How strong is the link between Mumbai’s slums and the spread of the coronavirus?

At a two-day conference on climate change in February, Mumbai’s Municipal Commissioner announced that densification – essentially, increasing Floor Space Index to construct high-rise buildings – is the only way for Mumbai to meet the twin challenges of environmental protection and housing.

People complain that through the process of slum redevelopment that accommodates residents of informal settlements in high-rise buildings, “we are creating urban vertical slums”, he said. But, he declared, we must look at the “big picture”. Building vertically allows us “to free up some land” for other facilities like sewerage and sanitation. Moreover, if we don’t “densify like this” we will have an “urban sprawl which [goes] 150 km outside Mumbai”.

Four months later, the pendulum swung the other way. As the number of Covid-19 cases in informal settlements like Mumbai’s Worli-Koliwada and Dharavi began to rise, “density” became a dangerous idea. Dharavi was described as “a ticking time bomb” – a “fertile ground for the virus to spread rapidly”.

The media hammered home the notion that informal settlements have been responsible for Mumbai’s spiraling Covid-19 numbers. Almost every article on Dharavi began by citing its density in comparison with Mumbai’s overall density. It is no secret that informal settlements have higher densities than the city average – Mumbai’s slums accommodate approximately 380 households per hectare as compared to 175 households per hectare in non-slum areas.

But while earlier, densification was a way to solve other problems of the city, now density itself has been framed as a problem. Slums are being blamed for being too dense. The proposed solution, paradoxically, remains identical: high-density high-rise slum-redevelopment.

So how can redevelopment simultaneously densify as well as de-densify slum settlements? The source of this mystery is in the ambiguity of the terms such as “density”, “physically distancing” and “slums” that are now being used to make a strong case for redevelopment.

In fact, the push for redevelopment has little to do with the problems of Mumbai or in its informal settlements. Slum redevelopment is driven by altogether different aims, while new justifications are periodically invented. As Maharashtra Housing Minister Jitendra Awhad candidly wrote in his letter to Chief Minister Uddhav Thackeray in May: “You won’t get a more appropriate opportunity to push Dharavi’s redevelopment.”

In Mumbai, redevelopment of older buildings and especially slum redevelopment has become touted as the universal remedy for every problem. From the lack of affordable housing, open space, amenities and infrastructure – slum redevelopment is presumed to solve it all. Therefore, it was only a matter of time before slums began to be implicated in the spread of the SARS-COV-2 virus.

A silent epidemic

Of course, it is not as though people living in housing poverty have been free of disease till the coronavirus came around. The poor live and die with (easily preventable) infectious and communicable diseases such as tuberculosis, malaria and dengue fever. These are working-class afflictions, and the means to treat oneself is typically a harsh choice between a meagerly funded public system and unaffordable private healthcare.

Tuberculosis, for instance, claimed the lives of 440,000 people in India in 2018, and 5,634 residents of Mumbai in 2016 – yet, despite the persistence of this silent epidemic, no lockdown has been enforced to eradicate it, no public health emergency has been declared.

Covid-19, in contrast, first hit the global power centres, the rich countries and the rich in other countries. When a crisis affects the powerful, state action is swift. In India, the lockdown was the longest in the world, the most severe and the most punitive. While an estimated 114 million people, predominantly informal sector workers lost their livelihoods in April, without any compensation for loss of income, the better-off could self-isolate with ease.

Many rightly pointed out the cruel irony of expecting the homeless to stay home, or those without healthcare to use masks and sanitizers, or those with poor access to drinking water to wash hands for 20 seconds with soap. It is indeed intriguing how responsibility for a disease that traveled across borders with passports and through aviation networks came to be laid at the door of Mumbai’s labouring people.

Which brings us to our central questions: do slums provide “a fertile ground” for the disease to spread rapidly? How strong is the link between spread of Covid-19 and the physical environment in squatter settlements? What specific conditions (density, poor sanitation, lack of hygiene) in informal settlements make them more vulnerable to the spread of the SARS-COV-2 virus? And how can these conditions, if identified, be alleviated?

If we go by the advice-laden sound bytes of commentators that peppered the media during the lockdown, it is an open and shut case: physical distancing is impossible in slums, and therefore slums are Covid-19 hotspots. Notwithstanding the air of certainty around the issue, the short answer to our questions above, at the moment, is simply: we do not know.

Mode of disease transmission

First of all, knowledge of the spread of the virus is still evolving. From the beginning of the outbreak, we have been asked to wash hands, wear masks, disinfect surfaces and stay at least six feet away from others. While these have seemed to help (especially wearing masks), the assumption behind all of this advice is that the virus is likely to spread through droplets in the air released when people cough or sneeze and through fomites (objects and surfaces that are often touched).

Recent evidence suggests that while droplets emitted while sneezing and coughing are a definite risk, small speech droplets (or aerosols) released when talking, singing and shouting, especially in enclosed spaces are a likely mode of disease transmission. The risks are compounded with long exposure in crowded and loud air-conditioned spaces such as bars, restaurants, offices and gyms.

This means that outdoor activities pose a moderate risk, but gatherings especially indoors are most likely to become super-spreader events. Airborne transmission in air-conditioned spaces through human vocalisation, in other words, perhaps poses a greater risk of spread than proximity or density.

An uneven pandemic

On the other hand, the impact of the pandemic has been uneven in different metro cities in India. While populous cities with sizable slum populations like Mumbai, Delhi, Chennai and Ahmedabad have recorded tens of thousands of cases, other large cities like Bangaluru and Kolkata have had much fewer.

Even within Mumbai, with its slum population of 52.5%, the number of cases in different wards has been quite variable. By the end of June, Mumbai’s M/East Ward in the eastern suburbs, with 84.9% of people living in slums, had registered 37.7 cases for every 10,000 people. On the other hand, the F/South ward in the Island City, with a slum population of 49.9% registered 104.7 cases per 10,000 – the highest in the city.

The chart below that compares the city’s ward-wise slum population and number of cases for each ward.

Selection and reporting bias

What about the high number of cases in Dharavi and Worli? Generally speaking, there is a strong correlation between extent of testing and number of cases. When the first cases in Dharavi began to emerge, the Mumbai municipal corporation began an aggressive programme of contact-tracing and quarantine. While a rise in cases may have prompted more testing, it is more likely that more testing revealed more positive cases. Unfortunately, the Mumbai municipal corporation has not provided ward-wise data on the number of tests conducted.

Furthermore, settlements like Dharavi tend to be more “visible” both to the authorities and to the public (due to persistent and widespread psychological tendency to associate the poor with disease and deviancy). In contrast, in middle class neighborhoods, under-reporting of both symptoms as well as contact with positives are way easier – often due to the fear of being quarantined, or of social stigma.

To put it differently, an individual who has symptoms or has been in contact with a positive case in Dharavi is more likely to have been tested than a more affluent person who lives on the hills of Malabar, Cumbala or Pali. Different levels of access and visibility due to social, economic or geographical factors often overestimate the incidence of disease among certain groups. Such a systematic bias cannot be ruled out in the data on positive Covid-19 cases in Mumbai.

This is perhaps an open secret among the better-off. Recently, one of us urged an acquaintance (an upper-class professional) who exhibited mild symptoms, to get himself tested. He replied: “And be forcefully quarantined in a cesspool of madness? I have isolated myself. I’ll be okay.”

His response is an illustration of the ability of upper-class people to become invisible at will, and claim to be responsible enough to deal with the pandemic on their own.

Residents of informal settlements, on the other hand, have been placed under constant surveillance by the authorities and their employers – always suspected of being carriers of the virus. In slums, the Mumbai municipal corporation proudly claims to have “chased” the virus, “traced” contacts, and successfully “quarantined” all the “high-risk” individuals. The “war” against the virus was fought on the bodies and in the neighborhoods of the poor.

In Worli Koliwada, for instance, residents vividly described how the relatives and acquaintances of people who were found positive were rounded up and forced into quarantine centers – almost as though they were being “kidnapped” and placed in “confinement”. The quarantine facilities were odious, with very few toilets and poor quality food.

When the village was declared as a containment zone, no food was allowed to enter for several days. Later, the fisherfolk who lived there were restricted from selling their catch even in their own village, and were forced to discard it. To add to all this, the neighbourhood was stigmatised, with some instances where residents were denied medical treatment – even for other conditions – because they lived in a “Covid-19 hotspot”.

Spatial data on Covid-19

The data released by Mumbai municipal corporation on Covid-19 reveals a very partial picture – especially since tests are performed only on symptomatic cases, or on traced asymptomatic cases. In fact, only a random sampling-based mapping (as was done in South Korea) may be able to provide a reliable picture of the spread in the city. The Mumbai municipal corporation’s ward-wise data on positive cases is not very reliable to establish a credible link between settlement conditions and the disease.

The picture gets murkier, since the municipal corporation – secretive as always – has not provided data on the spatial location of each positive case, or the number of cases in different kinds of settlements. It did, however, provide an interactive map of “containment zones” in the city, defined as “places where positives have been detected.” The picture may get murkier still, if we investigate how these zones were determined, what subjective elements were involved, and whether there was a difference in the way these were imposed in different areas.

But to use this “containment zone” data as a proxy for “Covid-19 cases,” as some have done, is quite erroneous since it reflects limited testing, selection and reporting bias, and a host of ambiguities in the map itself.

Towards planning for public health

Despite all these problems, let us assume, for the sake of argument, that many more cases are eventually detected in informal settlements. What does it tell us? Must we assume, rather simplistically, that it is due to high densities and impossibility of social distancing?

Perhaps we could be asking different questions to the data that could reveal other important dimensions: are informal settlements areas where people are less likely to work from home? Is it because slum-dwellers are more likely to use public transport? Is residential overcrowding (more people per room) more significant as compared to overall settlement density (more households in a given area)? Is socioeconomic segregation a better explanation for higher prevalence of Covid-19 as compared to urban density? Why do some informal settlements have more cases as compared to others?

We could also ask, crucially: is the targeting of slums a reflection of the failure of the public health system in addressing the spread of the virus? If the city’s public health infrastructure had been strengthened greatly in all respects to provide free, efficient and prompt identification, testing, and care, with well managed and adequate quarantines and treatment facilities, would we be looking at the question of slums per se at all?

In our rush to reach (often predetermined conclusions), we forget that it is inquiry that guides discovery, not data.

The right reasons for intervention

Undoubtedly, tracing the spatial determinants of the spread of Covid-19 (and other infectious diseases) is a most valuable endeavor, which will help in providing promising directions towards environmental design and planning for public health. Therefore, identifying the right reasons for intervention provides the best chance of the right kind of interventions.

Unfortunately, a predisposition for erasure and redevelopment of squatter settlements, backed by the commercial interests of real-estate boosters, have blocked more judicious approaches towards settlement upgradation. The simplistic link drawn between settlement conditions and disease, therefore, seems to serve a rhetorical and ideological purpose, rather than any analytical function.

Will redeveloping slums improve public health? It must be pointed out that one of the first reported cases in Dharavi was of a resident who lived in a redeveloped Slum Rehabilitation Authority building, not in its informal settlements.

At the moment, urban development policy in Mumbai is shaped predominantly by the prospect of profiting from urban land and real-estate. Slum redevelopment, as argued elsewhere, is driven by the aims of profiting from inequity rather than the concern of the welfare of the city’s working-class inhabitants. That is why, slum-redevelopment schemes have produced unprecedented residential densities, and perpetuated spatial inequalities.

As we pointed out above, people who live in housing poverty face a range of preexisting vulnerabilities: to economic shocks, to climate events, to epidemic outbreaks and more. Removing these vulnerabilities requires an explicit commitment to promote public health, urban democracy and socio-spatial equality – through a combination of socio-economic programmes and spatial interventions that seek to redistribute urban land and resources.

Slum redevelopment, as presently conceived, is no answer to the pandemic.

Hussain Indorewala and Shweta Wagh teach at the Kamla Raheja Vidyanidhi Institute of Architecture and Environmental Studies (KRVIA) in Mumbai. They are researchers at the Collective for Spatial Alternatives, an action research and community planning collective.

A time of unprecedented social suffering and uncertainty, Covid-19 serves as a moment of crisis as well as possibility for making urban policy differently. This article is the first in an eight-part series that seeks to address the question of how the pandemic could be used to transform Mumbai into a more inclusive, resilient city. Read the other articles here.