Maharashtra / Night of April 16-17 one of the toughest in career, shifted 168 patients: BMC chief

Mumbai: Iqbal Singh Chahal recounts night of April 16-17 “that changed us forever”, explains how he made oxygen shortage “history” in Mumbai, lists lessons for Delhi, including not pressuring hospitals to increase beds, and lays out plans for “vaccination tsunami”. Session was moderated by National Editor (Mumbai) Nirupama Subramanian

NIRUPAMA SUBRANIAN: You said that the intervening night of April 16-17, when as many as 168 patients were evacuated in an emergency operation from six civic hospitals in Mumbai, as one of the most difficult nights of your career. Why did you feel that way?

The issue of oxygen first came up at a meeting around the first week of April. It was mentioned that Maharashtra’s total installed oxygen capacity is roughly 1,200 MT, which included industrial, non-Covid and Covid use. By April 4-5, the state’s six lakh positive cases had started consuming almost 950 MT of oxygen. In our meeting it was projected that by April 15-20, our consumption may go up to 1,700 MT. That is when the alarm bells went off. We realised that even if we stop all industrial operations as well as non-Covid oxygen use, we still can’t manage beyond 1,200 MT of oxygen… So we requested the Government of India to give us an additional allocation of 500 MT. About 150-200 of this additional allocation was coming from Haldia in West Bengal, and for the tanker to reach Mumbai, the turnaround time was around eight days.

In the midst of these talks, on the intervening night of April 16-17, I was informed around midnight that six hospitals were running out of oxygen. There were 168 patients there… So between 1 am and 5 am, we deployed 150 ambulances and brought these patients to our jumbo Covid centres. Fortunately, we had 3,600 empty beds, of which 850 were oxygenated beds. I was so relieved that no lives were lost.

After the operation, I couldn’t sleep at all, and around 7 am I sent messages to top functionaries of the Government of India, including the Cabinet Secretary, Home Secretary, Health Secretary… I sent another set of messages to top eight leaders of Maharashtra, starting with the honourable CM. I said, this is not the end of the problem and this may happen again.

Within 15-20 seconds, I had an incoming call coming from the Cabinet Secretary, Rajiv Gauba. He told me, tell me what you want… I said we have to import oxygen into the state. I told him that we can’t manufacture oxygen at such short notice and that the turnaround time for oxygen coming from Haldia was around eight days… I worked under Gauba sir when I was joint secretary in the Ministry of Home Affairs… I told him that Reliance Industries was just 16 hours away from Mumbai, in Jamnagar, and oxygen tankers can come from there every night. He said that such an allocation cannot be made just for one city. I told him that he can allocate it to Maharashtra and I will make sure that it comes to Mumbai city only… And then 125 MT of oxygen was allocated to us from Jamnagar. The same evening, tankers started moving and now the problem (of oxygen) has virtually become history in Mumbai because of great help from the Government of India.

NIRUPAMA SUBRAMANIAN: So, would you say that Mumbai is now self-sufficient in oxygen?

Unfortunately, outside Mumbai, in the rest of Maharashtra, cases are not coming down. Mumbai is only 17% of the state’s population, and the demand (for oxygen) from other parts has not reduced.

After the April 16-17 incident, the state government created emergency systems. The FDA (Food and Drug Administration) Commissioner was given charge of allocating and organising seamless distribution (of oxygen). Only oxygen availability is not the issue, the bigger issue is optimal utilisation and proper channelising. That is why a team was created under the FDA, which has district collectors, divisional commissioners, BMC commissioner, and other commissioners… The team is functioning very well. So we are in good situation, but in 10-15 days, when cases start coming down further in the state too, we will become a little more comfortable. Now, stress is there.

SHUBHAJIT ROY: While you reached out to top bureaucrats and ministers after the April 16-17 incident, don’t you think there should be an institutionalised mechanism to address such issues?

I agree with you… In the first week of April, our crisis management team started discussing the oxygen crisis. It had started to build up but nobody knew that things were going to happen so fast and suddenly… In Mumbai, we have established six emergency stock points, which function 24/7 and store about 50 MT of oxygen each. Each point services four wards (there are 24 in Mumbai)… Now, if anybody gets an SOS call, they have to forward it to the ward officer, which is then sent to the deputy commissioner in charge of one of the six emergency points. And then, in two-three minutes, tankers start moving with supplies… We have learnt from our experiences, and our crisis management team continues to add on new activities to the mechanisms.

MALLICA JOSHI: Delhi has been experiencing oxygen shortage for over three weeks now. What could be the reason behind this sustained crisis?

In oxygen management, there are five areas which need to be taken care of. First is availability of stock and dedicated supply. Like from the moment an oxygen tanker leaves the manufacturing unit, it should be clear where it is going, and who is going to take custody of the tanker… Second… what is happening in many cities, including Mumbai, is that when the Covid pressure builds up, the administration tells the hospitals to add on beds. They don’t realise that the capacity of installed oxygen tanks is limited, and has a turnaround time of 24 hours.

At a meeting of Delhi government and Central officials on Wednesday, I said that this is the single biggest reason why SOS calls are coming… I said if you want to increase beds like Mumbai, don’t pressurise the hospital… What we did was to have more beds at jumbo centres which also have higher oxygen capacity. Now, we are building oxygen plants there as well to have in-house oxygen manufacturing for the jumbos. It will be implemented in the next three-four weeks. We have seven jumbos with 9,000 beds and another four are coming up with 6,500 beds. And, 70% the beds will be oxygen beds. So I told the government of Delhi that make sure that hospitals should not be forced to add on beds because that leads to crisis.

The third issue is of leakage of oxygen. So you should have emergency stock. We have the six points in Mumbai… So emergency stock can be rushed in time. The fourth point is related to our state taskforce which is headed by Dr Sanjay Oak and has many eminent doctors. I asked them to give us a protocol for oxygen consumption. They said saturation level should not be maintained beyond 94, and we circulated the protocol to all of Mumbai’s 176 hospitals. There is no need for saturation of 97-98.

And lastly, they (the task force) also said that high-flow nasal oxygen is a guzzler. You should not blindly give it to everybody just because it’s available. It should be used as a last resort. We also told hospitals that you should do your daily oxygen consumption audit — what was the per bed ratio — and try to reduce it by 5%. The government of Delhi agreed that high-flow oxygen is a guzzler and that they will revisit it.