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Wednesday, May 27, 2020

Quarantine challenge: How wards in Mumbai are contact tracing

The state public health department has directed all local bodies to form specialised teams to locate contacts and regularly follow up for signs of symptoms of the infection. A daily update is submitted to Mantralaya, which includes details of daily contact tracing and average number of contacts traced per case.

Written by Sandeep A Ashar | Mumbai | Published: April 27, 2020 3:10:41 am
coronavirus, coronavirus outbreak, coronavirus in maharashtra, coronavirus cases in maharashtra, coronavirus tracing in maharashtra, maharashtra coronavirus cases tracing, coronavirus cases in maharashtra slum, maharshtra slum coronavirus cases, covid-19, indian express news While the number of high-risk contacts vary from case to case, officials said Mumbai is currently tracing an average of 24 contacts per infected person. (Representational Photo)

As COVID-19 cases rise in slums and chawls of Mumbai, authorities are ramping up institutional infrastructure to quarantine people who may have been exposed to the virus in these dense habitations. But the first challenge is contact tracing.

Data compiled by BMC indicates administrative wards that have more affluent neighbourhoods and high-rise buildings have been able to find and quarantine a higher percentage of contacts of those infected. The data shared with the state government till April 24 shows for the 4,589 infected in Mumbai, 1,10,826 contacts were traced and quarantined either in institutional Covid care facilities or in their homes. While 17,915 of these were categorised as high-risk contacts, 92,911 were termed as low risk.

High-risk contacts are family members, caregivers and anyone in contact with the patient for six hours or more, whereas low-risk contacts are others who share the same physical space with the infected person.

The state public health department has directed all local bodies to form specialised teams to locate contacts and regularly follow up for signs of symptoms of the infection. A daily update is submitted to Mantralaya, which includes details of daily contact tracing and average number of contacts traced per case.

While the number of high-risk contacts vary from case to case, officials said Mumbai is currently tracing an average of 24 contacts per infected person.

On an average, around four high-risk contacts are found and quarantined.

But corresponding ward-wise data reveals that each ward in Mumbai has had widely varying success with contact tracing.

For instance, G-South ward – it includes parts of Worli and Prabhadevi – which is the worst-hit locality in the city, had till Friday evening 558 cases and had quarantined 4,842 contacts (862 high-risk and 3,980 low-risk). According to the BMC data, this is an average of under nine contacts per case — the high-risk contacts averaged at 1.5 and low-risk at 7.1.

The neighbouring G-North, also grappling with high number of cases, claimed to have successfully traced an average of 38 contacts per case. By Friday evening, it had reported 330 positive cases and reportedly isolated 12,448 contacts (1,812 high-risk and 10,636 low-risk). The local ward office report said that high-risk contacts averaged at 5.49 and low-risk contacts at 32.23 per case. Despite G-North having the highest average among nine wards in the island city, it is still less when compared with most wards in the western suburbs with a higher concentration of middle-class neighbourhoods.

With the exception of H-East ward, which includes Bandra East, Khar East and parts of Santacruz East, all other wards in the western suburbs have recorded a better contact tracing average than the city overall.

For instance, P-North (mainly Malad, Madh, Manori and parts of Goregaon) that has a higher number of multi-storied buildings than the rest of the wards, had until Friday quarantined 16,673 contacts (698 high-risk and 15,975 low-risk) while reporting 115 positive cases, averaging 145 contacts per case – the highest in the city.

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R-North, which has a similar residential profile, averaged around 53 contacts per infected person. Neighbouring R-Central had an average of 42 contacts per infected. H-West, which is considered to be the most affluent ward in the western suburbs, also had a high average of quarantining 44 contacts per infected person.

But H-East ward, which has a higher concentration of slums and where people are more densely packed, averaged only five contacts per case.

Wards in the eastern suburbs that have traditionally had a lower human development index and are dotted with high density slums, have had the lowest number of contacts for patients.

Barring N-ward, which also has a concentration of multi-storied buildings, all the other wards have isolated far fewer contacts on average than the city’s overall ratio. L-ward, which comprises slums of Kurla and Powai, had reported 324 cases by Friday but had traced 2,288 contacts – an average of 7.06 contacts per case.

S-ward, comprising Bhandup, had traced fewer – at 5.89 contacts per case with a tally of 131 positive cases. Neighbouring T ward (Mulund) had only 30 positive cases by Friday and traced an average of 7.83 contacts per case. M-East, which has emerged as a new hotspot, had traced an average of 22 contacts per case.

An inter-ministerial central team, visiting Mumbai for an on-spot assessment had also raised concerns on the lower than average number of contacts quarantined in slum areas. “Without aggressive contact-tracing, there’s always a risk that we won’t be able to contain further outbreaks. We’ve written to Mumbai, other municipalities to intensify contact tracing,” said Dr Satish Pawar, Additional Director, National Health Mission.

In wards with more slum pockets, where all contacts of a patient might be more difficult to trace, the BMC has so far gone for a containment strategy. “Our strategy is active contact tracing and cordoning off infected pockets within the slum,” said Assistant Commissioner (G-North) Kiran Dighavkar.

Dr Daksha Shah, BMC’s deputy executive health officer, highlighted how Mumbai had adopted an aggressive cluster containment strategy. By Friday, BMC had declared 1,196 containment zones, surveyed 17.01 lakh houses and 67.44 lakh people.

Now, signalling a shift in approach after the visit of the central team, Chief Minister Uddhav Thackeray has directed a massive operation to shift all “high-risk” contacts in slums to institutional facilities. With all those using the same common toilet and other facilities as the infected person now likely to be tagged as high-risk contacts, Principal Secretary Ashwini Bhide, on special deputation to BMC, said the numbers of high-risk contacts in these wards would go up sharply. “Till Friday, 5,825 high-risk contacts from slums were shifted to care centres,” she added.

“It is very difficult to convince slum dwellers to shift to quarantine facilities. In the last couple of days, we have doubled the capacity of intake of our institutional facilities,” said Dighavkar, who is in charge of the ward with Dharavi, where an estimated 8.5 lakh people live in an area of 2.4 sq km.

“Isolating people who live in buildings is easier. Their tenements are self-contained with attached toilets. Earlier, the cases in our ward were restricted to buildings. A few sporadic ones detected in slums in the last few days, pose a challenge,” said Bhagyashee Kapse, Assistant Commissioner (R-Central).

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