As Mumbai emerges with the highest count of coronavirus (COVID-19) positive cases in India, BMC Commissioner Praveen Pardeshi tells The Indian Express that the city should be prepared for more cases because there is more testing here than in any other part of the country. He talks about his plans for protecting municipal healthcare professionals and other staff from the infection.

Q. What challenges have you faced in trying to prevent the infection from spreading in a massive and densely-packed city such as Mumbai?

A. For about 400 to 430 positive cases, there are roughly 12,000 traced contacts. All don’t need to be in institutional quarantine, so we are focusing on those who live in slum areas. On the last count (as of Monday morning), we have forced 1,200 people out of their homes and into institutional quarantine — one example was Worli Koliwada — at hospitals, halls, lodges etc. The challenges we face are in looking after their hospitality, their logistics. Our ward officer, who is one person on the ground, is busy in finding out which are the positive cases are, locating their contacts, making arrangements for their containment and ensuring food supplies. Now, when you take all those arrangements in addition to regular duties of keeping the city clean, of keeping the water supply, power and the sewerage going, it is an onerous responsibility. We have more than 10,000 rooms vacant at lodges. We have now requisitioned all of them and and are putting all close contacts — not positive cases but close contacts — in such places under 14-day quarantine. They can’t run away from there and we can keep an eye on them easily right from the entrance. So these are the biggest challenges in terms of quarantine.

Q. How much manpower do you have for keeping a track of all quarantine facilities and for providing essentials?

A. We have provided staff to each ward officer from the central agency. Home guards and others have also offered to help. I am going to discuss with Sanjay Pandey, Director General of the Home Guards, to deploy home guards to guard quarantine facilities.

Q. How long do you think the lockdown should continue for Mumbai to be able to flatten the curve?

A. The curve has still not reached its full potential. Even in Dharavi, we found people who had gone to Nizamuddin (Delhi’s Markaz Nizamuddin, headquarters of Tablighi Jamaat). Now, they are coming one after the other and that period might go on for the next 13 to 14 days. We will have to assess the situation on April 14 and decide. I don’t think we can take that call now.

Q. There are also 56 cases (as of March 31) from Mumbai who do not have any foreign travel history or known contact with a positive person. Is community transmission taking place?

A. On the last count, 50 per cent cases have travel history and 40 per cent are close contacts. We could not trace only 10 per cent, so we can’t say whether community transmission is taking place. We will know in the next four days. There is still no clear evidence.

Q. How many BMC staff, including nurses and paramedics workers, are under quarantine?

A. It’s not a big number. We are being innovative now. So, Ashotoush Salil (joint municipal commissioner), Kiran Mazumdar Shaw (chairperson and managing director of Biocon Limited), Dr Nene (Dr Sriram Nene) and a Delhi-based group — all of them have got together with us and we are strategising to procure rapid antibody detection test. Though that can’t affirm whether a person is positive or not, what it does affirm the presence of antibodies, which can help us understand who will be able to face the viral attack. Two weeks from now, I want to categorise (BMC staff) into two — those with positive antibodies will be more confident to work at COVID hospitals, screening centres, fever clinics, and those who don’t have the antibodies can work in offices, EPID cell and help in planning and data crunching. That’s how we are going to safeguard our people. I am going to include bus drivers and ambulance drivers as well.

Q. Is this also for the general population?

A. First, I want to test our staff. It’s not a test that has been recommended but it has been enabled. The ICMR (Indian Council of Medical Research) does not ban the test. It doesn’t say anything. It only says this is the test that we have recognised.

Q. How many personal protective equipment (PPE) do you have in stock as of today? Are they enough?

A. We have 15,000 PPEs. They are not enough. We have given an order of 80,000 and, fortunately, private planes from big corporations have lined up to pick them up and bring them here. I don’t have a transport problem. Wherever there is a supply, they are willing to pick them up.

Q. There are at least two cases in which a person has died and the family members have not been tested immediately, but two or three days later even though they are in the highest risk category.

A. I agree but this has happened because we are testing 890 people per million in Mumbai. Despite the strategy, we have a lag. We have now enabled seven private laboratories, and another two have been roped in. We have testing constraints, but the whole of India is on one side and Mumbai is on the other. That is the level at which we are testing. We are trying to expedite and Kasturba hospital is working in three shifts. JJ hospital and other hospitals are working in one shift but the chief secretary has ordered them to work in three shifts. Private labs have more capacity but they don’t take in poor people. So, I have told all of them they have to conduct 25 tests daily for each BMC clinic for the poor people, that is people who are from the sanitation department or slums. They have agreed and I am hopeful this will reduce the burden on others.

Q. Do you have any projections for COVID-19 numbers in Mumbai in the coming days?

A. One model that we know of, for which the basis is not clear, is 300 cases per million, because of the Italian numbers That is one extreme. China was 10 per million, confining it to one province. It was being said India will reach between 50 and 1,200 per million or Maharashtra could reach at least 300 per million. So 300 means 3,600 cases in Mumbai. We have to find where these 3,600 cases are and that’s why we are taking an aggressive approach to tracing them rather than reacting.

Q. The state government has criticised the BMC over contact tracing. Do you think contact tracing in Mumbai could have been better?

A. There is no criticism. You can talk to the chief secretary and get back to me. I did not get any such feedback. It couldn’t have been better. The BMC is receiving information about people approaching private labs, and then we do their contact tracing for them. We have traced quite a large number and the tests are accurate. We have been able to get all contacts tested, and those who are positive, are being put in isolation. Just saying that 50 or 100 people have been quarantined or traced does not help. They are going to infect others, including those in quarantine.

Q. How many tests have you done in Mumbai so far?

A. We have conducted 10,500 tests in Mumbai city so far and you can compare it with the rest of Maharashtra. Forget Maharashtra, compare it with other states like Kerala, which has the second highest number of cases or even Delhi, which has 3,200 tests. If you are slightly well off you can get a home test or directly visit a lab. This is much better since hospitals don’t come under pressure then. The queues at Kasturba have reduced since we are going to people. Rich people can do this but poor people can’t, so we have opened fever clinics for them. We get 500 to 600 people at these clinics daily and for 10 per cent, swabs are collected for testing. About 400 swabs have been collected and sent for testing from these clinics.

Q. Private hospitals are facing issues. For example, at Jaslok and Wockhardt, some staff have tested positive and they have been put in containment and these hospitals sealed. They are not taking patients. Can the government do something to help them come up with a solution?

A. No, they are not being shut down. Saifee, for example, is admitting COVID-19 patients. Nanavati as well. Jaslok and Wockhardt are opening for treatment of non-COVID patients. Seven Hills, Saifee, Nanawati and Kasturba will be dedicated COVID hospitals. Also, cases that are non-symptomatic will go to Sai Hospital in Dharavi and Poddar Hospital in Worli. We are helping Jaslok and Wockhardt by taking them off COVID cases. We are telling them to screen COVID cases right at the gate and tell them to go to other specialty hospitals. Jaslok and Wockhardt hospitals will be shut for a few days till they can move their staff into quarantine and the area is completely sanitised. They have told me that they will open.

Q. There are BMC workers, including sanitation staff, who are going on leave for fear of contracting the infection. How is the BMC dealing with this?

A. We are trying to bring up their morale up. We are giving them Rs 300 extra daily. We are giving them protective equipment. For ward boys, extremely poor civic workers, we are giving a package of Rs 1,500 grain coupons. We are using various CSR (corporate social responsibility) funds to provide them with a month’s supply.

Q. The highest number of cases are in Worli, mostly in slum and chawl areas. Were you able to find a reason behind these cases?

A. We have managed to find index cases here and in Dharavi. The index and their contacts have been traced. That is why some 300 people from Dharavi and the Worli fishing village have been moved out to Sabagruh and Poddar hospitals.

Q. There is a perception that the BMC is attempting to hide information and delay information about cases.

A. We wouldn’t be reporting or doing so many tests if we wanted to hide information. Nobody asked us to do these tests. There were differences in information that was being uploaded by us, we were displaying information of evening the next morning. We took six to seven hours to validate before uploading the information. To put deaths as COVID-19 or non COVID-19 require time.

Q. Is there a need for better communication between the BMC and the state government?

A. There was a need earlier. Now that the state government has appointed a communications person (Ashwini Bhide, former MMRC head), the issue has been sorted out.

Q. People who have cough and cold are going to government hospitals for COVID testing and are being turned away because they have no travel history. It has been noticed that there is a delay in treatment and these patients are being admitted only when they are critical. Is the government still prioritising tests for those with contact or travel history?

A. These people should visit fever clinics, there are 10 in the city slums and they decide whether a person needs testing. They can also go to COVID hospitals. Even cities like London have just one COVID hospital, all other hospitals don’t admit people just like that. If people are showing symptoms they must be tested.