Can the Big Five Turn the Tide?
Not far from Azadpur Mandi in North Delhi stands Mahendru Enclave. A tanker sprays sodium hypochlorite in the narrow bylanes every morning. Here, 47 homes in Gali nos. 3, 4 and 5 were marked as a single containment zone on June 5, making it one of the largest Covid clusters among the national capital’s 240 active containment zones as on June 23. Only 4 km away, in Jahangirpuri, another 400 homes make up 10 of the 32 clusters in North Delhi district. This entire area has been a hotspot since April, when one Covid-positive woman infected 26 members of her family.
“We have been regularly sanitising public areas, monitoring movement with the help of drone surveillance and running police patrols,” says North Delhi district deputy commissioner Deepak Shinde, whose team faces the challenge of containing the virus in Jahangirpuri’s congested homes and galis where the prescribed norms of physical distancing are practically impossible to follow. “We have common toilets. The rooms are small and the galis just wide enough for one person to pass through. There is no space where you are not rubbing shoulders with at least three to four people,” says Mukesh Sharma, a resident of K-Block in Jahangirpuri. One of the homes inside the containment zones in Mahendru Enclave has 12 people living in a onebedroom tenement. “People still walk around without masks,” adds Sharma.
The North Delhi district, which is only 60 sq. km, has the second highest number of active clusters, after Southwest Delhi, which has 37 clusters and is spread over 250 sq. km. According to Census 2011, North Delhi’s population density is more than double that of Southwest Delhi. “Even if a mildly asymptomatic case is in close proximity to others—say, sharing a bedroom or utensils or toilets—there are chances of infection spreading,” explains Dr B.L. Sherwal, director of the Rajiv Gandhi Super Speciality Hospital in Delhi. Several of Delhi’s containment zones are congested marketplaces or urban villages—Sadar Bazaar, Ghazipur village, Naraina village, Masihgarh village, Pilanji village, Khadar and Ghuman Hera village, to name a few.
A similar situation has been noted in Kolkata, Mumbai, Chennai and Bengaluru. Covid infections in these cities have been particularly high in the densely packed and congested areas— Koyambedu in Chennai, Belgachhia in Kolkata, Dharavi in Mumbai and Padarayanapura in Bengaluru, which has turned into a hotspot most recently. As on June 23, it had 67 infected cases, the highest among Bengaluru’s 440 containment zones. According to Census 2011, Padarayanapura had some 120,533 people living per sq. km.
A FEW RIGHT MOVES
Covid thrives in congested pockets, but that does not mean it cannot be contained. With 800,000 people living cheek by jowl in a 2.1 sq. km area, Dharavi was a ticking time bomb for Covid spread in April. But the Brihanmumbai Municipal Corporation’s ‘Chase the virus’ programme paid off. Under this strategy, 15 people who came in contact with a Covid patient are isolated. The BMC screened around 550,000 people in Dharavi. Suspected cases were sent to institutional quarantine. Other strategies used in Dharavi included disinfecting 450 public toilets, used by 80 per cent of the residents, and strict enforcement of containment rules, where food and grocery kits were delivered at the doorstep. As on June 20, Dharavi’s five-day compounded daily growth rate of cases had dropped to 0.85 per cent, from 23 per cent a month ago.
In Tamil Nadu, Chennai continues to be an area of concern, particularly its congested northern limits. Three of every five cases reported in the state are from the city. On May 31, the state had 1,149 cases, but by June 22, the figure had reached 62,087. A second lockdown has been imposed, but this time around, the authorities are trying to lessen the impact of the shutdown with free supply of essentials and are offering Rs 1,000 as grant to indigent ration card-holders. “We have ramped up testing and stepped up contacttracing through mobile testing facilities as well as static and mobile fever clinics focused on the hotspots and buffer zones,” says Dr J. Radhakrishnan, state health secretary. In Chennai alone, there are 530 such fever clinics where over 30,000 people are examined every day. They are sent for testing if they report any of the Covid symptoms; earlier, a person in the state needed to exhibit five of the 15 Covid symptoms identified by the Union health ministry.
Kolkata accounts for a third of the 14,358 cases in West Bengal. “About 4.3 million people are spread over slums across the city and had we not tackled this segment, it could have turned into another Dharavi,” says Atin Ghosh, member of the board of administrators of the Kolkata Municipal Corporation.
Chief Minister Mamata Banerjee’s government seems to have turned a corner and given up its ostrich-like denial of manifest problems. Official estimates of the number of cases, casualties and tests conducted have caught up with the situation on the ground. From ranking the lowest in testing—183 per million population—on April 30, the state had scaled up testing to 4,565 per million by June 22. Most encouragingly, Bengal’s recovery rate is a high 60.5 per cent.
THE LONG BATTLE AHEAD
The fight, though, is far from over. With India in the Unlock phase, many urban centres are witnessing a spike in cases. Kolkata, for example, on June 16 saw its highest single-day spike of 170 cases. Delhi recorded over 3,000 cases daily between June 20 and June 23. In Mumbai, while the BMC focused on
THE ‘DHARAVI MODEL’ SHOWS THAT WHILE COVID THRIVES IN CONGESTED AREAS, IT IS POSSIBLE TO CONTAIN IT EFFECTIVELY
Dharavi, the slums in Kandivali, Malad and Dahisar turned into new hotspots, with a growth rate of over 6 per cent.
Ensuring affordable treatment has been a priority for all five cities. In Mumbai, at least 36 private hospitals stand accused of inflating Covid treatment bills. Kirit Somaiya, vice-president of the BJP in Maharashtra, alleges that private hospitals charge for even PPE kits, gloves and handling of biomedical waste. The BMC has been engaging with private hospitals to try and reduce these costs. In Kolkata, private hospitals have been instructed to display the availability of Covid beds and not refuse emergency patients. Delhi is setting up what is being billed as the largest Covid care centre in the world—a 10,000-bed facility in Chhatarpur. Every city district will be linked to a big hospital to extend care to Covid patients. A serological survey (20,000 samples) will be conducted from June 27 to July 10 to map the spread of infection.
STRATEGIC SHIFT
The overall strategy for all five cities is to control the pace of new cases such that the system is able to cope with the numbers. All state administrations understand that sudden spikes are disastrous because while beds can still be set up, healthcare workers have limitations. Analysts had for long believed that the low testing rates were a big reason why the cases were multiplying. But it is now clear that other factors also played a role. For example, Tamil Nadu, which has done the most tests in the country (14,094 per million people as on June 23), had 62,087 cases. But Rajasthan (with a population similar to Tamil Nadu) had done fewer tests (10,435 per million as on June 23) and registered only 15,232 cases. Rajasthan contained Covid through its public awareness efforts.
“Health outreach is crucial,” says Dr
Basab Gupta, former deputy commissioner, National Urban Health Mission. “Preventing infection is equally a matter of guiding people towards adopting the right precautions and behaviour.” A similar strategy was adopted in Northeast Delhi district. It has the highest population density in the city and yet not a single Covid cluster at present. Shashi Kaushal, deputy commissioner of district, engaged accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs) to conduct house-to-house screenings and raise awareness on cautionary measures.
That kind of outreach is really effective, specially in these congested slum pockets, where poor literacy makes access to quality information a particular challenge. In the early days of the outbreak, the Big Five cities were all remiss in ignoring this channel. While testing is still important to help isolate infected individuals, the real battle will be won only when we manage to raise the base level of public awareness about hygiene protocols that must be followed to fight the disease.
—with Amarnath K. Menon, Kiran D. Tare and Romita Datta SOME STATES HAVE BELATEDLY REALISED THAT SOCIAL OUTREACH IS A KEY ASPECT OF THE FIGHT TO LIMIT THE SPREAD OF COVID-19