Inside the wards of the Covid-19 jumbo centre at Mumbai’s Bandra Kurla Complex, on December 24, the staff were spreading out dry-cleaned mattresses and disinfected bedsheets on cots.

The sprawling makeshift hospital, built under fabricated sheets in 2020, had emptied out after it discharged its last Covid-19 patient on November 15 this year.

But now, as Omicron raises the threat of a possible third wave of the pandemic, its staff has begun contacting doctors who had worked there during the first and second waves to check if they were willing to return to work.

Sixteen kilometres away, at another jumbo centre in the Nesco compound in Goregaon, trial runs have begun of five new pressure swing adsorption, or PSA, plants that generate oxygen.

Mumbai is gearing up for a surge of Covid-19 cases, a month after the World Health Organisation on November 26 designated Omicron as a variant of concern.

The city’s daily Covid-19 caseload has risen from 200 to over 900 in the past week, mirroring the current surge in parts of Europe, the United States and several African countries. The daily test positivity rate has doubled to 2.6% in a week.

City officials suspect Omicron could be driving the recent surge in cases – but data is scarce at the moment. Of the 73 cases of the variant detected in Mumbai so far, most are connected to international travel. Officials fear that cases within the community may have gone undetected.

To check for community spread of Omicron, between December 21 to December 31, all Covid-19 positive cases in the city will be genome sequenced.

But city authorities aren’t waiting for better data to revive the systems that helped Mumbai weather the second wave comparatively better than other cities, especially the national capital, where Covid-19 patients died in large numbers as hospital beds and oxygen supplies ran out.

On December 21-22, the officials of the Brihanmumbai Municipal Corporation held meetings, following which they instructed all 24 wards of the city to reopen Covid war rooms and jumbo centres, stock up on medicines for the next three months and hire more medical staff.

The authorities in Mumbai are aiming to have at least 8,000 more isolation beds ready by January 1 across five jumbo centres. “We have decided to increase more beds in a phase-wise manner,” said additional municipal commissioner Suresh Kakani. “We don’t want to hire entire manpower and reactivate all isolation beds all of a sudden. Once our hospital capacity reaches 30%, more beds will be added,” he said.

A ward at the Bandra Kurla Complex jumbo centre where cots, coolers, cabinets and medicine trays have been kept ready. | Tabassum Barnagarwala

Bringing back the staff

Since the last Covid-19 patient at the Bandra Kurla Complex jumbo centre was discharged in mid-November, a skeletal staff comes to conduct vaccination and run a post-Covid outpatient department. “We reduced our staff strength by 80% after the second wave in June,” said the centre’s dean Dr Rajesh Dere.

Dere now plans to hire 300 doctors, 300 nurses and around 400 class IV employees for the 2,328 beds, including 166 intensive care units.

The hospital has a list of 400 doctors who worked during the first and the second waves. Medical officer Dr Sopan Patil said they have started calling up each doctor. “About half of them have started working somewhere else,” he said.

For nurses and class IV employees, the jumbo centre has contacted a private agency to hire contractual staff.

When the first wave of the pandemic had subsided in 2020, the Brihanmumbai Municipal Corporation had let 80% of the staff at jumbo centres go, since the patient count had dropped. In March 2021, when the second wave surged, the civic body had no time to hire and train new staff. The Bandra Kurla Complex centre was recording 200-250 admissions every day and was filled to full capacity within a week. A medical officer said they had to struggle at a short notice to get doctors for so many patients.

After the second wave subsided, the civic body again decided to terminate 80% of the contractual staff at jumbo centres – to save on costs. But this time, they plan to hire before a third wave hits.

“We realised that we need to prepare in advance. We need time to train staff in treatment, protocol and fire fighting,” a senior doctor at the jumbo centre said.

As hospitalisation is expected to increase in January, hiring of medical staff and healthcare workers will be completed by December, said officials.

Stocking up medicines

The Bandra Kurla Complex jumbo centre has also begun purchasing crucial medicines, personal protective equipment, and daily consumable medical items, such as gloves and syringes.

Medical officer Dr Sopan Patil said that during the second wave, blood thinners were in short supply due to the high demand. “Every patient on oxygen support requires blood thinners,” he said. As a result, the cost of one vial shot up from Rs 200 to over Rs 400. “We could hardly find distributors.”

“This time, we are stocking for one to two months,” he added.

The central purchase department of the Brihanmumbai Municipal Corporation has made note of the requirement of medicines from all civic hospitals for antivirals such as remdesivir and favipiravir, the immunosuppressive drug Tocilizumab and the relatively newer monoclonal antibody cocktail. The civic body has floated a tender and additional commissioner Kakani said stock to last all hospitals another three months will be purchased.

Ramping up oxygen supply

Mumbai’s second Covid-19 wave, which began in March and subsided by June, led to an acute crisis of medical oxygen with the peak demand rising to 275 metric tonnes per day. The municipal corporation estimates that the maximum oxygen requirement will increase up to 690 metric tonnes per day during the third wave.

The corporation has created a storage capacity of 1,150 metric tonnes for liquid medical oxygen. Additionally, 43 pressure swing adsorption plants, that can convert atmospheric air into pure oxygen, have been sanctioned. Of them 30 are operational and are undergoing trial runs.

At the Bandra Kurla Complex jumbo centre, five pressure swing adsorption plants will provide 7,500 litres of oxygen per day. Civic officials believe the oxygen storage and production capacity is sufficient even if the peak requirement during the second wave is exceeded in the future.

At the Nesco jumbo centre, 10 pressure swing adsorption plants have been approved, of which five have been funded through a corporate social responsibility initiative. Dean Dr Neelam Andrade said the trial run of five plants is under way. They can provide oxygen to 750 out of 2,215 beds in the centre. For the rest, there are liquid oxygen storage tanks.

Structural and fire audits and inspections of oxygen pipelines to check for leakage are also under way at the jumbo centres.

The municipal corporation has also notified private hospitals to prepare for an increase in admissions. During the second wave, 80% of the beds at private hospitals were reserved for government patients with a cap on maximum charges. Currently, none of the beds are reserved. “We have informed hospitals we can acquire their beds if cases rise,” Kakani said.

The municipal staff have also prepared a list of hotels, dharamshalas, lodges and community halls which can be converted into Covid care centres at short notice.

New pressure swing adsorption plants are undergoing trial runs in Mumbai. Of 43 sanctioned plants, 30 have been set up.

Stepping up surveillance

In Kurla in eastern Mumbai, medical officer Dr Jeetendra Jadhav said he is seeing an uptick in daily cases of Covid-19 – from five to 15 in a week. Most are restricted to the residents of high rise apartments. “We don’t know why, but most cases continue to come from non-slum areas,” he said.

An analysis of the small pool of Omicron cases in Mumbai shows that most of those infected remain asymptomatic and none have a severe infection.

While the positive cases under Jadhav’s watch had not been confirmed to be Omicron infections, he noted that 90% of them remained asymptomatic or showed mild symptoms, up from 80% during the second wave.

This made the task of detecting Covid-19 cases even more challenging: since most people remain asymptomatic, they do not opt for a test until they show symptoms or are close contacts of an infected person.

“To detect more cases, we will have to conduct more random tests,” Jadhav said. “We have increased surveillance. I have also instructed my health workers to test 20 contacts of every Covid-19 positive case.”

Simultaneously, the civic body is also trying to rapidly cover the entire population with both doses of the vaccines. The city has administered the first dose to 100% of the eligible adult population and second dose to over 80%. Every day, around 50,000 people are vaccinated.

A non-governmental organisation has tied up with the municipal corporation to raise awareness about vaccination in Kurla slums. A team of doctors and nurses vaccine people by the road in this vehicle.

The central government on Sunday approved vaccination for teenagers aged 15-18 years and a booster shot for health workers, frontline workers and senior citizens with co-morbidities from January 10, 2022.

Immunisation officer Dr Sheela Jagtap said Mumbai has an estimated population of nine lakh in the 15-18 age group. “We are planning on how to start their immunisation. The announcement just came,” Jagtap said.

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.