai to cross 7,600 cases, and only 12 days thereafter to cross 15,500.

Many factors such as Mumbai's topography, housing conditions and social structures are contributing to the rapid spread of the virus, health experts told us, with people finding it hard to understand the gravity of the crisis.

“Mumbai has reached the ascending phase and the important factor is the dynamics of people from one place to another (across the city),” Giridhar R. Babu, professor and head of Life Course Epidemiology at the public-private collaboration Public Health Foundation of India, told IndiaSpend. “One of the main factors to consider is the density of population in Mumbai, which is more than any other city. Mumbai has been able to identify and detect cases more than any other city or state in the country.”

Dharavi in Mumbai, home to the largest slum in the country, has reported 1,028 cases, more than states such as Bihar (940), Haryana (793), Jammu and Kashmir (971), Karnataka (959), Kerala (534) and Odisha (538).

“I would be worried if Mumbai doesn’t detect more cases,” Babu said. “Detection of more cases is good because it means that they have identified most of the vulnerable areas. Kerala continued to have the highest number of cases for almost two months, but because of early detection, contact tracing and community involvement, they were able to do well. Such quarantine mechanisms cannot be easily carried out in a complex metro like Mumbai. The main goal right now is to reduce deaths in the city,” he said.

The city has reported 596 deaths as of May 13, more than any other city or state in the country. More than 70% of the fatalities in the city have been among the elderly with comorbidities such as asthma and diabetes.

In efforts to fight the COVID-19 crisis, civic hospitals in Mumbai have started using a new drug “Injection Tocilizumab”, which has been tried on nearly 40 severely affected patients and has shown “encouraging results” in more than 30 patients, said an official release on May 12. “This medicine has improved the condition of the patients and has prevented patients to go on ventilator and has hastened the recovery,” the statement said.

“We are seeing good results from this medicine,” Daksha Shah, deputy executive health officer with the Brihanmumbai Municipal Corporation told IndiaSpend. “The timing of administering the drug is also very important. Fourteen patients have recovered and have been discharged. Due to clinical indications we are also giving it to other patients in hospitals who need it,” she added.

Shortage of doctors

With cases on the rise, the city is likely to face a “huge shortage” of doctors and health workers, in the coming days. The dearth of senior medical professionals at the frontline have left young inexperienced doctors to handle the crisis on their own, The Economic Times reported on May 9, 2020.

“There is a shortage of medical staff and we are sending letters to senior doctors and requesting the state health department to look into the matter,” Shah confirmed.

The Directorate of Medical Education and Research, Mumbai, had issued a notification to medical practitioners in the city to report at hospitals serving COVID-19 patients for providing their services, the Mumbai Mirror reported on May 6, 2020. “Your expert services are required for the prevention and treatment of Covid-19 patients, at least for 15 days. You shall, therefore, convey your willingness and place of choice where you would like to render your services," the notification read.

“Shortage of medical staff and PPEs are hampering the efforts of containing the virus as critical cases are going to be in larger numbers, while they need to be balanced,” a senior health expert said on the condition of anonymity.

“[T]he lack of PPE is a high concern not just in Mumbai, but everywhere,” Babu said. “The involvement of healthcare workers is going to be tough because of this."

“The main strategy ahead is the augmentation of services and facilities. We are also mainly looking at asymptomatic patients and we’re preparing accordingly,” Shah said.

“Mumbai will definitely see a descending phase in the coming weeks,” Babu said. “Mumbai cannot relax the lockdown but must continue with the surveillance. The focus must be on wards that are low in COVID cases. For now the main focus is to reduce the case fatalities. Also, the surveillance and management of severe acute respiratory illness (SARI) and influenza-like illness (ILI) cases are important.”

(Jacob is an intern and Mallapur is a senior analyst with IndiaSpend.)