On July 8th, the Municipal Corporation of Mumbai’s figures showed 87,513 COVID positive patients in the city.  59,238 people have shown symptoms and are awaiting test results. Mumbai continues to be the worst-affected in Maharashtra and newer hotspots in the Mumbai Metropolitan Region such as Navi Mumbai, Thane, Kalyan-Dombivli are mushrooming. The government is struggling to ramp up health infrastructure even as complaints of lack of ambulances, beds, and other health facilities mount.

Here’s a step-by-step guide on what to do if you are tested positive for COVID-19 in Mumbai: 

When to worry: The onset of symptoms is usually between 2 and 14 days from exposure. If you detect early symptoms such as fever, dry cough, fatigue, shortness of breath, sore throat, congestion, headaches, body ache, and sudden loss of smell and taste, do get checked by a healthcare professional. 

Ramping up testing: Testing in Mumbai was capped at 4,000 a day but it has gradually increased. While previously a patient could only get tested after a doctor’s prescription, Brihanmumbai Municipal Corporation has now dropped that condition. Any symptomatic or asymptomatic patient can get a test. Read the order here:

In order to compile this guide, we called the K-east ward control room where the operator transferred the call to in-house doctor, Dr Ram Wakshe, who clarified the whole process.

Step 1: Call up your Ward Control Room number for assistance. 

Recently, the corporation launched ward control rooms for the city’s 24 wards. You can call your Ward Control Room for assistance with identifying symptoms. The operators will also help with coordinating ambulance services or identifying a vacant hospital bed. 

Apart from the ward control rooms, BMC also has a centralised helpline: 1916.

Who can get tested: BMC’s guidelines so far insisted that a person could only avail a test if they had a doctor’s prescription mentioning symptoms and advising a COVID test. After securing a prescription, the patient could approach a government facility such as the Kasturba Hospital for a free test or a private lab such as Metropolis, Suburban Diagnostics, SRL Diagnostics, among others. 

BMC revised its guidelines on July 7, 2020 to remove the requirement of physician’s prescription: 

1. Laboratories are free to conduct RT-PCR tests for any individual in accordance with the ICMR guidelines. However, no prescription or self-declaration is required for COVID testing for symptomatic or asymptomatic individuals. 
2. Home swab collections for COVID testing (only RT-PCR) are allowed and no prescription is required for the same. 

Where to get tested:

There are broadly two kinds of tests available: 

1. The first is the RT-PCR test. Healthcare professionals use a throat or a nasal swab to detect the presence of a virus.
2. The second type of tests is called Rapid Antigen Detection Test. In this, they look for antibodies in blood that are produced to fight the virus. The BMC has procured one lakh of such test kits.

While the RT-PCR test takes about 8-9 hours, the rapid test takes significantly lesser time. ICMR has called RT PCR the “gold standard” for diagnosis while the rapid test is largely used  to generate epidemiological data or for hotspot surveillance.

There are two conditions for the Rapid Antigen Detection test:

1. BMC wants to conduct the tests in containment zones.
2. And for patients who have symptomatic influenza like illness* or patients who are asymptomatic but were direct and high-risk contact with co-morbidities* of a confirmed case. They should be tested once between day 5 and day 10 of coming in contact.

See the list of containment zones here:  https://stopcoronavirus.mcgm.gov.in/insights-on-map (scroll down to Containment zones or click here)

*Influenza like illness case is defined as one with acute respiratory infection with fever greater than or equal to 38 degree C (100.4 degree F) and cough.

* Co-morbidity, as defined by the BMC, means lung disease, heart disease, liver disease, kidney disease, diabetes, neurological disorder, blood disorder. 

What are the costs? 

Costs for RT-PCR tests in private labs are fixed at Rs. 2,200 if the person goes to the lab to give a sample or Rs. 2,800 if the laboratory collects the samples from home. Some labs collect samples from home only if the person is over 70 years of age, or a caregiver to someone who is over 70 years, or a high risk patient.

“The ward control room can also organise home testing if the patient is pregnant or disabled”, Dr Wakshe says.

The BMC has also directed all Assistant Commissioners “to increase testing by setting up camps/mobile vans (with help of assigned laboratories) in high incidence area to collect samples of all symptomatic individuals as well as their contacts with co-morbidity and get those samples tested by using rapid antigen detection tests”. They’re instructed to conduct at least 250 Rapid Antigen tests per day. 

If a patient is positive, the Municipal Corporation is intimated before the patient is, according to BMC’s guidelines.

Step 2: What happens if you test positive in a rapid antigen test 

If a person is positive in the rapid antigen test they’ll be treated as per protocol (mentioned below), if not, they will undergo an RT-PCR test for confirmation.  

Even if the RT-PCR test is also positive, you may not have to rush to a hospital. If you are asymptomatic, and if adequate facilities are available in the house you can be quarantined at home, by giving a self-declaration to the Corporation.

If a patient can’t be quarantined at home because of lack of space or a private toilet, such patients can opt to be housed in isolation facilities. 

Here’s a list of all isolation facilities for patients: https://stopcoronavirus.mcgm.gov.in/assets/docs/CCC2-Details.pdf

Positive symptomatic patients: These patients would be transferred to Dedicated Covid Health Centres (DHCs) or Dedicated Covid Hospital (DCHs).

Here’s a list of all quarantine facilities for high-risk patients who are close contacts of COVID patients: https://stopcoronavirus.mcgm.gov.in/assets/docs/CCC1-Details.pdf

According to the BMC dashboard, 246,145 are home quarantined whereas only 11,409 are in institutional quarantine.

Difference between Quarantine and Isolation

• Isolation is used to separate ill persons who have a communicable disease from those who are healthy. Isolation restricts the movement of ill persons to help stop the spread of certain diseases. For example, hospitals use isolation for patients with infectious tuberculosis.
  
• Quarantine is used to separate and restrict the movement of apparently healthy persons who may have been exposed to a communicable disease to see if they become ill. These people may have been exposed to a disease and do not know it, or they may have the disease but do not show symptoms. Quarantine can also help limit the spread of communicable disease.

(Source: https://stopcoronavirus.mcgm.gov.in/where-to-get-admitted)

Step 3: If you need hospitalisation

When you feel the need for hospitalisation, the operator at the Ward Control Room will note your requirement and call the nearby hospital to confirm the availability of a bed. “We call and confirm because we don’t want that bed to be claimed by another patient,” Dr Wakshe says. The operator also has numbers of ambulance drivers to coordinate the ambulance service. Depending on the severity of the condition, they might arrange an oxygen bed or a ventilator bed. 

You can see a list of MCGM, Government and private hospitals here: https://stopcoronavirus.mcgm.gov.in/assets/docs/DCH.pdf

According to data on the BMC dashboard on 7th July, BMC has a bed capacity of 23,252 of which 12,848 are occupied. Out of 60-70 calls received daily, Dr Wakshe says, “most calls are for ventilator beds.” But as per the BMC dashboard, out of 1,051 ventilator beds, only 137 are unoccupied. 

The Maharashtra Government has capped charges for an isolation ward at Rs 4,000 a day, the maximum charge for an ICU is capped at Rs 7,500 a day, and charges for ventilators are capped at Rs 9,000 a day.

Plasma Yoddha is a website launched to donate plasma led by doctors and researchers. 

What is the discharge policy?

There is no forthcoming discharge policy from the BMC. BMC is following the ICMR discharge guidelines, according to media reports. They are currently as follows:

For mild/very mild/pre-symptomatic cases:

• Patient can be discharged after 10 days of symptom onset and no fever for 3 days
• No need for testing prior to discharge
• Patient will be advised to isolate himself/herself at home & self-monitor his/her health for further 7 days

For moderate cases:

• Patient can be discharged (a) if asymptomatic for 3 days and (b) after 10 days of symptom onset
• No need for testing prior to discharge
• Patient will be advised to isolate himself/herself at home & self-monitor his/her health for further 7 days

For severe cases:

• Clinical recovery
• Patient tested negative once by RT-PCR (after resolution of symptoms)

Preparing an Isolation Kit

Keep this COVID test kit handy for unpredictable circumstances.

Necessary Information:
1) Contacts of family doctor/neighbourhood doctor, society office bearers/local volunteers
2) Contact numbers of COVID helpline of your ward, local CCC1 and CCC2 facilities, nearby hospitals, ambulance, medical store, medical oxygen cylinder provider, local plasma bank, people who have recovered recently from COVID-19, private and government COVID-19 testing labs servicing your area.

Documents
1) Insurance details, medical records, list of allergies, etc.
2) Form for COVID testing: Spare copies with data filled for everybody, to save on exertion when you are sick
3) Home isolation declaration, printed, with a few spare copies and extra blank sheet

Other Items
1) Finger pulse oximeter with spare batteries. A pulse oximeter is a small, lightweight device used to monitor the amount of oxygen carried in the body. This oximeter shows an SpO2 reading which is an estimation of the amount of oxygen in your blood. An SpO2 reading of 95% or higher is generally considered to be a normal oxygen level. However, an SpO2 reading of 92% or less might suggest that your blood is poorly saturated.
2) Face masks, thermometers, regular medicines
3) Toiletry and sanitation kit
4) Water bottle and cutlery (for use during quarantine), electric kettle and electric steamer
5) Garbage bags for proper disposal of trash
6) Large can of Sodium Hypochlorite or a disinfectant like Lizol, and hand sanitisers
7) Mobile charger, cable, power bank, laptop
8) Cash, credit card, cheque book, banking details, etc., for payments at the hospital

(Courtesy: Design Beku)

Keep checking https://stopcoronavirus.mcgm.gov.in/ for regular updates. 

Also read:

Eight things you must know about insurance policies covering COVID-19 treatment

What you should do if there is a COVID patient in your apartment community

What to do if you test Positive for COVID in Bengaluru?

What to do if you test positive for COVID-19 in Chennai

What to expect and how to cope if you test COVID positive in Delhi