Inside Dharavi: India’s largest slum and a major Covid hotspot
In the past month, Mumbai’s Dharavi, India’s largest slum, has emerged as a major hot spot of Covid-19 cases. The first case was reported in this slum on April 1; the number of cases have since rapidly increased -- to 344 in a span of just 29 days, along with 18 deaths.
The Dharavi slum is spread over 2.4 sqkm, has 850,000 residents and a population density of 354,167 per square kilometre, making it one of the more cramped spaces in Mumbai, itself the world’s fifth most densely populated city. The slum is characterised by difficult-to-manage makeshift shanties, or double storey stand-alone tin and concrete shanties. There are only a few multi-storey slum rehabilitation authority (SRA) buildings that are gated. There are 225 public community toilets in this slum, used by thousands of people daily. Residents are daily wage workers, or run small businesses from their homes. By some estimates, there are thousands of businesses in the shantytown.
Brihanmumbai Municipal Corporation (BMC) has sequestered 125,000 people from Dharavi in over 48 containment zones, screened over 62,500 people via door-to-door surveys, fever camps, and medical clinics of private doctors and conducted 1,530 tests so far in the slum. Community toilets are sanitized daily.
Municipal Commissioner Praveen Pardeshi said: “The most challenging aspect in Dharavi is delivering food packets home, as the population is very large. Community toilets, small homes, high population density, are all big challenges.”
Assistant commissioner of the Dadar West ward in South Mumbai, Kiran Dighavkar, said an even more challenging task is communication. “It is proving difficult due to the sheer number of people we have to communicate with. Moreover, a small room admeasuring 10 by 15 square feet is occupied by 8-9 people. Social distancing is impossible. We have to quarantine the maximum number of people in quarantine facilities. Convincing them to move to quarantine zones is yet another challenge. Chances of infection increase with community toilets.”
It is the task of 2500 health care workers to ensure things stay under control.
The high-risk contacts of index patients, family members and immediate neighbours are being moved to institutional quarantine facilities. Over 1,850 high risk contacts have been institutionally quarantined so far. There are 2,300 beds available in and around Dharavi alone for quarantining high-risk contact persons from the slum. Municipal schools have been converted to quarantine facilities, as has the Rajeev Gandhi sports complex.
Dighavkar said BMC delivers at least 19,000 food packets daily, with the help of its staff and police personnel, since many residents of Dharavi are daily wage workers. This food is funded by non-governmental organisations and charities, and handed over to the BMC for distribution.
Dighavkar said, “We are on the right track, even though the number 330 looks overwhelming. Out of the 330 cases, 61% cases are among people BMC has already quarantined, or screened. That means we were already suspecting to some extent that these persons need to be observed.” He was referring to the slum’s infection tally as of Tuesday night: 330.
Indeed, Dharavi’s percentage positivity (number of positive persons emerging from the total number of tested persons) stands at 21.5% as of Tuesday, much higher than Mumbai’s positivity ratio, that fluctuates between 7-8%. Both numbers will fall as testing expands.
BMC claims that around 60% of its cases are from five red zones: Kalyanwadi, Mukund Nagar, Social Nagar, Muslim Nagar and Madina Nagar, all identified and flagged as red zones on April 10, when the total positive cases in Dharavi stood at 28. This was also when BMC started door-to-door screening of patients.
Dighavkar launched Mission Dharavi on April 18, the day after the slum crossed the 100 case-count mark. It involved running fever camps in containment zones, providing door-to-door supplies of groceries, even cooked food to residents so they had no reason to leave their homes. Those using community toilets were moved to institutional quarantine centres right away. And following requests to its new Covid-19 helpline, 1800221292, BMC also started delivering milk, medicines, and biscuits on demand.
The first case in Dharavi, discovered on April 1, was also the first death. This 56-year-old man with no travel or contact history, developed symptoms on March 23, and visited his local doctor. He was prescribed medicines for cough and sent home. Six days later he developed difficulty in breathing and was admitted to Sion hospital, where his swab was collected for testing. His positive result came in on April 1, but he died the same day. The second and third cases were reported on April 2 -- a doctor from a nearby private hospital living in Dharavi, and a civic sanitation worker living in Worli, but worked in Dharavi.
Interestingly, what is working for Dharavi is the self-discipline of its residents, Praveen Pardeshi said. “Residents of Dharavi are strictly following all lockdown rules. No one is leaving their homes. We took the drone over Dharavi and saw the images. All streets were empty, no one was walking around. This is unlike some other areas in Mumbai, such as the E ward (Byculla area in South Mumbai), where people venture out of their homes despite the situation. This must be very difficult for them (the Dharavi residents) as their homes are small. But they are aware of the consequences.”