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Epidemiologists use the term to describe tragic excess deaths – but for Covid-19 it seems to be the de facto government policy

There’s a term we use in epidemiology to capture the essence of increases in deaths, or excess mortality, above and beyond normal expectations: “harvesting”. During heatwaves, or a bad season of influenza, additional deaths above what would be normally seen in the population fit this description. Harvesting usually affects older people and those who are already sick. Generally, it is viewed as a tragic, unfortunate, but largely unpreventable consequence of natural events. It carries with it connotations of an acceptable loss of life. It is, in a sense, what happens as part of a normal life in normal times. But the word also has darker connotations: those of sacrifice, reaping, culling. As such, while it may appear in textbooks of epidemiology, it doesn’t occur in national influenza strategic plans or national discourse. The concept of harvesting is restricted to epidemiological circles.

But what if politicians promote the notion of harvesting (while declining to use the term) where it is not a “natural” consequence of events but a direct consequence of government policy? What if the medical and nursing world do not accept harvesting in these circumstances? What if a policy that results in harvesting cannot be articulated because it is unacceptable to the broader population? This is where we have got to with the coronavirus pandemic. Nowhere better exemplifies this tension between a policy and its popular acceptance than the effects of coronavirus in nursing homes.

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The Brihanmumbai Municipal Corporation (BMC) on Monday claimed that around 75 per cent of the nursing homes in the city have restarted services, after its warning of cancelling their licences if they did not do so, on Saturday. The municipal commissioner has ordered the cancellation of licences of the remaining 25 per cent nursing homes. Action will also be taken against private clinics who continue to remain shut, under the Epidemic Diseases Act, 1897.

Warning issues
The associations of doctors, nursing homes have expressed fear to work during the COVID-19 pandemic without proper safety kits and strict guidelines. The BMC has several times offered to provide safety kits but most private clinics and nursing homes remain closed due to fear of transmission of COVID-19. On Saturday, the BMC warned nursing homes and clinics to restart immediately and refer patients who have symptoms of COVID-19 to its centres. On Monday, the BMC claimed that out of 1,416 nursing homes, 1,068 have restarted their service. "Out of 99 dialysis centres, 89 are working," said an officer with the health department of the BMC.

According to the press note issued by the civic corporation, the municipal commissioner has ordered the health department to start the process of cancelling licences of the 348 nursing homes which haven't started services yet.

Mayor in nurse's uniform

Mayor Kishori Pednekar visited Nair hospital to meet the nurses

Kishori Pednekar, mayor of Mumbai and a former nurse, donned on a nurse's uniform and visited the COVID-19-only Nair hospital on Monday morning. She was there to encourage nurses. The mayor will visit Sion hospital on Tuesday to communicate with nurses. Pednekar followed social distancing norms during her visit. "I was a nurse by profession and am aware of their challenges. I am getting many calls from nurses and their parents who expressed fear. This is a challenging time and we all should fight the pandemic," said Pednekar.

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Amid the rising number of COVID-19 cases in Mumbai, Deputy Municipal Commissioner (Zone IV) on Wednesday wrote to Addl CP West Region Manoj Kumar Sharma, demanding stricter implementation of rules in the containment zones between Bandra and Andheri, especially the slum areas in the belt.

These include Nehru Nagar (Juhu police station), Samta Nagar and Junaid Nagar (DN Nagar), CD Barfiwala Road and Juhu Galli (DN Nagar), Gaondevi Dongri, Gilbert Hill and Dhangarwadi (DN Nagar), Versova Village (Versova), Kranti Nagar, Anand Nagar, and Behraum Baug (Oshiwara). The municipal authority observed "that there is no fall in the rate of positively tested patients and are rather increasing. It appears that existing lockdown measures are inadequate," the communication said.

It asked local authorities to ensure that the localities, local pockets and chawls are strictly sealed and locked down to have effective control on spreading Coronavirus in these localities.

"This office has frequently informed senior inspectors of respective police stations regarding containment of areas in their respective jurisdictions on a day to day basis as and when positive cases are traced in particular localities," the letter read.

Sharma told mid-day that "the police have already increased patrolling in these areas and deployed more number of officials."

'Lack of individual toilets'

DCP Abhishek Trimukhe said, "We have barricaded these designated red zones and are ensuring that there is limited access. Only the government ration shops and medicine shops are allowed to be kept open. All other shops in red zones will remain closed. However, the main challenge in these slum pockets is that there are no independent toilets within the red zone itself. There needs to be a toilet facility otherwise people will keep venturing out of their homes to use the toilet. How can we keep denying people the need to use the toilet?"

Cops make the rounds of slum areas every day

He pointed out: "There is a heavy space constraint in these slum areas, as opposed to building societies, where containment is very good. The lanes are very narrow in some slum pockets and the population density is high."

Identification system required

Trimukhe said that the police had asked BMC to have some sort of identification procedure for people who are residents of these red zones. "Since the population of these areas is very high, a designated identification system would make it easier to identify and segregate people," he said adding that community meetings have been held with residents to explain the guidelines to them.

'Can't sit inside tiny homes all day'

Senior PI of Oshiwara police station Dayanand Bangar echoed Trimukhe's concerns. "People are always saying that they are either going to get medicines or buy milk but the biggest problem is that of common toilets," he said.

"Residents of these slum areas, who live in a 10x10 house, cannot sit at home all day," he said, adding that in areas like Kranti Nagar, there is zero growth of COVID-19 cases. "Even though this is a red zone, there are currently no positive patients here.

Seven people, who had gone for treatment, and are now back."

1.4k
No. of containment zones in city

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The Maharashtra Tourism Development Corporation (MTDC) is working on a tie-up between hospitality provider Airbnb and locals for offering home-stay to tourists visiting the Elephanta Caves island located in Mumbai Harbour. The policy aims to overcome the security concerns due to high security installations facing the island that does not allow construction of hotels and night stay.

Tourism Minister Jaykumar Rawal said the 29th two-day Elephanta Festival, beginning January 27, will be held on the island itself again. After the 2008 Mumbai terror attacks, the festival venue was shifted to the Gateway of India in south Mumbai. "Seventy years after Independence, the island is soon to get proper electricity connection depending upon the testing of the electricity meters," the minister said. Rawal said there are about 1,200 to 1,500 homes on the Elephanta island, also known as Gharapuri Island, located east of Mumbai.

The minister said no new constructions are allowed on the island due to high-security installations of ONGC and the Navy. The Caves are declared a heritage site by the UNESCO and protected by the Archaeological Survey of India (ASI). Rawal said the government in a tie-up with the Mumbai Port Trust and the Hindustan Petroleum Corporation Ltd (HPCL) is planning a cable car over the sea for travelling to the island. The island is expected to get proper electricity connection within a week's time.

"The Elephanta festival will coincide with the culminating phase of the Mumbai Shopping Festival that will end on January 31," he said, adding that the Elephanta fest will comprise activities like treasure hunt at Elephanta, a sculpture and a painting contests with prize money. Besides this, the festival will have art, dance and music performances by Zia Nath, Sangeeta Trivedi, Sumeet Nagdev, Hans Raj Hans and others, Rawal said.

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Covid-19 related deaths within the UK's care homes for the elderly and vulnerable doubled within just one week, according to data collected and analysed by a leading representative body for the not-for-profit adult social care sector. The National Care Forum (NCF) report, released on Saturday, demonstrates 2,500 deaths within care homes within seven days, figures which it says highlights significant flaws in the current national reporting of coronavirus related death toll in the UK. It is hoped that this analysis will provide insight and impetus for the government to better address the needs of the care sector, the NCF said. The group's research came as pressure mounts on the British government to start counting deaths within the wider community and care homes to its daily hospital toll figures, which hit 15,464 on this week. Amid concerns that the national statistics presented by the government for coronavirus related mortality rates were not incorporating figures of deaths within residential and nursing homes, the NCF said it led an independent benchmarking exercise.

As many as 47 of its care provider members contributed to the audit, representing 1,169 care services that collectively support 30,217 people across the UK - 7.4 per cent of the overall residential care sector population. The resulting sample analysis suggests that a total of 4,040 people may have died of the deadly virus within UK residential and nursing services before April 13.

The figure of more than 4,000 people passing away of Covid-19 within care homes in little more than one month is devastating. Every death is a loss and a tragedy, said Vic Rayner, Executive Director of the National Care Forum. It is even more worrying to see a virtual doubling of deaths within homes in just one week, clearly indicating that whilst all attention has been on managing the peak in hospitals, the virus has attacked our most vulnerable communities, she said. The NCF said the data should be a wake up call to the government and society as a whole to recognise that its official whatever it takes approach has to be applied equally.

By highlighting the scale of the tragedy, we are giving the government an opportunity to respond with equal effort. It must act immediately and build a `ring of steel' around care homes. They need the right PPE [personal protective equipment], medical monitoring devices, rapid and comprehensive testing, proper funding and intensive research to safeguard the people they care for, Rayner added. The UK's Department of Health has repeatedly explained the focus on hospital deaths in its daily death toll tally on the time lag involved in care home deaths being collated. "Every death from this virus is a tragedy and that is why we are working around the clock to give the social care sector the equipment and support they need to tackle this global pandemic," a DoH spokesperson said.

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