Taking cognisance of a Central report that has projected a staggering spike in COVID-19 cases in Mumbai, Maharashtra Chief Minister Uddhav Thackeray on Wednesday directed officials to ramp up the State’s response accordingly.
A day after The Hindu reported on a Central report projecting a spike of 6.5 lakh cases in Mumbai by May 15, Mr. Thackeray ordered converting the tertiary care GT Hospital and multi-speciality St. George Hospital into COVID-19 facilities on the lines of Nair Hospital.
In a presentation, senior State health officials said Maharashtra’s peak — taken at a doubling rate of 7 as opposed to the Centre’s assumption of 3.8 days — will result in 80,000 to 90,000 cases in the financial capital by May 15. The State is not completely discarding the projections made by the Centre but believes numbers could be restricted to under 1,00,000 by stringent measures, said an official present during the meeting at Mayor’s Bungalow.
“We are in the process of ramping up facilities at the GT and St. George Hospitals in line with the decision to convert the tertiary care Nair Hospital into a COVID-19 facility. The decision was taken by the Chief Minister,” said Principal Secretary Manisha Mhaiskar, currently in charge of the State’s response to the pandemic.
Earlier, a mathematical modelling study carried out by a Deputy Director General (DDG) rank officer from the Union Ministry of Health and Family Welfare on April 16, projected COVID-19 cases to touch an estimated count of 42,604 by April 30 and jumping to 6,56,407 cases by May 15 in Mumbai alone. The State has countered the methodology and tools used for the latest projection and gap analysis, and raised the “discrepancies” in the modelling with the visiting Inter-Ministerial Central Teams (IMCT).
‘Don’t discard figures’
During the meeting at Mayor’s Bungalow, Mr. Thackeray urged officials not to discard the Central figures even if they appear to be on a higher side. By substantially increasing contact tracing exercise in slums, the State will be able to achieve a doubling rate of 7 and later to 10, he said. “We are not discarding the Central report completely but are only scaling our response, especially contact tracing, to increase doubling rate to 7 and much higher to 10 by May. This way, the numbers will be controlled,” said an official present during the meet.
The Central projections raised a heated debate among experts who argued that the report seems to have completely ignored the State’s efforts to tackle the virus.
Subhash Salunkhe, technical adviser to Maharashtra on pandemic control, said: “The projections look as if the virus has a free hand. The aggressive quarantining activities in Mumbai, the lockdown, social distancing, treatment and recovery of patients and the impact of all these efforts have not been factored in at all,” said Dr. Salunkhe, adding that the projections were made when the city’s case doubling rate was at 3.8 days while it had now come to nearly 7 days.
A former public health official agreed that predictive mathematical models can be uncertain but questions must be asked how prepared is the State even if 15% of the predicted figures are to come true. “A lot of focus has been given to creating new COVID-19 facilities. It will be sensible if the government takes over private healthcare facilities that already have good infrastructure and a team of doctors who are not working at their full capacity,” he said.
Last week, an article published in the Journal of the American Medical Association also pointed to debates on predicting future of the virus. “In predicting the future of the COVID-19 pandemic, many key assumptions have been based on limited data. Models may capture aspects of epidemics effectively while neglecting to account for other factors, such as the accuracy of diagnostic tests; whether immunity will wane quickly; if reinfection could occur; or population characteristics, such as age distribution, percentage of older adults with comorbidities, and risk factors (eg, smoking, exposure to air pollution),” the article said, adding that some critical variables, including the reproductive number (the average number of new infections associated with 1 infected person) and social distancing effects, can also change over time. “However, many reports of models do not clearly report key assumptions that have been included or the sensitivity to errors in these assumptions,” it said.