Mumbai health care system overwhelmed as COVID-19 surges across India

Wasantha Rupasinghe

Due a surge in coronavirus cases, the health care system in Mumbai, India’s commercial capital and second-largest city, is collapsing. Home to around 20 million people, Mumbai has emerged as the epicentre of the coronavirus pandemic in India—with 31,000 confirmed infections, or more than one-fifth of the country’s total cases, and nearly a quarter of its 4,300-plus COVID-19 deaths.

According to an analysis in India Today on May 25, at least 0.22 percent of the city’s population has now been infected with the virus. “On May 22, Mumbai recorded 1,751 new cases, the most for any city in the world except Moscow (in Russia). Over the last week, the growth rate of cases in Mumbai has substantially exceeded that of Sao Paulo (in Brazil) and Moscow,” wrote India Today.

Hospitals are overflowing, forcing authorities to put patients on a waiting list to get a hospital bed. The Hindustan Times carried an article with horrific stories of COVID-19 patients who died after unsuccessfully attempting to find a hospital bed for days. In one case, a man tried for over a week to find a bed for his 38-year-old brother, only to watch him succumb to the disease.

“Last night in just six hours I saw 15 to 18 deaths, all from COVID-related causes,” a doctor from Mumbai’s KEM hospital told the BBC. “Never before have I seen so many people dying in a single shift. It’s a war zone. There are two to three patients per bed, some on the floor, some in corridors. We don’t have enough oxygen ports. So even though some patients need it, they can’t be given oxygen.”

A number of images and videos widely shared on social media provide a glimpse of the appalling conditions in Mumbai’s overwhelmed hospitals. Several weeks ago, a video appeared showing dead bodies wrapped in black plastic lying next to patients who were undergoing treatment at the Sion hospital. A similar clip shared by NDTV on Monday showed a corpse lying next to a COVID-19 patient receiving treatment at Rajawadi hospital run by Mumbai’s municipal government authority, the Brihanmumbai Municipal Corporation (BMC). A female patient in the clip said that there was a second dead woman in the ward. This “lady asked for water but no one was around,” says the patient, adding “there is no staff here.”

Speaking in the same clip, Deepak Munde, the President of the Maharashtra Association of Resident Doctors, commented, “The situation is bad and it will get worse. Those who remove bodies are short in number. … Paper work takes time, we are overburdened.” The NDTV reporter added, “Even ambulances are short in supplies … even octogenarian patients are being moved to the hospital in most trying circumstances with help of locals.”

The clip ends by highlighting the fact that “State hospitals are reaching out to other states like Kerala (in southern India) and Doctors without Borders to overcome the crisis.” In a letter to Kerala Health Minister K.K. Shailaja on May 24, the government of Maharashtra—the state of which Mumbai is the capital—requested 50 specialist doctors and 100 nurses to manage the 600-bed COVID Care Centre being established at Mumbai’s Mahalaxmi Race Course. This underlines how disastrous the situation is given that Maharashtra with 150,000 registered doctors, is home to 30 percent of all India’s doctors.

Another Hindustan Times article cited a top state department officer on condition of anonymity who explained that health care facilities are “inadequate.” According to the government’s calculations, almost 0.5 percent of Mumbai’s population, or at least 100,000 people, will be infected by the end of June. Assuming that 5 percent of patients will need treatment in an ICU, the city will need 5,000 ICU beds, observed the Times. However, even if one includes the more than 80 percent of private hospital beds recently commandeered by the government citing the health emergency, the BMC will have just 1,165 ICU beds at its disposal. This is little more than one-fifth of what will be needed.

Moreover, due to the crisis caused by the pandemic, patients with other conditions are going untreated, further driving up the mortality rate.

Ominously, the COVID-19 virus has become entrenched in Mumbai’s slums where much of the population’s health is already compromised due to poverty, and basic preventive measures against COVID-19 are impossible due to cramped living conditions and the lack of proper sanitation.

Mumbai’s Dharavi slum, which is home to some 700,000 people, is one of the most densely-populated places on the planet, with a population density of over 275,000 per square kilometre. Seventy-eight percent of Dharavi’s residents lack access to a regular water supply. On average, 50 people share a single bathroom, and eight to 12 people typically share single-room dwellings.

Total confirmed COVID-19 infections in Dharavi currently stand at 1,621. Fifty-nine people have died due to the disease.

The coronavirus is taking a horrific toll on the medical staff who are valiantly fighting in Mumbai and across Maharashtra to staunch the pandemic’s spread. Almost 1,000 frontline health care workers, including 250 doctors and 310 nurses, had been infected as of Monday. COVID-19 has claimed the lives of at least three Mumbai doctors.

Outraged by the death Sunday of a 45-year-old KEM Hospital health care worker whom management had forced to work for four days even after he showed COVID-19 symptoms, hundreds of his colleagues staged a five-and-a-half-hour walkout Tuesday. “We are working in poor conditions, and for longer hours. Ideally we should be quarantined and treated if we have symptoms, but that is not happening,” said Pradeep Narkar of the Municipal Mazdoor Union.

The horrendous conditions facing medical workers, and the population as a whole, underscore the utter failure of the “war” Prime Minister Narendra Modi and his far-right Bharatiya Janata Party (BJP) government proclaimed on COVID-19 in late March.

After doing next to nothing for two months to stop the spread of the novel coronavirus, Modi imposed an ill-prepared 21-day nationwide lockdown on March 25, with less than four hours’ public notice.

The lockdown, which is among the severest imposed anywhere, was subsequently extended three times, first for 19 days, then 14 days, and now for a further two weeks ending Sunday, May 31—although in the third and fourth phases the government, acting at the demand of big business, has aggressively pushed to “reopen” the economy, especially manufacturing and construction.

When the lockdown began, India had 657 COVID-19 cases and about a dozen deaths. As of yesterday, it had 151,767 confirmed cases, and at the current rate of more than 6,000 new infections per day, will reach 169,000, or twice the total number of cases in China, where the COVID-19 pandemic began, by Saturday. Total deaths stand at 4,337.

The lockdown was not connected to systematic mass testing and a massive injection of resources into the country’s ramshackle public health system. Moreover, the government callously left the populace to fend for themselves, failing to provide substantive financial support for the hundreds of millions of impoverished workers in the informal sector who lost their livelihoods overnight. As a result, millions of desperate migrant workers sought refuge by returning to their home villages, walking scores and even hundreds of kilometres on foot, and thereby inadvertently spreading the virus across rural India.

Now the Indian ruling elite’s ruinous back-to-work push is coinciding with a surge in COVID-19 infections and deaths.

Whilst Mumbai, New Delhi, Chennai, Ahmedabad, and other urban centres have hitherto accounted for the bulk of COVID-19 cases, recent days have seen infections spike in rural Bihar and West Bengal.

Modi and the Indian elite are cynically exploiting the misery and desperation caused by the calamitous lockdown to press for the abandonment of any systematic effort to halt the pandemic’s spread and the adoption of a “herd immunity” policy, in which the disease is allowed to run rampant so big business can resume sucking profits from workers’ labour.

That this will mean millions of deaths is blithely conceded by Jayaprakash Muliyil, the chairman of the Scientific Advisory Committee of the government’s National Institute of Epidemiology. Muliyil is an outspoken proponent of India “reopening” its economy and pursuing herd immunity.

In an interview with Outlook, Muliyil said, “With a substantial opening up of the lockdown, India may see at least two millions deaths … Mortality is low, let the young go out and work.”

Meanwhile, Modi’s Hindu supremacist BJP is trying to politically exploit the disastrous situation in Maharashtra to unseat the state government, including potentially through the use of “President’s rule.” This anti-democratic constitutional provision allows India’s central government to take over the administration of a state in an “emergency.” India’s second most populous state, Maharashtra is currently governed by the far-right Shiv Sena, until recently a close BJP ally, in coalition with the nominally secular Congress Party.