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The Dharavi unlock: How daily new cases down to single digit

The drop in new cases in Dharavi is characterised by a steep fall in the doubling time of 18 days in the last week of April to 78 days as of June 19.

Written by Sanjana Bhalerao |
Updated: June 21, 2020 9:40:54 am
Mumbai missing covid-19 deaths Health volunteers performing temperature scanning for covid-19 symptoms at Gul Mohammed Chawl in Dharavi on Friday
Express photo by Nirmal Harindran, 12-06-2020, Mumbai

Dharavi, the 2,400-square kilometre slum sprawl, which had emerged as a Covid-19 hot spot in Mumbai by mid-April, and had the Brihanmumbai Municipal Corporation (BMC) deeply worried, has witnessed a steady decline in the number of new cases in June. On Saturday, addition to cases was in single digit for the first time since the area reported its first case on April 1.

The drop in new cases in Dharavi is characterised by a steep fall in the doubling time of 18 days in the last week of April to 78 days as of June 19. At 78 days, it has the longest doubling time in Mumbai, where overall the cases are now estimated to double in 34 days.

On April 1, Dharavi reported its first Covid-19 case and also the first death due to the virus, albeit in a multi-storey residential complex in Baliga Nagar with good sanitisation facility and scope for social distancing. But alarm bells rang four days later, when the virus found its way to one of the largest and most dense slum clusters, Mukund Nagar. Controlling the spread of infection in an area, where 9-10 people stay in a 10×10 sq ft room, was seen as almost impossible.

BMC swung into action: within 48 hours, it barricaded the entrance and exit to the slum cluster, carried out disinfection of 425 public toilets, began door-to-door screening, and provided food to people in the first month of the world’s strictest lockdown to slow down the spread of the pandemic.

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Making of a new model

From roping in private and local medical practitioners to classifying every Covid-19 contact as ‘high risk’ given the density in the Dharavi slums, the Brihanmumbai Municipal Corporation took bold and smart calls over the last two months.

In due course, it brought in private practitioners to create an environment of trust for people to come out and report symptoms. Fever caps were set up to isolate vulnerable people, and shift high risk contacts from slums to institutional quarantine. The civic body also took over some private hospitals, so that it had adequate treatment capacity.

Against a 5-day compounded daily growth rate of almost 23 per cent on April 20, Dharavi’s 5-day CDGR on June 20 has dropped to 0.85 per cent.

In fact, a steady decline in cases has prompted BMC to consider an ‘unlock’ plan for Dharavi. This may include opening of small scale industries, and pottery work with minimum staff. The focus of the civic body is now restricted to just four hotspots — Matunga Labour Camp, 90 ft road, Dharavi Cross Road, Kunchi Korve Nagar — which are still showing a rise in cases.

With just seven cases on Saturday, the total number of Covid-19 cases in Dharavi stands at 2,158. Its daily growth rate is 1.57 per cent compared with the city’s 3 per cent. While there were no deaths recorded between May 30 and June 8, seven deaths have been reported since, taking the total toll in Dharavi to 79.

READ | How Bihar’s Bhagalpur is unlocking

Health workers talk to Dharavi residents

In the initial weeks, with a gargantuan task of screening the 8.5 lakh population, the BMC staff, with full personal protection equipment (PPE), carried out door-to-door screening of citizens. But the strategy didn’t yield results. Many staffers said citizens were non-responsive. “Citizens lied about the number of people living, about medical conditions after hearing the health workers are from the civic body,” said a community health volunteer working in Dharavi.

After screening 47,000 citizens, BMC changed its approach. The civic body roped in 350 private and local practitioners from within the area, provided them PPE kits, and asked them to open clinics; nine BMC dispensaries were also included along with fever camps, bringing detection to the doorstep of people. Vans were dispatched in slums announcing the symptoms of Covid-19 and the location of fever camps.

“There is a trust deficit between citizens and the administration. People feel that if a BMC staff has come in their area, then it is only to evict them. Hence my staff could not effectively screen, isolate, and transfer people to quarantine facilities. The 350 local practitioners worked as a bridge between us and the people in Dharavi. People had faith in the local doctors and followed their instructions diligently,” said Kiran Dighavkar, Assistant Municipal Commissioner of administrative G-North ward, which includes Mahim, Dharavi and Dadar.

READ | Meet private school principal in Telangana, forced to sell idli on a cart

mumbai coronavirus, covid deaths mumbai, mumbai covid deaths, At a private doctor’s clinic in Dharavi (Express photo by Prashant Nadkar)

This approach yielded dividends. Local authorities were able to screen 3.6 lakh people apart from another 1.2 lakh senior citizens, who are more vulnerable to the infection.

“Since patients were screened, and isolated early, they could be continuously monitored, thus avoiding a rise in the mortality rate,” Dighavkar said. The BMC has conducted around 7,000 tests of high risk contacts from Dharavi till date, and an additional 2,000-2,500 tests are being done through reference of doctors and fever camps in the area.

BMC officials said the exodus of migrant workers from Dharavi also meant lesser number of cases. Other than the congested settlements with nearly impossible social distancing, Dighavkar said around 70 per cent of Dharavi’s population comprises daily wage earners, of which, over 1 lakh are migrant workers — employed in small-scale leather and packaging industries – and auto-rickshaw drivers, among others.

Most of them, with little or no savings, had to step out daily amid the lockdown to either arrange for food and essential items or collect food packets. “Nearly, 1.5 lakh who live in Dharavi left the city and returned to their homes. It definitely eased the burden on the civic body,” said Dighavkar.

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The civic body also changed its strategy on classifying contacts of Covid-19 patients following deliberations with the visiting team from the Centre. Earlier, contact tracing followed a model of quarantining around 15 high risk contacts of every patient. Until the second week of May, patient contacts were classified as high and low risk. Later all contacts staying in slum settlements and used community toilets were considered high risk and shifted to quarantine facilities.

Nine quarantine facilities in schools, sports complexes, hostels and community halls were set up to accommodate the people. For providing critical care, the BMC took over five private hospitals in the area.

Until June more than 8,500 were quarantined in such facilities. Now, most new cases are of high risk contacts of patients and no new slum cluster has been added as a containment zone.

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