A: TL, DR. COVID-19 has disproportionately affected the lives and health of residents of slum communities, or informal settlements characterized by poverty, lack of basic services, crowding, unstable homes. Due to data limitations, it’s difficult to know a lot of detail about the spread of the disease and the impact on mortality.
We at Dear Pandemic love data. We love dashboards, demographic breakdowns, and descriptive statistics. We pore over case fatality rates and excess mortality data. We’re grateful to have access to many sources of information to help us better understand what’s going on and how it’s changing over time.
We also care deeply about social justice and are concerned about populations that are disproportionately at increased risk of exposure or poor outcomes from COVID-19. We’ve made prior posts documenting COVID-19 disparities by race/ethnicity, among indigenous populations, and among homeless people. We’ve even previously posted some of the risk factors that make the 1 billion residents of international informal settlements who are at high risk of contracting COVID19 (primarily, poverty, crowding, limited sanitation.)
Unfortunately, we don’t have great data on what’s happening in most of the informal settlements around the globe. One study found that nearly 57% of 7000 Mumbai slum residents tested positive for antibodies in July, compared to only 17% in its non-slum regions. This highlights the vast disparities in who is likely to contract COVID-19 in Mumbai. While some have interpreted the high seroprevalence to indicate that these communities are approaching herd immunity, others have cautioned that this result may reflect a high number of false positive test results. According to a recent pre-print in the Lancet, overall, India is not even close to herd immunity, with only about 7% of the adults having tested positive. Rather than waiting for natural herd immunity, we are hopeful about a widely distributed, safe, effective, and affordable vaccine to help minimize additional disease and death.
We don’t need perfect data to know enough that there’s a lot of work to be done among the world’s most vulnerable populations. A recent World Bank working document summarizes many of the reasons why slum residents are at high risk, in addition to offering dozens of strategies to mitigate infection and reduce the burden of disease. Some successful approaches learned from dealing with Ebola include: effective treatment of patients, resources for testing and isolation, involvement of non-governmental actors to build trust and provide clear communication (including debunking myths), establishment of curfews or neighborhood isolation, financial support, and the provision of childcare. Check out the full slide deck (link below) for many more ideas that are currently being implemented around the world in a wide variety of contexts.
Articles on COVID disparities in India: