Question

According to Caldwell et al., (2016), race/ethnicity, and geographical location have a definite impact on healthcare and health outcomes.

In your response, answer the following questions:

• What are the healthcare challenges with COVID-19 for these underserved populations?
• What is being done to address these inequities?

Answer 1

While coronavirus has swept across the entirety of the United States, several vulnerable groups are being hit the hardest.

Communities of color, the elderly, and the incarcerated population are facing some of the greatest challenges in the face of the coronavirus pandemic.

The underserved communities have had limited access to COVID-19 testing, which has been proven due to New Orleans, Milwaukee, Chicago, Detroit, District of Columbia, and Baltimore massive numbers in their inner cities. Documenting and informing the public of the country’s demographic analytics is a critical duty. Giving the underserved population power over their healthcare to fight COVID-19 may slow down the spread of the virus and save lives in the meantime

The pandemic has exposed the fragile state of our healthcare system, specifically in underserved communities. This pandemic can impact the underserved communities more than others due to their financial and health disparities. Their lack of health insurance, accessible community health facilities, and feelings of isolation may compound their existing inequalities. The lack of action to address these vulnerable populations will make it nearly impossible to control the spread of COVID-19.

During this time, not only is it going to take personal commitment to beat the virus, but the use of technology as well. Technology can play a vital and active role by tracking virus statistics, helping discover where the testing gaps are located, inventory of resources, and identifying where telehealth is most needed during the shelter-in-place.

The underserved communities have had limited access to COVID-19 testing, which has been proven due to New Orleans, Milwaukee, Chicago, Detroit, District of Columbia, and Baltimore massive numbers in their inner cities. Documenting and informing the public of the country’s demographic analytics is a critical duty. Giving the underserved population power over their healthcare to fight COVID-19 may slow down the spread of the virus and save lives in the meantime.

The workforce in the long-term skill facilities is faced with challenges that include staff shortages, frequent turnovers, significant resident to staff ratio, not enough personal protective equipment (PPE).

In India, , the virus does not differentiate between rich-poor or rural-urban dichotomies. It is particularly a threat to a country like India, where 65–68% of the population live in rural areas that also have the highest overall burden of disease globally

The Indian rural health care system is a three-tier system comprising Sub-Centres, Primary Health Centres (PHC), and Community Health Centres (CHC). There is currently a shortfall in health facilities: 18% at the Sub-Centre level, 22% at the PHC level and 30% at the CHC level (as of March 2018) . Although the number of facilities has increased over the years, the workforce availability is substantially below the recommended levels as suggested by the World Health Organization. Rural India has 3.2 government hospital beds per 10,000 people . Many states have a significantly lower number of rural beds than the national average. The state of Uttar Pradesh has 2.5 beds per 10,000 people in rural areas, whilst Rajasthan and Jharkhand have 2.4 and 2.3, respectively Maharashtra, which has seen the largest number of COVID-19 cases, has 2.0 beds per 10,000 population and Bihar has 0.6 beds per 10,000. Overall, there is a shortage of specialists working at the CHC level (81.9%). This includes a shortage of surgeons (84.6%), obstetricians & gynaecologists (74.7%), physicians (85.7%) and paediatricians (82.6%)  

The health care services and systems in India are still developing and have challenges of workforce shortages, absenteeism, poor infrastructure and quality of care. Despite the National Health Mission and Government’s commitment, adequate and affordable healthcare is still a mirage. The healthcare system in rural India faces a chronic shortage of medical professionals which is detrimental to the rural health system in terms of the quality and availability of care for rural people. The State focus has been on curative care, whereas poor infrastructure and poor coordination between the line departments makes it difficult to tackle public health emergencies such as COVID-19. The health care system is not adequate or prepared to contain COVID19 transmission in the rural areas, especially in many northern Indian States because of the shortage of doctors, hospital beds and equipment, especially in densely populated underserved states. We have failed to manage tragic medical emergencies in the past, such as the unfortunate death of over 150 children in Muzzafarpur in Bihar triggered by malnourishment. Public health challenges, including elimination of persisting communicable diseases like Tuberculosis and ensuring equitable health care, add to the challenges ahead, with the emergence of new pandemic.

We still do not know the real statistics of the epidemic in rural areas. The country is at a tipping point and we do not know what direction it will take. The outbreak can head either way. COVID-19 creates a special challenge considering the poor testing services, surveillance system and above all poor medical care including shortages that were mentioned earlier. The lack of full understanding of the pathogen and the realization that there is no effective cure has played an important role in determining government strategies and this is evident when official actions are examined. The preventive strategy adopted in relation to COVID-19 does not appear to be very innovative. It follows the strategy devised by John Haygarth’s 18th-century ‘rules of prevention’ for eradicating smallpox based on three principles: find every case, isolate the infected individual, and immunise all their contacts. In the case of COVID-19, vaccine is not yet available nor any drugs. However, the strategy has evolved further from a focus on individual patients and their contacts to the entire population. The shutdown and complete ban of normal activities for ordinary people seeks to stop community spread. But the obvious question is for how long? It is assumed that the spread of COVID-19 virus can be controlled by these actions. At the moment, these are only assumptions partly based on the experience of earlier outbreaks especially SARS or Ebola epidemics.

The impacts of this pandemic, especially the lockdown strategy in the social sphere is multi-dimensional. What could be important from a public health point of view is its impact on employment of millions of people in the rural areas who are migrant workers in many cities and educational opportunities. The emotional impacts of the strategies may add to this. The people are walking back to their villages in groups covering 500–1000 ​km after losing their jobs in the cities which is alarming and may exacerbate the problem as the chance of community transmission widens further. Apart from the economic suffering of the already famished society, this could disseminate or spread the disease in rural areas. We do not know about their exposure and status of infection of these population. It is a serious concern because if even one percent of them are infected, we will not be able to control the spread of the epidemic due to the resource limitations, poor health services in rural areas and other factors mentioned above.

It is a wakeup call and what is important at this moment is to use the lessons of this pandemic in the rural areas of many Indian states where the health care systems have to be improved considering the huge population in rural areas, untrained staff in caring and handling of patients during an outbreak of infectious diseases, and a huge shortage of beds, and equipment. Despite these challenges, the government can take a three-pronged approach to stop the epidemic. These are to invest and prepare healthcare providers in rural areas for the epidemic; massive education programme to educate people; and to create a strong surveillance system that can help in reducing the spread and fatality. Besides, many health care providers in rural areas are unregistered and untrained and do not know what to do in such an emergency. Hence providing clinical guidelines, training and handholding may help.