Coronavirus: Why Maharashtra has become such a hotspot?

Maharashtra has taken the biggest hit from the outbreak of novel coronavirus. It has become the first state to cross 3,000 Covid-19 cases in the country even as the total case count surged past the 12,000 mark across India. The state is the worst-hit in the country with a number of areas falling under the red zones reporting large outbreaks.

Mumbai: In terms of both the number of corona cases and the deaths in the country, Maharashtra tops all the states. The worrying thing is that the speed of the spread in the state is very fast and the mortality rate is very high. In fact, at 6 to 7 per cent, mortality is said to be the highest not just in the country but in the world.

The only solace, if at all, in this difficult time is its limited spread in terms of geographical area. Mumbai and Pune are the only two major hotspots in the state and the spread beyond these two cities has been limited at least for the time being.

Mumbai and Pune

A total of 414 deaths were reported from across the country by the evening of April 16, out of which 187 or 45 per cent, had happened in Maharashtra. In fact, 25 per cent or 3000-plus of the total 12000 plus cases in India are in Maharashtra. The Mumbai Metropolitan area, including Thane, Vasai, Panvel, Navi Mumbai and Mira Bhayandar, together had registered almost 70 per cent of these deaths, while Pune had reported 38.

If you look at the figures, as on Tuesday, out of the total 36 districts only five districts have more than 20 cases recorded so far. They are Nagpur, Aurangabad, Nashik, Ahmednagar and Sangli. Even amongst these, the corona spread in Sangli has subsided. And in Nashik city, there are only two cases, while the power loom city of Malegaon which falls in Nashik district has recorded about 24 cases. In the rest of the district, there are no cases so far.

Secondly, even among these five districts, the spread of Corona is limited to the major city areas. There too, the number of deaths has been only one or two. It has been more than a month now since the first case was reported in Nagpur. But today it has only 56 cases and only one death. Incidentally, the first cured patients were also reported from Nagpur. In the rest of Maharashtra, the number of cases recorded in almost all the districts so far is less than seven.

Some inferences could be drawn from this data:

1. The hotspot in Maharashtra is mainly limited to Mumbai and Pune area.
2. In rest of the districts and rural areas, so far, the containment has been successful. Most of them are having only two or three cases.
3. The three districts are free from Covid-19 so far, namely Wardha, Gadchiroli and Chandrapur.
4. The spread in the rest of Maharashtra (like in Nagpur or Aurangabad) had been mainly owing to
5. foreign travel connection. Since most of such trajectories have been detected, the figures have stagnated in these cities.
6. In some districts like Nashik(Malegaon) and Buldhana there had been a spread because of the Tablighi connection. And the infection has remain local so far.
7. In the meanwhile, there had been success stories like Sangli. There, 22 persons from one extended Muslim family were attacked by the virus. It all began from a person who had come from Saudi Arabia recently. But very stringent measures taken by the local adminstration bore the fruits and most of them have now been cured. The number of cases in Sangli is just 26 and the number has got stagnated.

Why Mumbai and Pune?

Mumbai with a population of 1.40 cr and Pune with about 75 lacs are the two main cities which attract the people not just from the state but from all over the country. Mumbai being a business capital and Pune being an IT hub, both cities experience huge incoming and outgoing of international travellers.

And as is the well-known majority of the Covid cases are linked to those who had travelled abroad or have come from foreign countries. It is also true in Maharashtra in about 90 per cent cases. Though some 150 kilometres apart from each other, Mumbai and Pune are so interlinked with each other that in future this whole area is likely to emerge as one giant urban cluster.

For the record, about 35000 cars ply on Mumbai-Pune Express Highway every day. A State Road Transport Corporation bus is available every 15 minutes all the 24 hours from both the cities to go to the other end. Apart from them, there are hundreds of private transport operators who carry lacs of passengers to and fro each day. Considering this kind and scale of exchange, it was almost a given that the spread in any one of them was to reach the other sooner or later.

On this backdrop, it was not quite surprising that the intensity of the infection in both the cities was almost the same. Mumbai being hugely more populated and its density being far higher than Pune, the number of cases in the former are expectedly on a higher side. It may well be remembered here that almost similar scenario had emerged during the Swine-Flu outbreak a few years ago. Then, however, since the Flu virus survives better in a cooler climate, Pune suffered more than the humid Mumbai.

Uddhav did well initially...

The three-party government under the leadership of Uddhav Thackeray took some early steps to counter the Corona outbreak. Maharashtra was among the first states to put restrictions on people's movement and banning public activities. In fact, as transpired later, Thackeray government wisely refused the permission to hold Tablighi Jamat congregation near Mumbai.

As is well-known, subsequently happened in Delhi and proved to be a big spoiler in the efforts of containment of Covid in India. With Corona remaining limited to the cities, and that too, mainly to Mumbai and Pune, Uddhav was in a better position to handle it, because, the public and private medical facilities in both the cities are in better shape than, say, in rural areas.

Secondly, Brihan-Mumbai Municipal Corporation (BMC) runs three very eminent medical colleges, perhaps only of its kind of instance in the country and a lot of hospitals across the city. Incidentally, BMC is ruled by Shiv Sena for almost 25 years and Uddhav Thackeray being the chief of Sena is quite well-conversant with the functioning of this medical system. So despite being a novice in the state administration, Uddhav did not have any problem in dealing with the situation initially.

But then faltered...

But his tough challenge lied elsewhere. Given the fact that the Covid-19 spreads with even a thinnest or smallest of the contacts, it was feared that if it finds its feet in Mumbai it would wreak havoc. And this nightmare has come true at its worst. As is known, Mumbai is densely populated and Mumbaikars depend on public transport than in any other city. About 85 lac people travel each day by local trains and public buses in the metro.

And despite it being one of the worst commuting, people prefer it because it is the fastest and cheapest mode of transport. For example, one-way ticket for about 30-kilometre travel by local train costs only about Rs. 3 to 4 in Mumbai. And even if you travel by first-class it is about 25 to 30 rupees. Hence from a person earning Rs. 100 a day to a diamond exporter – everybody travels in a local train in Mumbai.

And even in the worst of the times Mumbai local train travel never stops. Even when Kasab had attacked Mumbai on 26/11, trains were running. And even when the deadly serial bomb blasts happened in the

local trains itself, the trains kept on running. On this backdrop, for a lockdown to be effective, a complete halting of the local trains and buses was the first precondition. But given the fact, that the daily livelihood and surviving of millions of citizens was and is dependant on this rail/bus travel, it was not an easy decision. Naturally, Uddhav delayed it as much as possible.

And even people at large also did not want to happen it. How far this delay contributed to the spread of the Covid is quite debatable. But in a way, the decision in itself was indicative of the response. The response, not just of the government but of all the people.

People are equally to blame

Till very last, people in Mumbai as also persons in administration and the government as a whole thought that the pandemic would not go this far. They thought that small precautions here and there would work for them. They thought that they had successfully dealt with Swine Flu in the past and will be able to do so this time as well. Clearly they did not see it coming.

And even on the day when finally the train travel was shut, people thought that they could still travel in their own cars and two-wheelers. So it went on for two-three days. Later, even when their travel to their work-places was blocked, they kept on coming to the roads for many reasons. In many parts of the city the life went on as if nothing has changed. Markets remained opened, people kept coming and going. Only in the last week of March, slowly it dawned upon the people and the government that they need to be more restrained in their activities. But perhaps it had become a little late, which is now reflecting in the figures.

In other cities, a similar situation prevailed. In Pune, it was worst. Most of the people in the city are not dependent on public transport to reach to their workplaces. So they continued for some time to keep travelling and working. The police and administration had to take some harsh steps to restrict their movements.

But in the meanwhile, the Covid-19 had found its feet. The outbreak had entered its next phase. Now the speed and reach of the spread had increased. Once this happened, the inadequacies in the public medical system started becoming evident. There were shortages of everything – PPE to doctors and nurses and medicines. A lot of complaints are coming from everywhere about the shortages, unhygienic conditions in the hospitals, inordinate delays in the treatment etc. Clearly government medical facilities are incapable of coping up with this kind of pandemic.

Of course, one thing is sure, this is coming to fore in Maharashtra and Mumbai because the spread has been very severe. Had it happen on this scale anywhere else in the country the situation would have been no different, if not been worse than this.

Confusion in the strategy-

With the spread growing at a rapid speed the government fumbled on a few counts. For example, it thought that the best thing to avoid the crowding of public places was to allow the grocery and other shops for a maximum period of time. Hence, Uddhav Thackeray took an unusual decision of allowing these shops to keep open for 24 hours. But it did not help. On the contrary, this provided a pretext to the people to come out in open more and more at all the hours in the day.

Similarly, there had been a lot of confusion about keeping open the Agricultural Produce Marketing Committee markets. Navi Mumbai's Market, which is one of the biggest in the country was kept shut for two days. But later it was reopened on Monday. But there had again been news of some restrictions. Such frequent changes and inconsistencies add to lot of confusion.

Government has also not been consistent in taking over the hospitals run by central agencies like Railways or private or trust-run hospitals. For example, very big hospitals like Leelawati, Raheja which are just stone's throw away from Dharavi have not been utilised so far the way they could have been.

Testing Times

Conducting the tests was another similar issue. Though, generally speaking, Maharashtra and Mumbai have conducted more tests than any other state in the country there had been inconsistencies here as well. Out of the total 46588 tests conducted in Maharashtra till April 14, around 24279 have been done in Mumbai alone. Over 2,200 have tested positive, of which 10% have gone back home after recovering while 32 are serious. But, though, Maharashtra leads in conducting the tests, experts feel that more extensive testing in some densely populated areas in Mumbai and Pune would have helped further. Now in some areas the government has started door to door surveys.

Chief Minister Uddhav Thackeray announced recently that, special team of experts had been constituted for framing guidelines for such tests and surveys. Perhaps such a team should have been formed a little earlier. Now certain areas have been declared as special containment zones where a complete curfew has been imposed and door to door supply of daily needs has been arranged by the government. Further, rapid testing will begin after April 17, i.e Friday.

Rapid test is a cheaper and faster test that shows whether a person has developed anti-bodies against the virus. But now only symptomatic persons are only to be considered for tests and even those unsymptomatic but who have come into contact with foreign travellers will be excluded. One may comment on it only in the hindsight whether this is a correct approach.

Finally, a long term strategy-

The government has, perhaps, now realised that it is dealing with a problem which is going to be here for a very long time to come. Hence it is now seen to be formulating a long term strategy. As a part of this, it has set up a five-member death audit committee for analysing each death in Maharashtra. The state’s death rate stands at 6.8 per cent, among the worst-hit in India.

In Mumbai, which accounts for 60 per cent of deaths in the state, a separate nine-member committee has been formed. These committees will go into the cause of each Corona deaths in the state. Their analysis will help decide various treatment protocols and patient management in various situations. As Dr Archana Patil, chairman of the state committee said, “these committees will help decide the course of medication to be adopted as also when to shift the patients to another hospital or in intensive care units.”

Doctors have so far failed to see any uniform pattern in deaths. There are people of same age group with the same co-morbidity who are reacting differently to the virus. For example, not every heart patient or a diabetic is responding to the virus attack in the same manner. Hence the reports of these death audit committees would help in a long way.

While interacting with doctors all across the states through video conferencing, Uddhav Thackeray said that he wants to see the mortality rate in Corona cases to bring to zero at the earliest. This target is good but does not seem to be achievable in the near future.

A Special Box- What about Dharavi?

As is well-known, Dharavi, supposed to be the largest slum in Asia, where about more than 10 lac people live within an area of 2.5 sq. km., is again in the news all over the nation during this Covid19 season. This densely populated place is quite famous across the globe and is quite popular destination for international media persons. In fact, after the success of the film Slumdog Millionaire, tour operators started arranging for regular slum tours in Dharavi and they have become very popular and profitable.

With the outbreak of Corona many were worried that if it visits Dharavi the mortality rate could go into thousands given its density of population. Hence when the first case was reported in Dharavi's Baliga Nagar, it became national news instantly. Since then, with media keeping a keen vigil, Dharavi is constantly in news. And it will not be untrue to say that everybody is expecting something worst to happen in Dharavi.

Fortunately, so far, the speed of the spread in Dharavi is slow. And even the spread has not affected the core Dharavi, so to say. As said earlier, it all began in Baliga Nagar and later cases were reported from Diamond Nagar, Shahu Nagar etc. These areas are a kind of better-off parts of Dharavi. In fact, most of the buildings in Baliga Nagar are having good number 2 bedroom kitchen spacious flats. Many well-off traders live here. In the second week of April the cases emerged from the slums in Janata Nagar etc. But its speed is slow. So far about 60 cases have been registered and according to the government norms, since the number is less than 85, Dharavi is still not in hot- spot category.

But the speed of spread so far could very well be deceptive. Covid-19 could find fertile ground in this place, where most of the slums do not have private toilets and each public toilet is used by approximately 250 persons in a day and where 14-15 people could be staying in about 100 square feet area with a mezzanine floor kind of arrangement. Now the government has taken some measures of doing a door to door surveys and providing for the HCQ tablets to the probable patients in Dharavi.

But the government has a daunting task to face ahead, as executing the idea of social distancing is highly improbable here. Even for going to toilets or getting water for daily needs, people have to come out in the open. The only answer to this problem could be evacuating Dharavi and take the people to some shelter camps. But given the size of the population, it is not going to be easy.

And Dharavi is alone in Mumbai. There are equally large slums elsewhere in Mumbai like Mankhurd, Malvani or Kurla etc. Corona began in high places, got spread through the high profile airline travellers and initially affected a large number of middle class and well to do people. To an extent, the ideas of lockdown may work while dealing with the spread in this segment of population. But for any government the real hard battle is going to be when the Covid-19 changes its class and goes downwards.

Dharavi could be one of the toughest of the battle places.