On April 1, when Dharavi, Asia's largest slum, reported its first Covid-19 death, a 56-year old man, panic ensued.
Though, by then Mumbai, India's financial hub, had recorded 181 positive cases and nine deaths, it was Dharavi that the local authorities and healthcare associations did not want to take a chance with.
But the deadly coronavirus had spread.
"We knew if the virus spreads further it would be catastrophic. So our team of Mahim Dharavi Medical Practitioners Association and members of Indian Medical Association (IMA), together with 25 doctors, roamed for 10 days in the major hotspot areas of Dharavi, testing thousands of residents," General Surgeon Shivkumar Utture told Mint, an Indian financial daily newspaper.
Mumbai's civic body, Brihanmumbai Municipal Corporation (BMC), partnered with this team, isolating and quarantining possible cases. The municipal body also supplied free personal protective equipment (PPE) kits to private doctors, giving them confidence to open their clinics, which had been shut since March.
"So when in April only two or three clinics were open in Dhavari, now we have over 100 clinics open. This gave us the strength to detect more cases," said Utture.
Since late May, Dharavi has seen a decrease in number of cases. While average new cases have come down from 47 in May to 27 in June, the doubling rate of cases rose to 44 days against 21 as of May 24.
So far, Dharavi has reported 1,964 cases and 73 deaths, while 939 people have recovered from the disease.
Now, the continent’s most crowded slum, has gone from coronavirus hotspot to potential success story, offering a model for developing nations struggling to contain the pandemic.
Chase the virus
“It was next to impossible to follow social distancing,” Kiran Dighavkar, assistant commissioner at Mumbai’s municipality, who is in charge of leading the fight in Dharavi told Bloomberg.
“The only option then was to chase the virus rather than wait for the cases to come. To work proactively, rather than reactively.”
Dighavkar and his team made it clear that screenings and testing would continue even as the count increased - their objective was to keep deaths limited.
Testing by the municipality and private clinics has covered the equivalent of about 1.4% of Dharavi’s population compared with 1.2% for Mumbai, according to Bloomberg calculations based on data from various government departments.
About 850,000 people reside in the roughly 2.5 square kilometers that comprise Dharavi, allowing for more focused screenings than in the broader city sprawl that’s home to 20 million.
“We were able to isolate people at early stages,” Dighavkar said. “Unlike in the rest of Mumbai, where most patients are reaching hospitals at a very late stage.”
The strategy has helped reduce mortality and improve recovery.
About 50% of Dharavi residents who tested positive eventually recovered, better than Mumbai’s 46% rate. Of the 77 Dharavi Covid-19 deaths, only six have been in June.
Fresh infections are down to an average 20 a day from 60 in early May. India, meanwhile, added almost 12,000 cases on June 14.
Free services
Everyone in the isolation centers also received round-the-clock medical supervision free of cost, even as millions around the country lost their jobs due to the nationwide lockdown and reports trickled in of people dying before they were allotted hospital beds.
Once word got around, people would volunteer themselves to be quarantined as soon as symptoms appeared, according to Dighavkar.
Dharavi’s methods as described seem adequate to contain infections and authorities must test everyone with symptoms like fever or a cough, said T Sundararaman, the New Delhi-based global coordinator of the People’s Health Movement, a public health group.
Yet, Dharavi’s war against the virus is far from over. Once shelter-at-home restrictions are fully lifted in Mumbai and the bustling city goes back to work, there’s a risk of a second wave of infections.
“The battle can’t be over until the virus has gone from the entire city, state and country,” said Dighavkar.
“People are quite aware now of how to be safe and I think by the time the lockdown ends, most of us may have got herd immunity. Or so we hope.”
The exodus of migrant labours and creation of quarantine centres within Dharavi also supported the efforts of authorities in containing the spread of coronavirus.
Dharavi may have seen nearly 250,000 migrant labourers leave the slum clusters after the lockdown was announced in March. This helped the decongesting efforts of the BMC and doctors.
