Fewer Cases, Deaths: How Dharavi Dealt With The COVID-19 Crisis

With a dip in death rate and fewer numbers, here’s how Dharavi managed to flatten the curve.

There have been no COVID-19 related deaths in Dharavi in the first week of June.

(Photo Courtesy: The Quint/Kamran Akhter)

With more than one death and over two dozen positive cases detected every day, the slums of Dharavi was a major cause for concern for the Maharashtra government in the months of April and May. Now, in slightly more positive turn of events, the COVID-19 hotspot did not report any deaths in the first week of June.

The average number of COVID-19 cases recorded per day also dropped to 27 in the first week of June as opposed to 43 in May 2020. On 8 June, 12 new cases were recorded in the area and 13 new cases were seen on 7 June. On 9 June, however, there were 26 new cases and 2 deaths.

(Photo: The Quint/Erum Gour)

(Photo: The Quint/Erum Gour)

Early intervention, screening and isolation measures are being credited for this turnaround by senior BMC officials.

BMC officials going door to door screening residents. (Photo Courtesy: Gulzar Khan)

BMC Assistant Municipal Commissioner of G North Ward, Kiran Dighavkar says the authorities “started screening as many people in the area” and “simultaneously started building health infrastructure like quarantine centres”.

“We started acquiring schools to have a quarantine centre over there. We acquired Dharavi municipal school, Manohar Joshi Vidyalaya; we acquired a sports complex and various things. Also, in second week of April when cases were hardly some 16 or 20 in number, we acquired a hospital as well.”

Kiran Dighavkar, BMC Assistant Municipal Commissioner of G North Ward 

(Photo: The Quint/Aroop Mishra)

Dharavi has a population of about 15 lakh people densely packed in 2.5 sq kms. Over 1,830 people have tested positive for COVID-19 in the area so far and at least 71 people have died. What served as a wake-up call for the authorities was when the first person, a 56-year-old from Baliga Nagar, tested positive in the area and died on 1 April, within a day of testing positive for COVID-19.

What followed was a number of deaths one after another, as the BMC rushed to screen, contact-trace and isolate infected patients. According to data from the BMC, over 3,60,000 people have been screened in Dharavi so far, high risk slums have been sealed. Over 8,500 people have been quarantined at institutional facilities so far and over 38,000 individuals have been quarantined at their home till 7 June.

Targeted testing of suspected patients is another factor that helped, says Dr Shivkumar Utture, President, Maharashtra Medical Council.

“As a first stage, the local private practitioners, or the general practitioners, as we call them, or family physicians, see these patients who are with fever or with cough or with respiratory symptoms. Then, sort of triaging is done in the clinics itself and these patients are specifically referred to the BMC fever clinics for getting their further testing done.”

Dr Shivkumar Utture, President Maharashtra Medical Council, Member, National Medical Commission 

Dr Utture’s claims were backed by independent general practitioner Dr Anil Pachnekar, who has been practising in Dharavi for 35 years now. With his experience, Dr Pachnekar took the lead role in the door-to-door survey conducted in Dharavi to screen and test people for COVID-19. “We have done a lot of hardwork in Dharavi,” he said as he recounted the several steps taken in the initial phases that caused the number of cases to reduce.

“15 days ago when we used to examine patients, their oxygen level would be below 90, which is very risky. We have seen patients with 60, 65 to 80, 85 percent oxygen levels but since the last one week we have been getting patients coming in with more than 93 percent oxygen levels. That shows that Dharavi’s coronavirus cases have been brought under much control. This is because, us, doctors, are working day and night,” said Dr Pachnekar.

From creating public awareness among residents about sanitising their hands and washrooms to instructing the BMC about sanitation in and around public toilets, the doctors of Dharavi are directly responsible for the reducing the number of COVID-19 cases.

Coordination Between BMC and Private Clinics

A fever camp set up in Dharavi.(Photo Courtesy: Gulzar Khan)

In April, the BMC took over three hospitals to treat local patients. Apart from door-to-door screening, the civic body also set up fever clinics where over 3,200 people have been screened so far but what sped the process of identifying and treating patients was establishing coordination with private practitioners and clinics in the area.

Initially, doctors in private clinics in Dharavi were afraid of opening their clinics due to lack of proper PPE kits, said Dr Shivkumar Utture. But this changed in due course, he added. According to the BMC, as of 7 June, there are 9 dispensaries and 350 private clinics in Dharavi.

“Now the advantage of that is that once the clinics are open, the local population who knows the doctors for years and have been visiting these doctors have the confidence in these doctors and hence, even for slight fever, or any other symptoms, they approach these doctors, then it becomes very easy for our members to refer these patients to the concerned authorities for getting them further tested.”

Dr Shivkumar Utture, President Maharashtra Medical Council, Member, National Medical Commission

He further added, “The earlier you catch these patients, the easier it is to treat these patients. That is what has led to the dip in death rate in Dharavi.”

Another factor that Dr Utture believes encouraged residents to come forward and undergo testing, is because isolation centres were set up in the same locality. “When these centres are in the place in which the citizens are staying, they are very amenable to go and stay in these centres. And when they go into these centres, what we are achieving is that we are removing a positive patient who would be a spreader in society and isolating him in these centres,” he said.

The BMC, doctors and healthcare workers at Dharavi all agree that community toilets have been the key source of the spread of infection.

“Government isolation was very important because they are all using the same toilet. What we were doing is, we were cleaning the community toilet, we are isolating these people, treating them, testing them. Because of this proactive approach, the virus was detected at an early level and then treatment happened early and that turned into a discharge and lowered the mortality rate.”

Kiran Dighavkar, BMC Assistant Municipal Commissioner of G North Ward 

Exodus of Migrant Labourers Another Reason for Dropping Numbers?

Over the last two months, a very rough estimate shows about 10 lakh migrant labourers have left Mumbai. A large number of these migrants were residents of Dharavi and worked in the small textile, leather and other business units located in the slums. Most of these migrants have also left for their respective states.

Gulzar Khan, who runs the NGO Hum Sab Ek Hain Foundation, helped distribute ration to those in need within the slums. “The BMC and doctors have been screening and testing people but lakhs of people began leaving the slums since April. With most of these migrant labourers, the number of cases are bound to come down,” he said.

As of 9 June, Mumbai has recorded around 50,878 COVID-19 cases.