“We cannot sit back and say it’s over. There is always a chance of a spike. What is in our hands is to identify patients as early as possible and treat them.”
As of yesterday, Dharavi, Asia’s largest slum, recorded a mere 5 positive coronavirus cases, taking its tally to 113 active cases and 2,375 diagnosed cases. Mumbai, meanwhile, recorded 1,243 fresh cases yesterday, taking its overall case count to 92,988.
Considering it’s one of the most densely populated areas in the world with over a staggering 2,27,136 people per square kilometre, this is an incredible achievement. People here live cheek by jowl in houses located in narrow lanes spread over a mere 2.5 square kilometres. Each household has 8-10 people, as per the local municipal body. Moreover, there are 450 community toilets being used everyday with 80% of the population dependent on them.
The first positive case in Dharavi was recorded on 1 April 2020. By the end of April, the number of positive cases had jumped to 491 with a doubling period (number of positive cases doubling) of just 18 days, according to the Brihanmumbai Municipal Corporation (BMC). It was well on its way towards becoming a COVID-19 hotspot.
In May, Dharavi reported about 1,216 positive cases and 56 deaths as compared to 18 in the previous month. The following month, however, saw very few deaths and on an average the area saw fewer than 18 new cases per day with the highest single-day spike on 1 June with 34. By the end of June, however, the average doubling rate had increased to 108 days from 43 days in May.
Since the start of this month, the number of new cases has declined even further. On 7 July, for example, Dharavi recorded just a single case, noted the BMC. This month, Dharavi has seen a little over 65 new cases with the average doubling rate at 430 days.
According to the Union health ministry, the Maharashtra government and the BMC, working alongside local nonprofits, community leaders and common citizens, have been effectively able to bring down the COVID-19 spread in Dharavi.
Since the twin strategies of social distancing and lockdown do not work in an area like Dharavi where people live and work literally at an arm’s distance, here’s how this was managed.
1. Comprehensive testing: Four T model — Tracing, Tracking, Testing and Treating
As per recent reports, more than six lakh people have been screened in Dharavi so far. Irrespective of their symptoms, all patients were screened for fever. Also, their oxygen saturation levels were closely checked by doctors.
“We were very proactive in screening and testing residents. We never waited for them to come to us. In fact, we found out whether they were COVID-19 positive or not by going door-to-door, organising fever camps, senior citizen surveys and operating mobile vans, which helped us to identify patients at an early stage. In the past week, the number of cases have been in single digits,” says Assistant Commissioner Kiran Dighavkar, in charge of G north ward consisting of Dadar, Mahim and Dharavi, speaking to The Better India.
What are fever camps? “Fever camps are conducted by the BMC. High risk zones within Dharavi were identified, and with the help of doctors, nurses and ward boys, people living in these areas were screened and tested on the spot. Those who tested positive were sent to institutional quarantine facilities,” he notes.
On the subject of tracing, 47,500 households were covered by doctors and private clinics going door-to-door. When it came to tracking, more than 6 lakh people were screened since the lockdown first began. All possible contacts of patients or those with symptoms were tracked down extensively and shifted to quarantine facilities, notes the BMC.
Nearly 14,000 tests have been done so far in Dharavi, according to the Hindustan Times. Infrastructure had to be prepared in the slums for not only treatment, but also to provide people food all through the day. Only critical patients were moved outside Dharavi for admission to hospitals while 90% patients were treated inside the area, they added.
“To screen each of the households in Dharavi was nearly impossible. BMC staff in personal protection equipment (PPE) carried out the screening, often fainting due to the heat trapped in the narrow alleys,” notes a June 28 report in The Print.
2. Participation of private doctors
Manpower was definitely a concern in the BMC’s bid to conduct proactive screening in high risk zones and organise fever camps so the municipal body ended mobilizing all available ‘private’ practitioners.
Initially, 24 private doctors came forward and BMC provided them with PPE Kits, thermal scanners, pulse oximeters, masks, gloves and started door-to-door screening in high risk zones and all suspects were identified.
Soon, all private practitioners in the area were asked to open their clinics and attend to patients and communicate all suspected cases to the BMC, which eventually, went a step further and sanitised all the clinics of all these private practitioners and provided them all PPE, gloves etc all other logistical support, claims BMC.
3. Uninterrupted supply of goods and essential supplies to communities
“The BMC also distributed 25000+ grocery kits and 21000+ food packets for lunch and dinner separately within the containment zones so people stayed inside Dharavi and did not have the need to move out — thereby curbing the spread of the virus. Apart from this, food and grocery were also supplied and distributed free of cost by local MLA, MPs and corporators,” notes a document that the BMC shared with The Better India.
In addition, there were many non-profits, individual citizens and local community leaders who facilitated the distribution of food packets and groceries to residents.
“Police protection ensured no one was able to come out of the containment zone. We had identified a few community leaders in the area, whom we call community coordinators and they were given identity cards. These leaders would coordinate everything within the containment zone from helping identify which grocery and medical shops to keep open while high risk zones were completely closed off to facilitating any donation of essential commodities by those outside Dharavi. We, at the BMC, also sanitize all community toilets in the area at least 3-4 times a day everyday,” notes Assistant Commissioner Kiran Dighavkar.
“When we decided on containment zone measures and the appointment of community coordinators, they responded very well. Community coordinators would come forward for distribution of food or grocery packets. Also, locals have cooperated with us to shift themselves into institutional quarantine centres. Sometimes, they do it voluntarily,” notes another senior BMC official, who wishes to remain anonymous.
4. Quarantine Facilities
Since home quarantine was never an option, the focus was always on setting up of maximum institutional quarantine facilities covering all available schools, marriage halls, sports complexes etc. This ensured that patients didn’t have to scramble for beds in crowded public hospitals or get turned away from private ones.
The first large facility that the administration took over in Dharavi was the Rajiv Gandhi Sports Complex with 300 beds for asymptomatic patients or those with mild symptoms.
Following this step, other establishments like Prabhat Nursing Home and Family Care were taken over as well. “Soon, municipal schools as well Mahim Nature Park were taken over as isolation and quarantine facilities with a capacity of 3,800. Until June more than 8,500 were quarantined in such facilities…For providing critical care, the BMC took over five private hospitals in the area,” notes this report in The Print.
These facilities have community kitchens, where all three meals are served, 24/7 availability of doctors/nurses/medical staff, provisions for medicines, multivitamins and necessary medical equipment, claims the BMC.
5. Mass Exodus of Migrant workers from Dharavi
The Census population of Dharavi is around 6.3 lakh. Apart from this, there are 1.5-2 lakh migrant workers.
“As per police records, some 69,000 people have left Dharavi through government channels and another 50,000 people left by other means like private vehicles, walking, etc. Overall, nearly 1.5 lakh people may have left during this period. Although that must have helped, it cannot be the only reason for Dharavi’s success. On the contrary, by June end, many people started coming back once unlocked measures were announced. Many factories have started to open up, but we have not seen any surge till now,” notes the senior BMC official, to TBI.
“Having said that, there is always a chance of these workers coming back and that the number of cases may once again rise. We cannot sit back and say it’s over. There is always a chance of a spike. We are not concentrating on how many cases are coming in. What we can do is identify them as early as possible and treat them,” says Kiran.
Last Friday, in a virtual press conference in Geneva, Dr Tedros Ghebreyesus, the Director-General of the WHO acknowledged the city’s efforts to contain the outbreak in Dharavi.
“In the last six weeks cases have more than doubled. [However] there are many examples from around the world that have shown that even if the outbreak is very intense, it can still be brought back under control. And some of these examples are Italy, Spain and South Korea, and even in Dharavi — a densely packed area in the megacity of Mumbai — a strong focus on community engagement and the basics of testing, tracing, isolating and treating all those that are sick is key to breaking the chains of transmission and suppressing the virus.”
It’s imperative not to get carried away because as long as the virus wreaks havoc on the city, there is always a chance that Dharavi will get affected. Many parts of the country that were once considered ‘success stories’ have since struggled with newer outbreaks. But when everyone thought Dharavi would drown under the weight of this outbreak, it stood tall.
(Edited by Gayatri Mishra)