DHARAVI, India — Just south of downtown Mumbai lies Dharavi, India’s largest slum. Around one million people live in this neighborhood, which is smaller than New York’s Central Park. Families typically squeeze seven to eight people in living quarters that average fewer than 100 square feet. Furthermore, services and sanitation are poor. In fact, as many as 80 people will share one toilet. Regardless, this dense, impoverished area was averaging around one positive case of COVID-19 a day per 100,000 people in September. Although this number has increased some, it is still very low. This is remarkable when considering that the entire state of Washington has 40 cases per 100,000 people each day.
India’s Response to COVID-19
In April, COVID-19 looked poised to overwhelm India, especially in Dharavi. The entire country went into lockdown, but officials only strictly enforced lockdown measures in vulnerable areas like Dharavi. However, social distancing proved impossible because residents had to leave their homes to use the communal toilets, collect water and receive food packets. Even with the government completely sealing off Dharavi from the rest of the city, COVID-19 quickly spread, averaging 45 cases per day in May. Kiran Dighavkar, a municipal manager in charge of the COVID-19 response in Dharavi, realized that his efforts would have to be more proactive to stop the spread.
Dighavkar’s team started going door to door to contact trace, instead of waiting for residents to come to them. This group of about 6,000 health workers, mostly women, will continue this process until the end of the pandemic. When the workers identify someone who tests positive, the patient gets sent to a “fever camp.” Here, doctors remain in a separate room and use remote thermal cameras to test for symptoms. Those who test positive then move on to a quarantine facility, usually a local school or community center. By the end of June, around 360,000 people had been tested and a further 10,000 went into quarantine.
The entire process is time and labor-intensive, but the results speak for themselves. Its growth rate went from 12% in April to 1% by June. By July, Dharavi was down to about 10 cases per day. These numbers are among the lowest in India, and scientists have taken notice. Some wonder if residents in India’s largest slum already reached herd immunity. They also point to the young average age in Dharavi, which might be a factor in the death toll only being in the hundreds.
Regardless of any other factors at play, the Dharavi model certainly played a major role in limiting the virus, and its success is both admirable and astonishing. This success drew praise from the World Health Organization, which commended the “basics of testing, tracing, isolating and treating” that Dighavkar’s team put in place.
Dighavkar’s team will face the challenge of containing the virus as the economy reopens. Dhavari’s economy was hit hard by the lockdown because rural migrants constitute much of the labor force. Many returned to their home villages when the local factories closed. Now, with the economy slowly returning, workers will arrive from the countryside where the virus continues to run rampant. India’s largest slum is not out of the woods yet, but the team is confident that its success will continue.
– Adam Jancsek