Is Mumbai resilient enough to fight coronavirus?

Forty-two per cent of Mumbai's population resides in slums, according to the 2011 census. Can its communities, which have figured out how to survive on the most unpropitious contingencies, overcome this pandemic?

It's a blistering afternoon, but for NR Paul, a social worker from Dharavi, it is just another busy day. He represents the spirit of Asia's biggest slum, which refuses to accept failure. Every day, Paul works unrelentingly with a few other good samaritans to supply grocery and food packets throughout the area.

Almost 8.5 lakh people are packed into 2.4 sq km in Dharavi. One of the distinguishing features of the slum is a number of small-scale industries located here, but the enterprises that have employed many rural migrants have been hit by the lockdown.

Source: Google Earth

"Migrants from UP, Bihar, Jharkhand and Bengal suffer unimaginable hardships due to lockdown. The government has many vacant rooms in the Slum Rehabilitation Authority across Mumbai; if they are shifted from Dharavi and given temporary residence in these SRA buildings, 25% of cases will come down," Paul explains.

Dharavi reported its first COVID-19 case on April 1st. BMC screened 83,500 people in Dharavi, quarantined 2,380 and discharged 196 residents after full recovery from COVID-19 as of May 6th.

Coming Together in Times of Need

Teams distributing grocery packets in Dharavi

Source: NR Paul

State-enforced social distancing is a challenge here, where big families stay in single-room low-rise homes with tiled roofs. Paul argues that if NGOs and authorities provided residents with food and medicines, 30 to 40 per cent of the population would not come out on the streets.

Prioritising Basic Needs and Supporting Existing Community Leadership

Prabha, a long-term resident of Dharavi, agrees with NR Paul. "Buying drugs like Hydroxychloroquine has become a challenge now," says the homemaker, who has Lupus. She was diagnosed with tuberculosis last year, so her family doesn't allow her to step out of the house. 

Social distancing differs significantly inside the various localities of Dharavi, she explains. "The operating principle of our family is to avoid crowded marketplaces. Initially, many didn't buy masks, but after the spike in the number of cases, there is an increased adherence among the people."

Praveen Pardeshi, Commissioner of Municipal Corporation of Greater Mumbai, recently stated in a webinar that the spike in the number of cases is due to the high testing rate of the city. The megalopolis has quickly ramped up its testing capacity, according to BMC authorities. The daily average tests have increased from 300 tests per day in March to 4000 tests per day in May. Over 95,000 COVID-19 tests have been conducted in Mumbai as of May 6th, according to news reports.  

Although private clinics across the city have been shut, Dharavi’s clinics have recently reopened their doors to patients. MA Khan is a family physician who has been running his clinic in the area for more than three decades. He says, "One of the major issues…is the use of common toilets in the area. Hundreds of people use the same toilet. Even if authorities disinfect it daily, it's not enough.” So, are portable toilets a solution for containing the spread of the disease? "Maybe," says Khan, who is also a member of the Mahim Dharavi Medical Practitioners Association.

MA Khan with other doctors of Dharavi, who did the door-to-door screening of houses.

Source: MA Khan

Khan says that his patients often remove their protective masks when they talk. "Authorities should do a proper awareness campaign in the region about adherence as well as proper use of masks."

It is impossible to test every person in Dharavi. So, it's up to these doctors to identify the positive cases in Dharavi and assemble a functional care plan to treat the sick and prevent further spread of the virus. Since Dharavi’s doctors already know the history of their patients in the area, many hope they have the rapport and information necessary to make a positive difference.

Frontline Healthcare Workers

Priyanka Nair, a nurse who resides in the locality, admits that she is worried about bringing back illness to her mother, who has comorbid conditions. She also feels that that daily commute to the hospital is a hassle for many frontline healthcare workers. "We have to rely on private vehicles to go to the pick-up point for buses arranged by the hospital. Police have been considerate to many of us. There have been several instances when my colleagues, who missed their bus, were dropped by the police," she adds.

When asked about vulnerable patients such as pregnant women, Nair says, "Many depend on the clinics in the area. But due to the closure of Sion bridge, it often leads to a long commute for patients."

Understanding the Situation Better

Dr. Avinash Supe, former Dean of KEM Hospital, says that he expects an exponential rise in the number of COVID-19 cases in Mumbai. "By the end of May, the city will have more than a lakh patients. Currently, the city has around 40,000-45,000 beds and [that won’t be enough]. The city needs a four-tier healthcare response. The first tier should be Type 1 COVID-19 care centres where asymptomatic patients below 50 years are quarantined. Second tier care, with oxygen stations, is for patients above 50, with comorbidity and mild symptoms. We need at least 30,000 tier-two beds. The third tier is for patients with moderate symptoms, and the fourth tier is ICU for critical patients. We need at least 2000-3000 ICUs."

Dr. Supe believes that lockdown has flattened the curve, and that it continues to be essential to reduce the mortality rate. "We need a plan for the high-risk groups. The majority of patients who go on ventilators end up dying."

Infectious disease expert TJ John has a different take on the issue. He says that education is as crucial as health infrastructure to contain the spread in slums.

"Some of the measures required to fight coronavirus include intense health education. The mask supply must be large enough to protect every citizen, including children. Mask hygiene needs to be taught to residents, and heads of districts would ideally supply hand sanitiser to every household and common meeting places like shops, water-sources and medical shops. The provision of other essentials such as food, sanitary pads, drinking water and medicines—free or at subsidised prices—should be arranged for home delivery," he adds.

There are no easy and obvious answers for the COVID-19 challenges that Mumbai faces. Asking whether the city ever had a formal plan for a pandemic is a waste of time at this point; However, viral videos of patients lying next to dead bodies in BMC hospitals definitely raises questions about the preparedness of the public hospitals.  

John points out that Mumbai slums like Dharavi are better organised than other areas. "That is their secret of survival. If they are made to look like part of the problem and not allies in solution, we are on the wrong foot."