Coronavirus Dynamics: The Undulating Playing Field

by Bongs Lainjo

History has a way of reminding us that while the good times are great, a business as usual mentality comes with many unforeseen risks and challenges. Good times are in some cases pathways to complacency, apathy for some, and a “winner takes all” attitude. On a positive note, the stress, anxiety, and other mental health issues have turned around many mindsets. There are now significant and unprecedented levels of compassion, empathy, and more, originating from many populations. 

There was the first world war, there was the Spanish plague, there was the second world war and for the last 60+ years, we have had to live in a world of misgivings; ranging from populism to political unrests and instability in several parts of the world, primarily the Middle East and some parts of Asia.

When the current Covid-19 started in December 2019, many assumed that like its predecessors H1N1, SARS, different plagues and viruses etc., it was going to pass with a thud. Four months into the pandemic and countries continue to live in fear, driven by many unknowns and limited scientific evidence. In the meantime, this aggressive, stealth, and brutal virus continues to spiral unabated (existing intervention strategies notwithstanding). There is at least some consensus that once the peak of the pandemic has been achieved, there will be reason for optimism. This is based on the assumption that everything being equal (continuous self-exclusion, personal hygiene, social distancing etc.), the worst would then be behind us. While for the most part, this assumption is correct the reality is that the potential for a subsequent wave is real and compelling. The Spanish flu, also known as the 1918 flu pandemic, serves as a classical example. Its second wave of infection proved to be even deadlier than the first after non-medical intervention measures put in place had been relaxed. 

A troublesome pre-occupation in many affected regions is vulnerability. The notion that we are all equal in the fight against this virus has been quickly dispelled with early findings, revealing health inequalities amongst populations ranging from front-line service providers to marginalized communities to racial minority groups.

In the U.S., preliminary nationwide data released by the Centers for Disease Control and Prevention (CDC) revealed that although African Americans represent approximately 13 per cent of the U.S. population, they accounted for 30 per cent of all Covid-19 patients. Although far from complete, these data are consistent with the findings from other data collected on race and Covid-19 so far. A disproportionate toll is also being seen in the UK after the Guardian did an analysis of 12,593 patients who died of Covid-19 as of April 19, 2020. It showed that 19 per cent were Black, Asian, and minority ethnic (BAME) even though they make up 15 per cent of the population.

A number of factors contribute to certain populations being more susceptible to contracting Covid-19, experiencing more severe cases of it, and having poorer outcomes.

A lack of economic resources often translates to food insecurity, amongst other things, which in turn often leads to poorer health outcomes that includes a higher risk of underlying health conditions. In India, millions of people, including migrant labourers and daily wage earners, are facing hunger since the country’s shutdown in late March 2020 left them with no means to earn a living. A similar dire outlook is also threatening First Nations communities in Canada and black communities in the U.S. Canada does not report coronavirus morbidity by race or ethnicity.

In many cases keeping food on the table means foregoing safe working conditions and a greater risk of exposure to Covid-19. A large number of front-line workers like transport employees, sanitary workers, delivery people, etc., are often made up of BAME groups. In New York City, for example, Blacks and Latinos make up more than 60 per cent of the hard-hit Metropolitan Transportation Authority (MTA) – as of April 22, 2020 eighty-three MTA workers have died.

Even the most basic health recommendations to avoid contracting or spreading infection like hand washing and social distancing are major challenges in marginalized communities without sufficient access to water or housing. The number of people who don’t have regular access to water is mind-boggling: 36 million people in Mexico, over 2 million in the U.S., more than 100 First Nations communities in Canada, 63.4 million in India, etc. In all, 40% of the world’s population lack access to basic hand-washing facilities in their homes.

The inability to self-isolate, when faced with a virulent virus, places additional stress on communities who are affected by overcrowding and housing shortages. In many Indigenous communities in Canada – often living in remote areas with limited medical services – there are sometimes two or three families living in the same house. Indigenous Australians face the same troubling dilemma, compounded by a higher prevalence of underlying health conditions in Indigenous communities compared to general populations. There is compelling evidence that one of the risk factors that exacerbated the morbidity rates (incidence and prevalence) in Italy was ubiquitous intergenerational households.

For Brazil’s Indigenous groups, some having little or no contact with non-Indigenous society leaving them particularly vulnerable to disease, fears grow that entire communities could be wiped out amidst a rising number of illegal land invasions from loggers, miners, etc. As of April 17, 2020, Brazil’s Social Environmental Institute (ISA) has recorded at least 27 confirmed Covid-19 cases and 3 deaths, including a 15-year old from a village on the Uraricoera River – an access route for gold rush miners.

The World Health Organization’s biggest concern is Covid-19’s potential to spread in countries with weak health systems. While the 2019 Global Health Security Index, a health security assessment listing of 195 countries, highlighted fundamental weaknesses of healthcare systems around the world, it’s no surprise that the majority of countries found to be the least prepared were in Africa. Less than 50 per cent of the continent’s population has access to modern health facilities and countries are plagued with shortages ranging from low numbers of healthcare workers in ratio to the population, to medical equipment, medications, and capacity.

Densely populated cities, slums, and displacement camps; struggles with other simultaneous communicable diseases, ongoing conflicts in some regions, and a myriad of other dangerous conditions, make it seem inevitable that the continent will experience a substantial epidemic.

The one silver lining in terms of mortality rates is that the continent has the youngest population in the world − 60 percent of its 1.25 billion population is under the age of twenty-five, an age group likely to recover from Covid-19 infection.

Amidst all the sobering details emerging from this crisis, a light shines ever brighter on the pressing need to do more to address economic, social, and political structures to support vulnerable groups in having better access to quality of life essentials. 

Finally, as we go through these trying times, there is a need to regularly remind ourselves that while the vulnerable groups continue to subject themselves to this devastating virus, their motivation and dedication to respond to this professional call of duty requires special recognition, empathy, and compassion at all levels. In specific terms, this applies to health professionals who continue to expose themselves daily in an attempt to alleviate the suffering of victims of the pandemic. Institutional support remains inadequate and yet its involvement is a sine qua non that cannot be adequately emphasized. For example, and at a personal level, my daughter who is a senior nurse working for the Canadian government in one of the Indigenous clinics in the North recently told me her clinic has no supplies of personal protective equipment (PPE) including face masks! And this is happening four months into the pandemic. What a shame!