There is a real danger that covid-19 will become entrenched as a disease of poverty
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n986 (Published 19 April 2021) Cite this as: BMJ 2021;373:n986Read our latest coverage of the coronavirus outbreak
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Dear Editor
On various occasions, the phrase, ‘COVID-19 does not discriminate’ has been repeated. This, however, is a dangerous myth, sidelining the increased vulnerability of those most socially and economically deprived. To date, policymakers have targeted people with multiple co-morbidities after identifying them as the most vulnerable. However, this medical model of disease risks ignoring social factors, which can increase exposure to and mortality from COVID-19 (1).
Like infectious diseases of the past, Covid-19 is a disease of poverty. If you map Covid-19 prevalence with deprivation the results are stark. It has also exposed the ingrained inequalities across our society. But is it any wonder when people are living in overcrowded housing where few have a room to themselves, making it nigh impossible to self-isolate from the rest of the household, that the virus affects many if not everyone in that home. From a public health perspective, socioeconomic disparities can lead to health inequality with regard to COVID-19 (2). People with lower socioeconomic status have been segregated to overcrowded urban housing centers and workplaces, making physical distancing and self-isolation difficult and leading to increased risks of contracting and spreading COVID-19 (3).
Given the available data, it is not possible to know definitively what factors led to the temporal differences in the relationship between poverty and the number of confirmed Covid-19 cases and deaths. However, given the patterns of disease transmission and level of contagion, it does seem reasonable to consider the possibility that a large part of the cause is due to a lack of testing capability. In that instance, it is possible, and given the progression of the disease, perhaps even likely that Covid-19 continued to appear in relatively high rates within poor urban areas, even as the number of available tests in those communities declined relative to more affluent areas. Only further investigation and particularly an investigation into the allocation of scarce testing resources can answer this question with any certainty.
Data suggest that under-resourced workers in fields that have been deemed essential (e.g., public sanitation, grocery employees, delivery services) and who thus may be at particular risk may not have equal access to testing for the virus. These workers, though at elevated risk, may be without the ability to quarantine away from their families in the same manner as do health care workers, another group at higher risk for exposure to the coronavirus. Given that the limited testing resources have now been diverted to health care workers, certainly with good reason, this problem of potential underreporting of Covid-19 cases in under-resourced communities may continue to be a serious problem (4).
Emerging data from affected countries suggests that the poverty and distributional impacts of COVID-19 are materializing fast, with dire consequences (5). Substantial inequalities in COVID-19 mortality are likely, with disproportionate burdens falling on those who are of racial/ethnic minorities, are poor, have less education, and are veterans. Healthcare systems must ensure adequate access to these groups. Public health measures should specifically reach these groups, and data on social determinants should be systematically collected from people with COVID-19.
In summary, a combination of factors leaves the most economically disadvantaged particularly vulnerable to COVID-19. Possible causal mechanisms include an increased exposure to the virus, the stress and co-morbidities associated with poverty and reduced access to health care. The pandemic has highlighted the stark inequalities within society, and it will likely exacerbate them. Socioeconomic status was not associated with in-hospital mortality among COVID-19 patients, suggesting that financial coverage is an important factor for better prognosis of COVID-19 patients regardless of socioeconomic status. To address the vulnerabilities of the most economically disadvantaged within society, policymakers must introduce long-term legislation to improve social welfare.
References:
1. JA Patel,FBH Nielsen et al Public Health. 2020 Jun; 183: 110–111. Published online 2020 May 14. doi: 10.1016/j.puhe.2020.05.006
2. Anderson G, Frank JW, Naylor CD, Wodchis W, Feng P. Using socioeconomics to counter health disparities arising from the covid-19 pandemic. BMJ. 2020;369:m2149.
3. Khunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19? BMJ. 2020;369:m1548.
4. W.Holmes Finch and Maria E. Hernández Finch, Front. Sociol., 15 June 2020, https://doi.org/10.3389/fsoc.2020.00047
5. C. Sanchez-Promo, COVID-19 will hit the poor hardest. Here’s what we can do about it. https://blogs.worldbank.org/voices/covid-19-will-hit-poor-hardest-heres-...
Competing interests: No competing interests
Re: There is a real danger that covid-19 will become entrenched as a disease of poverty
Dear Editor
COVID-19 and Poverty
According to the World Bank, Global extreme poverty increased in 2020 for the first time in over 20 years as the disruption of the COVID-19 pandemic compounds the forces of conflict and climate change, which were already slowing poverty reduction progress.
The COVID-19 pandemic was estimated to push an additional 88 million to 115 million people into extreme poverty in 2021, with the total rising to as many as 150 million by 2021, depending on the severity of the economic contraction.
The COVID-19 pandemic has devastated economies worldwide. Although lockdowns are an effective measure to halt the spread of COVID-19, many people around the world lost their jobs and livelihoods. As a result, some find it impossible to support themselves and their families.
Handling the COVID-19 pandemic has been no easy task, and weighing out the economic costs of lockdowns to public health has proven to be nearly impossible. However, being the country to reduce poverty at the fastest rate in history, there is always hope for recovery in India.
Now during the second wave of COVID-19, the restrictions on mobility have amplified losses for small businesses, which were yet to recover from the initial impact of the pandemic. Several sectors such as aviation, tourism, retail, entertainment and restaurants are again worried, fearing a repeat of 2020.
Experts estimate that if vaccinations are not ramped up and the virus is not contained by the end of May, it could have a severe impact on business activity ultimately leading to massive loss of jobs and income. That could push more people into poverty.
Competing interests: No competing interests