The COVID-19 threat to slumdwellers
Today 1st April 2020 is the launch day of Urban Research. We’ve been working on this for months, of course: but meanwhile, the world has dramatically changed, and we’re starting up in the middle of the COVID-19 pandemic. So what does COVID-19 mean for slumdwellers, and for their basic service needs?
I should start with a strong disclaimer: I’m not a specialist in infectious disease control, and this blog simply outlines my personal views, from the perspective of basic services for slumdwellers. For authoritative guidance, go to the World Health Organisation! And maybe talk to people actually living in slums.
As at 31st March 2020, COVID-19 is not yet causing large numbers of deaths in sub-Saharan Africa. The most severe outbreak appears to be in Burkina Faso, with 246 confirmed cases and 12 deaths. Cameroon, Ghana and Nigeria are among other countries with increasing case reports. South Africa has 1326 confirmed cases, though only 3 deaths to date. The picture in South Asia is similar. Evidently, we can be concerned that these low reported rates are in part due to weak detection (very low testing rates, and possible under-detection in determination of cause of death). But certainly, as at 31st March, it does not seem to be a major problem yet.
However, this could change very rapidly, in a matter of days or weeks. Nearly all countries in sub-Saharan Africa and South Asia have reported some cases. If the virus can propagate easily in these contexts, there are multiple causes for alarm...
Slums are high-density areas, of course... many of us will have seen or experienced first-hand the tight packing of public transport in African cities.
Many slumdwellers have marginal livelihoods which can’t be replaced by “working from home”, and are unlikely to be replaced by government income support. As a recent Guardian article writes about life in the slums of Delhi, “Drivers, maids, auto-rickshaw drivers [...] and street vendors buy lentils or vegetables to feed their families from the day’s earnings. There are no reserves, well-stocked freezers, or anything saved for a rainy day.”
Handwashing facilities (water, soap) are typically limited and inadequate.
And of course healthcare systems (both for disease tracking and treatment) are grossly inadequate for most people living in slums.
In short, if COVID-19 does take hold in the slums of Africa and South Asia, the prospect is terrifying. It’s possible (but absolutely unconfirmed) that the virus may propagate less effectively in warmer climates. It’s possible (but again absolutely unconfirmed) that the much younger age pyramid of low-income countries might reduce impact.
To their great credit, many African governments have been quick and decisive in their responses, notably as regards incoming flights, as shown in the cover image to this blog post, from flightradar24.com on 31st March.
But evidently, if COVID-19 hits Africa and South Asia bad, the challenges facing people and governments are going to be immense.
From the perspective of basic services in slums, where might development partners help? Here are some possible areas for short-term support:
1) Emergency handwashing support, through provision of immediate short-term water supply solutions including handwashing water containers and soap.
2) Associated support for handwashing education: not in isolation, but rather as part of wider public health messaging around coronavirus transmission control.
3) Advisory and financial support to water utilities to help them maintain existing piped water supplies across the city, including in slum areas.
4) Support for widespread testing, whether exhaustive for contract tracing, or sample-based for wider epidemiological tracking.
5) Support to primary and secondary healthcare.
I stress again that these are merely my personal opinions, emerging as the crisis develops, and neither evidence-based nor expert-consensused. If you disagree or want to comment, please do so below!
And I'll end on two quotes...
Glenda Gray of the South African Medical Research Council has recently pointed out that “We really have no idea how COVID-19 will behave in Africa.”
And it was Benjamin Disraeli who said we should be “prepared for the worst, but hoping for the best.”