Dharavi model of COVID-19 management: A success story

Mahmood Hassan

(The writer is Director, Char Areas Development. Assam. He can be reached at mahmoodhassan61786@gmail.com)

Dharavi is one of the most densely populated slums of the world. Considered to be Asia's largest slum with a population of more than 15 lakhs, that is more or less equivalent to population of Bhutan, it has become success story of VOVID management. At the time when the entire country is fighting to contain the virus, the control over the spread of the disease in this locality has come under praise from many quarters, including World Health Organization (WHO). Active surveillance and containment measures have created a model for the others to follow suit.

Because of the huge density of the population and lack of living space it was expected that the pandemic would create havoc in this slum as social-distancing was next to impossible. This area is the hub of international exports with an annual turnover of more than $1 billion. There are more than 5000 GST registered small-scale enterprises in this location. So the big question was how could they control the spread of the disease? Dharavi has a population density of 2.27 lakh per sq. km where inhabitants live under appalling conditions and many families share bathrooms and toilets. This makes fertile ground for community transmission as well. Being one of the world's most dense urban settlement of nearly one-and-a-half million people packed in micro tightly packed tenements, commercial spaces and common washrooms the containment has become a matter of study.

The strong focus on community engagement and basics of testing, tracing, isolating and treating all those who were sick is the key in breaking the chain of transmission and suppressing the virus. The Municipal Corporation of Greater Mumbai (MCGM) took the challenge with a strong grip as without a better management thousands would have been affected and large number people killed. A series of innovative experiments were carried out that included bringing in private practitioners, isolating the vulnerable populations, getting larger quarantine facilities and taking over private hospitals for treatment to make the things turn around for the better. The MCGM adopted a model of actively following the 4 Ts - tracing, tracking, testing and treating. This proactive screening through the medical staff has created the difference.

There are nine dispensaries and 350 private clinics within Dharavi that took active part in the mobilization and surveillance process. Even municipal schools were turned into quarantine centres .The Rajiv Gandhi Sports Complex with 300 beds and municipal schools at 1,000 bed Mahim Nature Park were taken over as isolation and quarantine facilities with a capacity of 3,800.Those who were asymptomatic patients were put through aerobics, yoga and breathing exercises. The dedicated medical staff and other agencies created the differences and managed to flatten the curve. Micro management and marking out the clusters within the hotspot zones were carefully identified and patients were identified in rapid manner. Residents with symptoms were isolated or quarantined and subjected to rigorous follow-up. The large number of community toilets and bathrooms were sanitized a number of times every day. A public-private-partnership was developed with effective coordination in this drive. Regular camps were organized to identify the suspects.

An important feature is the response strategy in strict enforcement of the containment measures. Three primary components are – an effective containment strategy, conducting comprehensive testing and ensuring uninterrupted supply of goods and essential supplies to the community. The containment was done on a mission mode where NGOs and community participation helped the medical authorities in carrying out the drive. BMC provided the PPE kits, thermal scanners, pulse oximeters, masks, gloves, to identify the suspects. Private hospitals, including Sai Hospital, Prabhat Nursing Home and Family Care, participated in the process. A 200-bed hospital was set up in a record 14 days. Till the first week of June more than 6 to 7 Lakh people were screened out of which 1,830 number of positive cases were detected through this process out of which 71 died. In the process more than 8,500 people were quarantined in institutional facilities and more than 38,000 were home quarantined. Those who were placed under institutional quarantine were provided community kitchen apart from medical care for free. Most of the senior citizens were surveyed. In total 14,970 people were screened in mobile vans. Only critical patients were moved out to hospitals for better treatment.

The Centre has praised the MCGM for successfully reducing the growth rate of the infection from April to July. More than 82 per cent of the patients recovered from the disease and the number of active cases dropped sharply. Self-discipline and community efforts were a key to this success. At the end of a difficult and tense April-to-June quarter the number of positive cases declined, doubling the rate of infections vastly improved, and the dreaded curve has flattened. It has flattened further in the month of July. In July till date there are 2,370 cases which are barely 3 per cent of Mumbai's total. This decreasing trend proves that COVID can be controlled through effective management system with high level of civic awareness. Dharavi is an inspiration for the world to follow how to curb the spread of a pandemic.

COVID management at Dharavi drew heavily from the successful 'Kerala model' but adopted three specific counts – higher density, urban lower-class setting and poorer public health infrastructure. Public awareness was created on a large scale among all the slum residents. Praising the efforts of Dharavi's example the WHO Director General Tedros Ghebreyesus said that "Dharavi has been successful in breaking the viral chain and that there are many examples from around the world that have shown that even if COVID-19 outbreak is very intense it can still be brought back under control". He added that "...in Vietnam, Cambodia and Dharavi ,a strong focus on community engagement and testing, tracing, isolating and treating has been key to breaking transmission chain."

Assam can come out of this deadly virus if the COVID protocols laid down by the government is strictly followed as proved by the Dharavi model of COVID management.