‘A perfect storm?’ – Championing inclusion for health during COVID 19

Viruses and pandemics are not new

From the bubonic plague (1346-1353), Cholera (1852-1860 and 1910-1911), multiple influenza outbreaks (1889; 1918; 1956 and 1968), not to mention the HIV/AIDS pandemic which started in 1976 and peaked between 2005-2012, killing to date, 36 million people – Widespread infections and large-scale deaths from this unseen enemy have become part of our human history.

In almost every generation we have battled and survived through these pandemics – but the most important question is, ‘what have we learned?’

In my lifetime, the HIV/AIDS pandemic remains central in my memory of working as a nurse. My colleagues and myself fought on an almost daily basis to ensure that those living (and dying) with HIV/AIDS were afforded the same level of care, support and compassion as any other persons in the health system. The major issue we faced, was not the disease itself, but the prejudice, inequity and social rejection of those we cared for – people deemed to belong to ‘risky groups’ , often by nature of characteristics, lifestyles or choices which they more often than not, had little real power to change. What I learned at that time, and which once again I see in the early reports of the impact of COVID19 on communities, is that whilst viruses are universal  – our risk, health and life chances in the face of a virus, are not.

“COVID19, is not an equal opportunities virus.”

COVID19, like all the viruses that preceded it, is not an equal opportunities virus. Yes, as an organism, it does not know how to discriminate between one set of human beings and another – however, differences in the physical, environmental, social and professional spaces we occupy, afford it easier passage into the lives (and bodies) of some, compared to others in our societies. 

A virus, when presented scientifically, with graphs and data that track its course at a population level, can appear indiscriminate – striking where and when it will…. Silently covering continents and communities with equal force. But behind each of those data points, each numbered piece of evidence lies someone’s’ life, a family’s reality and a personal story.  

Equal but different

The phrase ‘all animals are equal, but some animals are more equal than others’ from Orwell’s book Animal Farm (1945), sums up what I see as the ‘equal but different’ variations that persist within and between communities in the face of a pandemic. The truth is, we do not experience viruses the same – we never have – if we look back at the plagues (pandemics) of the past, we see history repeating itself to some degree. In this macabre, cyclical recurring phenomenon, the clinical or physical manifestations of the virus, which theoretically could infect anyone, takes its toll almost predictably on those most marginalised, most silenced in our communities: The Elderly, the sick, the poor, those living with disabilities…and even more so, those who care for them. 

This was the case in the past and remains so with COVID 19. 

It would be easy to convince ourselves that it is the physical weakness of particular member of our society that renders them vulnerable to these pandemics  – however,  we must ask ourselves where and how does this weakness come from? When we view the pattern of deaths and illness globally, we see that physiology is only one part of the story. COVID19, occurring at a time of greater availability and access to global data ( current and historical) has I believe, served to highlight something which has existed in the shadows of earlier pandemics – That inequity, where it intersects with a virus, increases risk and reduces health and lifechances.

The Inequity

The unequal rate of death and illness amongst our most marginalised citizens cannot be disputed. We now have over 700 years of human experiences evidencing just that. However, we must not be fooled into thinking that the story ends there. COVID19, like the viruses before it, is not the cause of this inequity – instead it shines a light into the dark corners of our societies – to the things we shy away from or at other times convince ourselves are ‘normal’ or ‘the way of the world’. 

In the spaces between bench science and human experience lies the realities of living with and through a pandemic. No sadder evidence of this is there than the relatively high proportion of deaths (to date) in the current COVID19 outbreak of health an social care staff in the UK from Black, Asian and Minority Ethnic (BAME) communities. 

In a health care system free at the point of need, within a workforce trained to the same professional standards, working in the same system you would expect the risks to be the same. Yet deaths amongst these professionals are disproportionately distributed by race and ethnicity. 

It is too early to have definitive evidence as to why this is – and certainly calls to the British government to investigate this are growing – but if we look across and within roles and responsibilities of care professionals it becomes apparent that those from BAME communities are more likely to be engaged in care actions and procedures at the frontline, involved in direct patient care, where the risk is greatest. 

When this occurs within a background of higher levels of poverty, underlying conditions and powerlessness to challenge the status quo in the workplace, the risk is higher and the combination is deadly. The virus has not caused this problem, but brings to the fore and magnifies the complexities of living and working with inequity – we have to remind ourselves, through these examples that deaths during pandemics are not simply a measure of physical risk, but also a reflection of the ‘equity’ within our society. 

A Perfect Storm

The ‘politics’ of health and lifechances is a story of distribution of resources: What and how we chose to spend the holy trinity of time, money and human effort. Reflecting who and what ‘counts’ in our societies. 

For the majority of time this is played out as ‘the status quo’ with only minimal or localized protestations about the ‘unfairness of it all’. Then a few times every 100 years to so, along comes a virus…..and in the face of such ingrained injustice, ‘A perfect storm’ begins to rage. 

It always starts in the same way, in one place, one city, one country – initially leading us to believe it is somewhere else, someone else’s’ problem.  Then gaining strength, crossing oceans and scaling mountains until it announces its arrival in our consciousness through shared grief, body counts, loss and lives changed forever… 

As human beings, if we are to learn anything from this pandemic, we must on hearing of another death, ask ourselves – What is being revealed about our society?  What needs to change? – Or else COVID19 will pass, resigned to history as another example of ‘The perfect storm’, a time of global turbulence and human suffering, a record of what happens at the intersection of virus, inequity and human experience.