8.4 C
New York
Thursday, March 28, 2024

Cities in Poorer Countries Are at Risk as Covid-19 Spreads

Covid-19 is spreading quickly in the global south, posing particular problems in rapidly growing cities. Brazil now reports more than 460,000 cases, second only to the US. In Rio de Janeiro, the Maracanã stadium has been turned into a makeshift hospital, but beds, intensive care units, and protective equipment for staff are lacking. In Manaus, a city of 2 million in the Amazon, funeral homes and cemeteries have been overwhelmed by the number of bodies to bury. The number of Covid-19 deaths in Brazil are likely much higher than the official death toll of nearly 28,000, as the country performs fewer tests per capita than the US or Europe.

Hot spots are emerging across Africa. Doctors and public health experts have been warning about an unchecked outbreak in Kano, Nigeria’s second-largest city, which could spread elsewhere in West Africa. Cases have risen sharply since Ghana’s government eased lockdown restrictions in the capital, Accra, and in Kumasi.

Similar scenarios are unfolding across Latin America and South Asia with varying degrees of intensity and some exceptions, like Vietnam, which hasn’t recorded any deaths from the virus. Those regions also will suffer the economic fallout from the pandemic. According to the UN, Covid-19 could reverse a decade of efforts to reduce global poverty.

The health systems in these countries already were overstretched and underfunded, making pandemic response more difficult. “Most forms of disasters, including pandemics and to a smaller scale infectious disease outbreaks, do well to illustrate existing inequalities within our society,” says Matthew Boyce, a senior research associate at Georgetown University’s Center for Global Health Science and Security. “It's going to quickly show who are the haves and the have-nots.”

Cities are a focal point, because they are home to much of the population growth in low- and middle-income countries in Africa and Asia and often lack infrastructure to promote good health. By 2030, 2 billion people could live in slums, with poor access to basic sanitation, proper housing, and healthy food, according to the UN.

Many cities of the global south are already fighting infectious diseases, including dengue, tuberculosis, HIV/AIDS, and even leprosy. They’re also suffering increasing rates of chronic diseases like obesity, diabetes, cancer, and cardiovascular diseases.

Yet the proportion of the urban population in sub-Saharan Africa with access to piped water has decreased since 1990. When people store water as an alternative, homes become breeding sites for pathogen-carrying bugs such as mosquitoes, which transmit diseases including dengue fever; health officials reported a record 3.1 million cases of dengue fever in the Americas last year. In 2018, yellow fever appeared for the first time in the megacity of São Paulo, Brazil, and was spotted in the periphery of Rio de Janeiro.

From the 2017 plague in Madagascar to cholera in Haiti, recent infectious disease outbreaks have been centered in cities. The SARS virus was especially virulent in urban centers, including Hong Kong, Singapore, and Toronto. Ebola first appeared in rural areas in 2013, but it spiked after reaching urban centers in West Africa.

Cities of the global south have been growing faster than they’ve built infrastructure to prevent disease, says Thomas Bollyky, who heads the global health program at the Council on Foreign Relations and is the author of Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways.

>

Health in high-income countries improved in the first half of the 20th century as a result of infrastructure and public works like sewers, piped water, and waste management. But low- and middle-income countries have mostly reduced mortality rates through modern treatments like drugs and vaccines, without always building strong health systems to prevent the emergence of diseases.

“Many of the gains we've seen over the last half-century have been against infectious diseases and children dying unnecessarily,” Bollyky says. “They may have masked the lack of progress in the broader well-being of societies and the capability of health systems to address health threats.”

Fiscal regimes mandated by the International Monetary Fund and the World Bank in the 1980s and 1990s didn’t help. They gutted budgets for public health and public infrastructure. International aid targeted initiatives like mass vaccination campaigns and disease-specific programs, which reduced deaths without necessarily improving overall health systems.

Many of those campaigns have been halted due to physical distancing measures as part of the response to Covid-19, which could lead to other problems. Millions of people deprived of vaccination and treatment could develop tuberculosis, measles, or polio over the next few months.

The global health community responded to past epidemics such as Ebola but has struggled to make sense of the social and economic dynamics of cities. There is little data in the scientific literature about the health needs of the billion people living in informal slums.

“Responses to epidemics often tend to be quite short-term; they're about controlling the epidemic,” says Annie Wilkinson, an anthropologist and health systems researcher at the Institute of Development Studies. “The big kind of emergency infrastructure rolls into town, and then it leaves. They're just getting to grips with this urban dimension.”

That can lead to ill-suited policies. The World Health Organization’s advice on Covid-19, for instance, is largely inapplicable in slums, where maintaining social distance is impossible in overcrowded housing. So is washing your hands regularly when there is no running water at home. In the slum of Mukuru, in Nairobi, private water vendors hiked the price of water jerricans amid increased demand in response to sanitation guidelines. Stay-at-home orders are impractical when a day off work means there won’t be food on the table at the end of the day.

“There are big questions about how appropriate lockdowns are for low-income settings,” Wilkinson says. But she says there’s been little discussion of potential alternatives.

In some places, community groups are stepping in where health systems are lacking. Grassroots NGOs are coordinating food and mask donations in low-income neighborhoods in Mumbai through WhatsApp groups. In the Mfuleni township near Cape Town, South Africa, residents have planted urban gardens to grow and sell food locally. Muungano wa Wanavijiji, the Kenyan federation of slum dwellers, is tracking data on Covid-19 cases, as well as prevention and treatment activities, in the country’s informal settlements. Researchers are using the data to monitor the impact of localized initiatives by community workers, such as handwashing stations.

>

Support can come from unusual places. In Rio de Janeiro, drug gangs made headlines when they moved to enforce a curfew in some favelas, after Brazilian president Jair Bolsonaro questioned the seriousness of the pandemic.

“One of the really unique realities of cities is that they tend to be more nimble than a lot of other forms of government,” says Boyce, the Georgetown researcher. “They've enabled this form of creativity to do what they want and operationalize their guidance.”

C40 Cities, a group of 96 cities around the world that promotes climate action through urban initiatives, has published guides for managing Covid-19 in the global south, highlighting alternative policies. Ho Chi Minh City in Vietnam implemented small-scale lockdowns of buildings, streets, and districts to limit the spread of the virus between neighborhoods without shutting the whole city; Indian cities are providing isolation rooms in hotels to low-income residents, funded by corporate social responsibility funds from private companies; Manila, the capital of the Philippines, is supporting mobile markets that source produce from farmers, so residents can avoid traveling to busy markets to buy food.

The pandemic has exacerbated inequalities, but it has also shown that fighting diseases like Covid-19 requires addressing everyone’s health needs. Slums and other low-income neighborhoods have often been portrayed as hotbeds of diseases, but they’re also home to many people working in essential services, without whom entire economies would collapse.

“People can practice social distancing all they want, but if the coronavirus is burning through a specific subpopulation of a city, normal life isn't going to resume until the health needs of that population are addressed,” Boyce says. “Health truly is kind of like a public good.”


WIRED is providing free access to stories about public health and how to protect yourself during the coronavirus pandemic. Sign up for our Coronavirus Update newsletter for the latest updates, and subscribe to support our journalism.

Related Articles

Latest Articles