It was the Rich and not the Poor who were Downed by Covid

 by Suranya Aiyar

This article was originally published on the NDTV blog on August 6, 2020 under the title 'Mumbai Slums' Battle with Covid Defies Early Expectations'     

Photo: Pixabay, Free Use

In India and Brazil, it was anticipated that people in slums and favelas would be the hardest hit by Covid-19. But that is not quite how things turned out.

Contrary to the popular belief that Brazil had no lockdown, in fact state governors did impose lockdown. Brazilian President, Jair Bolsonaro, was critical of these measures, but he did not have the power to stop them. States began imposing containment measures, including calls for people to stay-at-home, restrictions on public gatherings and the closure of schools from around March 17, a week before India’s lockdown. By March 24^th, closure of non-essential businesses and quarantine were imposed in the cities of Rio de Janeiro and Sao Paulo, among other places.

But despite two months of lockdown, cases in Brazil had grown from around 2000 on March 23, to over 1 lakh by early May. The outbreak in Rio started not in the favelas, but in the richest and most exclusive parts of the city in their so-called “country-clubs” parties attended by jet-setters returning from Italy who are thought to have carried the disease with them.

By early June, although cases nationwide in Brazil had crossed 7 lakh, and reached over 36, 000 cases and 4500 deaths in Rio de Janeiro city, the Covid outbreak in Rio’s favela’s, even assuming significant underreporting, was relatively low. Voz das Comunidade, a well-known favela-advocacy group, which is tabulating Covid-19 data for favelas, reported a total of 1696 cases and 379 deaths from 15 of the city’s main favelas in early June. A month later, in early July, Voz das Comunidade the cases had grown by less than a thousand to 2357 cases and 469 deaths from Covid-19 in these favelas, while the city’s case count had grown to over 1 lakh cases. By July-end cases in these favelas had grown by about 1800 cases to 4100 and deaths to 624 according to Voz das Comunidade. Another group of favela-NGOs headed by an organisation called Catalytic Communities reports 5600 cases and 780 deaths. At the same time in the state of Rio overall cases were over 1.6 lakh.   

A similar story is heard from slums in other parts of the world. Bangladesh’s Rajbari district that houses Daulatdia slum, which is also one of the world’s biggest brothels, had, by early July, only 457 cases as against national figures of over 1.5 lakh cases.

During April-May, Covid-19 first came to the richer parts of Mumbai, the major early hotspot in India’s outbreak. In late March, it was the well-off G South Ward of Mumbai that had the most cases. In Mumbai, most of the early cases were traced to the USA and other foreign places. Cases began to appear in Dharavi only in April, when there were already 300 cases in Maharashtra, of which nearly 200 were in Mumbai and 1600 overall in India. Dharavi is said to be Asia’s largest slum, with between 8.75 lakh to 10 lakh residents, in an area of 2.5 square kilometres. At this time, it was reported that there were more Covid-19 cases in Mumbai’s upscale areas of Malabar Hills, Peddar Road, Worli and Dadar.

Six weeks after lockdown, at the end of April, Mumbai had over 6600 cases of which Dharavi had 344. By the end of May, Mumbai had over 39,000 cases. But less than 2000 of these cases were in Dharavi. 

In early June, Dharavi, Dadar and Mahim - all these are slum and low-income areas in the G-North Ward of Mumbai – had just under about 3000 cases. But at the same time, Mumbai’s upscale localities in which exclusive neighbourhoods such as Malabar Hills, Worli and Versova are located, had between about 1000 to 2000 cases each. In Mumbai's M East Ward, which has a population of 12 lakh, comprising lower income areas like Govandi, Shivaji Nagar and Mankurd, there were 1800 cases.

So the distribution of cases was fairly uniform across these areas despite great disparities in relative wealth and population density. Cases in Dharavi fell to nil in the first week of June, and showed daily increases only in the single digits from about mid-June onwards, when there was a second wave of cases in Mumbai’s posh high-rise buildings. The pattern that emerges is not of the disease being driven by poverty and congestion, but of its coming into the richer areas of the city via international travel, spreading from there to the lower income areas, and then coming back to the city’s better off areas often via domestic help. In late July, Mumbai recorded over 1 lakh cases of which only about 2500 were in Dharavi, and about 1600 each in Dadar and Mahim. A sero-prevalence survey in late July showed that 57% of Mumbai’s slum-dwellers had antibodies to Covid-19, compared with 16% among non-slum residents. This shows that slum-dwellers had either a high degree of pre-existing immunity or more asymptomatic infections compared with those in better off areas of the city. In Delhi also, though neighbourhood-level data is not being released at the moment, the district-wise containment zones show a fairly broad distribution of cases between richer and poorer areas.

There appears to be a more complex dynamic than the simple one of lessor wealth or infrastructure deciding the course of this disease. Even though, in the end, the number of cases in slums and chawls will be higher than in better off areas, owing to the much larger number of people there, the relative rates and size of spread between these impoverished and high income areas is not in proportion to the relative disparity in population density or wealth. There is something to be understood in the relatively slow and small spread in these areas for all these months, even after the relaxation of lockdown, despite the congestion and poverty. Even during lockdown congestion in slums and chawls is several times higher than in better off areas. There is research finding that people living in favela-like conditions spend 50% more time per day in contact with others than those living in richer areas. We seem to be missing something about the true nature of Covid-19, even though we so confidently set out to fight it by controlling transmission.