How India’s slums are faring against the second covid19 wave
As new covid19 mutants do the rounds, experts fear slums might turn into a tinderbox of infections once again
Tadiwala Road slum in Pune’s Dhole Patil area was in the ‘red zone’ when covid-19 broke out last year. Hundreds of residents tested positive by June, so the Pune civic body sealed all of its entry points for nearly two months. At the time, Jyoti Pawar’s family was among the few in the settlement that didn’t get sick. Now, as the second wave of the pandemic sweeps the country, she’s terrified again.
Pawar, 30, works as domestic help in a tony residential neighbourhood of Pune. It’s what her mother and grandmother did for a living, it’s what her three sisters do too. All of them live in a three-story house, in a tiny, sunless lane near the Pune railway station. That’s 19 members from four generations, from a 1-year-old to a 90-year-old.
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2020 was a difficult year, she recalls, as we sit on the floor her 10ft x10ft living room, along with her sisters, their children, and mother-in-law. The men in the family couldn’t find a job even after the lockdown eased. The women, too, weren’t allowed to go back to work by their employers in buildings for months. After the family burnt through their savings, they were forced to live off handouts from charities and do-gooders.
All that’s changed now. To Pawar’s knowledge, there are no covid19 patients in her neighbourhood this time. Instead, dozens of residents in the housing societies they work at are infected. As per the local ward office, slums accounted for a little over 200 active cases as on the last week of April, constituting 20% of the total number in the area. To rein in the spread, Maharashtra has strict curbs on citizens’ movements for weeks. Only those involved in essential services are allowed to step out. This includes domestic helps, too.
But the exemption bothers Pawar. Unlike last year, the government doesn’t conduct any health camps or door-to-door screenings in her slums. The residents, too, seem at ease: most of them were out without masks when I went over to Jyoti’s place in late April. “But we can’t not go to work,” she says. “They’ll stop paying us like the last time.”
Often, domestic helps aren’t informed of the infections at their workplace. Most rely on watchmen and drivers employed in housing societies to tip them off. A few days ago, Sheetal Khandagale, one of Pawar’s sisters, had confronted her “madam” about it: “Last year, you had asked us not to come. You said we might just infect you too. Why are you now asking us to come to work? Can’t you infect us?”
“What did madam say?” I asked.
“What will she say? She glared at me and went into her bedroom.”
The four sisters guffaw. They don’t often get to have the last word.
The second wave of covid19 is believed to have affected the affluent population the most. According to the Mumbai civic body, up to 90% of people in the city testing positive for covid19 come from non-slum areas. Other cities like Pune, Delhi, Chennai, Kolkata, Bengaluru or Chennai don’t release demographic data of its day-to-day infection rate.
“At the moment, we really have nothing more than anecdotal evidence [on the spread of covid19 in Indian slums],” says Dr Aurnab Ghose, associate professor at the Pune-based Indian Institute of Science Education and Research (IISER) and one of the principal investigators of the sero-survey in Pune. “In absence of data [in public domain], we only hear the noise of people that the media amplifies, which is the middle and upper middle class.”
There’s also the chance that the data available isn’t reflective of all sections of the society. The RT-PCR tests cost between ₹500-800, a stiff amount for a member of the working class. “So also there’s a possibility that if well-off people are getting more tests done, that reflects in the data.”
Going by the data of sero-surveys, it stands to reason that the non-slum areas are reporting high cases, he adds. The latest sero-survey in Mumbai, conducted by Brihanmumbai Municipal Corporation in March, found a sero-positivity of 41.6 per cent in slums and 28.5 per cent in non-slum areas. The sero-survey conducted in Pune, conducted between July-August 2020 by the Pune Municipal Corporation with a clutch of academic institutions, found 59.2% positivity in slums and 34.4 % in non-slum areas.
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“The disease seems to be moving to the previously uninfected population," says Dr Ghose. "As members of the middle class are stepping out, this population has turned into a breeding ground... On the other hand, the slums achieved a certain level of immunity at some point, so we see the infection in the population that didn’t see the disease.”
Given the high infection rate this time, the civic bodies in Mumbai and Pune have also reworked their containment strategy.
“This time, there’s no door-to-door screening or testing in slums,” says Dr Sanjeev Wavare, deputy medical officer at the Pune Municipal Corporation. The manpower and resources are already stretched, so it’s not feasible to do it, he adds. Contact-tracing has been difficult, too, says Kiran Dighavkar, assistant municipal commissioner in the Mumbai civic body, in-charge of the ward that includes Dharavi, the largest slum-complex in Asia. “With people going to work, travelling and using public transport, it is virtually impossible to trace all high-risk contacts,” he told the Times of India in the first week of April.
With the lack of enforcement and screening mechanisms, the residents of slum clusters are often seen not taking the state-imposed movement curbs seriously. “People aren’t as afraid anymore,” says Shahid Shaikh, a taxi-driver from Dharavi. "There’s no random testing, no health camps. Plus, it's the month of Ramzan and people want to celebrate."
Over a video call, he showed a crowded street near his Mukund Nagar residence. It was a Sunday morning in late April and the street was reasonably crowded, with shops at half-shutter and cloth-vendors doing business on pavements. “They close up only when the beat marshalls are doing rounds," said Shahid. "What choice do they have? They can’t afford staying at home, so they’d much rather bribe a cop than shut shop.”
Last year, between March to June, Dharavi had reported 2,000 cases. Given its 10 lakh-plus population within a 2 sq km area, the 'Dharavi model' was widely praised as a success-story in virus containment. But this year, as of 25 April, the complex had already reported 961 cases.
Dr Jacob John, retired professor of virology at Christian Medical College, Vellore, says that while the slums shouldn’t be ignored, the government’s focus on buildings to control the pandemic is the need of the hour. Studies across the globe have demonstrated that those who’ve survived the virus have an 85% less chance of getting reinfected. That the slums haven’t reported as many cases this time around, and going by the sero-survey findings, the residents of these areas may appear to be “more protected” than the rest.
“But that might change overnight,” he warns. The reason: the new mutations of covid19 that are known to escape immunity.
India has detected 5,000 variants since it started sequencing coronavirus mutations. “The [Indian variants] haven’t demonstrated high virulence (ability to cause death) but they spread faster,” says Dr John. So far, he adds, most of the previously infected areas haven’t shown high cases of re-infection. “But slums are a tinderbox. They are less visible, less likely to make noise about oxygen. As new variants come in, they’ll spread faster in slums.”
On 22 April, the PTI reported that one such covid19 mutant found to escape immunity has been discovered in West Bengal. The new lineage called B.1.618 is distinct from the B.1.617, virologist Upasana Ray, from Kolkata’s CSIR-Indian Institute of Chemical Biology, told PTI. There is, however, no evidence if this variant has spread across India.
Dr John says that such studies should be the immediate focus. In December, the Centre had approved 10 labs across the country to conduct genome-sequencing. That, however, needs to be increased, says Dr John. “We’re not doing enough of genome-sequencing in the country. So 1.5 years later, we’re still running blind.”
Sero-surveys in other major Indian cities haven’t released results based on demographics. But in December and January, the Indian Council of Medical Research’s (ICMR) conducted a sero-survey across 70 districts. Urban slums, it found, had a sero-prevalence of 31.7% and urban non-slums had 26.2%. Unlike Mumbai and Pune, this doesn’t reflect a large infection gap between the two demographics.
This is a cause for concern, says Dr Manoj Murhekar, director of the ICMR. “The herd immunity threshold required for interruption of transmission is high and even in slums this might not have been achieved,” he warns. The virus mutants is another cause for worry. “We have some examples in countries like Brazil where, despite high sero-prevalence, there were big second waves.”
The threat to slums is thus as present as it was the last year. The solution, say experts, is making covid19 testing accessible to residents in slums and ramping up the vaccination efforts. This also includes addressing vaccine hesitancy, which is documented to be far higher among the working classes. Suraj Lokhande, a social activist at Pune’s largest slum Janata Vasahat, confirms the same. “At our local vaccination centre, a lot more people from outside come than our own residents,” he says.
“You can’t expect people who have lost a year’s worth of income to actually take time off and vaccinate themselves,” says Dr Ghose. “So one needs to take vaccine at their doorstep. It’s not going to be easy, both in terms of awareness and the vaccine politics we see today. But given the nature of the virus, slums are perfect breeding grounds. To win the against covid19, they should be made a priority.”