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MUMBAI : In the middle of May, India’s worst virus-hit city Mumbai woke up to an unpleasant realisation: The monsoon was coming. While distress and disease have always followed the torrential deluge, there was an added problem this year. The city’s fragile and patchy health system had already been swamped by covid by mid-April.

What happens when malaria and dengue cases begin surfacing right in the middle of a pandemic. Frenetic, though delayed, preparations have been on for two weeks. “There is a huge mobilisation on the ground. I am not sure if any Indian city has seen a public health ramp-up like this," said Pankaj Joshi, executive director of the Urban Design Research Institute (UDRI) in Mumbai.

Neighbourhood-level fever clinics, an annual early surveillance mechanism for monsoon diseases, have been in place since early April to track the spread and prevalence of all respiratory diseases. But something is different this year, Joshi said. “It is far more extensive. There is almost one clinic for every 1000 households. I hope they make these clinics permanent and run it through the year. This could virtually transform public health in the city," he added.

The health hurdle
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The health hurdle

How Mumbai handles the unfolding 2-3 months – and what it chooses to make permanent – could thus offer valuable lessons for all Indian cities, as a phased unlocking of the country’s urban hotspots begins this week.

Despite 21st century visions, most major cities still tackle preventable, 20th-century illnesses almost every year like clockwork. Small signs of progress were starting to surface only recently. Last year, for instance, Mumbai didn’t record a single malarial death for the first time in a decade. And now, there are already early calls within Mumbai to make the covid-induced health ramp-up more sticky and to include primary health services as an important part of all future urban planning.

If nothing else, the country’s financial capital will have a better alarm system in place for any other SARI (severe acute respiratory infection) outbreak, said Dr Daksha Shah, deputy executive health officer, Municipal Corporation of Greater Mumbai.

“Infection control has become a priority. I think even after the pandemic passes, this will become regular practice," she said. “Another realisation is the need for streamlining data management. We have good systems in Mumbai for reporting Tuberculosis but that needs to be done for other infections as well," Shah added.

But much will depend on having permanent staff for core public health tasks like disease surveillance and local outreach, said Armida Fernandez, a former dean of Mumbai's Sion municipal hospital. “Right now, some of the staff have been hurriedly pulled out of other departments like the state’s ICDS programme because of the pandemic."

“The public health system clearly did not keep pace with the city’s population growth at least since the 90s. But over the last couple of months, while some private hospitals have shut after a few covid cases surfaced, the public health system has realised that it cannot close down," she said.

Now, with the monsoon around the corner, I am definitely worried, Fernandez said. “September and October will be difficult (if covid persists and other diseases show up simultaneously)."

(Tanya Thomas contributed to this story from Mumbai)

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