Why do slums appear to have fewer Covid-19 cases?

Fifty-year-old Shore Banu has been living in Dhaka's Korail slum for the last 22 years. She used to make ends meet by collecting waste bottles from different streets throughout the city.

Banu stopped going out to collect bottles after the government announced restrictions on movement from March 26 to curb the spread of the deadly Covid-19.

Despite being scared of the novel coronavirus, she does not wear a mask while outdoors in and around the slum area. When questioned about it, she simply answered with a smile, "I do not have my mask with me right now, because I left it at home."

"During these four months of the pandemic, none of my acquaintances have shown any symptoms of fever, cough or [novel] coronavirus, and no one has died from the disease yet," she said.

It was a Tuesday evening in the Korail slum. Children were playing, adults were gossiping at roadside tea stalls and many people were wandering around without wearing a mask.

Many of the slum dwellers supported Shore Banu's views on the situation. The residents think that the spread of Covid-19 is relatively low among them because they are low-income people.

Lucky Begum runs a day-care centre in the Boubazar area of Korail slum. The centre has resumed its operations after remaining closed for two months due to the pandemic.

"I have 40 children in this small facility, but none of them has shown any symptoms of fever or cough, which is common for Covid-19 patients," she told The Business Standard.

According to sources, nearly four lakh people live in the Korail slum. However, there have been only three reports of Covid-19 cases and one death in the area since the first patients were identified in Bangladesh.

In the beginning, a sample collection booth was set up at Ershad Matha, a playground near Korail slum, but it is no longer there.

Responding to queries, several drug store owners in the Korail slum said residents are buying normal fever and cold medications. However, none of them are giving samples for novel coronavirus testing.

Sub-Assistant Community Medical Officer Abul Hasnat, also the owner of Kazi Pharmacy in Korail slum, said many patients came to his shop for fever and cough medications. He believes that there are many Covid-19 patients in the slum, but no one is getting tested.

Photo: Rehman Asad/TBS

Like the Korail slum dwellers, Nazma Begum, who works at a fish market in the capital's Karwan Bazaar, thinks poor people do not contract Covid-19.

"We work under the sun, so we are safe from the virus. No one I know has had any symptoms of  Covid-19," said Nazma, who lives in a slum near the railway gate.

However, there are different opinions about the seemingly-minimal spread of Covid-19 among lower-income and poorer people, such as that the infection rate is low or individuals are simply not getting tested.

According to recent statistics posted by Worldometer, around 1,005 people from every 10 lakh are infected with this deadly virus in Bangladesh.

Commenting on the matter, Professor Nazrul Islam, noted virologist and former vice-chancellor of Bangabandhu Sheikh Mujib Medical University, said, "A kind of cross-immunity has developed among slum dwellers.

"So, [novel] coronavirus infections are less common in densely-populated areas such as slums. However, this [assumption] needs to be further researched."

Ashesh Chowdhury, professor and head of the Department of Immunology at BIRDEM, said, "The information that Covid-19 infections among slum dwellers or lower-income people are low is not true."

"There may be more asymptomatic patients among them, which is why the caseload seems to be lower. Around 80 percent of Covid-19 patients have mild symptoms that do not need any treatment," he added.

He further said, "Low-income people are recovering by using fever and cough medications. Antibody tests have now become urgent in slums. First of all, you have to test the antibodies at low cost to see if they have developed natural herd immunity."

"Then the PCR tests can be carried out to confirm the positivity rate," he added.

Dr M Mushtuq Husain, advisor of the Institute of Epidemiology Disease Control and Research (IEDCR), pointed out that it seems there are fewer Covid-19 infections in slums not because of less testing, but due to a lack of monitoring on isolation and contact-tracing activities.

He continued, "It is important to monitor the slums, otherwise the danger will increase if the number of patients suddenly goes up. The actual situation can be understood by monitoring the densely populated areas of the city like a red zone for three weeks."

"Before that, it cannot be said whether the infections are low in the slums or not," he added.

Photo: Rehman Asad/TBS

Regarding the low number of deaths of people exhibiting Covid-19 symptoms in the slums, Mushtuq Husain said, "Most of the people presently living in slums are young and healthy, who tend not to die of mild coronavirus symptoms.

"Elderly people with underlying health conditions have already returned to their villages due to the outbreak," he explained.

Dr ASM Alamgir, principal scientific officer of the IEDCR, shared his view saying, "Low-income people have fewer opportunities to get tested. A sample collection booth was set up in Korail slum, but fewer samples were available there, so it was shifted elsewhere."

"Because of the stigma, fear and neglect, they do not want to get tested," he said.

The IEDCR is currently researching the Covid-19 infection rate among different communities.

"We went from house to house and collected samples. The study covered slums too. That research report will be released next week, and will reveal the true picture of Covid-19 in the slums," added Dr Alamgir.