COVID-19 Pandemic of the 21^st century

The first case  of COVID-19 was detected during the last week of 2019 in China which then spread to other countries by the first months of 2020. This virus has now infected nearly 27 crore people and killed more than 53 lakh people worldwide. (Worldometer, 2021)  Research and investigations are still going on as to how and where the COVID-19 started, however there are various popular conspiracy theories in this regards. Some of those conspiracy theories seem to be related to a part of global political power relation as well. Along with those conspiracy theories various diverse opinions are also being expressed regarding bio-medical aspects of COVID-19 virus. Although multiple solutions are claimed regarding the treatment process of COVID-19, authenticity of all of these claims have not been proven. 

Despite the conceptual contradictions in the understanding of the Pandemic, human loss and pain suffered by the people around the world is a grim reality. Many of the pain and loss have come into the light and many are still hidden or remained in shadow. The pandemic of the 21^st century have been described mainly from the point of view of science and technology. As Covid 19 is a novel virus and disease, its technical aspects required scientific research and its interpretation and management is undoubtedly important. They can never be underestimated. However its impact on the social aspect of life should also be put in spotlight. While there is a heated debate about political and global market interest behind the technical aspect of the COVID19 pandemic, the suffering of the people and the tragic consequences of COVID-19 faced by the people are ignored and neglected.

This brief article is an expression of attempt to portray the image of the pandemic seen through the eyes of the marginalized and working class people deprived of development, prosperity and opportunities.

COVID- 19 pandemic is same, but the impacts are different 

Except the deep agony of infection and death of the loved ones, social and economic damage due to COVID-19 is still to be evaluated. Similarly, the extent of the damage that may happen in the future has been speculated but exact assumption has not come to surface. This extent of human loss cannot be taken lightly despite the development and achievement of health science and technology, public health system and international structure, regulations and monitoring process in 21^st century as compared to the past. It is not hard to assume the formidable scale of loss due to COVID-19 that could have occurred had it happened in previous centuries. It is expected to have higher number of effect of the pandemic due to increasing population of the world.

Almost all the countries have evaluated the damage caused by the pandemic in the human society in their own way and is being technically evaluated at the international level. The data of the infected and the deceased is being updated regularly in national, regional and international level and is easily accessible to all. But the number of infection and death alone cannot measure the pain suffered by the human society. Similarly, taking average of the data and its calculation cannot portray the exact damage caused because the effect of COVID-19, despite being a single disease, its scale of the damage may vary among different people and communities and such differences of damage have been experienced in reality. No one has the immunity against COVID-19 as this is the first time we humans have come across such virus. No matter one is rich or poor, living in village or big city, educated or uneducated, everyone is equally vulnerable of the risk of getting infected in view of biology and health science. However, the post COVID effect is different among different infected individuals. Being unable to cope up with the costly treatment cost, the pandemic proved to be a curse to the poor families who have to rely on low income to sustain. But still, such experiences of the citizens are dissimilar in different countries of the world depending upon political and economic environment, and country’s policy of responsibility towards citizens. Even though not infected, economic, social and psychological effects of the pandemic may totally be different on different class and cluster of people. Actual loss can come to the surface only if the sufferings of the working class due to pandemic are evaluated considering multidimensional aspect in micro level.

It is understood that no one can be totally safe from Covid-19 pandemic no matter from which country or part of the world. But it is not acceptable that the working class citizens have to undergo excessive pain and loss due to the discrimination of the system and inability of management. Discrimination between the able and unable, rich and poor at the distressful time of pandemic is shameful for the civilized society. May it be in the international level between rich and poor countries or in the national level between rich and poor citizens- it is purely injustice to the citizens not to have access to the achievement of the science and have opportunity to save live just because of being poor. Such discrimination is expressed occasionally but is not yet established in the institutional level.

COVID-19 pandemic in the context of Nepal

It was not possible for Nepal to remain untouched from the COVID-19 pandemic already spread to more than 200 countries around the world. In order to address this pandemic, Nepal took initiative to build organizational structure at different levels of the state, developed policy directives with legal provision, and strengthened the operational process of the health institutions.(Ministry of Health and Population, 2020) Without a doubt, the efforts made by the country helped in reducing the negative impacts of the pandemic, but it is still to be evaluated how far these efforts are effective and fair. Apparently, the loss experienced by Nepal due to the pandemic is not so small. However, the loss and damage are not the same for all the citizens. Covid 19 pandemic that spread in the Himalayan region, Terai region, urban area and village, has infected more than eight hundred thousand people and claimed life of more than eleven thousand people. Nepal experienced greater loss during the second wave of the pandemic. Despite that the spread rate of the transmission is comparatively slow at this time, the country is still not yet free from the risk of the infection. Be it health worker, security personnel, businessmen or entrepreneurs or be it political leaders, citizens of all sectors of the country have been affected by the pandemic and everyone has suffered the pain in their own way. But the pain suffered due to Covid 19 pandemic by the working class people who have to sweat every day to feed the family is totally dissimilar and incomparable.

Although impacts of Covid 19 pandemic to the working class citizens in Nepal are multi-dimensional, for the discussion purpose, they are grossly divided into three groups Even though these groups are interdependent on one another these groups have different policy and managerial corners. It is also very helpful to categorize the effects and the lesson taught by this COVID-19 pandemic in order to prevent the impact of such pandemics in the future.

a. Impact related to the infection of COVID-19

Mental stress caused by the pandemic in general is experienced by all, but the real mental suffering faced by the poor working class people is special and distressful. In one hand, working class people fear of losing their income source in case they get infected, and on the other hand, they are grieved with mental stress of possible financial burden of treatment if they get infected. Their concern is not merely imaginary but proven to be a reality. As the state could not manage the patients infected with the virus through a just system, the poor citizens of the country did not have easy access to the treatment of the disease. Although the stories of the loss of lives of many poor working class people being unable to access the treatment or being unable to afford the cost of treatment have been portrayed by the media, a real picture of the loss is still under the shadow. It may not have been hard for well off families to bear the high cost of the treatment which the government could not control, but it was not easy for medium class families and it certainly proved to be a curse to the poor working class citizens. Many such poor families will suffer from its long term effect. If treatment of Covid 19 available in the country were managed by the government in such a manner that the general public would have easy access and by controlling the cost, priority were given to the mobilization of the sources and have provided special discount to the working class people with low income, the burden could have been very nominal and tolerable.  Though the Government announced of free treatment, poor citizens could not avail the facilities and remained to bear the financial burden of the costly treatment. (Poudel, 2020) (Ojha, 2021) (Shah ‘Nepali’, 2021)

b. Impact related to the management of the pandemic

Like other countries, Nepal, in order to stop the expansion of infection of COVID-19, followed various public health measures including lockdown for an extended period of time. It was necessary at different times as a public health measure to maintain the distancing and contact with the people. Even though the impact of lockdown on different aspects of human life was obviously clear, government could not be sensitive and responsible enough as required towards the negative effects of the lockdown. Permanent employees and staffs who were able to work from home people who were able to bear the financial burden and to sort out alternative ways were affected economically, but the lockdown was not catastrophic for them. But for the people with the small businesses whose income was blocked, temporary employees, who lost the job, laborers and workers relying on daily wages, the lockdown imposed to control Covid 19 proved to be a misfortune.

The crisis and the pain of people due to the lockdown were not properly addressed by the government. There was not visible relief programme of the state to reduce the hunger of starved people. The sad irony about this was, the banning of distribution of free meals in public places by volunteers and voluntary organizations to help the victims. (OnlineKhabar, 2020) (Ojha, 2021) Various initiatives were taken by the industrialists to get rid of the financial loss. But even in those efforts, the needs of the labors were not adequately addressed. The government has set safety standards in the work places. But they were not effectively enforced in general and could not contribute to alleviate the economic hardships of the labors.

The pain suffered by the farmers during the lockdown is different. Lockdown did not affect agricultural production; instead it might have increased production. There was enough coverage in media about the incidences of decaying of agriculture products in the field due to lack of transportation for the access to market. However, the system did not show any concern about it despite that this problem could be easily solved. Ironically, neither the import of agricultural products nor the market demand decreased during this period. It was not a just coincidence that due to lockdown, there was no means to transport the agriculture product from the farm to the market but there was no obstacle in transportation of agriculture products for the import. If the government had organized the market by encouraging farmers to produce and facilitated transportation, it would have been a great relief to the farmers. It was also a good opportunity to discourage the import of agricultural products in the long run.

The suffering of Nepali migrant workers working abroad is even more painful. Due to the pandemic, many Nepali migrant workers working in different countries lost their jobs. According to Nepal Association of Foreign Employment Agencies, in Malaysia and the United Arab Emirates alone, 30 percent of the approximately 900,000 Nepali workers were unemployed; similarly, 20 percent of the 800,000 Nepali workers in Qatar and Saudi Arabia lost their jobs. (Mandal, 2020) According to a survey of returning workers in the Far Western region, about 99 percent had lost their jobs and returned home. (DanChurchAid, 2020) Even if it cannot be said with certainty due to lack of details at the border, it is estimated that around 500,000 Nepali workers returned home from India in March last year alone. (ACAPS, 2020) As stated in the report of the International Labor Organization (ILO), 1 lakh 27 thousand Nepalese from countries other than India were prepared  to return immediately by air and another 450,000 were willing to return to the country. (ILO, 2020) Jobs were lost, but the pain of returning home being unemployed was even greater. Even after reaching the border after enduring many hardships, they had to go through pains of not being able to be on one’s own land for quite some time (The Indian Express, 2020) and then the moments of helplessness faced on one’s own land are beyond the bounds of description. (Sen, 2020) (Katuwal, 2020) (Khabarhub, 2020) These workers are suffering because of our policy and managerial weaknesses in border and quarantine management. The pain would have been lessened if the state had been able to provide relief to the victims of the pandemic by improving management in the border and quarantine.

c. Health problems other than COVID-19:

In addition to these direct adverse impacts associated with COVID 19 pandemic, there are several other health problems experienced by the people. Many emergency patients with no access could not reach the hospital as there was no provision of ambulance service during the lockdown. Due to lack of proper management of hospitals, some patients and chronically ill people could not get timely treatment. People, rich or poor, were forced to go to private hospitals for the treatment of other diseases due to the extreme pressure of COVID 19 patients in government hospitals. Service costs in private hospitals were far beyond the capacity of poor people, financial burden of treatment was unbearable for them. The tragic news that many pregnant women have died without being able to go to the hospital has been reported in the media, (Poudel, 2020) but the other health-related side effects of COVID 19 have not been explored in detail yet.

This Pandemic is not the last one: A vision to face the challenges of the future

Human society has faced many critical crises and challenges of environmental catastrophe, famine, and violent war to save its existence and reach the stage of present development. Pandemic is one of such challenges. The ongoing Covid 19 is not the first-time pandemic human society has experienced. Throughout the history, human society had to repeatedly defend itself against the devastating pandemics for survival.  The bubonic plague, known as the Black Death, which lasted for seven years in the middle of the 14th century in Europe, North Africa and some parts of Asia, is estimated to have killed between 70 million and 200 million people. (Black Death, Wikipedia) The accuracy of this estimate can be questioned as the death toll could not be ascertained with certainty due to lack of development of information technology and systems at that time, but no matter how different the estimates may be, the death toll in proportion to the world’s population at that time was a crisis over human existence. This pandemic of plague had left many cities deserted, many settlements uninhabited. Smallpox, which has been eradicated today, had claimed countless lives for many years. One hundred years before, the last known pandemic was the Spanish flu pandemic, which spread from 1918 AD to 1921 AD, the death estimates range between 200,000 and 50 million people. With the world’s population reaching two billion in 1918, that number is certainly not small. (Palese, 2004) These are only some examples. Although many such catastrophes have been established in history, the number of small epidemics and the human toll they have caused has not been adequately mentioned due to the weak health sciences and public health systems and methods in that era.

Even a brief review of this vast field of history makes it clear that COVID 19 is not the last pandemic that human society will face. In the future, new micro-organism will cause pandemics of new nature and we will have to deal with such pandemics of different diseases technically in different ways. The nature of the pandemic may be different from scientific and technical point of view, so the method and approach of solving the problem may be different from the present pandemic. But its impact and suffering of people related with the policy and system is the same. The disparity and unbalanced burden of suffering of the poor is same. The mere research and scientific achievement to defeat the micro-organism are not the victory of human society, our success is the establishment of an equitable society and system with justice that guarantees the right to life to all the people of the world. It is not enough and necessary for a country to be rich and prosperous for building such a system, it rather depends on the vision of the leadership of the state power, the creator of the system about the social justice and direction of development. Apparently, if the impacts of current pandemic are not properly assessed with sensitivity to the suffering of marginalized and poor sections of the citizens, the state will not internalize its accountability to the people. As consequence, the pain will be even deeper and the gap between the citizens will be wider in future pandemic.

Recently, after a long time of beginning of the pandemic, the international community has become sensitive to disparity in addressing the COVID-19 pandemic and has begun to raise voice for justice to the poor people. The reflection became louder specially after development of vaccine against Covid 19, which was considered as a historical achievement in bio-medical science. When the facts were visible that poor people in the world were gradually pushed aside and deprived of access to vaccine it ignited not only the institutional advocacy on behalf of all the poor working people (ANI News, 2021) it also flared up anger against injustice and profit motive of global market at the time of human crisis . (Legge, 2021) (Al Jazeera, 2021) (Guerrero, 2021) This is positive and encouraging, but not enough. The spirit of justice and equity should be realized not only in the case of vaccine, but in overall management of the pandemic.

The issue of equity must be raised at the international level but there must also be fair management of pandemic within the country. The nature of COVID 19 disease, the inadequacy of resources in the country and the limited existing technical knowledge about the disease and the widespread misconceptions and confusions among the people are partly associated with the problem. But responsibility and accountability of the state towards the citizen, as well as leadership and managerial skills, are primarily responsible for these pain and miseries. These weaknesses are not created right now. Our incapability, inherent but hidden in the system, are only brought to the surface by the crisis of COVID-19 Pandemic. The country could not only alleviate the suffering of its citizens but also convert this crisis into an opportunity if the country could have managed the COVID 19 Pandemic with a sense of equity and justice realizing the responsibility towards the people. However, the leftist leadership in and out of power, expected to represent the working class people and speak out for their rights, equity and justice, could not demonstrate that level of qualification and ability this time. While this is a sad fact, we must also be optimistic that the Nation’s leadership will develop right vision and perspectives to manage the challenges and in responding to the pandemic in future.

References:

• COVID Live Update: 265,338,600 Cases and 5,261,621 Deaths from the Coronavirus – Worldometer. https://www.worldometers.info/coronavirus/
• Ministry of Health and Population (2020). Health Sector Emergency Response Plan COVID 19 Pandemic. Government of Nepal. https://www.who.int/docs/default-source/nepal-documents/novel-coronavirus/health-sector-emergency-response-plan-covid-19-endorsed-may-2020.pdf?sfvrsn=ef831f44_2
• Poudel, A. (2020). Private hospitals fleecing Covid-19 patients and forcing ordinary patients to pay virus safety charges. The Kathmandu Post. https://kathmandupost.com/health/2020/10/09/private-hospitals-fleecing-covid-patients-also-forcing-ordinary-patients-to-pay-virus-safety-charges
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• Legge, D. (2021). Genocide by big pharma. Millions will die https://johnmenadue.com/genocide-by-big-pharma-millions-will-die/
• ‘Stop being selfish’: Africans decry ‘vaccine apartheid’ (2021). | Al Jazeera. https://www.aljazeera.com/news/2021/8/31/prominent-kenya-health-expert-warns-against-vaccine-apartheid
• Guerrero, D.G (2021). Vaccine apartheid, a strategy of social murder. Global Justice Now. https://www.globaljustice.org.uk/blog/2021/10/vaccine-apartheid-a-strategy-of-social murder/
• नेपाल सरकार उद्योग, बाणिज्य तथा आपूर्ति मन्त्रालय ९२०७७० कोभिड् १९ महामारीको समयमा उद्योग, बाणिज्य तथा आपूर्ति क्षेत्रले अपनाउनु पर्ने सुरक्षा मापदण्ड (Protocol) सिँहदरबार, काठमाण्डौ

Dr. Sharad Onta  MD (Leningrad, USSR), MPH ( Edinburgh, Scotland), PhD (Denmark)  is currently the chair of Physicians for Social Responsibility Nepal and Country Coordinator of People’s Health Movement in Nepal. He has published several scientific publications both in national and international journals and has also served as the chair at Resource Centre for Primary Health and  assistant dean of the Institute of Medicine (IOM), and executive member secretary of Nepal Health Research Council. He is the founding general secretary of Nepal Public Health Foundation.