Intended for healthcare professionals

Rapid response to:

News The Big Picture

Delhi prepares to hit 500 000 covid-19 cases

BMJ 2020; 370 doi: (Published 14 July 2020) Cite this as: BMJ 2020;370:m2817

Rapid Response:

Success story of Dharavi against COVID-19

Dear Editor,
The epidemics are supposed to hit harder the urban areas with denser population and poor socio-economic conditions, i.e., in slums. The same pattern is being observed globally for the ongoing epidemic of Coronavirus Disease-2019 (COVID-19). Uniquely, we have seen a rare exception of this in Dharavi, Mumbai, Maharashtra, India. Although Mumbai is the economic capital of India and in many parts of the city are genuinely prosperous, Dharavi has gained a dubious honor of Asia’s largest slum. Dharavi has an area of 2.1 square kilometers and a population of about 1,000,000 (a population density of over 277,136/km²) which makes it one of the most densely populated regions in the world (1). It was used as a setting to represent the surviving challenges of the slum dwellers for the Oscar-winning film “Slumdog Millionaire (2).
Owing to optimum conditions for the epidemic outbreak and impossible to implement social distancing norms in Dharavi, when the first case of COVID-19 was reported on 1st April 2020, there was fear that the epidemic will spread like fire in the bush (3). Fortunately, the state government and the city administrators took proactive, swift, and coordinated measures to prevent the epidemic outbreak. The city municipality, Brihanmumbai Municipal Corporation (BMC), played a central role in that. The first fever clinic was set up just three days after the first case. Dharavi was given a priority over other city parts, and 2,450 government health workers were engaged for it alone (2).
Additionally, private medical practitioners, social activists, community leaders, and non-governmental organizations (NGOs) were roped to battle the epidemic at war footing. Basic epidemic control training to grass-root level health workers was given, and personal protective equipments (PPEs) were availed to all engaged personnel. Regular sanitization of all community places, including community toilets, was done (2). Large community quarantine centers were established. A vigorous approach of tracing, tracking, testing, and treatment (4Ts) was applied to limit the spread of the epidemic (4). Initially, door to door screening was done, and later community clinics were set up where residents could approach for screening and testing. Senior citizens were given special attention. Most of the symptomatic cases were treated at the community centers alone, and only critical patients were referred to the city hospitals (2). The investment was made in trust-building efforts to harness public support for ruthless containment measures. Strict lockdown was implemented, and at the same time, delivery of essential commodities was maintained (2).
No later, the concerted efforts made for the epidemic containment started paying. Although COVID-19 has severely affected the city and healthcare facilities have kept exhausted, a drastic improvement has been seen in Dharavi. The growth rate of positive cases, which was 12% in April 2020, reduced to 4.3% in May and to 1.02% in June (5). There were 491 COVID-19 cases in April and 1,216 in May, but only 274 cases and six deaths in the first two weeks of June (2). Doubling time, which was 18 days in April, was increased to 64 days in July (5). Currently, less than 100 active COVID-19 cases are remaining in Dharavi (6).
Recently World Health Organization (WHO) has applauded the success of Dharavi, and BMC is now presenting it as a model to replicate in other parts of the city (5). Effective containment of the epidemic in Dharavi has set an example and has raised hope that with proactive and multi-pronged approaches, COVID-19 spread can be contained in even the areas with the poorest socio-economic conditions and with negligible health infrastructure.

1. Dharavi - Wikipedia. Accessed June 26, 2020.
2. How the Dharavi slum in Mumbai, India, contained coronavirus - Los Angeles Times. Accessed June 26, 2020.
3. India: Asia’s largest slum rings alarm bells as COVID-19 cases surge. Accessed June 26, 2020.
4. Coronavirus | Dharavi turns the corner with steep decline in COVID-19 cases - The Hindu. Accessed June 26, 2020.
5. WHO lauds BMC’s efforts to check Covid transmission in Dharavi. Accessed July 15, 2020.
6. Mumbai's Dharavi slum adds 6 new patients; active cases below 100. Accessed July15, 2020.

Competing interests: No competing interests

15 July 2020
Ashutosh Kumar
Assistant Professor
Vikas Preek, National Brain Research Center, Manesar, Haryana, India; Ravi K. Narayan, All India Institute of Medical Sciences (AIIMS), Patna, India; Kamla Kant, All India Institute of Medical Sciences (AIIMS), Bathinda, India; Cheena Kapoor, a freelance journalist based in New Delhi, India.
All India Institute of Medical Sciences (AIIMS), Patna, India; Etiologically Elusive Disorders Research Network (EEDRN), New Delhi, India
Patna, Bihar India