The Forgotten Ones
Untold and unseen consequences of COVID-19
By Jeff Renaud
Western researchers Eric Arts, Kate Choi, and Prachi Srivastava are highlighting the inequalities that have caused vulnerable populations to be hit the hardest by COVID-19.
The new normal. Eric Arts hates this term.
The renowned Western virologist – actively working on a coronavirus vaccine – believes the COVID-19 global pandemic is anything but normal. It’s a world-crippling crisis. And Arts said we should’ve seen it coming, but didn’t – and that’s not even the biggest problem.
As the world remains hyper-focused on finding a vaccine and a cure for a disease that has killed close to one million people, it is becoming clearer every day that those most vulnerable and those who are racialized are paying the highest price with their healthcare, their education, their employment and, ultimately, their lives.
COVID-19 isn’t a racial issue, exactly. But Western researchers say the fear and uncertainty it has unleashed around the world has raised countless questions and concerns of inequality that society must confront if we are to return to normal. And even still, Arts and others at Western contend, ‘normal’ just isn’t good enough.
Kate Choi, a family demographer and acting director of Western’s Centre for Research on Social Inequality, is making creative use of existing data to test anecdotal evidence that COVID-19 has disproportionately affected Black, racialized, and immigrant people in Canada during the pandemic. A key challenge for researchers examining COVID-19 in Canada is the information void that emerges because data on the socio-demographics of COVID-19 patients aren’t being collected or released by government officials.
“A key finding that is consistent across different studies is that independent of socio-economic status, racial minorities and immigrants are more vulnerable to COVID-19,” said Choi. “Yet in Canada, specifically Ontario, the government is more concerned about privacy rules so they’re not collecting or releasing racial data on COVID-19 patients.”
With governments not collecting and sharing this vital information, researchers like Choi are not able to adequately assess the hardships truly facing Canada’s most vulnerable populations.
“If we’ve learned anything from this pandemic, it’s that we can’t really prevent or contain the virus without addressing concerns of inequality. We know racial minorities in Canada are substantially more likely to be infected by COVID-19,” said Choi. “They’re also more likely to lose jobs as a result of the economic shutdown and be evicted from their homes. And unfortunately, we also know that all of these economic consequences will not only have an impact on one generation, but they’ll have a perpetuating impact on future generations.”
Prachi Srivastava is witnessing these same emergencies of inequity and indifference not only in Canada, but around the world. An expert on global education and international development, the Western education professor is leading a high-level policy brief for the T20 Task Force on COVID-19, which will feed into the G20 Summit in Riyadh, Saudi Arabia later this year. She has also provided recommendations for Ontario’s Ministry of Education based on this work.
“Hopefully two years from now, we will be in a less precarious situation as it relates to secure and continuous access to education,” said Srivastava. “But I’m very sad to say that I think globally there will be a deepening of current inequities and an emergence of new inequities. Much of the progress that we’ve made in global education over the past 20 years and with the United Nations MDGs (Millennium Development Goals) is in grave danger of collapse.”
During the early days of the COVID-19 pandemic – and the resulting lockdowns and closures that occurred all around the world – UNESCO released a staggering number. More than 1.5 billion children were out of school due to the pandemic. That’s over 90 per cent of the world’s children and youth and nearly 20 per cent of Earth’s total population. Pre-pandemic, near universal enrollment was achieved, strongest in primary education, thanks in large part to the global community, national governments, and a host of researchers including Srivastava.
“That’s huge,” said Srivastava. “It was the first time in human history we were able to achieve that. But now global education has been disrupted. And we are going to feel the after-effects of this pandemic – the lost opportunities and mounting mental and monetary costs – for certain households, certain groups, certain communities, certain nations, certain marginalized individuals, long after finding a vaccine or an effective treatment.”
It’s unthinkable. The world was right there, said Srivastava. But there was still a substantial number of children out of school – an estimated 250 million – due to entrenched inequities.
A fight worth fighting
All things being equal, they’re not.
For the past 20 years, Eric Arts has been working on a vaccine for HIV/AIDS in his labs in the United States, Uganda and in Canada at Western’s Schulich School of Medicine & Dentistry. And while he understands the rapid course correction many G20 countries have taken to allocate resources towards developing a vaccine and a treatment for COVID-19 (his own research included), Arts said the decisions smack of inequality. For when he connects with his collaborators in Uganda to learn how the pandemic is affecting people in the cities and villages where they work, the stories he hears aren’t reflecting what he sees in his social media feeds, the daily government briefings and the nightly news. It’s quite the opposite.
Arts highlights a stark reality: while the virus has hit hard in low- to middle-income populations within some of the world’s richest countries, it’s largely not affecting developing countries in the same way.
“HIV/AIDS and diseases like tuberculosis and malaria have a far more dramatic and devasting effect on people in Africa but their economies have all been shut down for COVID-19, a disease that is largely a first-world problem,” said Arts.
An estimated three million people still die every year from HIV/AIDS, tuberculosis and malaria but those deaths predominantly occur in developing countries. Arts isn’t convinced the death rate for COVID-19 will surpass one million this year but because it’s also crushing the global economy, he said it’s become priority number one for policy-makers.
“For those countries that struggle with those other diseases, COVID-19 has pulled all of the resources away from treating them,” said Arts. “It’s really dramatic in certain parts of the world and now we have a situation where low-income countries that are less impacted by COVID-19 per capita are suffering even greater consequences because of the circumstances beyond the actual disease.”
Arts said if a person arrives at a clinic in Kampala, Uganda with a fever, COVID-19 is not the first disease they would check for. Prolonged fevers are associated with 16 million cases of malaria per year in Uganda – a potentially deadly disease, especially in infants.
“Doctors and health practitioners are having a terrible time securing medical supplies when there are a hundred things that will kill you before COVID-19,” said Arts.
And that’s the real problem. Countries like Canada and the United States are going to survive COVID-19. Arts said it may take a year or two, however, a vaccine will be discovered. But countries like Uganda will continue to suffer. The world has become so focused on COVID-19 that everything else is being exacerbated and everyone else is being left behind. Arts said if developing countries go two or three years with no resources, no funding, no programs and no projects, that’s when the world is really going to see inequality.
The differences between the haves and the have-nots can be found right here at home, as well.
During the pandemic, Kate Choi has been studying the socio-economic status of neighbourhoods in Toronto and has found a disturbing trend in how COVID-19 has further exacerbated inequalities. Lower-income neighbourhoods have endured far greater difficulty curbing the spread of the virus because a higher share of their residents belong to racialized and more vulnerable groups. She has also seen an alarming rise in gender inequality.
“We know that women have taken a larger, disproportionate share of the extra burden that has been created because of the disruption of daily life caused by COVID-19. We also know they are more likely to have lost their jobs as a result of the coronavirus because of the types of industries in which they traditionally work,” said Choi. “This amplifies gender inequality and reduces the gains in gender disparities that have actually seen growth over the past decade. Like socioeconomic class and race, we can see that inequality is increasing and amplifying and no one knows the exact magnitude of this inequality or how far it’s going to go.”
Choi believes there is a unique and “very small” window for governments in Ontario and Canada to mitigate the potential impact by providing financial, medical and housing resources to the country’s most vulnerable.
“COVID-19 could affect these neighbourhoods for a very long period of time – not just in our lifetimes but across the lifetimes of our children and grandchildren,” said Choi.
While Choi is looking decades ahead, what’s keeping Srivastava up at night now is school re-openings. She said there just isn’t enough money being spent on doing it right. Globally, Srivastava finds education nearly always draws the short straw on expenditures. The outcomes – and inherent risks during a pandemic – have now become life-threatening for some. Once again, emerging research is showing families and neighbourhoods with lower socio-economic status bear the brunt of this negligence.
However, data are sparse. Commenting on the limited publicly available data in Ontario, Srivastava said that early patterns show families in wealthier neighbourhoods stated they were more likely to send their children back to school for face-to-face instruction in September. The potential reasons need to be further explored, but families are likely calculating a risk-cost-benefit analysis. According to Srivastava, risk will be at three levels – community (linked to virus transmission), school (including factors like school catchment and implemented precautions) and household (including socio-economic and racial factors, pre-existing health conditions, and flexibility).
Children living in lower-risk communities, from lower-risk households, and in schools with smaller class sizes in well-ventilated classrooms led by stable, established teachers and support staff, and robust measures such as sanitization, personal protective equipment, extra indoor and outdoor space for physical distancing, and regimented flow plans will likely have a more stable experience this year. Families with flexibility and resources may feel they can always pull their kids out and supplement their education if things get very bad. Many are already supplementing with private tuition.
Higher-risk families are also predominantly Black and racialized, as data on infection rates show. They may have members with pre-existing conditions, be multigenerational, with older family members needing care from others living in the home, and they may not be living in single-family homes.
“Whether we’re looking at the COVID-19 pandemic in terms of vaccine development or public health or global education or socio-economic inequalities, what we’re seeing is a flagrant mishandling at the level of public policy,” she said. “We have to change the way we live, we have to take better care of our environment and we actually have to start giving a damn about the people who live on this planet.”
Srivastava said we should learn from how Vietnam, classified as a lower-middle-income country, can enact public policies as quickly as a high-income country such as New Zealand and quell the spread of COVID-19 to near non-existence, while G20 countries like the United States, the United Kingdom and some parts of Canada have been dragging their heels.
“There is no reason on Earth for these shortcomings other than a sheer lack of will to institute certain policies,” said Srivastava. “We have the resources, we have the space, we have the people and we have the money – and yet six months on, here we are.”