Beyond the Covid-19 red zones

Risk assessment of communities and areas is essential before full movement of people starts

Alexandria Ocasio-Cortez, the US representative from New York 14th congressional district (NY14), on April 8 reiterated her controversial views on environmental racism and its relation with the Covid-19 pandemic. In a Twitter post, she said black and brown communities in the US “have long been treated as dump yards. Trucking and waste sites spike respiratory and other disease”. The provocation of the tweet was a race-wise break up given out by governor Andrew Cuomo, New York’s most familiar face these days who is on television every day briefing about the pandemic.

Ocasio-Cortez said the Bronx locality already had some of the highest asthma rates in the US when Covid hit. A study by New York University’s Furman Center also said Bronx saw the highest rate of deaths per capita from coronavirus till April 8. The New York City had by then seen over 80,000 cases of Covid-19. The study says these cases are not evenly distributed across the city, nor is mortality from the disease. Neighbourhoods with higher rates of confirmed Covid-19 cases had lower median incomes. “This may result from higher rates of underlying health conditions that increase the risk of severe cases, or from more limited access to health care. Citywide data confirm that mortality rates due to Covid-19 are highest among Hispanic, Black, and non-Hispanic/Latino populations,” says the Furman Center’s study.
 

In India, race-wise data is irrelevant while caste-wise or religion-based data are best avoided because of the deep-rooted prejudices and discrimination against communities. State governments till now have not given class-wise data, but broadly the number of cases reflected in 107 districts that are red zone shows that Covid-19 positive patients are in big cities where people go abroad more than people from other places do or are closely housed, leading to faster spread of infection. The reason the Union government decided to exempt rural areas first from a complete lockdown of 40 days is precisely this. With less or no cases, villages cannot be subjected to prolonged lockdown and resultant humanitarian challenges.

There is so far no initial government study specifically looking at why particular areas are more prone to the infection though the government gives out Covid-19 data in a way that shows the prevalence of comorbidity — or whether a patient had any other disease when he died. It is widely accepted globally that those with respiratory disorders and low immunity levels due to other diseases are more prone to Covid-19 and that the risk of fatality is higher among them.

An initial study on the long-term exposure to air pollution and Covid-19 mortality in the United States by the Harvard T H Chan School of Public Health says a small increase in long-term exposure to PM 2.5 leads to a large increase in the Covid-19 death rate, with the magnitude of increase 20 times than that observed for PM 2.5 and all-cause mortality. The study underscores the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the Covid-19 crisis.

The PM 2.5 (particles less than 2.5 micrometre in diameter) count was 10 in New York and 151 at Wazirpur in Delhi at the same time on Tuesday, according to World Air Quality Index.

It can be easily argued that pollution does not lead to Covid-19 but the prevalence of weak lungs among people exposed to higher level of pollution is high and, therefore, the fatality rate can increase. On April 9, Chhattisgarh  Revenue, Disaster Management and Rehabilitation Minister Jaisingh Agrawal wrote a letter to his counterpart in the commerce and industry department, Kawasi Lakhma, expressing concern about how people of Korba were exposed to high levels of air pollution due to coal mining and thermal power plants and, therefore, they were more susceptible to Covid-19. Agrawal asked for a compulsory health impact assessment, especially since there is high incidence of asthma and bronchitis among people there. Similarly, the Bhopal Group of Information and Action convenor, Rachna Dhingra, accused the government of neglecting the Bhopal gas tragedy victims who may die of Covid-19 as they are more vulnerable to the virus. The gas leakage from Union Carbide plant in December 1984 had killed thousands and left many with respiratory and oncological issues.

Ocasio-Cortez put it rather, too, firmly when she said the reason for her NY14 community being the most impacted in the United States is “the vast, systemic inequalities that were growing pre-Covid” which was now determining “who lives or dies in this pandemic”. It could also have been that the people in her area were less careful with precautions that are being followed the world over for preventing the spread of the disease.

In India, however, any such assertion of why certain areas are riskier needs more analysis. While the national lockdown of 40 days will check the spread of the virus, risk assessment of communities and areas is essential before full movement of people can be allowed to start. This assessment should be different from the current one where 170 districts have been declared as red zones based on the number of positive cases. Backed by data, local governments could build a safety net around the vulnerable because a pandemic can easily take in even the less vulnerable in its wake.