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At midnight on April 17, as a deadly new wave of the coronavirus overwhelmed India, Mumbai’s Municipal Commissioner Iqbal Singh Chahal learned that six hospitals in his city would run out of oxygen within hours -- putting the lives of 168 patients at risk.

Amid the ensuing scramble, the patients were rushed to the temporary hospitals Chahal’s team had set up during the city’s first wave in 2020. He hadn’t dismantled the facilities even when cases dipped. Unlike most Indian hospitals that relied on cylinders, they had been equipped with pipes that supplied oxygen directly to patients’ beds. All 168 survived.

That night -- which Chahal describes as the scariest he’s ever had -- offers a look at tactics India’s financial capital used to quell its outbreak faster, and with fewer casualties, than other parts of the country. Mumbai has reported 2,784 deaths since the second wave began on March 1, around a fourth of the 10,595 in capital New Delhi. Even India’s Supreme Court has suggested that aspects of Mumbai’s model could be adopted in other parts of the nation like New Delhi.

By contrast, the record number of daily deaths India continues to report, along with the collapse of the health system in parts of the country, have highlighted broad shortfalls in governance and public planning nationally. The country reported an unprecedented 4,529 deaths on Wednesday.

Chahal attributes the city’s successes partly to a decentralized system his team set up during the first wave, which included neighborhood war rooms to manage cases by locality. He’s also made vast changes to the way the city sourced and used its medical oxygen, creating emergency stocks and tracking systems for tankers. So, even as families around India desperately pleaded for supplies on social media, Mumbai’s patients reported fewer problems.

With a population of 16 million spread across glistening skyscrapers, apartment complexes and sprawling slums, Mumbai is the world’s second-most densely packed city, according to data from the United Nations. About 32,000 people are crammed in per square kilometer. That makes lessons from India’s financial capital particularly valuable as fears grow about outbreaks in other crowded places from Bangkok to Kathmandu.

“I knew it was a long drawn war; and I knew only systems can win the wars -- individuals can’t,” Chahal said in an interview via Zoom. “Devising systems and making them run on auto pilot is key to the Mumbai model.”

As of May 11, Mumbai had almost half the number of active virus cases as capital New Delhi. Delhi Health Minister Satyendar Jain and Principal Secretary of Health Ashish Chandra Verma didn’t reply to calls seeking comment.

Still, the risks to Mumbai are far from over. The city has recorded 688,696 cases since the pandemic began, adding 1,544 on May 16. Chahal is preparing for a third wave by setting up jumbo pediatric hospitals because public health experts have warned his team that more children might be infected in the next surge.

Managing the trajectory of the virus in Mumbai is crucial given the potential human toll of a runaway epidemic. And as India’s financial capital, the city is also central to the nation’s already battered economy.

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