Dharavi

Is India testing enough? Or is there a method in this madness

(This is a reprint from NewsBred).

These are bad times for jokes but the one by India’s premier health agency looks particularly awful when it says it’s “testing” less than it could.

India is doubling the count of its Corona Virus patients twice every week and 40 have perished in the last 24 hours but the Indian Council of Medical Research (ICMR) simply hasn’t cast its net wide enough to assure an anxious nation of a billion plus.

India is dawdling at 190,000 tests put together as on Sunday which bears a sorry comparison with the United States (2,700.000), Italy (1,000,000) and Spain (350,000), three nations reeling the most under the unforgiving pandemic.

India today isn’t short of hands or testing kits. It’s good enough for 20,000 tests a day. It also isn’t shy of promising 100,000 tests a day soon. So what’s stopping it from showing its full hand to the growing footprint of the killer virus?

Specific and not random tests

It would seem India’s strategy is more by design than neglect. India has so far preferred to do tests only on those who have shown symptoms. Such information is either being relayed by patients themselves or a confirmed case is being followed up. In no case, suspects are allowed to visit nearby designated hospitals on own.

It appears there is a corollary to such caution. A nursing home in Washington made headlines for being the biggest harbinger of disease to nearby community. The Virus arrived on the host-patients and spread itself on staff, security and residents without distinction. Wuhan in China bears reports on patients calling up on routine health issues and ending up infecting those unfortunate to be around them.

The red flag of mass testing is obvious too. How do you do it? By rounding up people and allowing the disease to hop and spread to the last man in the queue? Instead, India’s healthcare is opting to swarm around hot-spots in the country of which they have identified a few dozens. It’s here that they are rolling up sleeves and getting into combat mode. Mass testing with lockdown in place doesn’t quite make much sense to them.

No community spread yet

India still maintains it’s in Phase Two of the spread, that it is still local and not communal which would’ve set alarm bells ringing. It went into a lockdown mode when there were still only 150 cases on the chart. Italy, Spain and France in contrast shut itself up at least 7-10 days prior but their cases–and fatalities–were already in thousands. The horse had already bolted.

India could also take comfort that out of its 707 districts, only 325 so far are in the infected list. It’s fatality roll of just over 300 isn’t cause for panic yet. The people have so far stoically borne the pains of a lockdown. Indeed, they are bracing for an extension of lockdown without quite throwing up.

It’s not to say India is out of woods yet. It’s a long summer ahead. Slums remain a major worry. Dharavi, one of Asia’s biggest in Mumbai, is racking up patients steadily. Delhi, India’s capital, has sealed off at least two dozen of its infected pockets. The western state of Mahrashtra which houses India’s commercial capital Mumbai, accounts for nearly half of India’s total deaths. India hasn’t turned the corner yet.

India, for sure, would ramp up tests in coming days. It’s also almost given that more cases and more fatalities would show up. It would hope it’s still manageable. And that its’ strategy of testing visitors, and enforcing lockdown when the numbers were still low, was a clincher. Else, it would rue it didn’t test enough when the time was still on its side.

Death in the slum: India holds its breath; world gasps

(This is a reprint from NewsBred)

India panicked. The world broke into a sweat. A man had died in Mumbai, India’s commercial capital, to the ever-so growing shadow of killer Corona Virus pandemic last week.

No, he isn’t the only victim India has had in the past few weeks. Nor was he a celebrity or a billionaire.  Indeed, he was just a garment seller. But he happened to live in one of Asia’s biggest slums, Dharavi, which houses one million people in a little over two square kilometer land. Lives are packed like stacked hay. And we know hay fires break out without even a spark—just being baled and moist is enough.

In no time a team of doctors and volunteers swooped on to the area. Cops were in tow. They fanned out and stayed till midnight. Family was isolated. Some 2,500 neighbours were stamped for quarantine. The deceased’s movement of last two weeks was retraced with the help of his people. A list of his acquaintances was mapped and alerted. His shop, and some 100 others, including the nearby 330 flats were put under barriers.  Common spaces between the buildings were sprayed. A posse of policemen now guarded the area to enforce no violation.

The world watched. It’s fears found a shape in headlines.  Dharavi is not unknown to humanity. Thanks to power of Hollywood, Dharavi was made famous through Oscar-winning “Slumdog Millionaire” in 2009. It topped the worldwide box office. Best-ever grosser for Fox Searchlight Pictures. “Visually dazzling and emotionally resonant” was the consensus on Rotten Tomatoes. The movie celebrated human spirit through the eyes of a child, growing up amidst faeces, open sewers, violence and murder.

The Unknown Dharavi

The world knows little more on Dharavi. Not just the world, even Indians don’t know that half of Mumbai’s waste is recycled in Dharavi. That everyone has a roof over his head, there is no homelessness. Nor any caste, creed or religious divides. Mosques, temples, churches share boundaries. Dharavi just accepts everyone; and supplies the sprawling Mumbai its faceless workers and helpers.This gritty humanity, and its small factories, pottery, plastic, textile, bakery industries etc, generate an annual turnover of $1 billion, 30% of which is paid as taxes. A 600 sq feet apartment costs half a million dollars in Dharavi! It’s in demand.

It’s not to say that Dharavi is not potentially explosive in the light of Corona Virus. It has a long history of epidemics. It was devastated in a 1896 plague which killed half of Mumbai’s population.  Other epidemics gripped it for next quarter of a century. Mortality was high. Dysentery, cholera, typhoid, leprosy, polio have made lives fall like flies. IN 1986, a cholera epidemic showed up most of its victims hailing from Dharavi. It has a poor-protection record: Those who survive viruses, are often consumed by fires and floods which are recurrent.

India girds up loins for challenge

Thus anxiety of the Indian officials is understandable.  It has counted the elders in the locality and put them under extensive testing. Fortunately, the country is now equipped with antibody blood tests which take only 15-30 minutes. India has an Integrated Disease Surveillance Programme (IDSP) for a decade and half now. It’s data allows health authorities to scan cases from Public Health Care (PHC) level upwards. It can spot clusters of a community outbreak of diseases. It’s following a geographical quarantine strategy. Movements, to and from, is interrupted in such clusters. Testing is ramped up. So is surveillance. Environment, heat and humidity, is factored in.

Indian authorities, for the moment, have identified around a dozen hot-spots. Dharavi is not one of them. Fortunately, cases have increased in Dharavi since. Mumbai, and Maharashtra, continue to be the most worried state in India. Officials are doing whatever best they could. A Containment Officer (CO) is co-ordinating with the police, the municipality and healthcare workers to ensure residents get essential supplies of food, milk, water and medicine round the clock.

Dharavi isn’t used to world’s concerns. Even “Slumdog Millionaire” had just a couple of shoots from within. It’s used to keeping homes and roads clean; water supply and essentials running of 20-million plus lives in the megapolis every day even as their own lanes, alleys and hearths escape the world’s attention. Once in a while, a Hollywood or a Virus brings it back into human consciousness. To be forgotten, as soon as the event is over.