Vulnerability during COVID-19

Most vulnerable during the COVID-19 pandemic

Countries most vulnerable during the COVID-19 pandemic

Before December 2019, SARS-CoV-2 — the virus that causes the COVID-19 illness — was unknown to science. "A pneumonia of unknown cause" was first reported to the World Health Organization on December 31, after a slew of cases appeared in Wuhan, China. Since then, the virus has been detected in more than a million people worldwide and killed tens of thousands.

This is a pandemic, a global crisis and tragedy on a scale that's hard to fathom.

There are a lot of new things for the public to learn — about the virus, controlling its spread, social distancing, treating the sick, and how our governments should react to this chaotic situation. It's like we've all been dropped in to study for a test in a class that no one signed up for. It's confusing and hard to process.

Tens of millions of Americans fit that description – the poor, the homeless, immigrants, the detained and incarcerated, the precariously employed and the uninsured. Nearly one-quarter of adult Americans do not have access to medical benefits, paid sick leave or access to medical care.

Already, the virus has revealed the faults, cracks and inequities in the U.S. healthcare system. As scholars in humanitarian aid, we're keenly attuned to these inequities. Here's a look at the challenges the U.S. faces to protect the health of everyone in our communities.

While we may not be able to join hands in person, we must continue uniting to fight the COVID-19 pandemic wherever we may be. COVID-19 is spreading across the world at an alarming pace. The escalating outbreak has brought devastating outcomes to our well-being and overwhelmed our health systems.

In Asia and the Pacific, the impact of COVID-19 has been tremendous due to the high concentration of people, economic activities and resource consumption. Economic shocks have already begun, and the economic and social well-being of informal labourers in the service sector is particularly vulnerable. The crisis has shown how tightly the Asia-Pacific region is woven into the economic and social fabric of the world.

The magnitude of this pandemic has prompted U.N. Secretary-General Antonio Guterres to urge that we "come to the aid of the ultra-vulnerable, millions upon millions of people who are least able to protect themselves." I echo his call to step up for those most at risk. As the virus moves to low-income countries, we are at a pivotal point where we must act immediately to leave no one behind.

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Watch after elderly during COVID-19

We have already experienced a universal response resounding across the world: stay home. This global appeal has been a crucial petition to curb the further spread of the virus. Yet the phrase assumes we have a home, and that it is adequate for basic needs. Neither is entirely right for the poorest in our region.

They often work in the informal sector or in small and medium enterprises. The economic fallout of COVID-19 has already resulted in a sudden decline in revenue, translating to countless lost livelihoods for informal daily wage earners. The majority of women in the region are in informal employment, compounding their responsibilities of unpaid care work.

Living conditions for the poor are often crowded, with limited access to sanitation, making it difficult to protect themselves against the new coronavirus. That is why our first responses should prioritize these people while cushioning the economic shocks to build a better home for all.

As wealthy countries with strong healthcare systems struggle to detect and contain COVID-19, the challenge of tackling an emerging disease in low-income countries, as well as in low-income community pockets in wealthy parts of the world, could prove to be the challenge of our time.

The global infrastructure for fighting outbreaks is tenuous. The pervasive and widespread nature of the COVID-19 outbreak is forcing governments to build on existing imperfect and often fragile healthcare systems, to which large swathes of the population do not currently have access.

To date, according to Google News, #coronavirus has received well over 1.1 billion mentions, compared to 56.2 million mentions for SARS, 40 million for HIV, 23.2 million for MERS and around 11.1 million for Ebola.

As the spread of the coronavirus accelerates, the United Nations is working to ensure that the needs of the most vulnerable are reflected in its response to the emergency.

Women, children, people with disabilities, the marginalized and the displaced, all pay the highest price in conflicts and are also most at risk of suffering devastating losses from COVID-19, said Secretary-General António Guterres in his recent appeal for a global ceasefire. He further reiterated that COVID-19 is a common enemy that does not care about ethnicity or nationality, faction or faith. "It attacks all, relentlessly."

Micheal Burgos, the Director of Family with Children Shelters responsible for four shelters in Queens and Brooklyn, is among the people working to protect one of those vulnerable groups - the homeless. In an interview with the U.N. Coronavirus Communications Team, he said that people in these shelters are exhibiting anxiety, stress, and fear about the COVID-19 virus as New York City has become a new epicentre of the pandemic.

"We have compositions of single parents with children and married parents with children," he said, adding that some are undocumented. Some have immediate concerns about food and where to live, others have concerns about the health of their family, he noted.

His agency is trying to implement a family-centred approach and avoid the "cookie-cutter" approach, addressing all of the concerns and needs of everyone in the family unit. 

"Staff is being mindful that everyone at a homeless shelter has a history of trauma," he said, explaining that the COVID-19 event only adds to their trauma. He said that a clear explanation of the virus is crucial to families to minimize their trauma histories. Also, instilling clear instructions on how to combat the virus is essential, he advised. 

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Despite all the therapeutic interventions, his agency implementing, economic and financial realities are weighing heavily on them. Many had to quit their jobs because their school-aged children now need to be homeschooled. The financial uncertainty is terrifying for families, only causing more significant trauma, he said.

Crowded living conditions make them highly vulnerable to COVID-19 transmission. Mr. Burgos said those families with symptoms would be required to go to a quarantine shelter. This would create anxiety for everyone else, so extreme confidentiality will be needed to reduce fear and panic with other families, he said, adding that he is trying to bring hope to them by sharing words of encouragement. 

SARS-CoV-2 is very contagious, and a huge portion of the global population is vulnerable

One thing we do know is that this coronavirus, SARS-CoV-2, is very contagious. Just look at the headlines: COVID-19, the disease caused by the virus, has now infected nearly a million people around the globe.

Scientists quantify the contagiousness of a disease with a figure called R0 (pronounced R-nought.) "The figure refers to how many other people one sick person is likely to infect on average in a group that's susceptible to the disease (meaning they don't already have immunity from a vaccine or from fighting off the disease before)," Vox's Julia Belluz explains. An R0 of 2, for example, means each infected person is expected to spread the virus to two others, on average. COVID-19 is currently believed to have an R0 between 2 and 2.5.

COVID-19 is a new disease, and there is limited information regarding risk factors for severe disease. Based on currently available information and clinical expertise, older adults and people of any age who have severe underlying medical conditions might be at higher risk for severe illness from COVID-19.

Corona Virus outbreak vulnerability

Persons with Disabilities

The United Nations Special Rapporteur on the rights of persons with disabilities, Catalina Devandas, has warned that little has been done to provide people with disabilities with the guidance and support needed to protect them during the ongoing COVID-19 pandemic, even though many of them are part of the high-risk group. "People with disabilities feel they have been left behind," the human rights expert said. "Containment measures, such as social distancing and self-isolation, maybe impossible for those who rely on the support of others to eat, dress and bathe."

"This support is basic for their survival, and States must take additional social protection measures to guarantee the continuity of support in a safe manner throughout the crisis," she stressed, adding that access to additional financial aid is also vital to reduce the risk of people with disabilities and their families falling into greater vulnerability or poverty. "Many people with disabilities depend on services that have been suspended and may not have enough money to stockpile food and medicine or afford the extra cost of home deliveries," she added.

Speaking during a Q&A the U.N. health agency hosted on its Twitter account on Thursday, Lindsay Lee, a World Health Organization (WHO) Technical Officer, who uses a wheelchair, explained that health care access is already difficult for some people with disabilities, even in high-income locations. Other barriers include physical obstacles, discriminatory laws and existing stigma. "These things, if Governments and communities aren't careful, can be exacerbated in crisis situations," she said. "But if the whole community is willing to do its part, these sorts of risks can certainly be mitigated".

While having a disability probably doesn't by itself put someone at higher risk from coronavirus, many persons with disabilities have specific underlying conditions that make the disease more dangerous for them, according to the Department of Economic and Social Affairs' Programme on Disability/Secretariat for the Convention on the Rights of Persons with Disabilities (SCRPD). Over 100 disability advocacy organizations and a coalition of disability rights and emergency management experts in the host country recently made an urgent call for an immediate response, addressing the specific needs of persons with disabilities to maintain their health, safety, dignity, and independence in the community throughout the COVID-19 outbreak and related health emergencies.

COVID-19 is a new disease, and there is limited information regarding risk factors for severe disease. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.

Older Persons

The World Health Organization (WHO) says that the virus can infect people of all ages, with the risk of severe disease gradually increasing with age starting from around 40 years, especially for those with underlying conditions. Older people, especially those over 60, are at highest risk. 

The International Telecommunication Union (ITU) says that in a time of social distancing, older persons are more likely to be isolated. The ITU Telecommunication Development Sector (ITU-D) Digital Inclusion Programme promotes information and communication technology accessibility as a means to empower all people – regardless of their gender, age, ability, or location. It supports ITU members in their efforts to create more inclusive digital societies in their respective countries and regions, as well as to ensure the socio-economic development and full and effective participation in society and the digital economy of all their citizens.

Older people are at higher risk for severe illness from COVID-19, which may result in increased stress during a crisis.

Fear and anxiety about the COVID-19 pandemic can be overwhelming and cause strong emotions.

Persons with HIV

Although the risk of serious illness from COVID-19 for people with HIV is not known, people with HIV may have concerns and questions related to their risk.

Older adults and people of any age who have a serious underlying medical condition might be at higher risk for severe illness, including people who are immunocompromised. The risk for people with HIV getting very sick is most significant in:

  • People with a low CD4 cell count, and
  • People not on HIV treatment (antiretroviral therapy or ART).

People with HIV can also be at increased risk of getting very sick with COVID-19 based on their age and other medical conditions.

Moderate to Severe Asthma

This information is based on what we currently know about the spread and severity of coronavirus disease 2019 (COVID-19).People with moderate to severe asthma may be at higher risk of getting very sick from COVID-19. COVID-19 can affect your respiratory tract (nose, throat, lungs), cause an asthma attack, and possibly lead to pneumonia and acute respiratory disease.

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There is currently no specific treatment for or vaccine to prevent COVID-19. The best way to prevent illness is to avoid being exposed to this virus. The WHO recently put out a statement saying its experts believe respiratory droplets primarily transmit COVID-19. When infected people breathe, cough, or sneeze, they expel little droplets of moisture that contain the virus. Another person in their vicinity could breathe in these particles and get infected. The virus-laden droplets can also land on surfaces that others may touch (and then get infected by touching their mouth, nose, or eyes). Scientists now believe the virus can remain viable on a hard, non-porous surface like plastic or steel for around three days, and a rough surface like cardboard for about a day.

The 6-feet-away social distancing guideline is meant to keep people out of the splash zone for these respiratory droplets. (But now there's no hard cutoff for how far the viral droplets can spread. A sneeze can propel material from the nose 20 feet or more, a recent MIT study found.)

What can people do?

People can work within their communities to identify needs. That includes, along with our neighbourhoods, our virtual, religious and professional communities. One approach that's working in remote African communities – called Champion Communities – targets the needs of the most vulnerable. The program can be adapted in the U.S. to provide online tools (like Google forms) to collect information on needs and resources. Social media –like neighbourhood-focused apps, messaging groups on text, WhatsApp and F.B. Messenger – can also be used to check on the most vulnerable; #ittakesavillage is being used on social media to highlight these efforts.

And a footnote: Every telemedicine call should screen for intimate partner violence and child abuse. Every call needs to record the presence of firearms in the house. Providers, in cooperation with intimate partner violence and child abuse helplines, need to come up with protocols for identifying and safely checking in on those at risk. During this crisis, the coronavirus is not the only thing we have to fear.

In addition to physical connectivity, investments in information technology and digital connectivity are crucial to expanding services like health care to underserved populations. Those with the least access to innovation become the most vulnerable.

We must work to reduce inequalities in broadband connectivity and bridge the digital divide. At the United Nations Economic and Social Commission for Asia and the Pacific, we will continue to support this critical infrastructure need.

Finally, COVID-19 calls us to reflect on the intimate relationship between humans, animals and the environment. Climate change and deforestation have contributed to deteriorating ecosystems, losses in biodiversity and faster transmission of diseases. Yet temporary reductions in both carbon emissions and energy demand during the outbreak have given the environment breathing space.

 

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