Testing, Tracing, Treating - How Asia's Biggest Slum Is Beating The Coronavirus

As the total number of confirmed COVID-19 cases in India passes 800k, pushing India past Russia and into third place on the ranking of most global cases...

...the country's leader, Prime Minister Narendra Modi has been hard-pressed to come up with a solution, particularly after an economy-crippling shutdown.

Earlier this month, local officials in Mumbai and New Delhi, the country's two hardest-hit areas, launched an effort to perform a 'COVID-19 audit' on the city's inhabitants in an ambitious testing program that would ideally test everyone in the two cities.

Now, local media are reporting that the WHO has praised an effort to contain an outbreak in Mumbai's Dharavi slum, said to be the largest slum in all of Asia, and also one of the densest.

World Health Organization Director-General Tedros Adhanom Ghebreyesus said during the WHO's press conference in Geneva on Friday that the situation in Dharavi is an example of how even some of the most intense outbreaks can be brought under control with a proactive strategy.

"And some of these examples are Italy, Spain and South Korea, and even in Dharavi - a densely packed area in the megacity of Mumbai," he had said.

According to local officials, the strategy they used to successfully start suppressing the outbreak relied on proactive testing first and foremost, along with the support of medical professionals and other medical resources focused on the area aside from the tests and the people needed to administer them.

The neighborhood, once deemed a global COVID-19 hotspot, has managed to flatten its curve.

One of the top hospital officials who participated in the effort said that the linchpin of the strategy was going out into the community and proactively testing individuals - especially the most vulnerable -  instead of waiting for patients to come to get tested at a facility.

"Proactive screening helped in early detection, timely treatment and recovery," he said.

When positive cases were found, officials diligently guided the subject to care (if they needed it) or quarantine, then made sure to trace cases back to the point of infection while keeping confirmed patients from spreading it to others.

Across Dharavi, 14,000 people were reportedly tested and 13,000, were placed in institutional quarantine with medical facilities and community kitchen for free," the senior official said. That's across a slum that measures 2.5 square kilometers, with a population density of 2,27,136 people per square kilometer.

Soon, officials noted progress in the data. In April, the doubling rate was 18 days. It was gradually improved to 43 days in May and slowed down to 108 and 430 days in June and July respectively.

As many as 2,359 COVID-19 cases have been recorded in Dharavi so far, of which 1,952 patients have recovered from the deadly infection, while there are only 166 active cases at present. However, achieving this monumental feat was not easy for the local authorities, who had to overcome their fair share of challenges.

"At least 80% of Dharavi's population depends on 450 community toilets and the administration had to sanitize and disinfect these toilets several times a day," Dighavkar said.

[...]

"Our approach to tackle the virus was focused on four Ts - tracing, tracking, testing and treating," he said.

Social distancing was next to impossible in Dharavi, where families of eight to 10 people live in 10x10 huts, and travel requires walking through narrow lanes in between the tenement houses.

Doctors and private clinics, as part of proactive screening and fever camps, covered as many as 47,500 houses, while 14,970 people were screened in mobile vans, the official said.

Apart from this, special care was taken for the elderly residents and 8,246 senior citizens were surveyed, he said.

Manpower was a major issue for organizing fever camps and proactive screening in high-risk zones.

"We mobilised all private practitioners. At least 24 private doctors came forward and the civic body provided them with PPE kits, thermal scanners, pulse oxymetres, masks, gloves, and started door-to-door screening in high risk zones and all suspects were identified," he said.

City officials also cleared schools and other buildings to transform them into makeshift hospitals and quarantine units. In just 2 weeks, a 200-bed hospital was devised.

Like the US, India saw a surge in cases after exiting a lengthy lockdown. The lockdown imposed by the Indian government was by all accounts far more strict than what most Americans experienced. Still, the virus has made a comeback, suggesting that lockdowns in India aren't a sustainable way to deal with the problem. But proactive testing sounds like it could certainly go a long way.