Closures don’t help all groups equally



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It has been more than a year since the new corona virus began to spread around the world. The spread of the infection remains high in many countries at the same time that worrying variants of the virus are spreading. Many countries have started vaccinating against Covid-19, but the availability of vaccines is limited and it is expected that it will be a long time before enough people have been vaccinated to have a significant effect on the spread of the infection.

For some time, we will have to live with continual restrictions. But the best way to reduce the spread of the infection with so-called non-pharmaceutical measures is still being debated. Much of the year has been about entire community closures. Countries closed and reopened multiple times to slow the spread of the infection. The WHO has called the closures a blunt tool.

Stefan Baral, a physician from Toronto, Canada and a public health researcher at the Johns Hopkins School of Public Health in the United States, agrees. Our risks of getting infected and getting seriously ill from infectious diseases are not the same, and the same applies to COVID-19.

– We understood from the beginning that this virus will not affect everyone in the same way, we are not in the same boat. But all efforts were focused in the same way, he says.

Stefan Baral was born in Sweden and spent his early years here, but the family moved to Canada when he was ten years old.

Stefan Baral was born in Sweden and spent his early years here, but the family moved to Canada when he was ten years old.

Photo: Marcus Rose

People working in Retirement homes, grocery stores, gas stations, the electric sector, or the like will still have to go to work and be in the community. Stefan Baral and his colleagues have shown that people from lower socioeconomic groups do not reduce mobility as much during a shutdown.

– Some have to keep society going and that is where infections end. It was like this during the first wave, and even more so during the second. This virus feeds on the injustices of society. Also in Sweden. It has nothing to do with cultural and biological differences, it is about where you work and how you live.

Data from Sweden, Canada, the United States and the United Kingdom, to name just a few, show that certain occupational groups and low-income areas have been most affected by COVID-19. Stefan Baral sees covid-19 as a network problem, that is, a contact pattern. Our contact patterns are different.

– If you live with a taxi driver or your parents, the situation will be very different than if you live alone. It’s not just about the risk of infecting yourself, but also the risk of transmitting the infection, he says.

Stefan Baral was born in Sweden and moved to Canada when she was ten years old. His family lives in Sweden. Therefore, he has a special interest in our country and the vision of the Swedish strategy. To nuance that image, he wrote a study of the measurements in Sweden.

He doesn’t want to point out which individual countries might have done differently, but he would have liked an answer that focused more on public health in general.

– There are three basic principles in public health work that I think would have helped us design efforts against covid-19. We do more for the people who need help the most, we weigh risks against all measures, and we want to involve those affected by the measures to participate, he says.

We need to improve our thinking outside of our own context when it comes to acting. If you think you are turning off so you can work from home, where will you get your food from and who will make sure you have electricity and internet?

By using these principles and looking at the data, not only at the national level but also at the local level, better measures can be created, according to Stefan Baral. If, for example, the spread of infection does not decrease in a group, then why is it?

Many countries of the western world It has focused on generalized testing for infection, but it is not enough. Expressen revealed that the tests are lowest in the socio-economically vulnerable areas of Stockholm. Surveys from, for example, the United Kingdom show that just under one in five follow recommendations for symptom testing, self-quarantine until the test result arrives, and isolate themselves if positive. The figure is lower among people with low income or low savings capital. Stefan Baral and his research colleagues have written in the scientific journal BMJ about how the opportunity to follow the recommendations is closely related to livelihoods and that special measures are needed to reduce the spread of infection in groups with a level lower socioeconomic level.

– We must improve our thinking outside of our own context when it comes to measurements. If you think you are turning off so you can work from home, where will you get your food from and who will make sure you have electricity and internet? I can certainly list 30 things that you will still need even if you work from home, he says.

Photo: Anette Nantell

There are three measures that all countries should focus on, thinks Stefan Baral. The first is to remove barriers to testing and care. For example, shift workers often do not have the opportunity to take time off to get tested, increasing the risk of new infections. The second is to provide space for those who are overcrowded and live in a multigenerational household to isolate themselves while they await test results, in order to reduce the risks of spreading the infection from homes to high-risk people. The last is to reduce the risk of infections in workplaces that must be open.

– We need to ensure that people do not feel compelled to work if they are sick and workplaces must work with infection control and increased ventilation. This has yet to be addressed in the event of a shutdown, but unfortunately not many countries have, he says.

The same groups that have an increased risk of COVID-19 infection will be more difficult to achieve with vaccination programs. Data from the US already shows that black Americans have been vaccinated to a lesser extent than whites.

– We must work so that vaccines are available to everyone. You and I can get vaccinated at any time, but shift workers will have to take time off to get vaccinated and then will be forced to choose between the vaccine and the money.

Stefan Baral hopes that the world will openly assess what measures have worked to help us deal with future covid-19 outbreaks in, for example, nursing homes, prisons or shelters. The assessment can not only focus on what measures were taken during the pandemic, but also on what the situation was like in these places before. Most of the COVID-19 deaths in Canada have occurred in nursing homes. In Ontario, there have been more infections and more deaths in for-profit nursing homes with more hourly employees, lower staffing densities, and more residents in the same area.

– It is misleading to say that reducing the spread of society is the only way to protect nursing homes, then you lose that you have to work harder to reduce infections in general in these places. Anyone who says this is easy is either dishonest or unaware of how difficult it is. I belong to a group of doctors who work with this every day and we think it is extremely complex, says Stefan Baral.

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