The pandemic has exposed deep inequality in our society
The world is changing, for better or worse.
There is a novel villainous phenomenon crowned on the world stage -- it has declared its presence over the last seven months, starting in Wuhan, China, and then spreading like a forest fire burning and devastating the world in its wake.
One of the highly disturbing pieces of information emerging from the analysis into the incidence of infection sweeping through our human habitat is the disproportionate incidence of death consequent to the novel infection in the Bangladeshi community, at least for now, in the UK.
We shall know if the phenomenon is universal across the pan-continental planes when the data analyzed in other countries where a considerable cluster of Bangladeshi expatriates live and when further statistics are explored in Bangladesh itself after the pandemic has run a substantial journey through the country.
These facts came into the public realms during the search for the social determinants exercising dominance over the causatum and consequences of the pestilence encompassing across the UK population.
One of the useful ideas of Sigmund Freud, the Austrian founder of psychoanalysis and neurologist is the fortuity of observing the structure of a crystal endowed by the crystal itself when broken. Radical disruption of so-called normality is revelatory and usually actuates the understanding of inequity, injustice, infringement, immorality, infraction, etc, inherent in a system.
Undoubtedly, social inequality is a colossal obstacle to the desired progression of human society.
Though the virus has been termed the “great equalizer” and appears to indiscriminately infect human hosts, data is emerging that many a social determinant such as poverty, homelessness, and exposure to smog/smoke but most importantly inequality governed by ethnicity and race leading to all other evils, can have serious deleterious effects on the outcomes of Covid-19 infection.
It is increasingly demonstrable that social inequalities in health are profoundly, and unevenly, impacting Covid-19 morbidity and mortality.
In the UK, hospital deaths from the pandemic are highest among the black Caribbean population, three times higher than the white British group, in the face of the white British accounting for almost 80% of the population of England.
Hospital fatalities, demonstrated in univariate analysis, were twice those of the white British group in the Bangladeshi community living in the UK. Deaths of the Pakistani expatriate community are 2.9 times as high, and black African deaths 3.7 times according to the report to a UK Institute of Fiscal Studies, published in May 2020.
However, further analysis of survival among confirmed Covid-19 cases and using more detailed ethnic groups, showed that people of Bangladeshi ethnicity had around twice the risk of death than people of white British ethnicity, after correcting data for the effect of age, sex, deprivation, and region.
This is in contrast to people of Chinese, Indian, Pakistani, other Asian, Caribbean, and other black ethnicities who had between 10% and 50% higher risk of death when compared to White British. However, these figures did not consider obesity, co-morbidity, and occupation in the multi-variate analysis.
It is not overkill to assume that the prevalence of serious and multiple co-morbid conditions like diabetes, heart disease, high blood pressure, chronic renal failure is common in the Bangladeshi community, an observation, I had experienced during my practice as a colorectal surgeon at the Royal London Hospital where a large proportion of the population are of Bangladeshi origin.
The extent of poverty varies considerably between London’s ethnic groups. Bangladeshi households are three times as likely to be in poverty as Indian or white households. Tower hamlets are home to the largest Bangladeshi population in the country, making up 32% of its population of over 300,000 with a household number of around 100,000.
Some 19,000 households are on the housing waiting list and more than 50% on the list are of Bangladeshi ethnicity. The majority of those Bangladeshi households are overcrowded and a substantial number of Bangladeshis are homeless.
In the US, the blatant disregard for the life of people of colour has exposed and highlighted the very worrying statistics. In the USA, though the proportion of non-whites accounts for 23% of the population, the incidence of infection by Covid-19 is far higher in the non-whites.
The race information is available in only about 40% of coronavirus infective cases, the infection rate is three times higher in predominantly black counties than in predominantly white counties, and the mortality rate is six times higher in the American black community.
The effect of social determinants of health and Covid-19 morbidity has been underestimated and so far, not been appreciated properly. Throughout human history, the great public health lesson is that pandemics disproportionately affect the poor and disadvantaged and mitigating social determinants, such as derelict housing, overcrowded accommodation, malnutrition, access to safe water, public health measures of proper sanitation adversely affects the outcomes of infectious diseases, even before the advent of effective vaccine or medications.
Despite an unabated increase in incidence and fatality from coronavirus infection in Bangladesh, the lockdown has casually been lifted, loosened or simply been ignored particularly by the Garment Owners Association, religious fanaticism, and most importantly policy-makers have failed miserably to direct the population in a planned and systematic way.
The lockdown and the practice of social distancing have never been effectively and systematically adhered to from the very beginning of the pandemic in Bangladesh.
The virus responsible for causing the Covid-19 infection is still shrouded in camouflage and much are unknown but enough information is available on the transmissibility and survival of the virus outside their human host.
Possibility of acquiring the infection
The possibility of acquiring the infection is multiplied when staying in close proximity and for prolonged intervals to infected individuals, particularly in closed space.
Chinese researchers had concluded that the possibility of acquiring the infection from an infected person at home was 10 times greater than from a patient in the hospital environment and 100 times greater in the public transport compared to the hospital.
The susceptibility of acquiring Covid-19 infection is much higher in communal areas with the multiplicity of travelling humans through the areas. It is also easily understandable that physical distancing measures, which are necessary to prevent the spread of Covid-19, are substantially more difficult for those with adverse social determinants.
For example, many Bangladeshi live in overcrowded accommodation, encouraged to a negligible extent by culture but more importantly due to social inequality leading to poverty.
Homelessness is another significant variable undermining the ability to battle against the pandemic and homeless people are at higher risk of infection during physical lockdowns especially if and it is more likely the accessibility to public spaces in the immediate vicinity are either limited or closed, resulting in physical crowding that is an important determinant thought to accentuate viral transmission.
Removing coronavirus restrictions too quickly and having to reintroduce lockdowns will be worse for the global economy than gradually easing restrictions, according to a modelling study published in the journal, Nature Human Behaviour.
The study modelled different scenarios for lifting lockdowns, including one in which restrictions are relaxed gradually over a year and another where all restrictions are lifted immediately but then reintroduced within one year.
The researchers found that the impact of supply-chain losses on global GDP in the scenario with gradual easing was projected to be about 10-20% lower than in the scenarios with recurrent lockdowns.
One of the core components in the theory base, attached to social work is “crisis intervention.” Crisis intervention encompasses learning from the crisis and utilizing knowledge and experience so learned, to grow and to be empowered simultaneous to the efforts of getting people out of the crisis.
The present coronavirus pandemic has exposed the adversity and affliction associated with social inequality.
The vicious curse of social inequality inflicts deep division in the human social structure that further empowers the already wealthy, feeding more power to the people who are antecedently powerful and conversely disempowering the deprived into further depravity, striking mercilessly the most vulnerable, the hardest.
The pandemic has demonstrated that people labouring in the garments industries are vitally important contributors to our society and economy.
On the other hand, it also is revealing, and would continue to unravel the ones who in our society cream off the profits for their lives of luxury, often bought at the expense of our public services and the very social fabric in our midst.
Despite the negative consequences of the coronavirus mishaps and misfortunes, the debacle also prescribes auroral sparks on our future direction. The question is -- will we take it?
Dr Raqibul Mohammad Anwar is a Specialist Surgeon and Global Health Policy and Planning Expert, and Retired Colonel, Royal Army Medical Corps, UK Armed Force.