“How can we get it, why are you here to test us… because we are poor and live in slums?” These were the words the son of the 68-year-old domestic help, who tested positive for COVID-19 on March 18, confronted civic officials with when they came knocking at his door in a 250 sqft home in a central Mumbai slum.
The first case perhaps in India where a slum-dweller has contracted COVID-19 infection has thrown open the challenges of community tracing in a dense slum where over 23,000 people are huddled in less than a square kilometre of land.
Tracing who the help met over 10 days in the vast slum since she was first exposed to coronavirus is proving to be difficult, but what health workers find impossible is to trace each woman who used the public washroom where she bathed every day.
On March 7, a 49-year-old man returned from the US to his home in Mumbai’s central suburbs. The 68-year-old help, who lives a lane away, cleaned his house every day. Ten days later, on March 17, he tested positive for COVID-19. His mother, the help, and two more close contacts were tested. The help was the only one to test positive.
While contact tracing remains a relatively easier task among the developed boroughs and localities of Mumbai, health officials are fighting suspicion and huge population as they undertake contact tracing in slum.
Dr Avdhoot Kanchan, a BMC official, said the woman was not allowed to use cellphone in isolation ward, as Kasturba hospital staff feared if the phone was given to her son, the infection would transmit outside. “When Kasturba doctors asked her who her close contacts were, she couldn’t reply properly. She was scared, didn’t understand what was happening, we think,” Kanchan said.
So health workers reached out to her son, a daily-wager. Her son was not ready to get tested. “He kept saying he had no symptoms, questioned whether we were admitting him because he is a slum-dweller. We had to counsel him about how it spreads, the risk his family is in if they don’t get tested,” Kanchan said.
After persuasion, he spoke — his mother worked in three more flats apart from the 47-year-old’s house. Civic officials managed to trace in total nine people— five from the help’s family and two couples in two of the houses where she worked. All were sent to Kasturba hospital for testing. The third flat was locked — its owner currently in Jaisalmer.
The help’s family of six lives in a tiny 250 sq ft room. Like matchboxes, several houses stand next to one another, each sharing a common wall. The houses were fumigated. Nearly 500 households were visited by officials to look for slum-dwellers with cough, cold or fever, but no symptomatic case was found. The 68-year-old used a public washroom to bathe, but civic officials say they can only hope nobody caught the infection from there. The bathroom is washed daily.
Contact tracing is a process to identify and manage people who may have been exposed to the virus. Eight more low-risk contacts who live nearby were advised home quarantine. “The challenge is to make them understand home quarantine without spreading panic in the slum,” said Dr Bhupendra Patil, the ward medical officer. “We spoke with neighbours to check if they saw the woman with anyone. They gave few names. The contact tracing process is on.”
In a slum where the doors to each hutment are usually open, children run from one home to another, and meals are often shared, the BMC fears the woman could have exposed many others to the virus.
Signs of community transmission have started to emerge elsewhere in India. A 20-year-old hairdresser tested positive in Tamil Nadu after he travelled from Rampur to New Delhi and boarded a train to Chennai. He has no history of foreign travel or contact with a confirmed case.
By Friday night, the civic staffers breathed a sigh of relief. None of the nine close contacts of the help had tested positive. “The chances of the virus spreading beyond are slim if these people tested negative,” hopes Suresh Kakani, additional municipal corporation, BMC.
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