Analysis: How for-profit health care worsened the pandemic

‘The U.S. remains the only one of the 25 wealthiest countries to not provide universal health care, and the health care system’s focus on profits and not health has cost Americans their lives. Despite having less than 5% of the world’s population, the U.S. has had 25% of the world’s confirmed cases and 20% of the deaths. Public Citizen’s new report demonstrates how:

• Before the pandemic, approximately 87 million Americans were uninsured or underinsured. About one-third of COVID-19 deaths and 40% of infections were tied to a lack of insurance;
• About half of Americans receive their health care through their employer. With more than 22 million Americans losing their job during the pandemic, millions have lost their health insurance;
• Racial health disparities, including access to care, have led to disproportionate deaths in communities of color;
• We have the highest rate of unmet need of any comparably wealthy country, with one-third of Americans reporting that they or a family member has avoided going to the doctor when sick or injured in the past year due to cost;
• Americans are significantly more likely to die of chronic respiratory disease, cardiovascular disease, diabetes or cancer than people in comparably wealthy countries with universal health care systems; and
• A lack of essential funding led to insufficient hospital capacity. The U.S. had only around half the hospital beds per capita of peer nations and far fewer than countries like Japan or Germany.’

Read here (Public Citizen, Mar 16, 2021)

I’m alive today because of our healthcare frontliners! — Joseph Ong See Sung

‘While at the hospital, I also made many friends among the patients. I was touched by what I saw. Everyone in the ward was helping one another. There was no racial barrier. Everyone took turns to look out for one another. I told myself — this should be the Malaysia that we should have, not one that’s divisive and ruined by people with selfish interests! 

‘I saw one very filial son who was with his father. Both had Covid-19. But this young man, despite being down with the virus, made all efforts to care for his father, who even suffered a stroke there! 

‘Every minute of my waking hour there, I saw people putting aside their personal and ethnic differences to help anyone within their sight! It warmed my heart and spurred me to get better so that I can tell the outside world that people were so caring at the hospitals. Both frontliners and patients! Why can’t more people be like that?’

Read here (Malay Mail, Mar 5, 2021)

Covid year: Topsy-turvy and gains

‘What should spring up eternally is compassion, tolerance, humility and other qualities that would unite us in this beloved land no matter what our ethnic or religious affiliations...

‘Any change in societal or personal lives is influenced by gender, social class, race, culture, age and other variables. I can only speak as a 73-year-old woman, former academic, Christian and Malaysian-Chinese, and post-polio person. Each facet of our multi-layered identity will be affected in different degrees by this season of Covid-19.’

Read here (Aliran, Mar 4, 2021)

The pandemic has unmasked America’s deepest inequities: Covid’s disparate racial impacts, by the numbers

‘Covid-19 doesn’t discriminate, but the havoc wrought by the virus—the deaths, economic devastation, and intergenerational trauma—has disproportionately affected Black, Latino, and Native American communities. The Trump administration’s feckless response didn’t help, yet even proactive steps have reinforced preexisting inequities: Stay-at-home orders protected people with the privilege to work remotely while frontline workers, disproportionately Black and Latino, took on greater risk of exposure. People of color have also experienced more unemployment and financial insecurity. As Mary Bassett, director of Harvard’s François-Xavier Bagnoud Center for Health and Human Rights, explains, none of this is caused by the virus itself: “It’s because of the social consequences of race in our society, which has been reinforced by decades, centuries of bad practices and policies.”

Read here (Mother Jones, Feb 12, 2021) 

Equity in vaccination: A plan to work with communities of colour toward Covid-19 recovery and beyond -- Introduction

‘The coronavirus disease 2019 (COVID-19) pandemic has had tragic and disproportionate adverse effects on Black, Indigenous, and People of Color (BIPOC) communities across the United States. The number of cases, hospitalizations, and deaths related to this disease is significantly higher in these groups. Additionally, members of BIPOC communities are among those hit the hardest by the economic and social upheavals caused by the pandemic.

‘As the COVID-19 vaccination campaign begins, it is critical that vaccines be delivered fairly and equitably—so that everyone has the same level of access to this lifesaving technology. Just as pressing is the need to address longstanding disparities that have created the unequal situation that BIPOC communities are now in.

‘This plan provides elected and appointed officials with the tools to create, implement, and support a vaccination campaign that works with BIPOC communities to remedy COVID-19 impacts, prevent even more health burdens, lay the foundation for unbiased healthcare delivery, and enable broader social change and durable community-level opportunities.

‘The 5 key principles and their associated action items in the plan are:

‘Iteration: Repeated engagement with BIPOC communities is necessary. There is a race to get as many people vaccinated as soon as possible, and this urgency must be balanced with the need to build real trust in BIPOC communities. In many areas, this trust is low or nonexistent, which means that building trust will take time. It will require committing to engaging with BIPOC communities, including organizing productive “listen-and-plan” sessions in which community members have the opportunity to explain their thoughts on COVID-19 vaccination and where officials have the opportunity to listen and hear what is being said, and in partnership, put these ideas into action.

 ‘Involvement: Moving forward, BIPOC community representatives and advocates must become active collaborators in the public health process. This will involve implementing mechanisms for 2-way communication (particularly with trusted leaders, influencers, and pillar institutions in local BIPOC communities) and engaging with these key representatives as partners, not as audiences to persuade or subordinates to command. One way this can be done is by encouraging BIPOC individuals and community organizers to actively participate in the COVID-19 vaccination campaign in ways that respect their self-determination and strengthen their self-reliance. A longer-term approach is to ensure BIPOC individuals are in positions of power in government and public health.

 ‘Information: Effective communication with BIPOC community members is essential in the ongoing COVID-19 vaccination effort. Applying best practices for communication during this time will be useful for moving forward. As a starting point, it is important to recognize that vaccination messages must be tailored to address the specific concerns of local BIPOC communities. This can be done in one of the following ways (or through a combination of these approaches): identify and support trusted BIPOC individuals and organizations who can relay information and help set community norms related to COVID-19 vaccination, apply learning from “listen-and-plan” sessions to frame COVID-19 vaccination in the communities’ own terms, and enlist allies to blanket BIPOC communities with accurate information that can drown out misinformation.

 ‘Investment: All of the efforts described above will require investments of time, attention, and funding. At the same time, the vaccination process itself can be viewed as an opportunity for economic revitalization, with the potential to lead communities out of the pandemic and its economic hardships. This type of revitalization is particularly important to BIPOC communities that historically, and presently, are often economically challenged. Practical suggestions for investment include: pull together the necessary resources to ensure COVID-19 vaccination is equitable (meaning, easily available to the most marginalized individuals in the community) and then fight to keep these resources in place moving forward; creatively finance nonprofit and for-profit entities with BIPOC community roots to strengthen the vaccination enterprise; and enlist the help of private capital to support vaccination, for example, by getting transportation companies to commit to providing free rides to and from vaccination sites or by having a local grocery store sponsor a “get vaccinated” poster contest for schoolchildren.

 ‘Integration: Looking forward to the end of the pandemic, it is important to recognize that recovery will take time. COVID-19 will have long-lasting physical, psychological, and financial effects, especially in BIPOC communities. Because of this, the COVID-19 vaccination campaign cannot be viewed as a final step in returning to “normalcy.” Instead, it needs to be seen as a step toward a more complete recovery that can, and should, include meaningful social change. This can take place as the recommendations outlined above—including “listen-and-plan” sessions, empowering BIPOC individuals and communities, and investing in equitable public health—are integrated into ongoing community initiatives and as government and public health officials commit to ensuring durable social change and community benefits that include adequate housing, food security, living wages, and leadership opportunities.

‘This approach will be challenging. Some may argue that a lack of time or funding or interest are barriers that make such an approach unrealistic, especially in the middle of a pandemic that is challenging on every front. However, it is important to keep in mind that challenges like the one we are currently facing often stem from social inequity and provide opportunities to change and improve. Some actions may be more appropriate to prioritize in the near term, but many actions that are crucial for the long term will have more of an overall impact if those efforts are initiated now.

‘COVID-19 vaccination is the most likely way out of the current pandemic. It is also an opening to create equity and durable benefits for BIPOC communities, who have been devalued and too often cut out of opportunities in the United States. We hope that you consider this and the specific recommendations made in this report as you begin to implement COVID-19 vaccination campaigns in your own towns, cities, and states.’

Download PDF here (John Hopkins Center for Health Security, Feb 09, 2021) 

Politics, race, and religion: Pandemic misinformation courses through the Southeast Asian internet

‘From tales of allegedly dwindling food stockpiles in Singapore to Indonesian land supposedly being traded to China for precious supplies of vaccine, false narratives about COVID-19 have swirled around the Southeast Asian internet for months.

‘Disinformation in the region is not a new phenomenon. During  the 2014 Indonesian election, Islamist groups targeted current President Joko Widodo and falsely claimed he was a non-Muslim of Chinese lineage. Online troll armies notoriously helped propel Philippines President Rodrigo Duterte to victory in his 2016 campaign. Concerns about misinformation have led governments to implement highly controversial legislation in Thailand and Malaysia.

‘Now, the misinformation ecosystem in Southeast Asia continues to thrive in the ongoing coronavirus pandemic.’

Read here (Defend Democracy, Jan 25, 2021)

The inequality virus: Bringing together a world torn apart by coronavirus through a fair, just and sustainable economy

‘The coronavirus pandemic has the potential to lead to an increase in inequality in almost every country at once, the first time this has happened since records began. The virus has exposed, fed off and increased existing inequalities of wealth, gender and race. Over two million people have died, and hundreds of millions of people are being forced into poverty while many of the richest – individuals and corporations – are thriving. Billionaire fortunes returned to their pre-pandemic highs in just nine months, while recovery for the world’s poorest people could take over a decade.

‘The crisis has exposed our collective frailty and the inability of our deeply unequal economy to work for all. Yet it has also shown us the vital importance of government action to protect our health and livelihoods. Transformative policies that seemed unthinkable before the crisis have suddenly been shown to be possible. There can be no return to where we were before. Instead, citizens and governments must act on the urgency to create a more equal and sustainable world.’ 

Download PDF here (Oxfam, Jan 25, 2021)

Revelations in Malaysia’s pioneering Covid-19 study

‘Malaysia has something new to be proud of... Just two weeks ago, a band of Malaysian medical professionals wrote and published Southeast Asia’s first national study on Covid-19 cases, representing an entire country’s experience.

‘It was featured in The Lancet, arguably the most prestigious and influential medical journal in the world. Titled “Clinical characteristics and risk factors for severe Covid-19 infections in Malaysia: A nationwide observational study”, it was written by Benedict Lim Heng Sim, Suresh Kumar Chidambaram, Xin Ci Wong, Mohan Dass Pathmanathan, Kalaiarasu M Peariasamy, Chee Peng Hor, Hiu Jian Chua, and Pik Pin Goh. It provides a detailed picture of the disease’s spread in Malaysia from Feb 1 till May 30, 2020.

Ethnic mix: ‘Malays account for 58.4% of all cases and 70.0% of all severe cases, while the Chinese account for 6.7% of all cases and 12.1% of severe cases and Indians account for 2.3% of all cases and 4.5% of severe cases. The ratio of severe cases to all cases of almost 2 to 1 for Chinese and Indians might be due to their slightly older-skewing population. Other nationalities account for 23.8% of all cases but only 4.9% of all severe cases – a ratio of almost 5 to 1. This, again, could be due to the foreign worker population which generally skews younger and so has a reduced chance of developing a severe instance of the disease.’

Co-morbidities: ‘Those with hypertension are the most at risk at 48.6%, followed by diabetes mellitus at 39.1% and chronic cardiac disease at 14.0%. Surprisingly enough, being an active smoker does not indicate an elevated risk of developing a severe infection. Smokers account for 9% of all cases and 7% of severe cases...’

Read here (FreeMalaysiaToday, Dec 2, 2020)

Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study

Read here (The Lancet, Nov 17, 2020)

Seroprevalence study estimates 6% of Britain's population infected, higher among ethnic minorities and healthcare workers

‘Researchers at Imperial College London reported findings from a large seroprevalence study involving more than 100,000 participants in the UK... It estimates the overall UK seroprevalence to be 6.0%, which translates to approximately 3.36 million adult infections through June 20. For comparison, the UK has reported 313,798 cumulative cases to date, which corresponds to approximately 0.6% of the total UK adult population.’ -- John Hopkins e-newsletter.

‘The pandemic of SARS-CoV-2 infection in England disproportionately affected ethnic minority groups and health and care home workers. The higher risk of infection in these groups may explain, at least in part, their increased risk of hospitalisation and mortality from COVID-19.’ Conclusion of the study.

Download here (Imperial College Institute of Global Health Innovation, August 2020)

To understand who’s dying of Covid-19, look to social factors like race more than preexisting diseases

‘The Sutter and MIT studies cast doubt on whether individual risk factors are as important as social determinants of health in affecting someone’s chances of contracting severe and even fatal Covid-19. “It should cause us to ask a different set of questions about what puts you at risk of hospitalization or death,” Schwalbe said.

‘More and more evidence is pointing to social determinants of risk, which puts the role of underlying health conditions in a new light. “Comorbidities are still used to blame people for how hard they are hit by Covid-19,” said Philip Alberti, senior director for health equity research at the AAMC. To reduce the U.S. death toll now that many states are seeing a new surge in cases, he said, “our response to this disease” must look beyond the strictly medical.’

Read here (STAT News, June 15, 2020)

Understanding Covid-19 risks and vulnerabilities among black communities in America: The lethal force of syndemics

‘Black communities in the United States are bearing the brunt of the Covid-19 pandemic and the underlying conditions that exacerbate its negative consequences. Syndemic theory provides a useful framework for understanding how such interacting epidemics develop under conditions of health and social disparity. Multiple historical and present-day factors have created the syndemic conditions within which black Americans experience the lethal force of Covid-19. These factors include racism and its manifestations (e.g., chattel slavery, mortgage redlining, political gerrymandering, lack of Medicaid expansion, employment discrimination, and health care provider bias). Improving racial disparities in Covid-19 will require that we implement policies that address structural racism at the root of these disparities.’

Read here (Annals of Epidemiology, Volume 47, July 2020, Pages 1-3, via Science Direct)

Race, ethnicity data to be required with coronavirus tests starting August 1

‘Data on who is being tested “are rarely being reported to CDC in usable format,” Giroir said during a conference call with journalists. “It is critical for us to ensure that there is equitable access to testing, especially for underserved minorities. And without the data we are now requiring, there is simply no way to determine that.”

Read here (Washington Post, June 5, 2020)

How coronavirus tore through Britain's ethnic minorities

‘In a report released on Tuesday, Public Health England (PHE) acknowledged the disproportionate effect the pandemic has had on Black, Asian and Minority Ethnic (Bame) people, including making us more likely to become critically ill, and to die. Black people are almost four times more likely to die of Covid-19, according to the Office of National Statistics, while Asians are up to twice as likely to die.’

Read here (BBC, June 3, 2020)

Covid-19’s race and class warfare

‘America has never been comfortable discussing the inequalities that America created, let alone addressing them. America loves a feel-good, forget-the-past-let’s-start-from-here mantra. But, this virus is exploiting these man-made inequalities and making them impossible to ignore. It is demonstrating the incalculable callousness of wealth and privilege that would willingly thrust the less well off into the most danger for a few creature comforts.’

Read here (New York Times, May 3, 2020)

Corona, East and West: Has Western-centrism mitigated against our well-being in the UK?

“That there is something special and distinct about Europe/the West, the ‘miracle’ view of Europe/West (Bhambra 2007; Sayyid 1997) are inextricably intertwined with othering views of the non-West. Such perceptions and views have contributed to narrow understanding of not just the West, but also the West’s understanding of ‘the Rest’. We need an examination of the extent to which such views and assumptions about the ‘West’ and ‘the Rest’ have come to shape the UK government’s reactions to the risks posed by the coronavirus.”

Read here (Discover Society, April 2, 2020)