Unspoken truths of its COVID-19 model
Dharavi has proven the doomsday predictions wrong and is now being hailed as a global model to combat COVID-19. How did one of the world’s biggest slums curtail the spread of the pandemic, when at least 10 people live in a cramped 1-2-metre shack? How did it manage to keep the number of cases and deaths low despite pathetic hygiene conditions and without proper medical facilities?
ISOLATION. IT’S an unfamiliar word for those living in Dharavi, one of the densest and poorest habitations on the planet. More than 0.86 million people live here—every sq km houses 0.2 million people, making it 600 times more densely populous than the country average. Spread over 2.2 sq km in the heart of Mumbai, the commercial capital of India, this settlement is dotted with 300 cm x 300 cm shacks, dubbed kholis, each shared by five to seven people. At places, the contiguity of their blue tarp roofs gets broken with double storey tin-roofed houses and some 450 community toilets which cater to the needs of 80 per cent of the population.
So, on April 1 when Dharavi reported its first case of COVID-19, it sent jitters among the authorities, already struggling to contain the spread of COVID-19 in Mumbai. With hospitals running out of beds, and death toll touching new highs, the city had become one of the hotbeds of infection in the country.
It was feared that Dharavi’s cramped set-up would soon lead to community transmission, making matters worse and throwing a medical challenge seen never before. After all, maintaining the physical distance of at least 6 ft (2 metres), which is the first line of defence to prevent the spread of COVID-19, is nearly absent in Dharavi even if one gets confined in a shack. Wearing masks in suffocating settings and regular washing of hands and maintaining hygiene are the other impediments. But Dharavi has survived the brush with the pandemic.
After 105 days since the first case was reported, we were in Dharavi to trace the pandemic’s trail in mid-July. By this time, Maharashtra was still in the exponential phase of COVID-19 infection, and was reporting 7,000-8,000 cases every day (see “The learning curve” on But Dharavi bucked all doomsday predictions and emerged as a global role model of COVID-19 management; cases there had dropped from a high 140 a day in May to just nine in the third week of July. We reached here assuming a habitation under
complete lockdown, enforced with military precision. What we found instead was a strange sense of victory as well as rejection among people.
THE DHARAVI MODEL
The congested and dimly-lit bylanes of Dharavi were, as usual, humming with life in mid-July. The market at one of the busy roads, named 90 Feet, was overcrowded and filled with noise. Regular traffic jams near the Kamaraj Memorial English High School, a famous landmark in Dharavi, gave an impression that COVID-19 had become history for the place.
In one of the bylanes of Kamlanagar locality, Saraswati Kunchikor was preparing food in her kholi. Two months ago, one of her neighbours, living in a house barely at an arm’s distance, had contracted
COVID-19 and succumbed to it. “That incident instilled so much fear in us that we all remained cooped up in our one-room house for a month. But no one has fallen ill in our chawl since then,” she added.
Ensuring all this was like solving a riddle, explained Kiran Dighavkar, assistant commissioner of Brihanmumbai Municipal Corporation (BMC), under whose jurisdiction Dharavi falls. BMC officials planned a change in strategy. Instead of adopting the “reactive” approach of identifying virus-infected people, they designed a “proactive” one. And this meant going after the virus before it infected people.
This strategy required conducting testing on a Himalayan scale. But since this was not possible, they mounted massive medical screening drives. Between April and mid-July, BMC officials screened 0.4 million people or 40 per cent of Dharavi’s population on two symptoms of COVID-19: temperature checks through infrared thermometers and blood oxygen levels through pulse oximetres. Nearly 15,000 people, who had symptoms, were tested for
COVID-19. While those who tested positive were sent to isolation wards in hospitals, those who tested negative were also monitored for 14 days at quarantine centres.
This not only helped them pull the virus out of the system, but also reduced the burden of conducting large-scale testing (see “The model...” on
But the major achievement lies in implementing this approach in a settlement with 860,000 population. For instance, said Dighavkar, how does one decide who to screen? So, his team focused on 13 areas with high case load for door-to-door visits or fever camps. “Doctors practising in Dharavi also informed BMC about people who came to them with COVID-19-like symptoms. They were soon segregated and then expansive screening was conducted in their bylanes,” explained Pradeep Awate, chief epidemiologist of Maharashtra.
Initially, there was hesitation among healthcare workers. Then some local private doctors who practise in Dharavi came forward and 10 teams, comprising 24 healthcare workers, were formed in the first phase for screening. Gradually, the size and scale of screening went up. Simultaneously, quarantine centres were built up in schools, colleges, parks, hostels and halls, with 3,840 beds. The state government also acquired three private hospitals and the government’s own Sion hospital in Dharavi was designated for COVID-19 treatment. Through this screening and testing strategy, as BMC deputy health officer Daksha Shah claimed, 50-60 per cent positive cases were identified. “For every positive case, we contact-traced 15 people at least.”
Many informed us that visits of doctors instilled confidence among them to volunteer for testing. “So in the second week of April, when doctors opened clinics, people started coming for self-identification of symptoms. This eased our burden of identification. We worked in tandem with the government and would report all suspected cases for tests. This coordination paid off,” said Anil Paschnekar, who has been practicing in Dharavi for 25 years and is also the national vice-president of the Indian Medical Association.
There was another group of medical
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Authorities deployed drones to discourage large gatherings