Republic At Risk: COVID-19 in India

While the novel coronavirus (COVID-19) has impacted almost every corner of the globe, parts of Asia are still just beginning to see the systemic effects of the pandemic. As the second most populous country in the world, India has experienced a rise in COVID-19 cases and deaths which magnify current injustices across the country. This blog addresses India’s importance within the COVID-19 pandemic and its relationship with human rights issues concerning feeble governance, police brutality, migrant displacement, and Islamophobia.

As of late-July, over 1.4 million Indians have been diagnosed with COVID-19, while over 32,000 have died from the virus. India’s western state of Maharashtra is currently the country’s epicenter with over 375,000 confirmed cases of COVID-19. On the southern coastline, the state of Tamil Nadu has the country’s second-largest number of confirmed cases (210,000+), while the capital territory of Delhi in the northwest has recently exceeded 130,000 confirmed cases. Additionally, the southeastern state of Andhra Pradesh has confirmed over 95,000 cases of COVID-19. Interestingly, India’s most populous state, Uttar Pradesh, has only confirmed just over 65,000 cases which triggers questions about access to COVID-19 testing and essential resources throughout the country.

A National Lockdown

In late-March, the Indian government issued a nationwide lockdown that lasted two months. Inconveniently, the country’s 1.3 billion inhabitants were given less than a 4-hour notice of this initial 3-week lockdown. The effects of this tall order were apparent on day one since so many people throughout the country live on a daily wage or in extreme poverty. As food supply chains became compromised and manufacturing facilities closed, the country’s unemployment rate reached a 30-year low. All the while, facilities such as schools and train coaches have been converted into quarantine centers. These attempts have seemingly delayed the inevitable spike of COVID-19 cases. However, it is speculated that the low number of confirmed cases is the result of low testing rates.

This outcome has been attributed to lax contact tracing, stringent bureaucracy, and inadequate health service coordination, namely in Delhi where cases have recently surged. However, as India reopens, the number of confirmed COVID-19 cases has increased. Additionally, the introduction of newly-approved antigen kits have allowed for rapid diagnostic testing, although testing is not to be distributed proportionately. More specifically, family members and neighbors of people who have tested positive for COVID-19 claim they are not being tested. Also, in several instances, the family members of people who have tested positive for COVID-19 were not being informed about their loved one’s diagnosis. After much scrutiny, however, local health authorities in Delhi have attempted to pick up the pieces by using surveillance measures such as door-to-door screenings, drones, and police enforcement.

Policing the Police

While the recent murder of George Floyd sent shockwaves across the world, India has been confronting its own relationship with police violence. In June, two Tamil Nadu shopkeepers, J Jayaraj and his son Bennicks Immanuel, were arrested for keeping their business open past permitted hours during the national lockdown. They were then tortured while in police custody and died days later in the hospital. Due to this event garnering considerable attention and protesting, six police officers have since been arrested for their deaths. Also, Tamil Nadu police officers with questionable track records will now undergo behavioral correction workshops. However, this incident is no anomaly. According to the National Human Rights Commission (NHRC), nine Indians die in judicial or police custody every day. In comparison, official government crime data claims 70 people were killed in Indian police custody in 2018. This striking differential in reported custodial deaths suggests India’s law enforcement entities lack accountability and are riddled with corruption.

Much like the United States, India has a history tainted with police violence that disproportionately affects minority groups, namely people from the lowest Dalit caste, indigenous groups, and Muslims. With no choice but to work during the national lockdown, many of India’s poorest citizens were beaten by police. Videos of these violent acts surfaced across social media. In opposition, there have been over 300 reported incidents of attacks on police officers alone in Maharashtra. These recent events highlight the need for the Indian government to pass anti-torture legislation that curbs police violence. By ratifying the United Nations Convention Against Torture, the Indian government can help remove the colonial vestiges of power and punishment that have plagued the country for generations.

Migrant Displacement

The sudden announcement of a national lockdown had tremendous repercussions for the tens of thousands of daily-wage migrants throughout India. Overnight, businesses closed and transportation systems suspended throughout the country, placing many migrant workers in precarious economic conditions. Men, women, and children hunkered down in urban centers across the country as they waited for their workplaces to reopen but to no avail. In response, India’s major cities experienced an exodus of migrant workers attempting to return to their home states on foot, many living hundreds, even thousands, of miles away. As thousands trekked home, many died due to dehydration, exhaustion, sunstroke, and traffic accidents. Reports of pregnant women delivering, and subsequently carrying, their children in these horrific conditions have also surfaced.

A recent Supreme Court order has urged the well-being of India’s 100 million internal migrant workers affected by the hardships of COVID-19 by requiring the government to register, feed, shelter, and transport them until they return home. However, these efforts are seemingly inadequate because most internal migrant workers have not qualified for these “relief packages”, while those who have qualified are experiencing limited coordination between state governments. All the while, India has ended its national lockdown and many migrant workers are trying to return to their places of employment. Some employers are sponsoring the return of their lost workers, while some must find their own means to return. As such, some states have sought local help to accommodate the loss of migrant workers which places many Indians in even greater economic uncertainty.

Migrant workers walking on the shoulder of a highway during the nighttime.
The Indian Lockdown Migration – IV (PB1_4728). Source: Paramvir Singh Bhogal, Creative Commons.

Pathologizing Islam

COVID-19 in India has contributed to a surge in anti-Muslim rhetoric that suggests this religious minority group is purposely spreading the virus.  The rumors began after Tablighi Jammat, a Muslim missionary group, held a congregation outside of India and, soon after, many members tested positive for COVID-19 in New Delhi. Videos on WhatsApp and various television channels have proliferated this misinformation to the Indian public alongside the usage of phrases such as “corona jihad” and “corona terrorism”. To make matters worse, the Bharatiya Janata Party (BJP)-led government, which is notorious for its Hindu nationalist sentiments, has begun incorporating Tablighi Jamaat-related statistics to its daily COVID-19 briefings. Such rhetoric has influenced a slew of Islamophobic acts such as prohibiting neighborhood entry, restricting sales by street vendors, and even violent attacks.

These recent events fuel an existing fire that posits Muslims as reproducing at a pace to outnumber Hindus and compromising “Mother India”. However, recent efforts between Muslim Indians and allies has been quick to respond to this COVID-19 misinformation because they have been protesting India’s new citizenship law that offers amnesty to various non-Muslim immigrants and a nationwide citizen count that necessitates proof of documentation dating several years back. The BJP has made it apparent that Muslims are not welcome in India and weaponized the COVID-19 pandemic as a part of its Islamophobic campaign. As such, these efforts corner Muslim Indians into political and economic insecurities that pressure apartheid at a time when unity is paramount.

Masked medical professionals walking with a crowd in the background.
coronavirus-india-rep-image-hyd. Source: Anant Singh, Creative Commons.

Human Rights in India

As displayed, India has an array of prevalent human rights issues that have compounded since the arrival of COVID-19. Among the efforts that could protect Indians from these concerns are labor protections, health care reform, civil rights for minority groups, food security, and income equality. However, Prime Minister Narendra Modi has propagated a narrative of self-reliance that undermines these systemic inequalities. Service provision has highlighted these discrepancies because resources are scarce, and those with power and privilege are placed to the front of the line. In addition, many Indians cannot abide to the recommended sanitation and social distancing measures due to living in poor, dense settlements in the heap summer when water sources are limited.

Although tearing through communities and disrupting daily life in India, the COVID-19 pandemic can be viewed as an opportunity for social change. More specifically, it is well within the power of Parliament, the media, civil society, and local governments to right these wrongs by ending communal bias and impartiality within state institutions. Addressing these corrupt and oppressive practices will not only remediate the effects of COVID-19 but help shape an equitable future for a country that is rapidly becoming a global super power and expected to be the most populous country in the world by 2027. Real change and equity in the world’s largest democracy could send a much-needed shockwave of justice across the globe.

Cataclysm: COVID-19 in Brazil

As the number of novel coronavirus (COVID-19) cases continue to grow in the United States (U.S.), another epicenter has been growing in South America. As the sixth most populous country in the world, Brazil has experienced an uptick in COVID-19 cases and deaths alongside an array of national controversies that make the response efforts considerably more difficult. This blog addresses Brazil’s growing importance in the COVID-19 discussion and how it impacts human rights issues concerning indigenous peoples, environmental degradation, favela communities, and good governance.

As of late-June, more than 1.3 million Brazilians have been diagnosed with COVID-19, while over 55,000 have died from the virus. Brazil’s most populated state, São Paulo, is currently the country’s epicenter with nearly 250,000 confirmed cases of COVID-19. The northeastern state of Ceará has the country’s second-largest number of confirmed cases (100,000+), while Pará in the northwest is nearing 100,000 confirmed cases. Additionally, the iconic city of Rio de Janeiro has over 105,000 confirmed cases of COVID-19. Unfortunately, Amazonas has to the highest COVID-19 death rate of any state with 67 deaths per 100,000 cases, compared to Bahia’s 11 deaths per 100,000 cases, which highlights the disproportionate impact of COVID-19 on indigenous communities that have been systematically killed, displaced, and denied access to health care and other preventative services that could help fight the spread of the virus.

Indigenous Peoples of Brazil

As the largest Brazilian state in the Amazon region, Amazonas is known for its indigenous communities who often live in isolated villages and have poor access to health care. In the city of Manaus, which has a population of 2 million+ and is only accessible by aircraft or boat, many recent respiratory-related deaths have resulted in quick burial in mass graves, which has likely led to a severe underestimate the pandemic’s toll on the local population. In the remote community of Betania, the Tikuna tribe has five government medical workers that accommodate an approximate 4,000 inhabitants, but they are not treating the sick due to lack of protective equipment and COVID-19 testing supplies. One considerable threat are the indigenous community members who are not quarantining and are, instead, traveling in and out of town for work.

These unprecedented events compound the colonial legacy that has threatened Brazil’s indigenous peoples for centuries. Centuries ago, indigenous tribes throughout the Amazon were decimated by diseases brought by Europeans. In a way, history is repeating itself because the Brazilian government’s ineffectual response to the crisis have allowed COVID-19 to ravage the surviving indigenous communities and put them on the brink of genocide. Aside from the tribes who have contact with the modern world, the Brazilian Amazon inhabits 103 uncontacted tribes who have virtually no knowledge or resources to protect them from the threat of COVID-19. Signing this petition will help urge Brazilian officials to protect the surviving indigenous communities throughout the Amazon.

Deforestation in the Amazon

Since COVID-19 has reached these Amazonian communities, deforestation in the region has also proliferated. The Amazon is the largest rainforest in the world and is important to the global ecosystem because it absorbs approximately 5% of the world’s carbon dioxide (CO2) emissions. Thus, protecting the Amazon is pivotal for stalling the effects of climate change. However, for years, the Amazon has been ravaged to accommodate the agricultural industry as well as illegal loggers and drug traffickers. As a result, indigenous leaders fear that the COVID-19 pandemic will be used to exacerbate the destruction these industries have already caused.

During the month of April, deforestation in Brazil increased by nearly 64% which resulted in more than 150 square miles of rainforest destruction. In response, 3,000+ Brazilian soldiers were deployed to the region to prevent illegal logging and other criminal activities that contribute to deforestation. Some worry that such activity in the rainforest will lead to outsiders giving indigenous communities infectious diseases, namely COVID-19. Brazil’s Secretariat of Indigenous Health (SESAI) has made efforts to distribute N95 masks, gloves, and goggles to the region, but activists warn that the only way to protect uncontacted tribes is by keeping illegal loggers and miners out of these areas. Despite the Brazilian government establishing three military bases to prevent illegal actors from permeating the region, they are only expected to be present for 30 days. This is because Brazil’s main environmental enforcement agency, Ibama, is expected to take over these efforts but are currently understaffed and underbudgeted.

Favelas in the Age of Social Distancing

More than 11 million Brazilians live in favelas which are shantytowns outside of urban centers. Already hit hard by gun violence, unsanitary conditions, and militaristic police presence, people living in Brazil’s favelas struggle to adhere to social distancing measures. Research has found that people living favela-like conditions spend roughly 50% more time per day with others than people in less-impoverished areas. Often, favelas are composed of two or three rooms with five or six people sharing these spaces. As such, favela conditions enable the spread of COVID-19, and with precious little assistance from the government, Brazil’s most impoverished communities are left to fend for themselves.

With little government help, residents of Paraisopolis in Sao Paulo (population: 100,000) have offered a community-based solution. Due to donations and volunteer work, residents have responded to COVID-19 by organizing distribution of free meals, ambulatory services, and neighborhood watch persons. They even designated one building the quarantine house and repurposed closed schools in self-isolation centers. In Rio, members of the gang City of God drive through the local favelas, blaring a recorded message ordering people to stay home. Other gangs have become knowledgeable about COVID-19 in order to deliver essential goods to favela residents and have even gone as far to enforce social distancing measures by preventing restaurants from putting tables out. These forms of gang vigilantism in Brazil’s favelas demonstrate the lack of government support and tension with local police.

Small grave onlooking a favela.
At the bottom of this block destined to the burials of COVID-19, is the favela of the Vila Nova Cachoeirinha housing complex. Source: Léu Britto, Creative Commons.

Trump of the Tropics

These criticisms are largely attributed to the leadership of Brazilian President Jair Bolsonaro who notoriously dismissed COVID-19 as a “little flu”. Aside from personally ignoring social distancing measures, Bolsonaro has organized large rallies in an effort to confront local governors who have locked down their regions. Recently, after ignoring federal regulation that require wearing a face mask in all public places, a judge ruled that Bolsonaro (and any public official) is not exempt from this policy and should expect a 2,000-reais ($387) fine like anyone else. Bolsonaro even fired his Health Minister, Luiz Mandetta, in April after he supported social distancing measures. His successor has since promoted a reopening of the economy and unproven medical treatments for COVID-19.

Known by many as the “Trump of the Tropics,” Bolsonaro has successfully maintained a strong coalition of supporters such as the agriculture community, evangelical Christians, and the military. Unlike the U.S., Brazil is an emerging economy with a weak social safety net that makes it difficult for government officials to convince people to stay at home. Health care access and the conditions to work from home are also quite limited. Recent cell phone tracking data has revealed that 45-60% of Brazilians are not complying with social distancing measures, likely due to the fact that they have to choose between feeding their families and being exposed to the virus. As such, it is assumed Bolsonaro’s defiance of a public health approach to COVID-19 is an effort to appeal to his core supporters. Bolsonaro has also slashed regulations and enforcement of land grabbing, which exacerbates the deforestation crisis currently impacting the Amazon.

Human Rights in Brazil

As demonstrated, Brazil has an array of chronic human rights problems that have been compounded by the arrival of COVID-19. In 2016, a constitutional amendment was passed that limited public expenditures in Brazil for the next 20 years. As a result, we are now witnessing how these austerity measures have affected access to housing, food, water, and sanitation when Brazilians need it the most, particularly within the most vulnerable groups – women, children, Afro-Brazilians, indigenous peoples, rural communities, and informally-settled persons.

Much like the U.S., Brazil’s COVID-19 response has mostly been subnational social distancing measures and an emergency basic income to placate the masses. However, these efforts are clearly inadequate considering Brazil’s COVID-19 cases are surging alongside another potential Zika outbreak. As a result, Brazil has effectively become the most prominent COVID-19 case study in the Global South, a nation plagued by a deadly virus and an array of human rights issues. Human rights experts suggest fiscal stimulus and social protection packages would only be the beginning of a COVID-19 response because many of these concerns are the consequence of marketization and privatization of public goods and services. As such, the COVID-19 pandemic serves as an opportunity to reverse the market-based ideology that has failed so many countries, especially the Land of the Palms.

Please sign the petition to help urge Brazilian officials to protect the surviving indigenous communities throughout the Amazon.

Taking It To The Streets

by Peter Verbeek, Ph.D.
Associate Professor,
Program Director MA Program Anthropology of Peace and Human Rights

Large crowd of individuals with masks on march in the streets holding signs that say Black Lives Matter
Source: Yahoo Images

On March 9, 2020, the IHR published my blog entitled ‘A Time to Recognize and Safeguard The Rights That Connect Us.’ On that date, there were 717 reported cases of the corona-virus infection in the US and 26 reported deaths. Today, about 3 months later, on June 6, 2020, while I am finishing writing this new blog, there are 1.94 million reported cases of the corona-virus infection in the US, with 111 thousand reported deaths. These numbers take one’s breath away; they invite retreating into a state of silence – to a state of being ‘comfortably numb’ (3), and to leave it all to others, whomever they might be, to deal with this shocking reality. But I cannot afford to become a passive bystander to this, no-one can. Not when so many scientists and practitioners are speaking up and calling for action on the urgent human rights aspects of the pandemic, not when so many health-care workers are putting their own health and well-being on the line for the care and comfort of COVID-19 patients, and not when so many of those most affected by and at risk for COVID-19 are out in the streets protesting against the human rights violations of police brutality and murder, and for the equal justice to which they have an inherent right and that is so long overdue.
On March 6, 2020, UN High Commissioner for Human Rights, Michelle Bachelet, M.D, urged policy makers and governments “to take great care to protect the most vulnerable and neglected people in society, both medically and economically” while devising and implementing measures to curtail the virus outbreak. She also wrote that “human dignity and rights need to be front and center in that effort, not an afterthought,” and added that “COVID-19 is a test for our societies, and we are all learning and adapting as we respond to the virus.”

Here in the US, the “COVID-19 test of our society” that Bachelet referred to, once again highlights the glaring inequalities and deep-rooted racism that continues to severely harm and disadvantage people of color, in particular African-Americans, and that in all its ugliness diminishes life for us all. In a statement released on June 3, 2020, Bachelet commented that “structural racism and police violence are of course found across the world,” and that “the anger we have seen in the US, erupting as COVID-19 exposes glaring inequalities in society, shows why far-reaching reforms and inclusive dialogue are needed there to break the cycle of impunity for unlawful killings by police and racial bias in policing.” She added “in addition, there must be a profound examination of a wide range of issues, including socio-economic factors and deep-seated discrimination. To move forward, communities must be able to participate in shaping decisions that affect them and be able to air their grievances.”

What role does science have to play in bringing about solutions for what plagues our society? What can scientists do to make things better? Taking my cues from conservation science and from my own work in the behavioral science of peace I propose two things: (a) taking our science to the streets-metaphorically, and (b) taking a holistic and comprehensive approach to the crises that we face. My inspiration for the former comes from an article that was released this week in the Proceedings of the National Academy of Sciences of the United States of America (PNAS), which documents the mass extinction and biodiversity loss caused by human activity and how it threatens our mere survival. It is one of the most urgent calls for “humanizing conservation” that I have come across in the last 10+ plus years.

I’ll let the authors, Gerardo Ceballos, Paul R. Ehrlich, and Peter H. Raven, speak for themselves:

“In view of the current extinction crisis and the lack of widespread actions to halt it, it is very important that scientists should metaphorically take to the streets (my italics). We have, for example, started a new global initiative we called “Stop Extinctions,” to address and publicize the extent of the extinction crisis and its impacts on the loss of biodiversity, ecosystem services, and human well-being, aspects still rather ignored by most people. There is time, but the window of opportunity is almost closed. We must save what we can, or lose the opportunity to do so forever. There is no doubt, for example, that there will be more pandemics if we continue destroying habitats and trading wildlife for human consumption as food and traditional medicines. It is something that humanity cannot permit, as it may be a tipping point for the collapse of civilization. What is at stake is the fate of humanity and most living species. Future generations deserve better from us.”

The major crises of the present time, the corona-virus pandemic, systemic racism, and the ecocide of climate change, mass extinctions and biodiversity loss are not disjointed separate crises, but, rather, interlinked existential crises that are impacting the entire world population. Attempts to solve one of them without considering the others are folly and doomed to failure. Attempts to solve one of them in one part of the world without considering the rest of the world are equally foolish and doomed to failure. What this implies for policy is that “we the people” need political leadership and governance informed by the science that shows how and why these crises are interlinked and why they constitute existential crises.

This also implies that across natural and social disciplines scientists need to develop and publicly share comprehensive solutions in ways that both clearly inform and can drive policy. I think that the times of coasting through a scientific career from tenure track to tenure on strictly basic research with no immediate applied value for society are over. Every science career should involve interlinked basic and applied work, and tenure and promotion reviews as well as grant reviews should be updated so as to properly assess achievements in each of these interlinked domains. The crises facing us are too formidable not to enlist all available good minds in both properly delineating the relevant component parts of the crises that we face as well as developing solutions to them.

Person holds up sign that reads "Science is Real"
Photo: Liz Lemon; Source: Flickr

While I have confidence in science in the part it can and must play in dealing with the crises that we face, my confidence in politics and governance here in the US in its present form is at an all-time low. In my opinion, the kind of informed and enlightened leadership that draws on science to map out the immense problems that we face to find the appropriate solutions, is, with few notable exceptions, missing in action here in the US, whether we look for it to the left or right of the political spectrum or right down the center aisle. As a consequence, the global leadership that is needed to guide international partnership efforts to combat global crises, leadership for which the US as the main democratic superpower is uniquely qualified, is equally lacking at present. Global partnerships developed and spearheaded by the US and built on mutual trust and respect that accomplished so much good for so many in the past, from defeating fascism and bringing down the iron curtain to establishing a universal human rights framework and systems to deal with global health responses, are, to put it bluntly, pretty much in shambles right now. Looking in solely on the status quo of the political side of things here in the US and their global effects, the future for humankind appears to look grim, indeed.

In his Gettysburg Address President Lincoln, exhorted Americans to resolve that government of the people, by the people, for the people, shall not perish from the earth. I think that President Lincoln’s call to preserve the essence of what and who we are as a nation has rarely been more urgent than now. I also think that the thousands of lawful nonviolent protesters that are out in the streets right now, are heeding President Lincoln’s call for action magnificently, showing America’s inherent greatness in doing so. I am deeply moved when I see the people most affected by the corona-virus pandemic and most at risk, risking their well-being by taking their rightful call for justice and equity, so long overdue, to the streets. I say to you, your lives matter tremendously, to all of us, and to the future of this country! And I say to you, take it beyond the streets! Run for office and practice to become the informed and enlightened leaders and policy makers that we so desperately need right now! I have my vote and science at the ready to share with you!

And to return to the call by the eminent conservation biologist Paul Ehrlich and his colleagues, yes, we must take our scientific knowledge “to the street,” as scientific knowledge is truly of the people, by the people, and for the people. We must step down from our ivory towers and speak up publicly and clearly about what the facts tell us and what we see as solutions to the crises that we face. Yes, we need those peer reviewed publications to keep our work valid and meaningful, but we should work with our institutions and granting agencies to provide free access to these journal articles to all. The existence of large for-profit publishing houses dominating the journal article universe becomes untenable in the face of the role that science has to play in combating the existential crises that threaten us all.

We must overcome any distrust and tribalism that hampers collaboration between natural and social science. We need good minds in both major areas of science to work together on the interrelated crises of the corona-virus pandemic and ecocide. For those of us working in the behavioral science of peace we must call a spade a spade when it comes to human rights violations right here at home. Attacks on human dignity, whichever form they may take, and irrespective of where they take place, or who commits them, from teargassing lawful and peaceful demonstrators during a respiratory disease pandemic to publicly insulting and disparaging individuals and groups holding a different opinion than one’s own, are attacks on human dignity and thus constitute human rights violations and should be properly labelled as such (Universal Declaration of Human Rights, see Articles 1,3,5,12,19,20).

Three pairs of hands painted blue and green to represent the earth
Source: Yahoo Images

As peace scientists, we must also speak up about the solid evidence that our biological inheritance includes a capacity for peace through our ability for empathy and for taking the perspective of others, and through our natural preference for reciprocity and justice (1). We can point anyone who has any doubts about the content validity of our comparative findings to the international news feed showing peaceful demonstrations from Asia to Europe to Africa and the Middle East in solidarity with the protests against police brutality and murder and systemic racism that are going on throughout much of the US. Politicians of all stripes should be made aware of the fact that people in vastly different cultures across the globe all demonstrate a shared disposition to not take kindly to injustice. And we can point anyone who expresses doubts in how science and government can effectively work together to deal with crises as monumental as the corona virus pandemic to New Zealand, where the Prime Minister Jacinda Ardern announced yesterday that the country has officially eradicated COVID-19 and will return to normal after the last-known infected person recovered.

News reports show that many of the protesters who have taken their grievances to the streets of America following the murder of George Floyd are young. As US scientists let’s take to the streets – at least metaphorically – to offer our support and to help make a difference toward a just society and a sustainable future for all – in sum, toward a sustainable peace. As Paul Ehrlich and his colleagues propose, “future generations deserve better from us.”

(1) Verbeek, P. (2018). Natural peace. In P. Verbeek & B.A. Peters (Eds.), Peace ethology. Behavioral processes and systems of peace. Hoboken, NJ: John Wiley & Sons, Ltd. Publishers

Pigmented Pandemic: Racial and Ethnic Disparities in COVID-19

Ubiquity of the novel coronavirus (COVID-19) has drastically changed the way we behave in almost every corner of life. One silver lining drawn into these unprecedented times is that many people are more appreciative of their families, friends, and communities. However, the odds of being in a social network that knows someone who has been diagnosed or died from COVID-19 are greater if you are a racial/ethnic minority living in the U.S. As such, this blog focuses on COVID-19’s disproportionate effect on communities of color and how a human rights approach can help address racial/ethnic health disparities.

Racial/ethnic minorities are particularly vulnerable to reduced access of health services and the psychosocial stressors of discrimination which is why some argue that racism is a fundamental cause of health inequalities. These disparities are largely due to the disadvantaged economic and social conditions commonly experienced by many racial/ethnic minorities. Compared to Whites, racial/ethnic minorities are more likely reside in densely populated areas, live further from grocery stores and medical facilities, represent multi-generational homes, and be incarcerated. Additionally, racial/ethnic minorities disproportionately represent essential worker industries and have limited paid sick live. As a result, the living and working conditions for many racial/ethnic minorities put them at odds with threat of COVID-19.

Vestiges: Black American Health Disparities

Black Americans have disproportionate rates of COVID-19-related risk factors such as diabetes, hypertension, and obesity. As such, they are disproportionately dying of COVID-19 in many counties across the U.S. These disparities are even more alarming at the state-level. For example, in Georgia, 83% of all COVID-19 cases linked to a hospitalization were Black patients despite the community only representing a third of the state’s population. Also, in Michigan, Blacks represent 14% of the state’s population but 41% of the COVID-19 deaths. On a national level, Blacks (13% of the total population) represent 33% of all COVID-19 hospitalizations, while Whites (60% of the total population) represent 45% of all COVID-19 hospitalizations.

Not only do Black Americans disproportionately live in many of the U.S.’s early COVID-19 hotspots (e.g., Detroit, New Orleans, and New York), they are also more likely than their White counterparts to experience poverty and have no health insurance. For centuries, the labor of Black Americans has been deemed “essential”, while the COVID-19 pandemic adds insult to injury. In the medical field, Blacks are less likely to be health professionals and more likely to represent personnel that cleans, provides food, or work in inventory. As such, Black essential workers who are not on the frontlines are more likely to acquire COVID-19 in the pernicious form of regularly contacting cardboard, clothing, or stainless steel. Thus, health disparities in the Black community demonstrate how the legacy of slavery and segregation thrive in the social and economic conditions of COVID-19.

Segmented: Latino American Health Disparities

Many Latinos in the U.S. have immigrant status and work in high-risk essential industries such as agriculture, food service, and health care. This largely explains why Latinos are up to three times more likely than Whites to be infected and hospitalized by COVID-19. These striking outcomes are compounded when considering that Latinos face other disproportionate hurdles such as inadequate communication resources and language barriers. Also, Latinos often socialize in “mixed status” immigrant networks which means those who are undocumented are not eligible for COVID-19 stimulus funding.

A recent Pew poll found that Latinos are almost 50% more likely than the average American to have been laid off or lost a job due to the pandemic. This is particularly salient to Latinos with a high school education or less and those ages 18-29. However, immigrant Latinos were less likely to lose their jobs but more likely to take a pay cut. As a result, the Latino experience during the COVID-19 pandemic is not only fraught with social and economic drawbacks, much like other communities of color, but complicated by the fact that their large immigrant population is ineligible for needed resources and often relied on in the essential workforce. These outcomes suggest the social and economic consequences of COVID-19 are uniquely challenging to Latinos, namely immigrants with limited access to resources that are often afforded to citizens.

Overlooked: Native American, Native Hawaiian, and Pacific Islander Health Disparities

Often overlooked in the racial health disparities conversation are outcomes for Native Americans. Some state health departments (e.g., Texas) classify Native American COVID-19 statistics as “other” which ultimately dismisses the unique health profile of this underserved population. However, early statistics from Arizona and New Mexico suggest Native Americans represent a disproportionate number of COVID-19-related deaths and cases, respectively. Reports from health authorities in Navajo Nation, which is comprised of areas in Arizona, Utah, and New Mexico, indicate this community’s confirmed COVID-19 prevalence rate is the highest in the country, although they have a test rate higher than most U.S. states.

In March, the Seattle Indian Health Board requested medical supplies from local health authorities but instead received body bags and toe tags. This callous response demonstrates that local authorities in Washington state have actively devalued the lives of Native Americans during these trying times. The Cheyenne River Sioux Tribe in South Dakota have responded to their state’s negligence by refusing to end COVID-19 highways checkpoints across tribal land. Cheyenne River Sioux Tribe Chairman Harold Frazier argues that the checkpoints are the best thing the tribe has to prevent the spread of COVID-19 because they are only equipped with an eight-bed facility for its 12,000 inhabitants. The nearest critical care facility is three hours away.

Also overlooked are COVID-19 outcomes among Native Hawaiians and Pacific Islanders (NHPI). Early reports from California, Hawaii, Oregon, Utah, and Washington indicate that NHPI have higher rates of COVID-19 when compared to other ethnic groups. A precursor to these outcomes is that NHPI have some of the highest rates of chronic disease which puts this demographic at higher risk of COVID-19. Much like other racial/ethnic minority groups, NHPI are more likely to work in the essential workforce and live in multi-generational households. Thus, these conditions allow COVID-19 to proliferate among NHPI enclaves.

Person with a protective mask preparing food with a front door sign that reads "No Mask, No Entry".
Thank you essential workers! Source: spurekar, Creative Commons

Health and Human Rights

Health is argued to be a fundamental human right. Ways this can be achieved is through creating greater access to safe drinking water, functioning sanitation, nutritious foods, adequate housing, and safe conditions in the workplace and schools. As such, health exists well outside the confines of the typical health care setting. However, the U.S. has yet to officially ratify the Universal Declaration of Human Rights which ultimately prevents the government from being held accountable for the socioecological influences that generate health disparities across racial/ethnic minority groups.

These health disparities are not debatable and even acknowledged by the U.S. Commission on Civil Rights. In response, national efforts, state-level policies, and public health programs have successfully reduced these disparities but have only made modest progress. Thus, comprehensive, systemic, and coordinated strategies must be implemented to achieve health equity. Although solving this daunting task cannot achieved by the U.S. government alone. It must also incorporate non-profit and philanthropic on-the-ground efforts already seeking this goal as well as greater public awareness about the impact social and economic policies have on racial/ethnic health disparities.

Despite these discrepancies, the COVID-19 pandemic serves as an opportunity for social change. More specifically, these unprecedented events bring greater light to issues such as poverty, homelessness, unemployment, and migration, all of which disproportionately affect communities of color. As a result, the ubiquity of COVID-19 has gathered people from every corner of the justice community to declare that health is a human right, thus bringing us one step closer to true equity and inclusion.

Double Tragedy

By Grade Ndanu

Two individuals in hazmat suits stand in front of a Kenyan woman as the first cases of Covid-19 are diagnosed
Source: Yahoo Images

As we watch the news and as I write these lines, the novel corona virus epidemic that started in China, has affected more people than the severe Acute Respiratory Syndrome. Globally on the 30th January 2020 the World Health Organization of the United Nations declared the epidemic a public health emergency of international concern. This defines the outbreak as an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response. Countries and airlines suspended travel from affected areas, which is all the countries to be specific and initiated a comprehensive screening at airports.

Wherever we are in the world, we are all living the COVID-19 pandemic. The virus is a public health challenge for the entire global population. Many countries shut down to prevent the spread of the virus. And it came to that day that students never returned to class, employees are working remotely if they can, cinemas are shut, and shops are closed. Basically everything stopped, maybe it’s because the world may have been caught off guard by the size and ramifications of the COVID-19 crisis.

Me being in a unique family, I will share what we are doing to keep safe from the virus and at the same time busy. First we take all the precautions that we are supposed to. We regularly and thoroughly clean our hands with an alcohol based hand sanitizer or just wash them with clean water and soap. All the surfaces including the floor we clean using soap and jick to kill the germs and any bacteria that may be there.  We also try our best to practice respiratory hygiene where we cover our mouth and nose when we cough or sneeze. Us being divided in groups that we call families, we tend to help and guide the young ones.

In the centre we are girls of different ages which makes three different groups. The least ages is ten and below. They do coloring and drawing almost daily, and my opinion is, they enjoy which makes them happy. The middle group of ages eleven to fourteen.  They usually have their sessions on Thursdays where they are taught about different things for example, last Thursday they were taught about being in a good company, how to stay out of bad company, and how to be a good example. The other group is of ages fifteen and above, and am in that group.  We usually have our meetings every Saturday. In this group we are not taught we learn from each other. We are still young to learn about marriage, but yes that was our last topic. Thanks to our mom who acts as our facilitator who we ask very may questions and on top of she teaches us how to bake every Saturday.

Due to the deadly virus, all countries are under lock-down meaning we are all stuck in quarantine. Home is where everyone should feel safe. Being at home means, above all else, being in a place that is dear to you. It should mean protection. But for many children, adolescents, and women, home is a place of violence and abuse. Girls and young women kept at home are safer from the disease but face increased inter-family tensions and an overload of domestic work. Girls, especially those from marginalized communities and disabilities, may be particularly affected and also cutting them off from essential protection services and social networks.

Economic stress on families due to the outbreak can put children, and in particular girls, at greater risk. Girls who are often considered to be adults in the society, experience from very early age the negative social norms that demand they do what women do when they are considered matured for example, cleaning, cooking and child care. Apart from child labor, there is also sexual abuse that is going on. A lot of rape cases before this pandemic the victims were raped by people who they know and also people who are very close to them. Now, we are all stuck with our families whether good or abusive ones. I am really worried of the girls, boys and women who are stuck with their abusive relatives. Even if there are helplines one can’t ask for help because the abuser may overhear the conversation and he may decide to do worse so that the victim may never open up.

Talking of girls, there are girls who are at a greatly exposed to the societal cultural beliefs and practices. In the urban areas, everything seems to have stopped or controlled right now but in the rural areas everything is normal. No lock-downs or restrictions and even no curfews. Meaning that there are so many girls who are undergoing Female Genital Cut, who are helplessly waiting to undergo the cut. Some parents are giving out their daughters hands for marriage. The parents feel that they are free to do anything with their daughters. When schools were on the girls told the teachers what was going on and that prevented many cases of retrogressive cultural practices. Now there is no school where girls would go to their rescue. Am certain these girls feel abandoned.

Activists, social workers, and with the government should be concerned at the potential rise on domestic and cultural violence during this epidemic. While quarantine measures are necessary to reduce the spread of the virus, they should be implemented in a way that guarantees protection for children and women. Measures should be in place so teachers can stay in contact with their pupils. Risk factors should be identified and taken care off.  should be visits to the communities, homes, and houses particularly where it is suspected that there might be a girl, child, or a woman in danger.

Let us not just worry about our families and friends. Let us also think of those other people that we don’t know who are vulnerable not only to violence and retrogressive cultural practices but also those who sleep hungry because they luck something to eat. As we remember them in our daily prayers lets wash our hands and take all the precautions that we need to be safe.

COVID-19 and Healthcare

two doctors demonstrate glucometer to patient.
How to make most of doctor’s appointment. Source: Army Medicine, Creative Commons.

COVID-19 has had a significant impact on the lives of billions across the globe from a disruption of our daily lives to the loss of loved ones to the severe financial burden that has been placed on the world economy. One aspect of society that has been disproportionately affected is the healthcare system. Aside from the financial impact on healthcare systems the way we receive our general healthcare is changing rapidly with this new pandemic. While our primary concern internationally is getting control of this pandemic, non-infectious and chronic conditions are still prevalent and at an increased risk of being neglected.

With the increase in COVID-19 cases in every part of the country, people are being discouraged from coming to hospitals and doctors for non-emergent care. This means that primary healthcare visits either have to be postponed or done through telehealth, which is a remote visit. While telehealth is a great way to have normal checkups without having to go to a doctor’s office, many insurance plans don’t cover telehealth, which makes it harder to afford necessary visits safely.

Additionally, many people no longer have the financial stability they used to. With the downturn in the economy, not only are people who are working making less, but there are also some that have been laid off or furloughed and no longer have access to insurance through their employer. A quarter of those that remain insured have deductibles that are $2000 or higher, which they can no longer afford. This means that in addition to postponing primary care visits, more emergent and necessary visits are being put off.

Those with chronic conditions face more barriers than before to receiving health care. Those with underlying conditions are more likely to have a severe case if they contract COVID-19. However, they need continual care that must be done at least occasionally face-to-face. For example, people with cancer must continue to receive treatment, but many times that treatment makes them immunocompromised. Because of the increased risk, many hospitals no longer allow visitors in, which can decrease patient morale. Many patients also run the risk of having their treatment delayed due to coming in contact with someone that has tested positive for Covid-19. Many chronic conditions, like cancer, are time sensitive, so delays in treatment can be devastating.

Another group of people that have had their healthcare greatly impacted by COVID-19 is pregnant women. There are many check-ups that women are recommended to attend when expecting a baby to ensure the best health possible. However, with the pandemic, that has become harder. There is no evidence that pregnancy makes it more likely to have a severe case of COVID-19. Additionally, there is no evidence that it can be transmitted to a fetus. It’s still important that pregnant women do everything they can to prevent coming in contact with COVID-19. To help in that effort, many OB/GYNs have reduced the number of visits pregnant women should attend in person, switching these visits to telehealth visits.

While a mother cannot pass COVID-19 to her unborn baby, the baby can contract it after birth from her or any other caregivers. To prevent spread to new babies, nurses, and doctors, many mothers are tested when they arrive at the hospital to give birth. Additionally, those that have scheduled C-sections are sometimes tested at home.

doctor performing a checkup on an infant
Dusti Tellez, a registered nurse at Naval Hospital (NH) Jacksonville’s maternal infant unit, holds a newborn baby for a checkup. Source: U.S. Navy, Creative Commons

According to UNICEF, around 116 million babies will be born during the COVID-19 pandemic. These babies along with the babies born shortly before the pandemic will be missing important doctor’s appointments. The appointments in the first two years of a child’s life play a large role in the child’s overall health for two reasons. First, children will typically receive vaccinations at these appointments, which will keep them from contracting deadly, but preventable diseases. The growing number of children who will not be receiving their vaccinations on time raises concerns about outbreaks of diseases that we’ve kept at bay while also still in the midst of the COVID-19 pandemic. Second, these visits are a good way to track the health of children early as screening for conditions, such as developmental delays, are frequent, and catching them early can give kids with these conditions a helpful jumpstart. Because of these two reasons, many experts advise parents to keep children’s visits up to date, but parents are still hesitant.

In addition to regular checkup visits, people are hesitant to go to the emergency room when they need to for non-COVID-19 related illnesses and emergencies. Hospital visits in the Baptist Hospital system in Memphis, TN were down 27 percent between March 15 and April 15 compared to the month before. Additionally, they noticed that the people that were coming in were more likely to have to be admitted instead of treated and sent home. This means sick people are staying at home longer for fear of COVID-19, and some are dying at home from treatable conditions.

Finally, there are areas of healthcare that are overlooked when we mention essential healthcare workers. My mother is a home health physical therapist, which means she goes to people’s homes to work with them. She mainly works with elderly people, and often visits nursing homes and assisted living facilities. According to her, these places have stricter requirements than before when it comes to letting people in: visitors have to have their temperature checked and have a symptom screening. Some facilities don’t even allow visitors anymore, even for wound care or physical therapy. While therapy might not seem essential, it is often used in this population to prevent accidents, like falls, that would send them to a hospital, where they would be even more at risk of contracting COVID-19.

While many of the changes to the healthcare system are temporary, like the decrease in general healthcare visits, some may become permanent. Telehealth has been shown to be beneficial for healthcare visits that don’t require tests and scans. In fact, many shy children have felt more comfortable with these visits. Additionally, the precautions taken by nursing homes and assisted living facilities when it comes to screening visitors make sense during flu season as the flu kills the over 65 population at a disproportionate rate. While the pandemic has changed some things for the worst, it has also helped us find where some changes need to be made to increase our safety in the future.

Coronavirus and Religion

Source: M. Rehan, Creative Commons

As the Covid-19 pandemic is taking the whole world by a storm of chaos and confusion, it is directly affecting various aspects of people’s lives. People around the world are trying to get used to this new normal and cope up with the challenges and changes in daily life caused by this global crisis. Since we are facing an outbreak like none other, it has directly affected and changed how we live, work, communicate, and carry out our daily lives. Religion is a very important part of most people’s lives and affects their everyday routine as well as physical, psychological, emotional, and spiritual beings. The freedom to have, follow, and practice a religion is a fundamental human right, and I will explore how the novel coronavirus crisis is impacting and interfering with the religious rights of people.

Since the pandemic has affected most places in the world, religious institutions and houses of worship are no exception. Churches, mosques, synagogues, and temples have been closed for all kinds of gatherings due to the social distancing protocols set through by the CDC as a response to Covid-19. In these unprecedented times, billions of people are resorting to religion as a first resort for comfort and solace. When all else looks unsettling, people of faith are turning closer to religion and spiritual observance throughout the world. But the pandemic has also interfered with traditional ways of practicing religion through the closure of the places of worship and withdrawal of gatherings of this sort. As a Muslim myself, I would like to share my observation and experience of the influence of this pandemic on the religious experiences of Muslims around the world.

Islam is the second largest and fastest growing religion in the world with more than 1.9 billion followers, thus a significant population of the world is facing challenges in exercising their religious rights and rituals. During the initial phase of the outbreak, the first immediate effect on Muslims was the cancellation of the Friday communal prayer. People were ordered to pray in their homes in order to avoid close contact with each other. This congregational prayer is of great significance to Muslims as they come together in mosques to listen to the weekly sermon, pray together, and fulfill this obligatory ritual. Therefore, its dismissal was a big deal for the Muslim communities worldwide and also led to conflicts in some areas. For example, worshippers in Pakistan clashed with police personnel trying to enforce the lockdown at the time of the prayer. Similarly, some mosques in Bangladesh continued to operate despite government restrictions and a massive prayer gathering with tens of thousands of devotees was held without permission from the authorities. The pictures of the event were shared on social media, where it was greatly criticized and sparked an outcry from people in favor of the lockdown. People in Indonesia were divided over Friday prayers and coronavirus fears, resulting in some praying at home and others gathered in mosques. Religious leaders in the U.S. also faced a dilemma in making the best decision for their followers, facing disagreements on whether or not to cancel Friday prayers. In the second week of March, Muslim organizations including the Islamic Medical Association of North America and the Islamic Society of North America gave a joint statement suspending Friday prayers and recommending necessary precautions to the Muslim community.

Protecting human life is one of the fundamental objectives of Islamic Shari’ah. This concept takes precedence over all other objectives of Islamic faith as life represents the foundation of our existence. Therefore, at times, preservation of human life and human rights is far more significant than the continuity of even essential practices of devotion.

People are finding alternate ways to keep practicing religion while also practicing social distancing. Online platforms are being widely used to share information, resources, and ways to get closer to religion as well as interact with other people of faith for support. To lift up the spirits of the Muslim community amid this pandemic, the call to prayer, Adhan, was chanted from loudspeakers in the heart of Europe in early April. Nearly 100 mosques in Germany and the Netherlands rang out with the sound of Adhan as a gesture of support for Muslims. A lot of mosques in Muslims countries have added a line at the end of every call to prayer, asking people to pray at home.

Adhan recited from mosques to fight against COVID-19 in Germany. Source: Yeni Safak, Creative Commons

Islam’s holiest site in Mecca, known as the Kaaba, which is always packed with tens of thousands of pilgrims year-round, was emptied due to Covid-19 concerns earlier this March. Muslims around the world were shocked, shuddered, and deeply saddened to see the holy place deserted for the first time in millennia. The images of the empty Kaaba inside Mecca’s Grand Mosque were extensively spread over social media as Muslims showed their concern and disappointment on this unprecedented yet imperative move. Every year, nearly 2.5 million pilgrims visit the holy sites of Mecca and Medina for a week-long ritual known as Hajj; one of the five pillars of Islam and obligatory for every able-bodied Muslim once in their lifetime. The kingdom of Saudi Arabia stopped Umrah, a non-mandatory pilgrimage, in late February due to the pandemic. As the unfavorable situation still persists, the cancellation of Hajj, which starts in late July, is also being considered. This is one of the largest human gatherings in the world, and its potential cancellation will affect millions of people and businesses around the world.

The holy Kaaba in Mecca, Saudi Arabia. Before and after Covid-19. Source: Creative Commons

The Islamic month of Ramadan started a few days ago and it is one of the most important, sacred, and celebrated time of the year for Muslims. It is marked by fasting from sunrise to sunset, charitable giving to the less fortunate, spiritual renewal, praying and reading the Quran, abstaining from worldly pleasures to reconnect with the self and with God, and coming together as a community to celebrate. Muslims around the world are having a Ramadan like no other this year. The mosques are empty, the daily nightly prayer Tarawih is canceled, people are observing the holy month by praying in their homes and sharing meals with immediate families instead of large community feasts. People are trying to find alternate ways to have the Ramadan experience by holding virtual Iftar meetups, online sermons and halaqa sessions, and donating through online platforms amidst these social-distancing times. On one hand, lockdown in Ramadan has also allowed people to spiritually indulge themselves without worldly distractions like work and school and to modify their daily schedules accordingly. It has given some relief to those who are fasting to catch up on lost sleep from late night prayers and waking up in the middle of the night for the pre-fast meal suhoor. On the other hand, the cancellation of open Iftars organized by mosques and charitable organizations that allowed sharing a meal for everybody has taken a toll on the less fortunate who rely on these meals during Ramadan. Since the world is already facing an economic crisis and a lot of people are in an uncertain situation financially, this time of festive observance is becoming harder for those who are unable to provide for their families and take part in all the celebrations. Since the month of Ramadan teaches empathy and encourages acts of compassion and generosity, Muslims around the world are stepping up to help their brothers and sisters in this time of need. The act of fasting teaches patience, self-discipline, sacrifice, and empathy and these virtues are more important than ever for all of us to practice in these difficult times.

The end of Ramadan is commemorated with a celebration called Eid, which is also referred to as a gift for those who fasted the whole month. For us, the day of Eid is marked by wearing new clothes, going to the communal Eid prayer in the morning, celebrating with the community, and sharing meals and presents with family and friends afterwards. This year, it is expected to have a similar fate as Ramadan if the state of emergency continues, resulting in all the festivities being called off.

Muslims praying in a mosque. Source: Shaeekh Shuvro, Creative Commons

Coronavirus has also changed how funeral services and burials are carried out across the world. Islam has specific guidelines and rituals to perform for the deceased including washing/bathing the dead body, putting it into a coffin, and offering the collective prayer before a procession of friends and family takes the body for burial. According to the CDC guidelines, gatherings are not supposed to exceed 10 people and the body of the infected person should not be touched. Muslim scholars in the US have proposed alternative ways to carry out these procedures such as limiting the handling of the body to the specific staff of the graveyard or funeral home with the use of proper personal protective equipment (PPE). They have also suggested doing tayammum instead of bathing the dead body, which is characterized by wiping the face and hands of the deceased after touching a sandy surface. Additionally, family and friends are not allowed to be physically present during the burial or the prayer. Attendance at funerals is considered a collective obligation that must be carried out by a sufficient number of people, but changes are being made to ensure the safety of everyone. My mother’s uncle passed away from coronavirus last week in Boston, Massachusetts and his family was not allowed to see him at all. Instead, the funeral was live streamed and the prayer was held in the presence of only four people, one of them being the imam who led the prayer.

It is important to note that not only is this Covid-19 situation affecting religious experiences, but some of these rituals have also contributed to the spread of the virus. For example, a gathering of 16,000 worshippers at a Malaysian mosque became the largest known viral vector of the pandemic in Southeast Asia, spreading the coronavirus to half a dozen countries. Similarly, the pilgrimage of Shia sect Muslims to the holy cities of Iran led to the spread of the virus through Central and South Asia. The pilgrims reportedly caught the virus in the holy city of Qom, which was the epicenter of covid-19 in Iran and caused it to spread in their home countries upon return. Even though Pakistan shares its border with China, the novel coronavirus was introduced into the country through pilgrims returning from Iran. Similar cases have been seen around the world where coronavirus infections have been linked to religious gatherings, such as church services in South Korea and North Carolina, Jewish Purim celebrations, and Muslim prayer gatherings.

To conclude, religion is both a source of solace as well as a possibility of risk during a pandemic. People of faith around the world are struggling to keep a balance between religious practices and safety precautions. It is in the best interest of everyone to follow the social distancing guidelines whenever possible and find peace in their own beliefs, whatever they may be.

COVID-19: A Glimpse to the East

An image of a crowd of people in Wuhan, China. They are all wearing masks as a response to the COVID-19 pandemic.
2019-20 Wuhan coronavirus outbreak. Source: Wikipedia. Creative Commons.

COVID-19, otherwise known as the 2019 novel coronavirus, has spread to many countries around the world, affecting many immunocompromised populations and impacting millions of people worldwide. My colleagues have referenced hotspots where the response has impacted the most, from the Middle East to migrants right outside U.S. borders. They have illustrated how discrimination, isolationism, and plain ignorance have shattered families and populations, destroyed economies, and brought fear and terror into the hearts and minds of Earth’s people. It is in that essence that this article will continue to explain the impact of COVID-19 in another hotspot of the world, Asia.

The Asian continent, comprising 48 countries, according to the United Nations, encompasses immense diversity and roughly 60 percent of the global population within its boundaries. This diversity includes, but is not limited to, having the highest and lowest points on Earth, “the world’s wildest climatic extremes,” and “the birthplace of all the world’s major religions.” For the sake of this article, I will be focusing on three countries that are handling the virus very differently, India, China, and South Korea.

Food Insecurity

Having one of the highest populations in the world, India is often referenced as a case study when examining the impact of overpopulation, economics, and food security. In 2012, Uttar Pradesh, India’s most populous state, 60 million out of 200 million people were considered living below the poverty line. Economic inequality has further negatively impacted India’s poorest communities with “57 billionaires controlling 70 percent of India’s wealth” as of 2017. Such inequality has led to the increase in poverty, a lack of medical equipment and access, poor living conditions, and a lack of food.

An image of Indian Census data from 2011. The country is seen with an immense population density per square kilometer. Uttar Pradesh and the city of Kolkata are most dense.
Demographics of India. Source: Wikipedia. Creative Commons.

However, this pandemic has exacerbated the lack of access to food by Indian residents that comes on the heels of Prime Minister Nahendra Modi’s announcement to begin a “21-day nationwide lockdown.” With such an announcement also came with rising panic from Indians, crowding grocery stores and shops with people panic buying everything in sight. Under Modi’s plan, the “Prime Minister’s Poor Welfare Scheme”, individuals will be able to receive five additional kilograms of rice or wheat for the next three months. Although proposed to benefit 800 million people, many are wary of its success due to the closure of interstate travel, trains, and flights. It is under this lockdown that residents could face two years in jail and a financial penalty if they leave their home for non-essential reasons. In an interview with Time, an autorickshaw driver expressed concern over Modi’s decree to lockdown the entire country. Before the decree, his main concern was to save enough money to help get his son through college. However, “as he stays home with no daily income, his main concern is putting food on the table. He’s not sure what he will do” once those savings run out. When examining a singular issue impacted by COVID-19, the situation in India highlights the issues that countries with an enormous informal sector may face due to economic hardship and lack of infrastructure. For example, India can grow enough food for its growing population, although millions are left underfed due to “bottlenecked supply chain[s], inadequate logistics, food wastage and sharp societal inequalities.” The virus has further called to attention the lack of food security that many around the world face on a daily basis which infringes upon their basic human rights and a Sustainable Development Goal that must be achieved by 2030, Zero Hunger.

Government Control

An image of the spread of the coronavirus in January. The Wuhan province is shown to be the most effective, colored in black.
Timeline of the 2019-20 coronavirus pandemic from November 2019 to January 2020. Source: Wikipedia. Creative Commons.

Being the most populated country in the world, China is often criticized for its drastic measures and horrifying treatment of Muslim minorities. When examining the pandemic, COVID-19 is known to have originated in the Wuhan province in China and was noticed by Chinese ophthalmologist Li Wenliang. Dr. Wenliang had used a private online chat to explain his worry for the novel virus, which quickly went viral, resulting in him being reprimanded by Chinese police. Following this observation, the province had shut down, cutting off transportation and sealing residents off from the outside world. In an interview with Dr. Bruce Aylward, “the leader of the World Health Organization team that visited China,” had praised the Chinese government’s decisive actions towards preventing the spread of the virus:

“I think the key learning from China is speed — it’s all about the speed.” — Dr. Bruce Aylward

Although the Chinese government has sought to demonstrate its prowess and handling of the virus, through building hospitals in 10-days and publishing photos of patients who have been cured of the disease, many human rights groups have expressed concern and worry over the treatment of those who have been critical of the government. For instance, Chen Qiushi, a Chinese human rights lawyer, was “put under quarantine”, Fang Bin, a citizen journalist, disappeared in February, and Li Zihua, another journalist, was taken away by a group of men. Dr. Wenliang had died due to the virus early February of 2020. With the news of his death, thousands of comments flooded Chinese social media site Weibo criticizing the Chinese government and censorship in the country with top hashtags such as “Wuhan government owes Dr Li Wenliang an apology” and “We want freedom of speech.” According to the British Broadcasting Corporation (BBC), when they searched for the hashtags a day after Wenliang’s death, they disappeared having been censored alongside many comments aimed at the Chinese government.

From Wuhan province, we now turn to the Xinjiang province in Western China, where the imprisonment of millions of Uyghur Muslims could prove to be a breeding ground for the virus as it spreads throughout the world. You can read more IHR blogs about The Uyghur Muslims in the context of Crimes Against Humanity here and how this crisis is affecting refugees on the US-Mexico border here. In Xinjiang, there are an estimated three million people detained in re-education camps in Western China, mostly of Uyghur Muslims who have been suppressed by the Communist Party. As alleged by Jewher Ilham, the daughter of a jailed Uyghur academic, some of the “conditions at the detention centers offered the perfect chance for coronavirus to spread” citing “systematic abuse, serious overcrowding and poor sanitary conditions inside the camps.” Given allegations of China’s unwillingness to publish the truth about these conditions combined with the alleged suppression of critics and ethnic minorities, it is deeply concerning to gauge the risks of infection amongst those who have been cited as not having enough to eat or doctors on staff to treat those infected. This is also a signal to international groups and organizations to ensure that all people have the chance to be cured and not suffer as a result of the virus or violating the human rights to freedom of speech.

An image of China divided into province. The Xinjiang province is highlighted with the highest concentration of Muslims
Xinjiang Region, China. Source: Flickr, futureatlas.com. Creative Commons.

Some Potential Success?

Amongst all the panic buying and the loss of toilet paper throughout the country, there seems to be some light at the end of the tunnel manifesting itself through ‘flattening the curve’. This method has seemed to be close to perfected by South Korea whose growth in COVID-19 cases has significantly slowed compared to the United States. When examining South Korea, many writers have explained the situation by comparing it to religion and culture, chalking it up to higher levels of social trust and the lingering aspect of Confucianism. However, that does not seem to be the case. By flattening the curve, South Korea has demonstrated that it is due to “competent leadership that inspired public trust.” Having tested more than 5000 people per million inhabitants than the United States, it is no wonder that taking early action and mobilizing health officials could lead to a successful response.

“No sacred Confucian text advised Korean health officials to summon medical companies and told them to ramp up testing capacity when Korea had only four known cases of COVID-19.” — S. Nathan Park

Compared to China, India, and even the United States, South Korea did not have to “lockdown entire cities or take some authoritarian measures,” rather, they learned from their past experience with MERS (Middle East Respiratory Syndrome). Such preparation allowed the South Korean government to be proactive and “improve hospital infection prevention and control.” Combined with South Korea’s industrial and developmental advantages over both China and India, the government was able to take a proactive approach and deter the worst effects of the virus. Once South Koreans started getting sick in early February, the government immediately began “testing aggressively to identify cases — not only testing people who are so sick that they’re hospitalized but also mild cases and even suspected cases.” This initiative has allowed South Korea to quarantine those at a high risk while also managing to keep their factories, schools, hospitals, and entire cities open while other countries around the world are having to shut down everything to contain the spread.

An image of the cumulative and new cases of coronavirus in South Korea. The graph is showing a flattening of the curve.
2020 coronavirus cases in South Korea. Source: Wikipedia, KCDC. Creative Commons.

Conclusion

Looking back at India, China, and South Korea, it becomes apparent that a swift and proactive response is necessary in order to not allow for the lockdown of entire cities and countries. However, that proactivity must balance itself between being lax and aggressive. For example, China’s efforts to curb the spread of the news rather than the virus has made human rights concerns more apparent to the world, especially since the freedom of speech for civilians is being curbed to protect China’s global reputation. In India’s case, the pandemic has shown many human rights groups and countries the issues that a country with a massive impoverished population faces during difficult times. By being able to demonstrate good leadership and mobilizing experts, South Korea has ultimately done what many other countries would only hope to accomplish. Such success has already inspired other Asian countries to follow suit, especially Singapore, Japan, and others. And although South Korea’s population is significantly small compared to that of India and China, their success is one that can be successfully implemented worldwide. Instead of casting these successes aside as an element of Confucianism or culture, it is necessary for us to be able to model our response like South Korea’s so that were such an event to occur again, we will be able to swiftly contain the spread rather than suffer through weeks and months at home without physical human interaction.

How Covid-19 Exposes the American Healthcare System

When I studied abroad in Spain, I had many discussions with my host family comparing the United States and Spain. These conversation topics ranged from politics, social expectations, and the weather. One topic that my host mother was especially interested in is the American health care system in comparison to the Spanish health care system. Spain has a universal health care system while still allowing private insurance whereas the United States has purely private insurance. Neither system is perfect. However, as the Covid-19 crisis continues to progress it is important to understand how the crisis brings to light the many issues with the American health care system.

A woman in a mask.
Woman in Mask. Source: Patrice CALATAYU. Creative Commons.

It is a well-accepted fact that the United States was significantly less prepared for the impact of Covid-19 than most other developed countries. By any metric of pandemic preparedness, America is significantly behind the rest of the developed world in regard to medical supplies. The country has a severe lack of health care infrastructure within the system; even before the international pandemic, the United States had fewer doctors and hospital beds than the majority of other developed countries. The United States lacks in the number of doctors per capita with 2.6 doctors per 1,000 people. The comparable country average is 3.5 per 1,000 people, which shows just how behind America is. The United States also has fewer hospital beds per capita than the majority of other developed countries. To make matters worse, America has some of the highest rates of unnecessary hospitalizations. These are hospitalizations of patients with chronic conditions that have preventable treatment, making it unnecessary for the patient to be hospitalized. With a pandemic such as Covid-19, these unnecessary hospitalizations are diminishing. However, in the beginning of the crisis within the United States, unnecessary hospitalization significantly slowed down the efficiency of the health care system in caring for Covid-19 patients.

An important trend in the preparedness of the United States for Covid-19 is that the United States, with a private health care system, was noticeably less prepared than countries with universal health care systems. It is true that universal health care is not the perfect response to pandemic emergencies like Covid-19. This is shown by Italy, a country who has a federalized national health insurance program. Italy still needed to lock down and for a while had the highest case and death rate than any other country. However, countries like Italy with universal health care were able to begin recovery and slow the spread of the virus much quicker than those without.

a hospital
Hospital Beds. Source: Presidencia de la Republica Mexicana. Creative Commons.

As health providers have been working tirelessly to make the necessary changes to care for Covid-19 patients, private health insurance companies have been making very few changes to their processes. One system health care providers have been implementing is telemedicine, a program that allows patients to securely consult with their health care providers virtually therefore easing the burden on the infrastructure of the hospitals. Despite President Trump expanding provisions on telemedicine, private health companies are not required to pay health systems for telemedicine. At the same time, while some insurance companies have waived some Covid-19 related costs, out-of-pocket expenses are not waived resulting in patients needing to pay thousands of dollars. To put these costs in perspective, in 2018 the average amount for a patient covered by private insurance admitted to the hospital for a respiratory condition similar to coronavirus was $20,000. Additionally, as hospitals across the country prepared for an influx of Covid-19 patients, stable patients without the virus were forced to stay in the hospital beds. These patients, who should have been moved to a rehab facility or released, were taking up unnecessary space due to private insurance companies taking multiple days to authorize the next steps for each patient. This has been a known delay in hospitals before the pandemic but now it is a delay that has dire consequences.

Quite possibly the biggest problem in the American health care system is cost. This problem is unique to the United States. Citizens are required to pay higher out-of-pocket costs than those in most other countries, leading Americans to forgo their health care in order to save money. Reports have shown that 33 percent of Americans reported a cost-related barrier to receiving care. This is in comparison to the 7 percent who reported the same in Germany. In 2019, a study showed that 33 percent of Americans also reported postponing medical care due to the cost of that care. It is only in the United States that citizens are risking thousands of dollars in order to seek help in a medical crisis like the one posed by Covid-19. A major concern across the world is that Americans will not seek care for corona symptoms due to the high costs of healthcare in the United States and the high amount of people without insurance in the country. This will spread the disease significantly faster than officials within the country would like to believe.

man with supplies
Medical Supplies. Source: Navy Medicine. Creative Commons.

As the Covid-19 cases rise in number across the country, an unusually high number of African Americans in the United States have been infected with Covid-19. This news, while terrible, is unfortunately not shocking and highlights the many racial inequalities in the health care systems. Coronavirus does not have a racial factor but the structural racism within the American health care system is evident. African Americans are over-represented in many essential workplaces making the population more at-risk than other populations. At the same time, African American populations are less likely to have health insurance coverage leading to a disproportionate number to not receive the necessary help from the health care system. There also exists a racial empathy gap that disproportionately affects African Americans and Hispanics within the United States. A racial empathy gap is when medical professionals show less empathy and sympathy to African American patients who are experiencing pain. Human rights workers have been working on mandatory reviews to ensure that health workers are providing an equitable form of treatment for minority patients. However, due to a bias developed and enforced by societal constructs of different races, there exists a higher risk for minority populations within the American health care system.

A few examples of problems within the American health care system that have been exacerbated by Covid-19 are highlighted above. While officials within this system and within the government must work to make necessary changes, it is also important to recognize the lifesaving and tireless health care workers who work within the imperfect system. Covid-19 has shown the country how necessary health care workers are. Nurses, doctors, surgeons, and so many other health care providers have dedicated an immense number of hours to fighting Covid-19. These individuals who are working to save lives within the corrupt health care system are extremely important and we must recognize their hard work while we work to make the system fairer and more equitable.

 

Where Social Distancing is Impossible

US-Mexico Border
Source: Yahoo Images

As the COVID-19 outbreak crosses borders throughout the United States, the Center for Disease Control has released recommendations for maintaining public health, which includes working from home, hand washing, and staying six feet away from any person, if possible. For the past few weeks, I have noticed people in my own community adapt to this new way of life. Kroger and Home Depot put masking tape six feet apart in the checkout lines, and every company I’ve ever heard of has sent me a helpful email explaining their own “pandemic plan.” Amidst the anxieties associated with this global pandemic, focus understandably turns to our immediate family and community. I may get frustrated about the lack of toilet paper in my local grocery store, but millions are incapable of following any of the CDC’s guidelines. Areas with a lack of hand-washing stations, affordable healthcare, clean water, internet, housing, and infrastructure do not allow for proper social distancing. Even at the United States’s southern border, relief agencies are struggling to address the growing pandemic.

Thousands of migrants along the United States-Mexico border are stuck in limbo. Many have fled from Central America, fleeing domestic violence, gangs, and death threats, to seek shelter in the United States. However, due to the threat of COVID-19, “The U.S. closed its border to asylum-seekers, Mexico suspended refugee processing, and many migrants are afraid to go home to their native countries, even if it were safe to travel.” Therefore, people seeking asylum are left on their own to find shelter, food, water, and medical care in a place that lacks these things when there is not a global pandemic occurring. Volunteers that would usually come to help have been quarantined, basic supplies have become hard to find due to panic buying, and any assistance from medical staff has been stretched thin as case numbers continue to rise in both Mexico and the United States. Additionally, asylum-seekers have to be concerned for their own safety even after they have made it to the border and received a court date for immigration hearings. Human trafficking, sexual assault, and gang violence are all risks in the camps, and since immigration hearings have been put on hold indefinitely, asylum-seekers have to wait even longer in these dangerous areas. Aid efforts become increasingly complex with more restrictions put in place by Mexican and United States governments each day.

Pew Research Center Graph showing countries that have closed their borders due to coronavirus
Source: Pew Research Center

As economies are negatively impacted by the virus, countries are becoming increasingly isolationist. 90% of the world’s population currently live in countries with restricted travel, while almost 40% live in countries with closed borders. These countries include Canada, China, Japan, and Ecuador, with Greece suspending asylum claims at its border with Turkey, much like the United States’s current policy with asylum-seekers at its southern border. Millions of United States citizens have filed for unemployment, and businesses and individuals are struggling to stay financially afloat and pay rent. It makes sense that countries like the United States are turning their attention to the plight of their own citizens, but according to the United Nations (UN) Secretary-General Antonio Guterres, “If we let the virus spread like wildfires, especially in the most vulnerable regions of the world, it would kill millions.” For many relief agencies and nonprofits, grants and funding for the year have already been distributed. However, the funds are typically earmarked for certain programs. Unfortunately, many of these programs, like funding for computer education, community engagement, and language classes, cease to exist in a world with COVID-19. Now, funding is needed to help displaced persons combat the threat of COVID-19, but it would require authorization to transfer funds from one program to another. Jan Egeland, Secretary-General of the Norwegian Refugee Council, has said that banks have not financially supported relief agencies who would help UN sanctioned countries like Iran and North Korea because they fear being sued by the US government. Bureaucratic lag in providing humanitarian resources will likely mean death for thousands, particularly those with limited resources. With donor countries being overwhelmed with their own coronavirus crises, where would the funding come from?

War-torn countries and refugee camps in countries like Syria and Sudan receive assistance from the UN in the form of educational, medical, and financial resources. When we see pictures of a child fleeing violence and war in Syria, it is understandable why the UN would come in to help. However, rhetoric around the US-Mexico border paints a different picture. Often, this population is thought of as simply a group of people seeking the “American dream”. In truth, these asylum-seekers and refugees are fleeing for their lives, just like refugees on other continents. Regardless of opinions surrounding citizenship and legal status, the reality is that thousands of people have come to this region to escape deadly violence. Executive Director of Global Response Management (GRM), an organization that provides medical care to vulnerable populations worldwide, Helen Perry explains the unique situation, “There’s not a lot of great oversight. Normally in a displacement situation, the UN would come in at either the request of the country they’re fleeing from or the country that’s receiving them…but unfortunately at the border that’s not happening because both governments [Mexico and the US] are sort of unwilling to admit that there’s a problem.” As a former nurse in the US Army, Perry is especially adept at assessing the needs of struggling communities. When she came to the US-Mexico border for the first time in 2018, she was surprised to see people facing similar levels of violence to patients she had helped in Yemen who had fled the Civil War there. Fortunately, her organization continues to provide aid along the border, but COVID-19 adds an additional layer of complications. The dire situation described above was her take last year, and her organization has had to make adjustments due to the pandemic, including creating a makeshift hospital. They’re not the only organization building makeshift shelters. A government agency tasked with building the US-Mexico border wall is currently creating semi-permanent lodging for its construction workers so they can continue building, despite concerns at COVID-19. These workers, like asylum-seekers on the other side of the wall, are worried about their health and how a lack of resources could impact them and their families.

Asylum-seekers and refugees have limited access to news updates, so there is a lack of knowledge in the camps about COVID-19 and its impact. Border towns like Tijuana are already overwhelmed with patients who are US citizens, so it would be virtually impossible for a non-citizen to get accepted should the need arise. They have been instructed by relief agencies to attempt to follow the previously mentioned CDC guidelines about social distancing and handwashing, but this is incredibly difficult in the camps. Tents are small, and many people have to sleep next to each other. Water stations and bathrooms are few and far between. As coronavirus tests are barely accessible to US citizens, finding one would be challenging for someone in the camps.

Discussions of this contagious virus have created anxiety for any empathetic person. Despite the grim reality, there are some positive efforts taking place. GRM is currently working on a twenty-bed field hospital near the Matamoros camps, although they may face more challenges as United States volunteers may not be allowed to travel there. Al Otro Lado, a legal services organization, and the Refugee Health Alliance have distributed medication and additional hand washing stations to many asylum-seekers. While there are few suspected cases of COVID-19 at the camps as of yet, these actions could be crucial in containing the virus should an outbreak occur. It’s important to remember wise words by Richard Blewitt, UN representative for the International Federation of Red Cross and Red Crescent Societies, “At this time we need global and local solidarity and compassion with all those affected by COVID-19, wherever they live.”