Imagine one million people living next to each other in an area spread over 2.5 square kilometers. Or at least 40 people for each square metre. That is the state of Dharavi, Asia’s biggest slum.
So, what happens when many people live in a small place? They use community toilet facilities, common kitchens, and share spaces to sit and meet each other every day. Such close contact of people can cause infections and communicable diseases, experts say.
Though this is an extreme example, there are many and just like this densely populated areas – with people, there are a number of localities where people are living in cramped spaces. This in fact is the reality of most cities and towns today.
Understanding the ground-reality of a pandemic in densely populated areas, was possible only through reportage by journalists. The reporters visited several hamlets in the city of Bengaluru during the dark days of the pandemic and found that even basic food was a far-fetched dream for many.
Why is living in densely populated areas a threat?
If there are 20 people living in a three-bedroom house and one person is down with infection, there are high chances of spreading it to others at least by 60 per cent, says Dr Neha Mishra, consultant-infectious diseases, Manipal Hospitals, Bengaluru.
“In a crowded living space, individuals share resources which makes them more susceptible to any spread of infection. The air they breathe, the water they drink, the sanitation facility they use, are all prone to increase the chances of exposure,” she added.
Common health conditions in densely populated areas
- Respiratory diseases such as influenza and pneumonia can spread rapidly due to the shared space.
- Gastrointestinal diseases are more associated with poor sanitation and lack of hand hygiene. It often spreads in the entire family when the infected person contaminates food and water without washing hands.
- Vector-borne diseases such as dengue could spread. Due to crowded areas and poor sanitation, the mosquito breeding increases, and the chances of infected mosquito biting others are high, leading to rapid spread.
What happens in densely populated areas?
Lack of basic facilities
“We are six in our family, and we live in a small 100 square feet house where we have one living room and a hall. We share toilet space. We share common vessels even when anyone is sick at home,” says SA Khan, a truck-driver, and a resident of Padarayanapura (hotspot of infections during COVID-19), Bengaluru.
Recalling COVID-19 days he said that the next door was just a knock away and it was easy for infections to spread.
When people are living in a small space and in a clustered setting, chances of spreading infections is high, says Dr Krishnappa, a medical officer, Hongasandra and Kodichikkanahalli, Bengaluru Hongasandra covers an area of 1.32 square feet, has 23,898 houses with a population of 81,000.
“Poor sanitation, lack of hygiene, lack of awareness on health conditions and lack of ventilation in the houses were core reasons,” he said.
Dr Krishnappa saw the in and out of the pandemic outbreak. Recalling the first case, he said, “A migrant labourer from Bihar lived with his fellow labourers in a small shed.”
In these small sheds 6×6 feet, there were five to six individuals sharing their spaces. One infected individual was enough to spread it to all the inmates living in the area as they shared a common kitchen, open toilet, and a common bathroom, he said.
Spread of communicable diseases
Infections like tuberculosis were also reported in high numbers in these densely populated areas. When we visited the Public Health Center (PHC) of Hongasandra and Kodichikkanahalli area, the doctors reported that there were 21 and 19 cases respectively. “This is again because of lack of personal hygiene, no sanitation facilities for the households and close living proximity,” said Krishnappa.
Risk of malaria
Due to poor infrastructure, citizens fall prey to a series of infections in the densely populated areas. Dengue cases have started spreading rampantly, too. Residents cry foul at these areas as they cannot avoid dengue cases.
Manohar Ram, a resident of Kodichikkanahalli said, “If one individual is suffering from dengue, it is a known fact that many more in our surroundings will crop up due to bad living conditions. We all live in proximity and when it rains, there are many of us who fall sick and get infected.”
Stomach flu
Stomach flu, also known as norovirus, is contagious . A healthcare worker from Kodichikkanahalli PHC says that due to lack of hygiene in areas densely populated, they do not wash their hands and meet each other too often. “We are seeing a rising number of cases of stomach flu in densely populated areas,” the health worker on anonymity told Happiest Health.
Controlling the spread of infections
Former Health Minister of Karnataka State Dr K Sudhakar says that when people are living in proximity, they come in close contact with each other too often. “All individuals need to be screened for infections in the areas densely populated, the infected or suspects need to be quarantined so that there is no spread of infection,” he said.
The former minister was in-charge of the State during the COVID-19 pandemic and recalling the controlling measures, he told Happiest Health that strict maintenance to protocol, social-distancing and vaccination helped mitigate the situation.
While social distancing is a major issue in the densely populated areas, protocols are tough to follow. However, Munish Moudgil, a bureaucrat from Karnataka who handled the pandemic war room said that in emergency situations, adhering to strict health protocols is a must.
He added, “In the low-economic status areas lack of awareness towards health protocols is high. The awareness about of the spread of the disease is also low. The infrastructure needs to be good and emergency situations can be handled only when a mass population follows strict health protocols.”
Are we ready for another pandemic?
In May 2023 as part of the 76th Session on World Health Assembly Agenda 3 by Director General speech, the WHO Chief Tedros Adhanom Ghebreyesus stated, “The threat of another COVID-19 variant emerging that causes new surges of disease and death remains. And the threat of another pathogen emerging with even deadlier potential also persists.
