Pandemics rarely affect all people in a uniform way. The Black Death in the 14th century reduced the global population by a third, with the highest number of deaths observed among the poorest populations.1Duncan CJ Scott S (2005). What caused the black death?.Postgrad Med J. 2005; 81: 315-320Crossref PubMed Scopus (81) Google Scholar Densely populated with malnourished and overworked peasants, medieval Europe was a fertile breeding ground for the bubonic plague. Seven centuries on—with a global gross domestic product of almost US$100 trillion—is our world adequately resourced to prevent another pandemic?2Roser M The short history of global living conditions and why it matters that we know it.https://ourworldindata.org/a-history-of-global-living-conditions-in-5-chartsDate: 2019Date accessed: March 23, 2020Google Scholar Current evidence from the coronavirus disease 2019 (COVID-19) pandemic would suggest otherwise. Estimates indicate that COVID-19 could cost the world more than $10 trillion,3International Food Policy Research InstituteHow much will poverty increase because of COVID-19?.https://www.ifpri.org/blog/how-much-will-global-poverty-increase-because-covid-19Date accessed: March 23, 2020Google Scholar although considerable uncertainty exists with regard to the reach of the virus and the efficacy of the policy response. For each percentage point reduction in the global economy, more than 10 million people are plunged into poverty worldwide.3International Food Policy Research InstituteHow much will poverty increase because of COVID-19?.https://www.ifpri.org/blog/how-much-will-global-poverty-increase-because-covid-19Date accessed: March 23, 2020Google Scholar Considering that the poorest populations are more likely to have chronic conditions, this puts them at higher risk of COVID-19-associated mortality. Since the pandemic has perpetuated an economic crisis, unemployment rates will rise substantially and weakened welfare safety nets further threaten health and social insecurity. Working should never come at the expense of an individual's health nor to public health. In the USA, instances of unexpected medical billings for uninsured patients treated for COVID-19 and carriers continuing to work for fear of redundancy have already been documented.4Hoadley J Fuchs B Lucia K Update on federal surprise billing legislation: new bills contain key differences.https://www.commonwealthfund.org/blog/2020/update-surprise-billing-legislation-new-bills-contain-key-differencesDate: Feb 20, 2020Date accessed: March 23, 2020Google Scholar Despite employment safeguards recently being passed into law in some high-income countries, such as the UK and the USA, low-income groups are wary of these assurances since they have experience of long-standing difficulties navigating complex benefits systems,4Hoadley J Fuchs B Lucia K Update on federal surprise billing legislation: new bills contain key differences.https://www.commonwealthfund.org/blog/2020/update-surprise-billing-legislation-new-bills-contain-key-differencesDate: Feb 20, 2020Date accessed: March 23, 2020Google Scholar and many workers (including the self-employed) can be omitted from such contingency plans. The implications of inadequate financial protections for low-wage workers are more evident in countries with higher levels of extreme poverty, such as India. In recent pandemics, such as the Middle East respiratory syndrome, doctors were vectors of disease transmission due to inadequate testing and personal protective equipment.5Bedford J Enria D Giesecke J et al.COVID-19: towards controlling of a pandemic.Lancet. 2020; (published online March 17.)https://doi.org/10.1016/S0140-6736(20)30673-5Summary Full Text Full Text PDF PubMed Scopus (827) Google Scholar History seems to be repeating itself, with clinicians comprising more than a tenth of all COVID-19 cases in Spain and Italy. With a projected global shortage of 15 million health-care workers by 2030, governments have left essential personnel exposed in this time of need. Poor populations lacking access to health services in normal circumstances are left most vulnerable during times of crisis. Misinformation and miscommunication disproportionally affect individuals with less access to information channels, who are thus more likely to ignore government health warnings.6Pirisi A Low health literacy prevents equal access to care.Lancet. 2000; 3561828Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar With the introduction of physical distancing measures, household internet coverage should be made ubiquitous. The inequitable response to COVID-19 is already evident. Healthy life expectancy and mortality rates have historically been markedly disproportionate between the richest and poorest populations. The full effects of COVID-19 are yet to be seen, while the disease begins to spread across the most fragile settings, including conflict zones, prisons, and refugee camps. As the global economy plunges deeper into an economic crisis and government bailout programmes continue to prioritise industry, scarce resources and funding allocation decisions must aim to reduce inequities rather than exacerbate them. We declare no competing interests. COVID-19 puts societies to the testAs of April 21, the coronavirus outbreak has infected more than 2·3 million people and taken 162 956 lives—35 884 in the USA, 24 114 in Italy, 20 852 in Spain, 20 233 in France, 16 509 in the UK, 5209 in Iran, 4642 in China—all underestimates most probably. Beyond these numbers are people, families, communities, societies that have been affected in unprecedented ways. The coronavirus pandemic puts societies to the test: it is a test of political leadership, of national health systems, of social care services, of solidarity, of the social contract—a test of our very own fabric. Full-Text PDF Open Access
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