Authored by Salma Abdalla and Sandro Galea

“Many countries in Africa are burdened by high rates of malnutrition, different types of pneumonia, widespread malaria, and a large number of people living with HIV/AIDS, tuberculosis, or both. The prior existence of these endemic infectious diseases, coupled with an increasing prevalence of non-communicable diseases, make for a population in many parts of Africa that is particularly vulnerable to COVID-19. In light of that fact, it is not surprising that several African governments have enacted national responses to the outbreak and responded swiftly to address the spread of the virus. A number of these responses, however, have mimicked lockdown measures currently in place in some European countries and North America. We worry that given the differences in context, even between African countries, lockdown approaches are unlikely to succeed in the region.”

Photo by Omotayo Tajudeen

Authored by Nasan Maani and Sandro Galea.

“The scale and unequal distribution of this disruption to human life must give us pause. Such measures do not just cause economic disruption but are also acutely harmful to population health. Focusing only on the health harms associated with unemployment, loss of income, and the broad impact on mental health outcomes associated with traumatic events and social isolation can give us a sense of the tip of the iceberg.

Unemployment has long been associated with a significantly increased risk of death in general, particularly for low-skilled workers in the U.S.. The risk of heart disease, the leading cause of death in the U.S. at almost 650,000 deaths per year, has been shown to increase by 15–30 percent in men unemployed for more than 90 days. Among older workers, involuntary job loss can more than double the risk of stroke, which already claims 150,000 lives in the U.S. per year, as well as increase the likelihood of depressive symptoms that then persist for years. Such harms are likely exacerbated by concomitant longer term social isolation, which in of itself is associated with a 30 percent increase in mortality risk. Loneliness and social isolation have been associated with a 29 percent increase in risk of incident coronary heart disease and a 32 percent increase in risk of stroke. The scale of these elevated health risks is significant—comparable to that caused by taking up light smoking or becoming obese.”

Authored by Carlene Pavlos, Sandro Galea, and Cheryl Bartlett

“We appreciate the immense challenges facing our state policymakers. What they – and we – face is unprecedented and overwhelming. There is no playbook. Assistance and leadership from the federal government has been limited, late, and inconsistent, at best.

Even as we recognize these challenges, we are disappointed that the state’s response does not embed equity at its heart. There is, as of now, far less than we should expect in the way of clear plans, guidance, or resources that are targeted to protecting communities that already experience marginalization.

Two weeks ago, we announced urgent policy recommendations from the Emergency Task Force on Coronavirus & Equity – recommendations supported now by more than 150 Massachusetts organizations – designed to ensure communities experiencing the effects of racism, poverty, and xenophobia aren’t put at even greater risk during the outbreak. There has been some progress on these recommendations, but none have been fully implemented.”

THE COVID-19 PANDEMIC is rapidly evolving. Massachusetts, like the rest of the world, is working to hone its response to this novel coronavirus. State residents have accepted physical distancing, work and school closures, and other measures necessary to slow this disease.

Yet for all our efforts to stop Covid-19, the difficult truth is that, in many ways, we opened the door to its spread. We did this by accepting the conditions that create health inequities.