‘Mission Dharavi tough, not impossible’Updated: Apr 30, 2020 00:36 IST
From the first case on April 1 to 344 cases 29 days later, Dharavi, India’s largest slum, has emerged as a major hotspot of Covid-19 in the city, with cases rising daily. In such a grim situation, how do you contain the spread, given the space constraint, stigma and lack of awareness, sanitation and even essentials? The civic body’s answer – Mission Dharavi, a daily fight involving 2,500 health care and sanitation workers. Although the mission is still on, and at a crucial stage considering the rise, the civic body is confident of a positive outcome.
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. It is characterised by difficult-to-manage makeshift shanties, or double-storey standalone tin and concrete shanties. There are only a few multi-storey slum rehabilitation authority (SRA) buildings, which are gated. There are 225 public community toilets in this slum, used by thousands of people daily, through the day. Residents are daily wage workers, or run small businesses from their homes.
Dharavi jumped to 330 positive cases in a span of 28 days since the first case and first death were reported on April 1. Since then, it took 17 days for this slum pocket to record the first 100 cases, six days to record the next 100, and only five days to record 100 more. On April 17, Dharavi recorded a total of 101 Covid-19 positive cases. This figure doubled by April 23, when Dharavi recorded 214 cases. On April 28, the figure of total Covid-19 positive cases touched 330. Its first patient was cured and discharged on April 11.
WHAT IS BEING DONE
Kiran Dighavkar, assistant commissioner of Dadar West ward in south Mumbai, BMC’s administrative unit which covers Dharavi, launched the mission on April 18, the day after the slum pocket recorded its first 100 cases. It included running fever camps in containment zones, providing door-to-door groceries, and even cooked food to residents, so they had no reason to leave their homes. Those using community toilets were moved to institutional quarantine centres. The BMC’s newly started toll-free helpline for requesting food, shelter, and transport during the lockdown due to Covid-19: 1800221292, too, is headquartered at the G/North ward. Following requests to this helpline from Dharavi, the BMC also delivered milk, medicines, and biscuits on demand to keep people indoors.
Even earlier, on April 9, when Dharavi had 17 positive cases, Dighavkar had issued a circular stopping sale of fruits and vegetables on footpaths of nine roads in Dharavi, where these cases were found. This was later expanded to all containment zones in Dharavi.
HOW IT IS BEING MANAGED
The Brihanmumbai Municipal Corporation (BMC) has sent 125,000 people in over 48 containment zones, screened over 62,500 people via door-to-door surveys, fever camps, and medical clinics of private doctors. It has conducted 1,530 tests so far. Community toilets are being sanitized daily.
Municipal commissioner Praveen Pardeshi said, “The most challenging aspect for Dharavi is delivering food packets home, as the population is very large. Community toilets, small homes and high population density are major challenges.”
Dighavkar said, “The most challenging aspect of containing the outbreak in Dharavi is dialogue with residents. It is proving difficult due to the sheer number of people we have to communicate with. Moreover, a small room admeasuring 10x15 sqft is occupied by 8-9 people. Social distancing is impossible. Challenge is to quarantine maximum number of people. Convincing them to move to quarantine zones is yet another challenge. Chances of infection increase with community toilets.”
The high-risk contacts of index patients such as his family members and immediate neighbours are moved to institutional quarantine facilities. More than 1,850 high-risk contacts have been institutionally quarantined so far. There are 2300 beds available in and around Dharavi area alone to quarantine high-risk contacts. Municipal schools have been converted into quarantine facilities, as has the Rajeev Gandhi sports complex, spread over 12,000 sq m.
Dighavkar said BMC delivers over 19,000 food packets daily, with the help of its staff and police personnel, since many residents of Dharavi are hand-to-mouth earners. This food is funded by NGOs and charity trusts, and handed over to BMC for distribution.
Dighavkar said, “We are on the right track, even though the number 330 looks overwhelming. Of the 330 cases, 61% are among people the BMC has already quarantined, or screened.”
Dadar West ward’s data shows out of the 330 cases recorded as of April 28, 104 were from persons already in institutional quarantine, and 98 were discovered from among people screened by the civic body, totaling 61.2%. The remaining 128 cases have directly reported themselves. Moreover, 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, which fluctuates between 7% and 8%.
The BMC has also permitted opening up the 350 private clinics that operate from Dharavi for early detection of cases.
The civic body claimed that around 60% of its cases are from five red zones: Kalyanwadi, Mukund Nagar, Social Nagar, Muslim Nagar and Madina Nagar. 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, and deployed 10 teams of 4-5 people each, to do so.
The first case in Dharavi, discovered on April 1, was also the first death. The 56-year-old male who had no travel or contact history had developed symptoms on March 23 and had 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 was finalised on April 1, but he died soon after the same day. The second and third case was reported on April 2, who were a doctor from a nearby private hospital living in Dharavi, and a civic sanitation worker living in Worli, who cleaned in Dharavi. Incidentally, Worli falls in the administrative ward with the most number of cases recorded in Mumbai. The fourth case was recorded on April 4, and the fifth on April 5. While April 6 and April 11 recorded no new cases, the days right after these ones brought new challenges for the local administration, giving then no time to prepare. Everyday since, cases multiplied rapidly.
In Mumbai the wards with the lowest number of cases such as Mulund in the eastern suburbs, Marine Lines in the island city and Borivli in the western suburbs had many days in between the positive cases reported in their area, and hence had more time on their hands to put containment and quarantine measures in place, isolate index patients and break the chain of spread of the virus.
However, what is working for Dharavi is self-discipline of its residents. 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 in south Mumbai), where people venture out of their homes despite the situation. This must be very difficult for them as their homes are small. But they are aware of the consequences.”