COVID-19 outbreak in India

India has suffered a particularly severe second wave of COVID-19, with more than 400,000 new infections registered on a single day—the highest ever daily count recorded globally. Since 30 January 2020, the country has accounted for 17 per cent of the world’s COVID-19 cases and almost 10 per cent of the global coronavirus related deaths. Having started in March 2021, the 2nd wave in India is currently declining, although underreporting and access to testing affect the reliability of data and epidemiological trends can vary significantly from one place to another.

In Mumbai, a densely populated city in the state of Maharashtra where 42 per cent of the population are living in low-income housing, the poor living conditions and lack of hygiene facilities have put people at high risk as coronavirus spreads. Maharashtra accounted for more than 20 per cent of India’s confirmed new cases of coronavirus in April. MSF is responding in Mumbai through dedicated treatment facilities and community testing and education programs in order to slow the spread of coronavirus. 

WHAT CAUSED THE CRISIS

From October 2020 to mid- February 2021, India experienced a decline in new confirmed COVID-19 infections. Some public health experts believe this lulled people into a false sense of safety, with many abandoning physical distancing and mask wearing. India’s high population density has also made it difficult to follow required measures in public places. 

“No one was ready for the second wave," says Medical Coordinator Mabel Morales. "In a very short time, it’s turned into a major crisis. The authorities here are well-organised and are adapting to the situation as it evolves as best they can. But as the cases increase, it’s getting harder to find beds. They’re calling from hospital to hospital trying to refer patients, but they’re struggling.” 

WHAT ARE MSF’S BIGGEST CONCERNS?

Vulnerable groups: Those who are particularly vulnerable include people who have existing illnesses, such as diabetes, HIV, or tuberculosis. Other vulnerable groups include those in temporary or inadequate housing, where distancing and adequate hygiene measures are almost impossible, as well as the elderly. 

“For patients with lung complications from tuberculosis, there are concerns that they may deteriorate faster," says Aparna Iyer, MSF Project Medical Referent. "We’re also worried that people may not be accessing TB care because they are scared and worry about what will happen if they get COVID and become serious, and what may happen to their families… my main concern is oxygen availability and bed capacity for patients with TB as it’s also an acutely deteriorating illness.” 

Staff infections: Staff can be overwhelmed by large numbers of patients, leading to a reduced and exhausted workforce and increased transmission rates within healthcare staff. Safety for healthcare workers should be a top priority in every healthcare facility, as they are the first line of defence in the pandemic. 

Inadequate access to healthcare: The surge in severe cases of COVID-19 has increased the number of people requiring hospitalisation and oxygen therapy. With the increasing number of cases—and the heightened need for hospital beds and dedicated care—it is likely that the health system will be further stretched. 

HOW MSF IS RESPONDING

MSF’s response in Mumbai is focused on three areas: 

Supporting health authorities: MSF is collaborating with the Municipal Corporation of Greater Mumbai in Maharashstra in a dedicated COVID-19 health centre with 2,000 beds. We are supporting this centre with a team of laboratory technicians, anaesthesia technicians, doctors, nurses and psychologists, who are working to improve the capacity for the care of moderate and critical COVID-19 patients.  

Equipping healthcare staff: We are focusing on recruiting and training new staff, and providing mentorships and psychosocial support to healthcare staff working in COVID-19 treatment centres. 

Community education and screening: Educating communities on the spread and prevention of COVID-19 is key to ending the outbreak. We are scaling up screening, shielding and testing activities, and our teams have restarted digital health promotion and water and sanitation activities in east Mumbai to help the most vulnerable avoid infection in densely populated informal settlements. We are distributing hygiene kits with masks, disseminating health messages via advertisements on tuk-tuks, and providing psychosocial support to vulnerable groups. 

Our key responses in Mumbai

• We have deployed doctors and nurses to BKC hospital (known as Jumbo Hospital) in Mumbai, where there are two wings dedicated to treating COVID-19 patients. Each wing can admit up to 1000 patients. 
• We are collaborating with the Municipal Corporation of Greater Mumbai in Maharashtra by managing one of the Dedicated COVID-19 Health Centres (DCHC), working to improve the care for patients with moderate and severe cases of COVID-19.
• We are ensuring continuity of care for our patients with drug-resistant tuberculosis at the Shatabdi hospital outpatient department and our independent clinic.
• We are scaling up screening, shielding, testing and referral activities in the hospitals we work in, nearby communities, and nine health posts. These shielding activities focus on vulnerable groups in informal living situations, elderly people, and patients with existing illnesses who are more susceptible to contracting COVID-19. 
• We have set up mental health support to help patients manage their anxiety while in isolation and separated from families and loved ones.