From discriminatory acts to language, several factors are increasing groups’ vulnerability to Covid-19 resulting in dramatic outcomes. Even though Coronavirus doesn’t know borders, however, vulnerability is spread unequally creating disparities that involve race and ethnicity. April statistics of Covid-19 global crisis, broken down by race, are alarming.
In Chicago (USA), 72% of people killed by Coronavirus were black, even though only one-third of the city’s population is.
In Georgia (USA), white people accounted for 40% of Covid-19 infected people where the race was reported, although they characterise the 58% of the entire State.
In the UK, of the first 2,249 patients diagnosed with Coronavirus, 35% were non-white. This data is much higher than the proportion of non-white people in the UK, which accounts –14%, according to the most recent census.
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In Canada, 48% of autochthonous households dealt with food insecurity even before the pandemic outbreak made it even harder to keep fisheries open. And in 2018 in the USA, black families were twice as likely to be food insecure as the national average, with one in five families lacking constant access to enough food, even before the crisis. The consequences of lacking access to consistent nutrition include higher risks of health conditions, and for these reasons, African Americans are generally more likely than their white counterparts to have diabetes, heart disease and hypertension which increase the weakening of the immune system. And the people with pre-existing health conditions are more likely to suffer from Covid-19 symptoms.
Certainly, this doesn’t only mean certain groups are more vulnerable to Covid-19. It also means they’re more vulnerable to its financial effects. In South Africa, an economist at the University of Witwatersrand Imraan Valodia has estimated that the lockdown will cause up to a 45% loss of income for the poorest 10% of households, with harmful effects on informal workers without a safety net. He declared: “For the upper social classes who can keep earning a wealth income, the lockdown is easy to manage. For the lower classes, this is not the case”.
But the financial disparity is not the only challenge faced by BAME (Black, Asian and Minority Ethnic) groups. Non-stop environmental injustice also means that high numbers of ethnic-minority households in North America and Europe live near incinerators and landfills, and schools with lots of minority students are based near highways and industrial sites.
Racial biases play a role too. Some recent surveys discovered that medical workers are more uncertain and less communicative with non-white patients than with whites. Shockingly, one 2016 analysis found that white medical students were surprisingly likely to believe that black patients experience less pain than white people. These kinds of beliefs and patterns can translate into less successful medical care for black patients, regardless of patients’ income or educational status. Then there is racism itself. It has been proved that the stress caused by racism and discrimination-caused disadvantages trigger the frequent secretion of stress hormones. Studies suggest that this affects the health deterioration and mortality of higher-income African Americans -especially women- as well, including their babies.
And why certain racial and ethnic groups are unreasonably represented in at-risk occupations? 26.4% of Transport for London staff are from BAME groups, and they are more likely to be unemployed, underemployed or precariously employed. Housing differences also are likelier to affect lower-income groups across the globe. One report revealed that 26% of Bangladeshi British families have more people than bedrooms, compared to just 2% of white British households. In the UK, Bangladeshi, Indian and Chinese households also have higher rates of elderly people living with children –a factor for passing on Coronavirus to the most vulnerable age group.
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Precarious housing is another challenge, as people who are homeless or vulnerably housed are less able to observe social distancing and self-isolation. In the UK, at least 31% of homeless households prioritised for assistance are non-white -although, as we’ve seen, non-whites make up just 14% of the overall population of England and Wales. Demolitions of shack settlements have continued in Durban, South Africa despite the public health crisis. Nigerians are being targeted for eviction in Guangzhou, China. And black women in Milwaukee and other US cities are much more likely than white residents to rent their homes -and to be evicted from them, although evictions have been suspended in Milwaukee County in response to the crisis.
It’s important to remember that residential segregation isn’t simply a by-product of income inequality. It’s also a result of systematic and widespread housing discrimination based on race, caste and other identity-linked factors.
At the same time, the crisis is amplifying misinformation and biases against specific groups. It has boosted Islamophobia in India, thanks in part to “corona jihad” rumours on social media about Muslims deliberately coughing and sneezing on others. The US has also seen rumours, especially during the early part of the epidemic, about black people being somehow immune to the virus – a myth that persists across Africa as well.
Biases also mean some are less likely to take preventative behaviour like wearing masks. Black men in the US have reported being uncomfortable wearing masks in public: racial bias and profiling mean they’re more likely to be seen as a criminal or dangerous, rather than as simply protecting their health.
Then there is the impact on Asians and Asian Americans.
Cynthia Choi is one of the executive directors of the Chinese for Affirmative Action. This organisation, along with the Asian Pacific Policy and Planning Council, launched the Stop AAPI Hate website on 19 March 2020. The site collects reports of harassment and assault of Asians and Pacific Islanders in the US, including incidents of Asian Americans being physically assaulted and coughed and spat on. Most of the people targeted in these incidents have been women.
Asians and Pacific Islanders are becoming increasingly fearful of being harassed or attacked – Cynthia Choi. “AAPIs are becoming increasingly fearful of being harassed or attacked going to work, walking in their neighbourhoods and going to public places,” Choi says, based on the incident descriptions received by Stop AAPI Hate.
Even language has had a marginalising effect on some groups around the world. Much of the initial public health guidance around Covid-19 has been in dominant languages, points out Salman Waqar, an academic GP registrar at the University of Oxford and the general secretary of the British Islamic Medical Association.
“There needed to be a better understanding at the beginning of this pandemic that these messages may not necessarily get through to the grassroots,” he says. Indeed, terms like “social distancing” and messages about safety measures have been difficult to translate into several languages.
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You only need to look at the Ebola outbreak that started in the Democratic Republic of Congo in 2018 to see what effect this can have, notes Ellie Kemp, head of crisis response for Translators without Borders. For instance, official communications from the Ministry of Health and the World Health Organization likely started out in either English or French, then were translated into a non-local version of Swahili, with key terms like “swab” remaining in French.
“One of the net results of the confusion that caused was that people didn’t really trust the information,” Kemp says. Women and less educated people, especially, “didn’t understand the language used by the doctors and the medical staff. And so, they didn’t feel they were able to make themselves understood.” Many chose not to seek medical care or were misdiagnosed.
“There’s this terrible coincidence between people who are likely to have less health literacy to start with, and people who are less likely to speak an international language,” Kemp says.
She remembers widespread puzzlement about the term “contact tracing”. People didn’t know what a “contact” meant – was it someone in your phone book? Sexual contact?
The phrase was ultimately translated into a Swahili version of “monitoring people who’ve been close to a sick person” – a term that was easier to understand.
Experts say that addressing these disparities in the short term will require steps that will help everyone, but especially people of colour: getting protective equipment to all essential workers, including janitors and sanitation workers; increasing access to medical care, whether in private or public facilities; providing secure housing for people who fall ill; increasing financial support to both individuals and non-profit organisations; and ensuring the basics, like handwashing stands and soap, in the areas with the fewest resources, including informal settlements and refugee camps.
Getting vitamin D supplements to vulnerable groups, including darker-skinned people, could help with immune response in general -although there isn’t a consensus about how widespread vitamin D supplementation should be, and in which amounts.
There’s also an urgent need for more data, broken down by demographic groups, to know how to best serve different communities. But this has been stymied by political obstacles in some countries and insufficient resources in others.
As of 14 April 2020, only 22% of Covid-19 cases reported in the US specified the race of the patient. And microbiologist Elamin points out that in Sudan, it’s challenging to collect medical data on whether, for instance, respiratory illnesses recorded in December 2019 and January 2020 could have been cases of Covid-19. Gathering more specific demographic information on population groups most affected would be even tougher and more sensitive.
Attention to the medium and long term will also be needed. The pandemic highlights and exacerbates health inequities, but it doesn’t create them. Nor will the disparities end with the emergency.
The pandemic has highlighted, even in higher-income countries, the importance of a strong and well-funded health system that is available to all –Grania Brigden. As a result, say, experts, policy discussions around social protection and universal healthcare are more important now than ever. According to lung health expert Brigden, the pandemic “has highlighted, even in higher-income countries, the importance of a strong and well-funded health system that is available to all”.
The world also needs an acceleration of environmental regulations that reduce air pollution -which particularly weakens respiratory health among marginalised communities. The US is currently seeing a rollback, instead. And there needs to be a careful look at how economic fallout will disproportionately impact BAME communities. For example, after the 2008 financial crisis, ethnic minorities in the UK faced higher unemployment, lower earnings and higher housing costs.
“What’s going to kill us more: the bug, or the poverty that’s associated with the bug?” asks microbiologist Elamin. For now, it’s impossible to answer. But what is clear regarding coronavirus is that, as he says, “the way it spreads is not equal”.
But there is a best-case scenario. And that is that the current pandemic will galvanise more, and longer-lasting, attention to the social, political and economic structures that shape how different people experience the pandemic – and spur action so that, in the future, a factor like an individual’s race or ethnicity will have less impact on the risk to their lives.
Source: BBC Future