Who’s Hit Hardest By COVID-19? Why Obesity, Stress And Race All Matter

2020/04/20 Leave a comment

More on disparities in health outcomes:

As data emerges on the spectrum of symptoms caused by COVID-19, it’s clear that people with chronic health conditions are being hit harder.

While many people experience mild illness, 89% of people with COVID-19 who were sick enough to be hospitalized had at least one chronic condition. About half had high blood pressure and obesity, according to data from the Centers for Disease Control and Prevention. And about a third had diabetes and a third had cardiovascular disease. So, what explains this?

“Obesity is a marker for a number of other problems,” explains Dr. Aaron Carroll, a public health researcher at the Indiana University School of Medicine. It’s increasingly common for those who develop obesity to develop diabetes and other conditions, as well. So, one reason COVID-19 is taking its toll on people who have obesity is that their overall health is often compromised.

But does obesity specifically affect the immune system? Perhaps.

Prior research has shown that people with obesity are less protected by the flu vaccine. They tend to get sicker from the respiratory disease even if they’ve been immunized. In fact, researchers have found that as people gain excess weight, their metabolism changes and this shift can make the immune system less effective at fighting off viruses.

“What we see with obesity is that these [immune] cells don’t function as well,’ says Melinda Beck, a health researcher at University of North Carolina, Chapel Hill. Basically, she explains, obesity throws off the fuel sources that immune cells need to function. “The [immune cells] are not using the right kinds of fuels,” Beck says. And, as a result, the condition of obesity seems to “impair that critical immune response [needed] to deal with either the virus infection or [the ability] to make a robust response to a vaccine.”

So this is one explanation as to why people with obesity seem more vulnerable to serious infection. But, there are many more questions about why some people are hit harder, including whether race is a factor.

The CDC found that 33% of people who’ve been hospitalized with COVID-19 are African American, yet only 13% of the U.S. population is African American. Some local communities have found a similar pattern in their data. Among the many (26) states reporting racial data on COVID-19, blacks account for 34% of COVID deaths, according to research from Johns Hopkins University.

This disproportionate toll can be partially explained by the fact that there’s a higher prevalence of obesity, high blood pressure and diabetes among African Americans compared with whites.

And as Dr. Anthony Fauci of the National Institutes of Health said last week at a White House coronavirus task force briefing, this crisis “is shining a bright light on how unacceptable that is, because yet again, when you have a situation like the coronavirus, [African Americans] are suffering disproportionately.”

There are several factors, including some genetic ones, that may make African Americans more vulnerable to COVID-19. “There have been a few studies that have pointed to African Americans potentially having genetic risk factors that make them more salt-sensitive,” says Renã Robinson, a professor of chemistry who researches chronic disease at Vanderbilt University. This may increase the likelihood of high blood pressure, which, in turn, is linked to more serious forms of COVID-19. “It could be a contributing factor,” she says, but there are likely multiple causes at play.

Another issue to consider, she says, may be high stress levels. She says when a person experiences racial discrimination, it can contribute to chronic stress. She points to several studies that link discrimination and stress to higher levels of inflammationamong black adults. “And chronic stress can make one more vulnerable to infection because it can lower your body’s ability to fight off an infection,” she says.

Chronic stress is linked to poverty — so this could be a risk factor for low-income communities. In fact, research has shown that people who report higher levels of stress are more likely to catch a cold, when exposed to a virus, compared with people who are not stressed.

According to a new survey from Pew Research Center, health concerns about COVID-19 are much higher among Hispanics and blacks in the U.S. While 18% of white adults say they’re “very concerned” that they will get COVID-19 and require hospitalization, 43% of Hispanic respondents and 31% of black adults say they’re “very concerned” about that happening.

And other aspects of structural racism could contribute to the elevated risk for black Americans.

“Every major crisis or catastrophe hits the most vulnerable communities the hardest,” say Marc Morial, president and CEO of the National Urban League. And he points to several factors that help to explain the racial divide.

“Black workers are more likely to hold the kinds of jobs that cannot be done from home,” Morial says. So, they may be more likely to be exposed to the virus, if they are working in places where it’s difficult to maintain social distancing. In addition, he points to longstanding inequities in access to quality care.

“There also is bias among health care workers, institutions and systems that results in black patients … receiving fewer medical procedures and poorer-quality medical care than white individuals,” he says. He says an expansion of Medicaid into those states that still haven’t expanded would be one effective policy to address these inequities.

The characteristics of the communities where people live could affect risk, too especially for those who live in low-income neighborhoods. The roots of chronic illness stem from the way people live and the choices that may or may not be available to them. People who develop the chronic illnesses that put them at higher risk of COVID-19 often lack access to affordable and healthy foods or live in neighborhoods where it’s not safe to play or exercise outside.

“Let’s take a patient with diabetes for example. They are already at high risk for COVID-19 by having a chronic condition,” says Joseph Valenti, a physician in Denton, Texas, who promotes awareness of the social determinants of health through his work with the Physicians Foundation.

“If they also live in a food desert, they have to put themselves in greater risk if they want access to healthy food. They may need to take a bus, with people that have COVID-19 but aren’t showing symptoms, to get access to nutritious food or even their insulin prescription,” he says.

Poor nutrition, and the obesity linked to it, is a leading cause of premature death around the globe. And, this pandemic brings into focus the vulnerability of the millions of people living with lifestyle-related, chronic disease.

“We’re seeing the convergence of chronic disease with an infection,” says UNC’s Beck. And the data suggest that the combination of these two can lead to more serious illness. “We’re seeing that obesity can have a great influence on infection,” she says.

So, will this shine a spotlight on the need to address these issues? “Hopefully,” Beck says. “I think paying attention to these chronic diseases like obesity is in everybody’s best interest.”

Source: Who’s Hit Hardest By COVID-19? Why Obesity, Stress And Race All Matter

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How the language of migration put expats on a pedestal – and left immigrants in the dust

2020/04/20 Leave a comment

Good discussion on the changing meanings of immigrant, migrant and expat. The greater distinction, in my view, is between immigrant and migrant/expat, as the former means settling more or less permanently with a more formal pathway to citizenship, whereas migrant/expat is more temporary, with the distinction being more with respect to socioeconomic status:

Growing up in Hong Kong, I was constantly surrounded by people from around the world. From the UK to South Africa and Canada, I was exposed to a number of different cultures in my day-to-day life, especially in school. But it wasn’t until middle school, where acquaintances would casually use two distinct terms to define either affluent or poorer areas of the city, that I really began to take notice of the significance of the language of immigration.

Based on what I observed, it was clear that whenever someone referred to a person as an “expat”, they generally tended to be middle to upper-class native English speakers, working in professions such as banking, tech, education or creative roles. When it came to the word “immigrant”, the term tended to apply loosely to both blue-collar workers, and those desperate to flee their birth country in order to make “a better life” for themselves.

Around a month ago, while FaceTiming a friend who had just moved back to Singapore from London, the extent of those differences became even more pronounced. In the middle of our chat, he mentioned a print magazine called Expat Living, and how bizarre it was that among other publications, it was still considered a best-seller in the country despite the dying print media industry. It led me to think about the marketing power of the word “expat” – clearly a symbol of financial value in society. It placed them on a uniquely aspirational pedestal.

Expats are praised for daring to move to a new country, while immigrants feel pressured to get approval from citizens and assimilate for survival. Whether it’s a conscious or subconscious decision, there’s no denying that these terms represent the double standards in society’s view on immigration. It’s not so different here in London, where even after seven years of living here, I’m still confronted by the same forms of hypocrisy, especially in the language the media uses in stories about immigration. Prior to this pandemic, for example, a simple search for the terms “immigrant” would typically pull up more divisive and sensationalist headlines.

In popular media, the word “immigrant” often showcases individual storylines of struggle, hard work and overcoming hardships. On Instagram, a search for accounts and posts hashtagged with “immigrant” reveal feeds of documentary-style visuals and text about sacrifice and injustice. Clearly, there’s a heavy sense of activism connected to the immigrant experience in the media, in contrast to the image of luxury and privilege that is seen to come with being an expat.

Why? When it comes to the way people treat both groups, the narratives the words we use to describe create an unconscious bias. There’s a general feeling that immigrants are associated with negative qualities about their birthplace, whereas expats are commended for living in a country outside of their own. The meanings we’ve ascribed to these words have a lot to do with connotations about certain races and class systems.

Look at the etymology of the word​ “expat” (the short form of “Expatriate”), for example. It derives from the Latin terms “ex” (out of) and “patria” (fatherland). By definition, an expat is just someone who moves to live in a country they weren’t born in. Interestingly, the term was most commonly used in the 20th century to describe British servants who were often sent to work abroad against their will. According to Sophie Cranston, a lecturer in human geography at Loughborough University​, who spoke to The Atlantic about the changing meaning of terms like expat, it was only in the early 90s, that it came to mean what it does now: a descriptor for (typically wealthy) westerners living abroad.

With immigration being brought up more on social and mainstream media, it’s also important to note that these terms are being reclaimed. The term “migrant”, which is sometimes used in place of “immigrant” and often bears the same connotations (although the definitions vary from place to place), seems to have been reclaimed.

In 2015-16, immigration became the hottest political topic in the UK due to the European migrant crisis and Brexit. The Leave campaign heavily focused on villainising immigrants in the media, using anti-migrant propaganda and anti-migrant sentiments to create fear towards them, which subsequently led to their unfortunate victory.

The negativity has since inspired a rise of people from immigrant backgrounds to create movements reclaiming and redefining the meaning of being an immigrant. Groups like Migrants in Culture and Migration Collective are both optimistic examples of how immigrants have used the power of art, statistics, and culture to express different realities and examine issues regarding immigration in the UK.

Migrant Journal, a monthly print and digital magazine with a social media platform that focuses on the experiences of people, goods, and information around the world and the positive impact they have on various spaces, has also embraced the word “migrant”. The design of their issues are illustrative, with cerebral stories and minimal details that bring a smart and thoughtful impression to “migrant” labels. They’ve shown that beyond the stories of people, other things such as objects, spaces and fine art can express the immigrant experience in media in a highbrow manner.

Contrastingly, there’s a rise in using social media to poke fun at “expat” realities and stereotypes. For instance, the popular meme Instagram account @hkmehmeh was founded by a Korean woman who identifies as an expat living in Hong Kong. Her account uses popular internet culture with a mix of Cantonese slang and relatable “Hong Kong” sayings to create humorous memes that put a light-hearted spin on living in the city from an expat perspective. The account’s satirical integration of expatriate stereotypes and local culture makes it entertaining for all people who reside in the city – there’s no discrimination with her memes. As a Korean expat, her presence is inadvertently broadening the image of “expat” and diminishing the assumption that expats can only be white people.

While these labels once showed the double standards of the language of migration, they’re beginning to break away from strict definitions. By forging cultural visibility for terms like these, we create opportunities for more open conversations about questioning the need for labels, their effect on our unconscious bias and reclaiming these terms in a positive way.

Platforms that enable positive outlooks on reclaiming negative labels can unite people rather than split them apart. Hopefully, more of this kind of action will allow people to see that regardless of your identity, anyone who immigrates to another country shares more similarities than differences and that labels shouldn’t limit or define anyone in what they want to achieve.

Source: How the language of migration put expats on a pedestal – and left immigrants in the dust

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Critics say more action needed from Alberta government on immigration issues in wake of public opinion survey

2020/04/18 Leave a comment

Reflects the overall more conservative rural base and while the difference with other provinces is significant, there is less polarization than portrayed in the article. The UCP government, like most provincial governments, is generally pro-immigration:

Almost half of Albertans feel that there is too much immigration, a major increase over the national average. But advocates say the Alberta government has not done enough to curve that discrimination.

According to the Canadian Public Opinion on Immigration survey conducted in 2019 by the Environics Institute, 42 per cent of Albertans feel there is too much immigration. This is nine per cent more than the national average, with British Columbia at 30 per cent and Saskatchewan at 34 per cent.

The survey was based on telephone interviews conducted via landline and cell phones with 2,008 Canadians between Oct. 7 and Oct. 20, 2019. The results are accurate to within plus or minus 2.2 percentage points in 19 out of 20 samples.

These results don’t come as a surprise, as Alberta has made headlines for its anti-newcomer sentiments.

In 2016, an article from the National Post reported that a Calgary school was vandalized with anti-Syrian and anti-Trudeau graffiti. These messages included “real Canadians hate Syrians” and “burn all mosques.”

A similar story happened later in 2016 when a Calgary man spray-painted anti-Syrian graffiti to a Calgary LRT station because he was “mad at ISIS.” According to the CBC, the man later apologized in court and stated he had “changed his views.”

Two years later, a video of a woman shouting at a group of men in a Lethbridge Denny’s was uploaded to Facebook. The video shows the women yelling things such as, “Go back to your own f–ing country. We don’t need you here,” and “You’re not Canadian.”

The group of men she was yelling at were of Afghan background.

That anti-immigrant sentiment continues to this day. Dina Farman – an immigrant who moved to Alberta in 2006 – says she still faces discrimination.

“I worked in retail. I know how some people don’t like immigrants,” she says. “And even with me actually, I have black hair and [an accent], and some people give you that look like you’re not welcomed or something.”

One group that has been accused of making newcomers feel unwelcome is the Yellow Vests, a movement that has members in Calgary. The group was inspired by the “gilet jaunes” protests that began in France in 2018 as a result of high gas prices and the rising cost of living there. The movement there has been linked with outbursts of racism and anti-semitism.

But, in Canada, the Yellow Vests Facebook page says the group was created to “protest the CARBON TAX, Build That Pipeline and Stand Against the Treason of our country’s politicians who have the audacity to sell out OUR country’s sovereignty over to the Globalist UN and their Tyrannical policies.”

This movement is also known for opposing the presence of some newcomers in Canada and have been associated with racist and xenophobic behaviour and comments. In Calgary, members advocate for an end to what they describe as illegal migration while supporting immigration of “people who share our democratic values.”

One member of Yellow Vests Calgary — who wished not to be identified to prevent media scrutiny — says that for her, migration and immigration are different. Migrants and refugees have created some negative experiences for her, while the immigrants who “are willing to integrate are a joy.”

“I would consider immigration to be something that’s embedded, that we are choosing people that are going to help us economically, that are going to contribute and integrate and that they’re going to become Canadian. That’s a good thing for this country.”

“But then you have a large faction of people that come, that aren’t integrating and they’re clinging to a nation for which they’ve kind of turned away from but haven’t really [given up],” she says.

“If there’s an idea that they’re bringing with them [from] wherever they’ve come from, and it doesn’t fit with the morals and values of the country that you’ve chosen to come to, then that’s the challenges you face as an immigrant.”

Abdie Kazemipur, a professor at the University of Calgary who studied the socio-economic experiences of immigrants in Canada, says this is a very common argument. However, he says every time there is a pressure by mainstream institutions or populations to force immigrants to adopt their mainstream values, it actually backlashes.

“Even if immigrants [integrating] into the mainstream values and cultures is the desired outcome, the way to achieve that is by opening the society to them and giving them their space and allowing them to have interactions,” he says

Meanwhile, some governments in Canada are trying to reduce discrimination against refugees and immigrants.

In Manitoba, that led to the creation of their Advisory Council on Citizenship, Immigration and Multiculturalism in 2015.

Their council is similar to Saskatchewan’s multicultural council, which was founded in 1975 to raise awareness of the benefits of cultural diversity and the dangers of racism.

More recently, the United Nations Refugee Agency created the campaign #WithRefugees in order to invite cities and local authorities all over the world who are working to promote inclusion, support refugees and bring communities together to sign a statement of solidarity.

While 16 cities across Canada have signed onto this campaign to show support, no cities in Alberta signed on.

But, at a provincial level, Alberta has taken some action. In 2018, the government released a long-delayed report on anti-racism activities. At the time, Global News published an article in which Greg Clark, the now-former MLA for Calgary-Elbow, said “it just fell off the radar and we’ve heard nothing about it. So obviously there is action needed.”

After that release, the Anti-Racism Advisory Council was created as the first government organization to fight the increase of racism in Alberta. A $2 million anti-racism community grant was also introduced to do the same thing.

However, since the UCP government has come into power, there has been no update found on the Anti-Racism Advisory Council’s webpage.

The UCP government has also eliminated the Alberta Human Rights Commission’s human rights education and multiculturalism fund as of November 2019 under the recent budget cuts. This $1-million grant has helped fund anti-racism and anti-discrimination in Alberta since 1988.

Additionally, the $2-million anti-racism community grant was replaced with the multiculturalism, indigenous and inclusion grant program with a budget of $1.5 million under the UCP government. In other words, less money is now being used to address a lot more problems – just one of which would be anti-immigrant sentiment.

Sam Nammoura, the co-founder of the Calgary Immigrant Support Society, says the government of Alberta can be doing more to bring awareness towards the discrimination of immigrants.

“Instead of making a one-week event to create awareness, it should be addressed constantly,” he says.

Kazemipur, who wrote his PhD thesis on the economic experiences of immigrants and ethnic minorities in Canada, also says the Government of Alberta is taking too minimal of an approach.

“They can actually try to encourage the population to develop better views and better experiences of immigrants and minorities,” he says.

“After this happens and after this population blends into one larger population, then this distinction between immigrant and non-immigrant becomes basically meaningless. So all these negative feelings towards immigrants will disappear as a result.”

Kazemipur thinks that the best way to encourage this solution would be through educational programs that bring people together.

“Educational programs are definitely a starting point to emphasize the cultural competence and to expose people to different lives despite different cultural orientations and the values that are embedded in any of these alternative lifestyles,” he says.

“I think there could be more education in order to move people from their own comfort zones so that they can engage with people from other cultural backgrounds.”

Nada Bodagh, who moved to Canada from Iraq in 2009, agrees.

“People just don’t understand yet because they need answers to their questions,” she says. [Immigrants need to] feel they are involved so they are not isolated because the worst feeling when they are new here is feeling lonely and isolated.”

Kazemipur says that the government needs to make improvements to strengthen the bond between the population.

“The provincial government could be more proactive and could make this a priority knowing that without [social interaction] in the population, the economic plans and political plans wouldn’t succeed,”

“I think there’s a lot more work that needs to be done,” says Nammoura.

To better understand the work that is being done by the Alberta government, the Calgary Journal attempted to contact Leela Aheer, the minister of culture, multiculturalism and status of women for an interview involving the lack of programs in place that create inclusiveness for immigrants and refugees.

Instead, we received a statement from the press secretary, Danielle Murray.

“Our government is working to build a province where all people feel safe, welcome and valued. We are working with the Alberta Anti-Racism Advisory Council to determine how they can support our work to address racial and multicultural barriers in Alberta,” the statement read.

We did not receive any further response after a second request for an interview with Aheer.

Source: Critics say more action needed from Alberta government on immigration issues in wake of public opinion survey

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‘A Perfect Storm’: Extremists Look For Ways To Exploit Coronavirus Pandemic

2020/04/18 2 Comments

As they seek to exploit all issues:

For months, authorities say, 36-year-old white supremacist Timothy Wilson amassed bomb-making supplies and talked about attacking a synagogue, a mosque or a majority-black elementary school.

Then the coronavirus hit the United States, giving Wilson a new target — and a deadline. The FBI says Wilson planned to bomb a Missouri hospital with COVID-19 patients inside, and he wanted to do it before Kansas City’s stay-at-home order took effect at midnight on March 24.

“Wilson considered various targets and ultimately settled on an area hospital in an attempt to harm many people, targeting a facility that is providing critical medical care in today’s environment,” the FBI said in a statement.

The attack never happened. Wilson died in a shootout March 24 when federal agents moved to arrest him after a six-month investigation. It was an extraordinary domestic terrorism case, yet it got lost in the nonstop flood of news about the coronavirus pandemic. Extremism researchers warn against overlooking such episodes; they worry the Missouri example is a harbinger as far-right militants look for ways to exploit the crisis.

Already, monitoring groups have recorded a swell of hatred — including cases of physical violence — toward Asian Americans. Dehumanizing memes blame Jews for the virus. Conspiracy theories abound about causes and cures, while encrypted chats talk about spreading infection to people of color. And there is the rise of “Zoombombing” — racists crashing private videoconferences to send hateful images and comments.

“We know from our work in the trenches against white nationalism, antisemitism, and racism that where there is fear, there is someone organizing hate,” Eric Ward, executive director of the Western States Center, said in a statement. The Oregon-based monitoring group recorded about 100 bias-motivated incidents in the two weeks after the alleged Missouri plot was foiled.

Here are some areas extremism trackers are watching as the pandemic unfolds:

Hate crimes

A March FBI assessment predicted “hate crime incidents against Asian Americans likely will surge across the United States, due to the spread of coronavirus disease,” according to an intelligence report obtained by ABC News.

The report, prepared by the FBI’s Houston office and issued to law enforcement agencies nationwide, warned that “a portion of the U.S. public will associate COVID-19 with China and Asian American populations.” That idea has been reinforced by political leaders including President Trump, who has referred to the “Chinese virus” and variations that reference China or Wuhan rather than the clinical terms used by health officials.

Asian Americans say they have experienced hostility, with a dramatic increase in reports of racist incidents. A handful of them were violent attacks that are under investigation as hate crimes. For example, federal authorities say hatred motivated a 19-year-old Texas man who was arrested in a stabbing attack that targeted an Asian-American family at a Sam’s Club. The suspect told authorities that he thought the family was spreading the coronavirus.

Some Asian Americans have expressed fears that violence could increase once stay-at-home orders are lifted. A coalition of advocacy groups has appealed to Congress to denounce racism and xenophobia linked to the pandemic.

“This is a global emergency that should be met with both urgency and also cultural awareness that Covid-19 is not isolated to a single ethnic population,” Jeffrey Caballero, executive director of the Association of Asian Pacific Community Health Organizations, said in a statement. “Xenophobic attacks and discrimination towards Asian American communities are unacceptable.”

Recruiting out-of-school kids

Millions of young Americans are home from school, bored, and scrolling through social media sites for hours every day. To white supremacist recruiters, they’re prey.

Cynthia Miller-Idriss, an American University professor who writes extensively about far-right extremism, said the increase in unsupervised screen time at a time of crisis creates “a perfect storm for recruitment and radicalization.” PERIL, the extremism research lab Miller-Idriss runs on campus, is scrambling for “rapid response” grants to develop an awareness campaign and toolkit for parents and caregivers about the risks of online radicalization in the coronavirus era.

“For extremists, this is an ideal time to exploit youth grievances about their lack of agency, their families’ economic distress, and their intense sense of disorientation, confusion, fear and anxiety,” Miller-Idriss said. Without the usual social support from trusted adults such as coaches and teachers, she said, “youth become easy targets for the far right.”

Anti-government flashpoints

Militias and self-described “constitutionalist” factions, categorized by federal authorities as anti-government extremists, are making noise about stay-at-home orders. Some armed groups reject the measures outright, calling them unconstitutional or overreaching. Another subset is openly defiant, as if daring authorities to use force and turn the issue into a high-stakes standoff.

Over Easter weekend, Ammon Bundy, who led an armed occupation of a federal wildlife refuge in Oregon in 2016, held a service that drew some 200 people to a warehouse in Idaho. Photos showed worshippers, including children, unmasked and sitting in close quarters.

If the perceived constitutional infringements worsen, Bundy has told his supporters, then “physically stand in defense in whatever way we need to.” That kind of provocation could turn ugly quickly, warn monitors of the anti-government movement.

Calls for violence

Extremism monitors are keeping tabs on so-called accelerationists, a subset of the racist right that believes in using violence to sow chaos in order to collapse society and replace it with a white nationalist model.

The Southern Poverty Law Center, an extremism watchdog group, has said, “Accelerationists consider themselves the revolutionary vanguard of the white supremacist movement.” In chat forums, they’ve discussed using the virus to infect people of color, staging attacks on medical centers and other forms of violence they hope will trigger a domino effect leading to the breakdown of society.

“These far-right extremists are arguing that the pandemic, which has thrown into question the federal government’s ability to steer the nation through a crisis, supports their argument that modern society is headed toward collapse,” wrote Cassie Miller of the Southern Poverty Law Center.

Miller wrote that, for now, the fallout is already so chaotic that the accelerationists are content to watch, reckoning, “the situation seems to be escalating on its own, requiring no additional involvement on their part.”

Miller cited a white supremacist podcaster who told his followers: “It seems to be going plenty fast, thanks.”

Source: ‘A Perfect Storm’: Extremists Look For Ways To Exploit Coronavirus Pandemic

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Corak: COVID-19 is not the great leveller. It’s the great revealer

2020/04/17 Leave a comment

Great and accurate commentary by Corak:

In a medical sense, COVID-19, as highly contagious as it is, can be thought of as the great leveller. No one has immunity, and we face the health risk of this virus with a sense of our common humanity.

But in a socio-economic sense, it is not as contagious. The jobs some of us hold give us an economic immunity, and we face the economic risk of this virus with a very different sense of our interconnectedness.

Last week Statistics Canada reported that more than one million jobs were lost as social distancing and mandated work shutdowns took force. A further two million people saw their hours of work fall dramatically, implying that over three million Canadians were directly impacted.

The big hope, the hope upon which the entire government response rests, is that the COVID-19 economic shock will be temporary. The goal is to freeze the economy until the winds of illness pass by, allowing us to start again where we left off. Public policy is focused on the challenge of adjustment and rebound.

But Statistics Canada’s look into the socially distanced economy also reveals longstanding inequalities that have been growing wider and wider for decades.

For many families, the bottom end of wage inequality means an insecure standard of living and lower prosperity for the next generation.

The usual economic parable claims that this is the price paid to foster growth, and eventually more prosperity for everyone. We need to adjust to win.

The market has sent a signal: tool up, get better skilled, move elsewhere and move onward. The next and better job is just around the corner!

And after all, if you have a job, even if you need more than one to stay afloat, there is always a sense of hope, a shred of dignity, the aspiration of a better tomorrow. Income inequality is easier to ignore in a full employment economy.

But the great revealer has arrived in the form of a virus, its economic fallout showing almost perfectly the divides between those who are vulnerable and those who are not.

Now, some of us do work that is not public-facing.

Some of us do work that is flexible and supported by technology and computers.

And of course some of us do work that gets us an income well above average, offering security, health, a home with space, and a comfortable family life.

This work gives us an economic immunity.

What is the big deal about working at home if you normally spend half your time working from an airplane seat?

But underlying Statistics Canada’s report are some dramatic differences.

The employment change among managers and those working in professional, scientific, or technical jobs was “decimal point dust,” but 300,000 people working in accommodation and food services lost work, a fall that wiped out 20 years of growth.

The foot soldiers in this very first economic battle against COVID-19 were the young and women, those who work in part-time and temporary jobs, with no union contracts and lower wages. Students and those who were already unemployed were also out of luck finding their next job.

Now that we are collectively facing a health risk that is spreading across space, we’ve been given the opportunity for empathy with many people who individually confront risks that repeat over and over again during the course of their lives, an accumulation of bad draws over time that leads to lower and more precarious incomes, housing that is less stable and of lower quality, families that are less secure.

In much of this there is no question of merit and just desert, it’s just bad luck.

It is nice for premiers and prime ministers to thank truck drivers and grocery store clerks for their essential work, but it will be hypocrisy of the highest order for our governments to only hope to start up again where we left off.

Inequality has been robbing many Canadians of security, prosperity and dignity for decades. That is what COVID-19 reveals.

No, we don’t just have an adjustment problem. We have — as we have long had — an inequality problem.

Source: ContributorsOpinionCOVID-19 is not the great leveller. It’s the great revealer

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Weaponizing the ‘paradox of prevention’

2020/04/17 Leave a comment

Interesting and relevant article by Max Fawcett:

Amid all the bad news being generated by COVID-19, it’s only human to try and find the silver linings. And when it comes to the current crisis, there’s a school of thought that suggests the lessons we’re all learning right now about self-sacrifice, social solidarity and mutual interest can be applied to the fight against climate change.

“We are learning, overnight, that simplicity isn’t necessarily austerity, frugality need not be privation, and that we can forgo quite a lot of our leisure and consumer entitlements if it serves some higher purpose,” The Intercept’s Charles Komanoff and Christopher Ketcham wrote in a recent piece.

With trillions of dollars of stimulus already sloshing through the global financial system, and more surely on the way, there’s even a hope that we can use this moment to build both a greener economy and a low-carbon lifestyle. “If our society can act, finally, to manufacture a million ventilators and a billion protective masks,” Komanoff and Ketcham suggest, “surely we can within a few years act on a far grander scale to erect, say, 1,000,000 wind turbines, insulate and solarize 100,000,000 buildings, carve ribbons of bicycle paths throughout our cities and suburbs, and so on.”

I wish I could share that hope. But I’m afraid that the opposite may turn out to be true, and the sacrifices we’re all making to limit the spread of coronavirus will only make it harder to do what’s needed to fight climate change.

That’s because there’s a catch-22 at work here, which is that the better we do at flattening the curve on this virus, the more people will question whether we ever needed to try so hard in the first place. As Emilie Mazzacurati, the founder and CEO of a California-based climate risk data firm Four Twenty Seven told Forbes recently, “if you do things right, it means you’re never proven right because you’ve prevented bad things from happening.”

In the comparatively genteel world of public health, this is sometimes known as the “paradox of prevention.” As the U.S. Institute of Medicine’s Harvey Feinberg noted in a 2014 presentation at the Johns Hopkins Bloomberg School of Public Health, there are a number of factors that stand in the way of efforts to prevent a negative health outcome rather than responding to it.

Some, like the long delay before rewards appear, and the fact that the benefits of prevention don’t always accrue to the person who paid for it, are unavoidable realities. Others, like the acceptance of avoidable harms as normal or conflicting with commercial interests, are reflections of our less admirable traits as human beings. But together, they make it far more difficult to take preventative action than it should be.

Those factors were on full display during a recent segment of Laura Ingraham’s television show on America’s response to COVID-19. In it, the Fox News provocateur called attention to the fact that the shortages of ICU beds and ventilators that public health officials had been warning about have yet to materialize. But rather than attributing that to the belated social distancing efforts that have been underway for weeks now, she blamed the models that informed them. “Americans should be furious about this,” she said. “This is a lot of money that we’re spending on a response that was based, again, on faulty numbers.”

The Toronto Sun’s Candice Malcolm also pulled on that thread in a recent column, arguing that “before we further destroy the economy and cause endless misery and suffering as Canadian businesses fail and families lose their homes, we should make sure the so-called experts we’re relying on have thoroughly double-checked their work.” And in an echo of her frequent criticism of anything to do with climate change and efforts to actually front it, she suggested that “the science is not yet settled on coronavirus.”

Indeed, for those who have made undermining the scientific consensus around climate change their life’s work, the disparity between the forecasted impacts of COVID-19 and its reality (so far, at least) will present an irresistible opportunity to cast further doubt on the wisdom of collective action and sacrifice. It will also serve as a template for how they’ll frame the efforts to fight climate change that are already underway.

Proactive climate policies, and the politicians who implement it, won’t get credit for the major hurricanes that don’t happen, the droughts that are averted, or the heat waves that aren’t as intense. They won’t get credit for the economic benefits associated with averting those outcomes either. Instead, they’ll get blamed for having warned people that they could happen in the first place—and for having spent money trying to avoid outcomes that never came to pass.

So how do we escape this paradox? When it comes to public health, Dr. Fineberg suggests using “multiple media channels to educate, reframe and elicit positive change.”

But as we’ve learned over the course of the Trump presidency, mere facts tend to get swamped by the hurricanes of bad-faith bluster that people like Ingraham and Fox News routinely whip up. Paying people to take preventative measures, and thereby effectively making prevention cheaper rather than free, is a more viable strategy, and it’s one that informs the push for carbon pricing. But as we may be about to learn with COVID-19, it’s hard to get people to respond to a threat when they can’t see its worst impacts—and when others insist on telling them they don’t even exist.

Source: Weaponizing the ‘paradox of prevention’

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Being Counted in Canada’s Coronavirus Data, Ontario’s lack of diversity data for COVID-19 is an embarrassment

2020/04/17 Leave a comment

Two good commentaries on the lack of diversity data, starting with Howard Ramos of Dalhousie:

The lack of COVID-19 data on immigrants and racialized minorities collected and shared by Canada’s many layers of government could lead to health inequities.

Canada is not alone in having a data gap on immigrant and racialized groups. In the United States civil rights groups and doctors have called on its federal government to release demographic data on coronavirus infections.

Analysis that looks at the number of COVID-19 cases based on publicly available American data and census information shows that counties that are majority African-American have three times the rate of infection and almost six times the rate of deaths as counties where white residents are in the majority. It is a trend that has raised alarm across American cities.

Understanding Canada-U.S. differences

Past research suggests, however, that Canadians should be cautious in reaching conclusions and not automatically assume that what takes place in the U.S. naturally holds true north of the border.

The ‘healthy immigrant effect’ debate, for instance, which shows that many newcomers to the country self-report better health than native-born Canadians may mean that immigrants, who are also largely racialized, may not follow the same patterns as seen in the U.S.

What is needed to answer that question, and many others, is access to quality data. And just like personal protective equipment – it is currently in short supply.

Part of the problem in capturing immigrants and racialized groups in health data rests with how they are captured. Health data is largely the domain of provinces and territories, leading to uneven data collection and reporting across them.

When asked if Ontario could offer insights on the pandemic’s impact on racialized communities, Dr. David Williams, the province’s chief medical officer of health, noted that “statistics based on race aren’t collected in Canada unless certain groups are found to have risk factors.”

Ironically, if data are not collected, one cannot tell if a group has risk factors to begin with. This could lead to health inequities for African-Canadian, Indigenous, racialized, and other new Canadians.

That scenario is a big reason why the African, Caribbean and Black Network of Waterloo Region recently launched a petition demanding that data on race, ethnicity, sexual orientation, and socio-economic status be collected and reported on.

Data gap flows all the way to Ottawa

The data-gap is also seen at the federal level too. For instance, the new and innovative crowd sourced survey on the social and economic impacts of COVID-19 run by Statistics Canada measures age and gender but not other demographic features. The same absence is also seen in the Public Health Agency of Canada’s ‘detailed confirmed cases of coronavirus disease’ data, which is hosted by Statistics Canada.

The detailed data does not provide geo-coding or additional information on the location of the cases which means that researchers cannot link it to census tracts or other geographic units to do the kinds of analysis that was done for American communities.

As a result, the maps offered through the interactive Canada’s COVID-19 Situational Awareness Dashboard are fairly coarse. In many cases, more detailed information can be found through non-governmental sites such as ViriHealth. But, once again, sociodemographic characteristics are not provided and the location data is where people are treated over where they live.

Lastly, once Canada begins to move towards recovery, Statistics Canada’s data on job loses and employment can report on immigrants and racialized groups. Much of this data is collected through the Labour Force survey, which is good news. It’s only logical that measures of health and wellbeing be captured with the same level of detail.

If there’s one thing silver lining to Canada’s experience during the COVID-19 pandemic, it’s reinforcing the point that collecting data matters. It’s essential to insure that everyone, regardless of race or ethnicity, is treated equally as citizens.

Source: newcanadianmedia.ca/being-counted-…

Secondly, the Ontario situation by Adam Kassam a Toronto-based physician:

The United States recently earned the unfortunate distinction of having the highest number of COVID-19 cases in the world, at more than 575,000. The true number of infected individuals, of course, is likely much higher given the lack of widespread and available testing.

But in that U.S. data, an alarming trend emerged: The coronavirus appeared to be disproportionately killing African-Americans. Last week, the Centers for Disease Control and Prevention (CDC) released a preliminary report suggesting that there were higher rates of hospital admissions and death among black Americans compared with other communities.

These revelations have intensified a nationwide conversation on the social determinants of health and the necessity to collect better data. The CDC report is far from comprehensive, which has led to presumptive Democratic nominee Joe Biden calling on the organization to be more transparent by releasing more information. Even U.S. President Donald Trump has expressed concern, and instructed his African-American Surgeon-General, Dr. Jerome Adams, to formulate a federal response to address the problem.

This discourse about diversity data and its impact on racialized communities in the U.S. stands in sharp relief against the Canadian experience. Last week, Dr. David Williams, Ontario’s Chief Medical Officer of Health, summarily dismissed calls for the collection of racial data. He asserts that statistics on race aren’t collected unless certain groups are found to have risk factors, and that “regardless of race, ethnic or other backgrounds, they’re all equally important to us.”

We have a problem in this country when Donald Trump sounds more progressive about racial disparities than our own public health officials. Imagine if our Chief Medical Officer of Health claimed that it wasn’t important to collect gender-based data? This would be a fireable offence. It is, therefore, inconceivable that this same official, in the country’s most diverse province, would willfully choose to effectively ignore the unique needs of the nearly four million visible minorities who call Ontario home.

This is the manifestation of structural and systemic biases that have been omnipresent within our medical community for generations. Canada’s poverty of diversity data has been an indefensible blind spot, both in terms of health care and in our educational institutions. It is the symptom of an insidious disease, whose current hallmark is a leadership that looks increasingly less like the communities which it serves.

How else could you explain the dearth of visible minorities in some of the top leadership roles in health care across Ontario? Public Health Ontario’s executive does not appear to include a single visible minority. A visible minority has never served as Ontario’s health minister. And because diversity data of this nature is not collected or made public, we don’t know how many deputy ministers of health, deans of medicine or chiefs of medical departments have represented diverse backgrounds.

In many ways, you only measure what you really care about. Ontario’s Chief Medical Officer has unfortunately made that very clear. Never mind that collecting race-based data wouldn’t be an onerous task; crucially, it is part of good science. Only by intentionally studying diverse populations have we learned that women experience certain health challenges, such as heart attacks, differently from men. In the same vein, disease has been shown to manifest differently for patients from different ethnic backgrounds. It is my belief that all people deserve to know the details of their lives and to know that their lives are worthy of study.

While we don’t know whether racial differences influence COVID-19′s effect on individuals, Canada should be invested in determining this definitively, instead of taking its cues from the World Health Organization.

Early reports from the U.S. have pointed to disadvantaged and marginalized groups – the poor, immigrant, black and brown communities – being more significantly affected, and this has prompted crucial scrutiny of the deep and enduring fault lines between the haves and have-nots. Yet we cannot have those conversations here, as we cannot know whether the U.S. data reflect Canada’s, even though just a border separates us.

In Canada, where we are quick to declare that diversity is our strength, we must now dispense with the empty platitudes and put our money where our mouth is. Our governments should openly commit to funding the collection and publication of diverse health data during and after this pandemic. Their explicit goal should be to create policy that improves the health care of all its citizens. What’s clear is that this ethos will only become a priority when our medical leadership more closely reflects the Canada of today.

Source: Ontario’s lack of diversity data for COVID-19 is an embarrassment: Adam Kassam

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New Survey Highlights Racial Disparities In The Coronavirus Pandemic

2020/04/16 Leave a comment

Yet more evidence:

A Pew Research Center survey conducted this month among 4,917 U.S. adults found that 27% of black people personally knew someone who was hospitalized with or died from COVID-19, compared to just 1 in 10 white and Hispanic people.

The results highlight how coronavirus is disproportionately affecting lower-income people of color.

The survey asked people how concerned they were about contracting coronavirus; of those polled 24% say they are very concerned about getting the virus. Of that group, one-third had lower incomes, versus just 17% classified as upper-income. Of that very concerned population, 43% were Hispanic, 31% black and 18% white.

Differences in income and race were also highlighted in responses to a question that asked people how concerned they were about unknowingly passing on the virus to others. Thirty-three percent of people surveyed said they were very concerned about passing on the virus without knowing; that percentage was composed by nearly half of Hispanic adults and 38% of black adults, compared to 28% of white adults. Thirty-eight percent of those very concerned that they could pass coronavirus to others unknowingly were lower income.

In the last weeks in places like New York city and Chicago, officials have reported people of color dying at higher rates from coronavirus compared to white people. Experts say this isn’t because minorities are biologically predisposed to the disease, but as Dr. Jerome Adams, the U.S. surgeon general, said at the White House briefing last week, people of color are “more likely to live in densely packed areas and in multigenerational housing situations, which create higher risk for spread of highly contagious disease like COVID-19.”

Source: New Survey Highlights Racial Disparities In The Coronavirus Pandemic

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Study aims to uncover who is most vulnerable to coronavirus

2020/04/15 Leave a comment

Hopefully, will be broader than just age and gender and include socioeconomic and ethnic origin characteristics:

For infectious disease experts, one of the most intriguing mysteries about COVID-19 is why there is so much variation in the virulence of the disease, particularly among people in different age groups – including children, who rarely experience severe illness.

While it’s been clear since the beginning of the pandemic that the elderly or those who have chronic medical conditions such as hypertension or diabetes are at higher risk of getting a severe case of COVID-19, it is also true, based on worldwide data, that there are some cases of healthy young adults as well as children, who are becoming critically ill.

“The question is why,” said Lisa Strug, associate director of the Centre for Applied Genomics at the Hospital for Sick Children in Toronto. “That’s where we believe we’re going to get some insight from genetics.”

Now Dr. Strug and her colleagues have launched a cross-Canada initiative to sequence the DNA from a large number of individuals who have been infected with COVID-19. The project, which is partly funded through private donation, will make its data widely available with the goal of identifying genetic variations that are relevant to the severity of the disease and that could help inform treatment.

Key to the project is the question of age and its relationship to the progress of a COVID-19 infection.

“We are looking at the entire spectrum – from birth to over 70 – otherwise you might not get the full picture,” said Upton Allen, the hospital’s head of infectious disease, who is co-leading the effort with Dr. Strug.

Disease modellers have been starved for information about the character and prevalence of COVID-19 in the young. Evidence suggests that most children who are exposed to the virus will have only had mild symptoms or none at all. However, they may still be transmitting the virus to others. This means children could be an important factor in the community spread of the disease – a detail that is difficult to capture in forecasts that could help determine when physical distancing measures can be lifted.

While there have been theories about why the disease has the age profile that it does – a profile not seen in influenza, for example – researchers are looking to ground those ideas with hard data.

“It’s humbling,” said Jesse Papenburg, a pediatric infectious disease specialist at the Montreal Children’s Hospital. “It seems that many of the things we thought we knew about respiratory infectious disease in children don’t seem to be playing out that way with COVID-19.”

Dr. Papenburg is among the collaborators that the Toronto group has already reached out to in order to gather a diverse set of genetic samples for the study.

Because a patient’s genes do not change after the disease has come and gone, Dr. Allen said the project will be able to obtain genetic data from individuals who were ill and in hospital but are now recovered. The study will include a control group of individuals who were infected but who did not experience serious symptoms.

Some of those controls will be drawn from family members who live in the same household as those who became ill but who, for whatever reason, were spared despite a similar level of exposure. In that situation, Dr. Allen said, the strategy will be to find the family member who is most distantly related (such as a spouse) to see what genetic differences turn up.

Dr. Strug said the study will involve reading and comparing the entire DNA sequences of large numbers of individuals, and using statistical tools to see which variations may correlate to different responses to the COVID-19 virus. Researchers will also focus on genes that are linked to specific pathways in the immune system or that relate the way the virus attacks cells.

The project’s original aim was to sample the genomes of at least 1,000 people who have been infected with COVID-19, but that was before it was clear how extensive the outbreak would become across Canada.

“Unfortunately, access to individuals that are symptomatic is not going to be a challenge,” said Dr. Strug, “so I think that we are going to far exceed a study of 1,000.”

She added that initial results could emerge within the next six to 12 months. Parallel projects supported by the British-based Wellcome Sanger Institute and the Howard Hughes Medical Institute in the United States are also under way.

Stephen Freedman, a clinical scientist with the Alberta Children’s Hospital Research Institute in Calgary who is not involved in the genomic studies, said they would yield important information and potentially answer some of the biggest questions surrounding COVID-19. However, he added, COVID-19 is outpacing research to an extent that some of those answers are more likely to inform the next pandemic.

Dr. Freedman is leading a separate study that will combine Canadian and international data to help health workers spot COVID-19 in children and better predict which cases will likely require hospital care, as well as determine what interventions are most effective.

“Trying to glean out that data is really crucial to coming up with management strategies in real time,” he said. “Even though children do better than adults, there are still a host of children who do poorly and there are children who die,” he said.

Source: Study aims to uncover who is most vulnerable to coronavirus

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Do COVID-19 Racial Disparities Matter? Opinion versus evidence

2020/04/15 Leave a comment

The wilful blindness of dissociating race with socioeconomic factors.

Opinion, rather than any hard analysis, compared to more evidence-based work by the CDC CDC Hospital Data Point To Racial Disparity In COVID-19 Cases and the Associated Press Outcry Over Racial Data Grows as Virus Slams Black Americans:

There is now a racial justice angle on the coronavirus pandemic. Ibram X. Kendi, Director of Antiracist Research at American University, led the charge in the Atlantic a week ago, calling for data on COVID-19 deaths broken down by race. Nikole Hannah-Jones (whose work Wilfred Reilly mentioned in this space back in February) followed up with a Twitter thread documenting the disparate impact the virus has had on black Americans. Dr. Anthony Fauci, America’s top immunologist, hit a similar theme in a recent press conference. To sum up the argument: Black people make up roughly 14 percent of the American population, but far more than 14 percent of Americans killed thus far by COVID-19.

According to one view, this racial disparity amounts to evidence of systemic racism. But the argument rests on the false presumption that, in the absence of racism, we would see equal health outcomes by race. The data suggest otherwise.

In fact, blacks are more likely than whites to die of many diseases—not just this one. In other cases, the reverse is true. According to CDC mortality data, whites are more likely than blacks to die of chronic lower respiratory disease, Alzheimer’s, Parkinson’s, liver disease, and eight different types of cancer. The same thinking that attributes the racial disparity in COVID-19 deaths to systemic racism against blacks could be applied equally to argue the existence of systemic racism against whites.

In some cases, there are obvious biological reasons for racial disparities in disease. Melanin content alone might explain the racial disparity in skin cancer, for example. But in other cases, the source of the disparity is mysterious. Why are whites more likely to die of Alzheimer’s? We don’t know. What’s important is that disparities between groups are not abnormal and are not, by themselves, a sign of any deeper societal malady.

A softer version of the above-described argument would concede that racial disparities in COVID-19 don’t prove anything by themselves—but would point to the various risk factors that nevertheless make black Americans more susceptible to COVID-19. Blacks are more likely to work in the service sector, for instance, which means they have more opportunities to contract the virus. Moreover, blacks are more likely to suffer from diabetes, asthma, obesity, and hypertension, all of which make the virus more deadly. Moreover, black Americans are less likely to have access to high-quality health care, and are more likely to live in areas that are served by over-burdened hospitals and emergency-response services.

But if we are going to discuss underlying risk factors, we should discuss them directly rather than immediately using race as a proxy. Focusing on age makes sense, because it has been obvious since early on that the elderly face a far higher COVID-19 case fatality rate. Focusing on people with pre-existing medical risk factors makes sense for the same reason. But absent some hitherto undiscovered genetic factor, focusing on race makes about as much sense as focusing on, say, religion. If anyone bothers to look, there will probably be disparities between Catholics and Protestants. Yet no one will feel the need to mention these at a press conference, and our public health efforts will not suffer as a result.

The fact is that our culture is obsessed with race. Part of this stems from a sincere desire to help the less fortunate, who are disproportionately black. But much of it stems from a deeply felt shame over the sins of history—slavery, Jim Crow, and all that followed. As a result, anything vaguely resembling a concern for black suffering is applauded—and no further questions are asked.

The House Democrats’ proposed coronavirus relief bill included a provision requiring that federal government agencies use as many minority-owned banks as possible, and another provision requiring corporations to maintain staff and budgets dedicated to “diversity and inclusion” for at least five years as a condition of receiving emergency funds. It is hard to see how either policy helps the less fortunate, much less why such non-urgent provisions are appropriate to include in a disaster relief bill.

On the sillier end of the coronavirus race obsession, CNN ran a story about black Americans who won’t wear masks because they fear being mistaken for criminals and killed by the police. A tweet from one black educator—“I want to stay alive, but I also want to stay alive”—received 124,000 likes.

Though the CNN article suggested that the fear was valid, it did not give even one example of a black person actually being harassed in this way, much less killed. Last year, 41 unarmed Americans were shot and killed by the police—nine of them black. Meanwhile, the coronavirus has been killing over 1,000 Americans per day. There is simply no comparison. Given how high the stakes are, the media should be disabusing people of life-threatening racial paranoia, not catering to it.

There are many lessons to take away from this pandemic, but the importance of race is not one of them. Italy, Spain, and France—all heavily white countries—have been among those hardest hit by the pandemic. British Prime Minister Boris Johnson, who possesses as much race and class privilege as anyone on Earth, has been hospitalized as a result of the virus. If there is a lesson to take away from COVID-19, it’s not that your racial identity matters, it is that ultimately all of humanity shares a common fate.

Source: Do COVID-19 Racial Disparities Matter?

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