COVID-19: Scientists urge 'equitable and inclusive' response

As the world faces the uncertainties that accompany a pandemic, researchers urge authorities to respond to the crisis in an “equitable and inclusive” way that does not shut out people belonging to the most vulnerable social categories.

An increasing number of countries are enforcing lockdown measures in response to the new coronavirus pandemic.

These measures mean that authorities are restricting individuals’ freedom of movement, many businesses have had to close doors, and there are much stricter rules around access to health care.

Some researchers — although they agree with the need to enforce strict measures to fight this pandemic — now worry that some of the most vulnerable members of society will become even more isolated and less able to access basic items and services.

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In an editorial in The BMJ, a team of scholars from the United States — hailing from Johns Hopkins School of Medicine in Baltimore, MD, the University of Massachusetts Lowell, Georgetown University in Washington, DC, and Indiana University in Indianapolis — are expressing their worries, and urging “equitable” measures for all.

Clear, accessible information is a must

The authors of this editorial are Prof. Ross Silverman, associate professor Zackary Berger, assistant professor Nicholas Evans, and adjunct professor Alexandra Phelan.

Together, they write that response measures must make sure to address the need of “homeless people, those without adequate insurance or employment, communities of color, indigenous communities, immigrant communities, people with disabilities, and certain frontline healthcare workers and emergency responders.”

One way of attaining inclusivity, the academics argue, is by providing clear, consistent information and instructions to local communities in many languages, as well as in sign languages.

The researchers also warn that public health officials must address potential feelings of mistrust towards local healthcare systems that may be prevalent among “underserved communities,” including people of color, those with disabilities, and undocumented immigrants.

The authors point out that the latter often “fear punitive measures should they present at a clinic or hospital,” as previous research has suggested.

Avoid further marginalizing those at risk

Another appropriate measure, they suggest, is to ensure that individuals “without adequate access to health services or insurance benefits” receive appropriate care from the state, not just in the eventuality of them contracting the new virus, but also for existing health conditions.

The scholars emphasize that:

“Relying on emergency and acute care settings to care for uninsured people is inefficient, expensive, risks the spread of COVID-19, and may cause those at risk to avoid care.”

They also argue that there should be free testing for COVID-19 for all, regardless of citizenship status.

However, at a time when social distancing is the most important measure for stopping the virus from spreading, the authors urge officials to consider how this measure is affecting the most vulnerable communities.

They note that bans on mass gatherings, as well as the closure of institutions, such as schools, may “disproportionately affect” those with disabilities, as well as those who rely on such institutions to ensure “food, shelter, residency, and safety.”

Put more thought into work policies

The editorial argues that policies of self-isolation may hit certain categories of workers especially hard.

Yet, as existing research on influenza outbreaks has suggested, having appropriate paid sick leave policies in place can encourage people to adhere more strictly to self-isolation requirements, and help “lower […] infection rates by up to 40%.”

The editorial also turns its attention to people who live in prisons, nursing homes, homeless shelters, or refugee camps.

Again, the academics highlight that these individuals are more limited than the general population in their access to health care, and they may be more at risk of severe health outcomes should they contract the new virus.

For this reason, the authors urge authorities to reconsider policies they may have in place for those who find themselves in refugee or immigration camps, for instance.

Authorities ought to make sure that such individuals have access to COVID-19 testing and appropriate care.

Last but not least, the writers express concern for practitioners, responders, and support staff in healthcare settings who are more at risk of contracting the virus and whose mental health may be particularly at risk in these uncertain times.

Governments should make explicit provisions to safeguard the health and well-being of these individuals, the editorial says.

“Governments, institutions, and healthcare facilities all have a role in enacting policies that respect members of vulnerable communities while working towards ending the pandemic,” the group stresses.

“We all hold social and ethical responsibilities to assess and mitigate risks for those groups so often left behind.” the authors conclude.

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