Covid-19 affects the poor more than others, and even more so in SA

The Covid-19 pandemic represents a biological onslaught the likes of which our generation has never seen. In the absence of a vaccine or even an effective treatment, Covid-19 has also become a social phenomenon defining almost every aspect of our lives, frozen in a state of lockdown and paralysing economic activity, with some communities more compromised than others.

While the coronavirus can infect anyone, it is becoming clear from other countries that social and race groups are likely to experience both the virus and its repercussions differently. Emerging evidence from the US and UK — both in the eye of the storm — show that poorer communities are more likely to be adversely affected.

Understanding the impact Covid-19 will have on the poor in SA — widely acknowledged as one of the most unequal countries in the world — is critical to a well-considered humanitarian response.

Data in The New York Times shows, for instance, that while African-Americans make up less than a third of the population of Chicago, they currently account for more than half of those tested positive for Covid-19 in the city and, alarmingly, 72% of coronavirus-related deaths. The trend is echoed across the US.

Public health experts interviewed by The New York Times point to long-standing structural inequalities to explain Covid-19’s seemingly discriminatory impact. African-Americans have lower levels of access to healthcare and, therefore, if infected, are less likely to seek costly medical assistance earlier, and are more likely to have pre-existing (or untreated) conditions that may exacerbate Covid-19. African-Americans are also more likely to carry out jobs that make it difficult to work from home.

In the UK, The Guardian reported that the Intensive Care National Audit and Research Centre found that 35% of almost 2,000 coronavirus patients were non-white — nearly triple the 13% proportion in the UK population as a whole.

Apart from suffering pre-existing conditions, members of this community are reported to typically live in relatively deprived areas; and in larger, multi-generational households in which social-distancing or social isolation is difficult.

What this means for towns and cities is that proactively assessing environmental factors that highlight vulnerable groups (both to the virus and its aftermath) could work as a valuable proactive tool to mitigate the impact of Covid-19. Understanding vulnerability allows authorities to deploy resources optimally; not only medical resources, but also information campaigns to prepare and empower those most vulnerable with tools to protect themselves and their families.

In SA one’s ability to practise social-distancing and lessen the risk of contracting Covid-19 is clearly a function of wealth and access to resources. There are a number of key areas that specifically define the challenges faced by the poor in self-isolating: living in informal housing; large household size; inadequate access to water and sanitation; reliance on public transport; high population density; and low annual income.

Using Stats SA data, it is possible to model these different variables. On Ward IQ’s index of vulnerability to Covid-19 contagion, broken down by ward across SA, the highest-scoring wards are, by and large, the country’s poorest, in KwaZulu-Natal, the Eastern Cape, North West and Limpopo.

The government is currently co-ordinating the deployment of resources through inter-governmental disaster management functions at the district level if there is existing municipal capacity or, if necessary, through national departments directly, via the National Command Council. If infection rates increase exponentially, identifying and targeting areas most susceptible to contagion will be critical.

David Hunter, professor of epidemiology and medicine at the University of Oxford, lamented in The Guardian that “Covid-19 has exposed the deficiencies of national disease detection and prevention systems in many countries [and a] lack of coherent and joined-up information systems means we still cannot answer many important clinical questions of relevance to this epidemic”. These include pre-existing illnesses, medications, or genetic susceptibility.

In SA access to healthcare likely reflects poverty and the risk of contagion can be assumed to be predominantly among those who have limited access to services, as well as those living in densely populated areas and large households. Knowing this, we can focus proactively on these areas and prepare for Covid-19 on all fronts, not just the medical.

The harrowing lesson we have learned is that Covid-19 does discriminate. Like so many wars, the wealthy or famous may be affected, or a single world leader humbled, but it is the poor who will bear the brunt of its burden. Covid-19 threatens to decimate our most vulnerable communities, and armed with knowledge, we cannot allow this to happen.

• Allan is Municipal IQ’s MD and Heese its economist. The Covid-19 indices are available at www.municipaliq.co.za.