This study is among the first to investigate whether patterns of access to basic services could explain the disproportionately severe impact of COVID-19 in slums. Using geolocated containment zones and COVID-19 case data for Mumbai, India's most populous city, we find that cases and case fatality rates are higher in slums compared with formal residential buildings.Our results show that access to toilets for men is associated with lower COVID-19 prevalence. However, the effect is opposite in the case of toilets for women. This could be because limited hours for safely using toilets and higher waiting times increase the risk of exposure, and women and children sharing toilet facilities results in crowding. Proximity to water pipelines has no effect on prevalence, likely because slumdwellers are disconnected from formal water supply networks. Indoor crowding does not seem to have an effect on case prevalence.Finally, while police capacity-measured by number of police station outposts-is associated with lower prevalence in nonslum areas, indicating effective enforcement of containment, this relationship does not hold in slums. The study highlights the urgency of finding viable solutions for slum improvement and upgrading to mitigate the effects of contagion for some of the most vulnerable populations.

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