With its narrow streets, congested housing, underfunded health care and poor sanitation, many thought India’s largest slum would be devastated by COVID-19.
In fact, Dharavi — located in India’s financial capital Mumbai — was often heralded as a prime example of why the country was ill-prepared to deal with the coronavirus.
Stigma associated with the disease spread deep into the neighbourhood.
“Everyone was scared and locked themselves in their homes,” local resident and asthma sufferer Sameer Vhatkar told the ABC.
“When corona was spreading in our local areas, we felt that Dharavi was going to be finished.”
Mr Vhatkar tested positive for the virus in May after he took a neighbour, who had contracted COVID-19, to hospital.
At the time, Dharavi had recorded only a few hundred cases, but the health care system was already struggling to keep up.
Patients were being refused hospital admission and ambulances would go missing.
Residents complained that quarantine facilities lacked basic services and cleanliness.
“We thought it would be better to stay home instead of going to hospital. You would not survive in hospital,” Mr Vatkar’s wife Yogita said.
Her husband’s symptoms deteriorated.
“I had fever, chill and breathlessness,” Mr Vhatkar said.
Soon after, his wife and two children also tested positive to COVID-19 and were taken to various quarantine shelters.
“Corona was not just killing me, but killing my family as well,” he said.
“I lost hope for my survival and left it on God.”
Authorities got on the front foot by doorknocking and testing
Much has changed in Dharavi since the early outbreak.
Not only has the 44-year-old father and his family made a full recovery, but the entire neighbourhood appears on the verge of victory against the virus.
Instead of hundreds of daily cases, Dharavi in recent weeks has been reporting only single digit increases, and the number of active cases is less than three per cent of the total. The mortality rate is also low.
The World Health Authority has lavished praise on local authorities after they embarked on an ambitious and comprehensive program to bring the coronavirus under control in a region where social distancing and contact tracing is impossible.
With a million residents crammed within 2.4 square kilometres, local government assistant commissioner Kiran Dighavkar said relying on home quarantine was not an option.
“In one apartment of 10 feet by 15 feet, you’ll find at least 10 to 12 people,” he said.
“It is very difficult to do contact tracing because one person who used the community toilet, or toilet seat, is used by another 500 people.
“Once it starts, it can spread like anything.”
Anything from sports centres, schools, nursing homes and hotels were converted into coronavirus treatment and isolation centres.
Hundreds of community toilets were sanitised multiple times a day.
Instead of waiting for symptomatic patients to come forward, authorities would door knock homes to test temperatures and oxygen levels.
Anyone considered at risk or showing depleting oxygen levels was taken into care.
“Slowly, slowly, the cases were appearing in all the slum pockets,” said Dr Virendra Mohite, a chief medical officer for one of Dharavi’s coronavirus hospital wards.
“So, our biggest challenge was to isolate the high-risk contacts from the slum to the institutional quarantine.
“If we diagnose suspects early, it is easy to cut the chain of transmission, to start the treatment early and reduce further mortality.”
Most temporary treatment centres have been closed due to the decline in cases, but authorities say they remain vigilant for a second wave.
The Dharavi Model has been adopted in other parts of the country
The system was initially rough around the edges.
Containment zones were set up with little notice, leading to distress, and residents often had to queue for hours to get essential supplies.
But the “Dharavi Model” — as it is now known — was not established overnight, rather it was implemented lesson by lesson.
“There was no reference book for this. Fortunately, now the health infrastructure is in place, people know there are references, like the Dharavi Model.”
The Dharavi Model has been such a success that authorities in other parts of the country, such as Hyderabad and Kerala, have adopted the same approach.
While more than two million people in India have contracted the coronavirus, less than a third of those cases are now active.
The number of daily cases is slowly coming down in hotspot megacities — such as Delhi, Chennai, Pune and even Mumbai — but numbers are surging in poorer states like Bihar.
“We do not have very good health infrastructure,” said Professor Shamika Ravi, from the Brookings Institute.
“While 75 per cent of our health infrastructure is concentrated in our urban areas, we are already beginning to see the spread of infection to smaller, rural townships.
“We cannot give up on containment. It’s a very large country.”
Experts have suggested that given India’s huge population and diverse states, the impact of the coronavirus on India should be looked at on a state-by-state basis, rather than as a whole.
“We are already beginning to see several patients from Patna, which is the capital of Bihar, move to Delhi for treatment,” Professor Ravi said.
“That’s never a good strategy.”
Another possible reason for India’s recent success
There is a theory emerging that the decline in active cases in Dharavi is because a large proportion of the population has already been infected. Some have suggested herd immunity is now at play.
“I think Dharavi has reached herd immunity,” said epidemiologist Dr Jayaprakash Muliyil.
“There are very sparse cases. It’s stopped.”
Officials in Dharavi aren’t sure if herd immunity is responsible for stopping the spread.
A serological survey — which is type of blood test — showed 57 per cent of residents in Mumbai’s slums had coronavirus antibodies, meaning more than half the residents had been exposed to the virus.
Most were asymptomatic, and the mortality rate was low.
Professor Ravi said the science of herd immunity was uncertain.
“The latest data from Italy is saying … the antibodies decay very quickly,” she said.
“Perhaps the whole concept of herd immunity needs to be questioned.”
In July, another serological survey in Delhi showed almost one in four people had been exposed to coronavirus.
Like Mumbai’s slums, most were asymptomatic.
If extrapolated to the entire city, that would mean more than four million residents have been infected, which is more than twice the official national figure.
Dr Muliyil says this could mean that India’s official coronavirus count was “pretty badly off”.
“Containment has not worked. The virus is spreading, and the main emphasis should be on treating the sick,” he said.
But Dr Muliyil was also hopeful the wide presence of antibodies meant a vaccine was possible.