Thread by @yaneerbaryam

How did India go from 90,000 cases per day to just over 10,000?

Answer is riveting

Start with Dharabi, largest slum in Asia: Impressive community case finding, contact tracing, isolation, quarantine, communications, massive health and volunteer effort, lockdown, support.

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COVID-19 Containment in Asia’s Largest Urban Slum Dharavi-Mumbai, India: Lessons for Policymakers Globally

by Mahaveer Golechha

link.springer.com/content/pdf/10…

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“Dharavi, Asia’s largest and densely populated urban slum, has successfully contained the COVID-19 with its innovative public health policy response. The municipal administration called this model as “chasing the virus” rather than waiting for people to report it.

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“Dharavi, a sprawling slum in the heart of Mumbai, India’s financial and entertainment capital, has an area of 2.1 km^2 and a population of about a million. With a population density of over 277,136/km^2, Dharavi is one of the most densely populated areas in the world.

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“Dharavi reported its first corona positive case on April 1, the policymakers and officials feared that the slum will become the biggest hotspot of COVID-19 in India

“The local population worried that soon Dharavi will become New York of the USA or Lombardy of Italy.

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“Immediately after detection of first case on April 1, the local municipal acted swiftly. The municipal corporation barricaded the entrance and exit to the slum cluster, carried out disinfection of 425 public toilets, and began door-to-door screening, robust surveillance,..

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“engaging private doctors in containment activities, partnering with NGOs for building community trust and providing food to needy population, ramping up quarantine and treatment facilities, and implementation of strictest lockdown to slow down the spread of the pandemic.

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For the first time since the first week of April, the slum recorded just one case on July 7.

Governance, Multi-sectoral Coordination, and Stringent Lockdown:

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The multi-sectoral approach to pandemic preparedness emphasizes significant roles played not only by health sector but also by all other sectors, individuals, families, and communities, in mitigating effects of a pandemic. Outbreak response requires coordination at all levels

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The municipal administration collaborated with other line departments for various containment activities, especially door-door-screening, risk communication, and supply of essential groceries. This multi-sectoral approach has ensured the effectiveness of lockdown.

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The municipal administration imposed a curfew (stringent lockdown) and sealed the border of slum with 24 check-posts set up at all entry/exit points to monitor movement control.

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Strict containment measures were deployed in virus hotspots, including the use of drones to monitor their movements and alert police, while a huge army of volunteers swung into action for implementing containment measures.

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All forms of transportation services and movement of vehicles were stopped; small industries, shops, and markets across the slum area were shut down with immediate effect. The officials zeroed in on five zones that they deemed high risk due to initial infections and patients

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Around the clock war room was established monitoring every aspect of tracing, testing, quarantine, and lockdown in containment zones.

The social distancing is very difficult people living in slum areas; the daily wage earner has to earn daily money to keep the family alive

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Most of them, with little or no savings, had to step out daily amid the lockdown to either arrange for food and essential items or collect food packets.

For effective implementation of lockdown and reducing the discomfort to the public..

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"..due to stringent lockdown, the administration has ensured door-to-door regular supplies of milk, vegetables, grocery, and other essentials.

"Robust Surveillance, Contact Tracing, and Screening:

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Surveillance during the pandemic is pivotal for the core information on which pandemic-response decisions are based. It enables the development and implementation of evidence-based interventions during a pandemic event.

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"It seems impossible to control spread of infection and community transmission, where 9–10 people stay in a 10 × 10 ft^2 room

The government deployed army of nearly 2500 doctors and healthcare workers of Mumbai’s over-burdened public health system to Dharavi’s narrow alleys

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"The healthcare workers with personal protective equipment (PPE) suits knocking on door after door for screening, paying particular attention to houses or workspaces in the vicinity of positive cases

It was test-trace-isolate-repeat approach initially implemented in Dharavi

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"The teams were assigned clusters and zones to assiduously and aggressively conduct the testing-and-tracing drill. The municipal teams carried out screening of 47,500 people through door-to-door screening.

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"Many healthcare workers reported non-responsiveness from citizens on ground of trust deficits and considering civic body workers as outsiders. The municipal administration roped in 350 private and local practitioners, which are considered insider and trustworthy.

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The municipal administration also opened several fever clinics for screening and testing of population for any symptoms of Influenza-like illnesses. Due to limited resources for testing, teams decided to use oximeters ..catching people with low levels of oxygen.

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The population was checked and re-checked with thermal scanners and oximeters. Anyone with symptoms would be sent for lab tests and quarantined. Within few weeks, municipal teams completed gargantuan task of screening 548,270 people, including 1,20,000 senior citizens

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The suspected cases were shifted to well-organized COVID care centers and quarantine centers. All contacts staying in slum settlements and used community toilets were considered high risk and shifted to quarantine facilities.

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"Due to timely screening, early isolation and continuous monitoring have ensured low mortality rate in Dharavi.

"Ramping up of Quarantine, Isolation, and Treatment Facilities:

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"While contact tracing was one measure, setting up large quarantine centers was the complementary factor. The administration converted schools, marriage halls, and community centers into nine quarantine facilities with food, regular checkups, and free healthcare and testing.

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The first large facility that the administration took over in Dharavi was the Rajiv Gandhi Sports Complex with 300 beds. A total of 9500 people have been placed under quarantine.

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"Due to isolation and uncertainties about the infection, people quarantined were under enormous mental health crisis. The administration organized yoga, aerobics, and breathing exercise session for boosting immunity and reducing mental stress.

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The administration then took the unprecedented step of taking control of five private hospitals along with their staff and medical equipment to treat high risk COVID-19 patients.

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Public-Private Partnership (PPP)

coronavirus pandemic has shown us importance of public and private sectors partnership during emergency response. Pandemics..necessitate catalyzing make-shift and long-term PPPs to remediate unprecedented burdens on the healthcare system.

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"Community Participation and Risk Communication:

"Community participation and ownership are always crucial for controlling the pandemic and other epidemic outbreaks.

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"Slum leaders play an important role in solving problems of residents; therefore, understanding their role and activities are pivotal to community-driven approaches to contain the transmission of virus.

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"The “Dharavi model” has been so successful in curbing the spread of COVID-19 in a hotspot that the other states are replicating this model, and central government has also asked other Indian states to replicate its model of “chasing the virus.”

Outstanding!

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Yesterday there were 10 cases in Dharavi. Last time over single digits was Jan 17. They are reacting to stop transmission.

freepressjournal.in/mumbai/mumbai-…