4 min read.Updated: 25 May 2020, 11:09 PM ISTKabir Nanda
In Mumbai, the infection had a high concentration in slums where large populations reside in close proximity and share public facilities.
Increasing access to sanitary facilities, training communities to undertake basic screening as well as reporting of covid cases, and sharing data can help mitigate the risk of its spread in other parts of the country.
Even as India emerges from the lockdown, covid-19 is here to stay. Its rapid spread through Mumbai’s slums demonstrates how physical distancing protocols cannot apply to highly dense urban areas in India. In the coming months, Indian cities are likely to see this pattern repeated. They have a small window of opportunity to prepare, and can do so using several relatively straightforward measures, before the human and economic costs begin to mount.
The pattern of spread in Mumbai over April and May shows a clear concentration in administrative wards with large slum populations. Disaggregated data until 25 April showed a relatively rapid spread in such wards. The earliest major cluster was in Worli Village (Ward G/S), an urban village with slum-like characteristics. After the Brihanmumbai Municipal Corporation (BMC) stopped releasing disaggregated data, an analysis of its containment zones showed that this pattern continued. On 14 April, 31% of Mumbai’s 488 containment zones were inside slums, another 34% within 100 meters of a slum, and the remaining 36% within 800 meters (Patranabis, Gandhi and Tandel, Brookings India). Between 30 April (1,576 zones) and 11 May (2,643 zones), about 57% of the containment zones were in ‘Congested Areas’, or slum-like settlements. Mapping against census data also shows about two-thirds of the containment zones are in wards where over 40% of the population resides in slums.
This pattern is not surprising, as structural factors limit the feasibility of boilerplate physical-distancing norms. As much as 42% of Mumbai’s population lives in slums, occupying just 8% of the city’s area. Most households reside in one-room facilities; up to 12 people share a 100 square-foot room. Crowding is the norm, with most residents receiving water from common access points (taps or tankers) a few hours a day and sharing community toilets. For example, almost 250 people share one public toilet every day in Dharavi. The economic costs of the lockdown, given the lack of a social safety net, have compounded these factors and pushed people to venture outside. It is also possible that the stigma associated with covid-19 may have led to lower voluntary disclosure of symptoms.
Other cities face similar challenges. Already, over 70% of India’s covid-19 cases are concentrated in 10 cities. Around a quarter of India’s urban population lives in slums (United Nations Millennium Development Goals Database, 2014). This number is closer to a third for major cities like Hyderabad, Kolkata and Chennai. These slums have the same structural issues to contend with—although they may be slightly less dense than in Mumbai—and are thus highly vulnerable. However, the spread of covid-19 can be contained with proactive measures that will cost significantly less than dealing with an outbreak.
First, we can reduce crowding. Cities can drastically increase the availability of water in slums by installing additional taps or commissioning tankers to ensure 12 hours of supply daily, as opposed to 2 hours currently. Modular toilets can be installed to ensure that only 25 people share a toilet daily, instead of 250. Universal free provision of alcohol-based sanitizers and reusable masks can improve personal hygiene. Also, universal provision of food (or cash) will help keep economically vulnerable people indoors. This is important given the large share of slum dwellers that depend on daily wages. All these measures can be undertaken rapidly and will have a relatively lower financial and administrative burden than ramping up isolation and critical-care beds when outbreaks inevitably occur.
Second, we can train communities to undertake basic screening, case reporting and contact tracing. The existing infrastructure of civil society organizations working in slums can be leveraged to support this effort. This will generate employment, reduce the burden on municipal authorities, and create a proactive detection infrastructure that can respond rapidly to cases. These measures could be bolstered by the deployment of mobile testing (for covid and antibodies) labs that can be shared among a fixed number of sites through the week.
Third, we can make isolation comfortable and targeted. Reports in Mumbai indicate that slum dwellers have at times been isolated in facilities that were considered unfit for living; these communities also alleged discrimination. Isolating slum residents in comfortable and hygienic facilities as close to their homes as possible (for example, in underutilized buildings), and staffing them with community members, will build trust and generate employment. Providing immediate relief to the families of those isolated will incentivize reporting. In situations where severe outbreaks occur and targeted lockdowns must be imposed, authorities could consider immediately isolating residents with recognized co-morbidities (e.g. tuberculosis, asthma, diabetes, etc.); recent research at the Massachusetts Institute of Technology by Daron Acemoglu and others suggests that such targeting could achieve health outcomes similar to those arising from total lockdowns.
Finally, we can communicate. The spread of covid-19 is geographically and temporally asymmetric. What happened in Mumbai today may happen two months later in Hyderabad. As such, it is important to start preparing, communicating and learning from the successes and failures of Mumbai. The BMC has likely generated a rich amount of data and insights that can benefit other municipal corporations. More broadly, all cities would benefit by sharing detailed data publicly to enable contributions from the research community. And as we look to the medium-term, this is an opportunity for introspection and planning as to how our cities can better integrate and provide for a large part of their ‘essential’ workforce. Perhaps this can be the impetus to envision a newer and healthier future for our cities and their slums.