On March 23, a 56-year-old man from a large labyrinthine shanty town in the city of Mumbai in western India went to see a doctor. He felt feverish and had a bad cough.
The clothing merchant lived in Dharavi, where more than half a million people are spread across 2.5 dirty square kilometers, less than a square mile. (Imagine a larger population than Manchester living in an area smaller than Hyde Park and Kensington Gardens.) The slum was the inspiration for the Oscar-winning film Slumdog Millionaire and city planners around the world have studied its thrilling economy and society.
The local doctor examined the man and left with a prescription for cough syrup and paracetamol. Three days later, the man arrived at the private hospital in Sion near his home. Her fever had increased and the cough was getting worse. He said he had no travel history, so the doctors gave him more cough syrup and sent him home.
On March 29, the man returned to the hospital with signs of respiratory distress. Doctors admitted it and quickly sent pads for the Covid-19 test.
Three days later, the results arrived – he had tested positive. His condition deteriorated sharply and doctors tried to move him to a larger hospital already treating patients from Covid.
It was too late: he died that evening.
This clothing trader was Dharavi’s first Covid-19 patient. The inhabitants of this crowded slum suffer from all the common diseases that affect Mumbai, one of the most densely populated cities in the world, from diarrhea to malaria.
But a coronavirus epidemic in a place where social distancing is an oxymoron could easily turn into a serious public health emergency and overwhelm the city’s strained public health system.
No one realizes this more than the officials who run to screen for and contain the infection.
Patient # 1 in Dharavi lived with his family of eight – his wife, four daughters and two sons – in a 420-square-foot one-room apartment in a low-rise slum surrounded by sordid songs.
“When we interviewed his family, they told us that the man had no recent travel history and had only gone to the local mosque,” said Kiran Dighavkar, deputy city commissioner in charge. of the region.
But there was a twist in history.
The man owned another apartment in the same complex. He welcomed five people who are believed to have arrived from Delhi after attending a conference in early March organized by Tablighi Jamaat, a religious movement that has followers in more than eight countries, including Indonesia, Malaysia and the United States.
Hundreds of people who attended the religious event in the capital have sparked several Covid-19 clusters across the country and are now linked to some 650 cases in 14 states.
Police believe the five men lived in Dharavi’s apartment for two days – between March 19 and March 21 – before leaving for Kerala. “We are trying to find these people,” said Mr. Dighavkar.
“We have to find the source of the infection. How did this man get the infection and from whom? And we must contain this infection by taking aggressive measures, ”he said.
The family of the deceased trader insisted that he did not have a passport, which the police were skeptical of. So they try to dig his cell phone records to find out more about his movements.
For now, the race is to make sure the infection is contained. Thus, 308 apartments and 80 stores in nine six-story buildings in the complex where the merchant lived were completely sealed. Some 2,500 residents have been quarantined at home. Food rations are provided. Health workers disinfected the apartments with bleach. Swabs from eight “high risk” building occupants – the merchant’s family and an acquaintance of the building – were sent for testing.
Over 130 residents over the age of 60 and 35 others with unrelated respiratory illnesses are being closely monitored for symptoms of Covid 19.
Fearing an epidemic, authorities took over the 50-bed hospital in Sion and quickly set up a 300-bed quarantine facility at a nearby sports complex. Protective equipment was given to doctors and nurses at the hospital.
All of this may not be enough to prevent an epidemic.
On Thursday, a 35-year-old doctor working in a private hospital and living in the slum tested positive for the virus. City workers rushed to isolate and seal 300 people living in the doctor’s building. They also identified 13 high-risk contacts in the building and sent their swabs for testing. The doctor told authorities that two nurses from his hospital had tested positive for the virus. And on the weekends, a 30-year-old woman inside the same building complex as the shopkeeper, a 60-year-old man, owner of a metal workshop and a 21-year-old male laboratory technician, were tested positive.
“We can always try to contain the infection of closed slum settlements. But there are the slums outside, and if we get cases there, we can’t isolate them at home, and we have to send even the high-risk cases to the quarantine center of the sports complex “, said Mr. Dighavkar.
If this happens, the struggle to contain the infection will turn into a messy battle. The local hospital and quarantine fortune will easily be overwhelmed by the cases.
The tests will have to be intensified and the results will have to arrive on time. After the first two cases – the shopkeeper and the doctor – 21 samples were taken in slums. After more than 48 hours, only seven results are entered. The public hospital where the tests are carried out says it is inundated with samples. Another 23 samples were taken after the two new cases and sent to the laboratory on Saturday. We do not know when the results will arrive.
“We are wasting time because of the delay in the results. It also delays the movement of people who test positive in isolation, “said Virendra Mohite, the medical consultant, who heads the health teams in the slum.
These are some of the real challenges for containing a massive epidemic of disease in a single, otherwise self-contained shantytown that is home to fishermen, potters, furniture makers, clothing makers, tailors, accountants , waste recyclers and even some from Mumbai. most daring rappers. Dharavi, the writer Annie Zaidi has already observed it, is a place full of “stories of despair and courage, initiative and very, very hard work”.
Now he faces his most daunting challenge to prevent a cataclysmic wave of contagion.