Adeeba: Covid-19 Outbreaks, Deaths Expose Inequalities

Infectious disease expert Prof Dr Adeeba Kamarulzaman highlights poor infrastructure in cramped PPR flats that make it difficult for people to self-isolate if they’re exposed to the virus.

KUALA LUMPUR, Oct 11 — Covid-19 has disproportionately impacted the country’s most vulnerable communities, namely the urban poor, migrants, refugees, and prisoners, infectious disease expert Prof Dr Adeeba Kamarulzaman said.

Cramped living conditions and lack of access to medical care put these individuals at higher risk of being exposed to the virus than others.

She said coronavirus outbreaks in low-income flats, migrant worker dormitories, and prisons point to deep inequities in society that only underlines the risks of overlooking marginalised populations.

“As we recover, as we plan, and as we look back on what we did well and what we didn’t do well with Covid-19, that it will not just be from a biomedical lens, but also that we tackle those difficult questions of migrant workers, of the urban poor, and of the over-reliance on criminalisation for drug substance use — because 60 per cent of our prisons are full of people who use drugs.

“Those are difficult debates to have, difficult policies to reform. But reform we must because otherwise, when the next pandemic comes, we will surely regret,” Dr Adeeba said at the Sir John Monash Lecture webinar organised by Monash University Malaysia last Thursday.

Thousands of coronavirus cases and deaths have been reported involving migrant and undocumented workers, as well as in prisons and detention centres since the start of the pandemic in March last year.

Bangi MP Ong Kian Ming recently highlighted on Twitter that 13,038 fatalities or 48.9 per cent of the country’s 26,683 Covid-19 deaths as of October 3 were ethnic minorities and non-nationals. Similar statistics were seen in Selangor, the country’s most industrialised state, where over 40 per cent of brought-in-dead (BID) cases were ethnic minorities and non-Malaysians.

Poor living conditions mean that some of the nation’s biggest Covid-19 clusters involve migrant workers who work at factories and construction sites, and inmates in prisons.

Dr Adeeba further noted that poor infrastructure at public PPR (People’s Housing Project) flats also exacerbated the problem in low-income households, causing many to struggle to comply with public health orders, especially to isolate themselves if they become exposed to the virus.

She cited a Khazanah Research Institute study on the impact of Covid-19 on the urban poor which stated that PPRs may be the “perfect breeding ground” for the virus, as a typical flat in Kuala Lumpur consists of at least 316 units per 17-floor block.

“If the average household size is 4.6, then assuming all units are occupied, approximately 1,455 people would be crammed together in one building,” the report stated.

Dr Adeeba said while some efforts to reform overcrowding issues in prison and to improve living conditions among migrant workers were undertaken, they still fell short on implementation and a longer-term plan.

“These are really structural, very deeply embedded issues that we have to continue to chip at. Here we need an all-society response to demand those changes, I think, because in the end, as we’ve all lived through over the last two years, we all become victims. Of course, the impact is not the same but in the end, we are all affected,” she said.

Separately, Dr Adeeba hypothesised that high Covid-19 deaths in patients aged 18 to 59 were partly attributed to dietary and nutrition. She noted that Malaysia’s diabetic rate is at 3.9 million or one in five adult Malaysians, while one in two adult Malaysians were overweight or obese.

CovidNow data show that 46 per cent of Covid-19 deaths in the past six months as of October 10 involved those in the 18 to 59 age group.

“We do know that from this systematic review and meta-analysis of the association between obesity and metabolic disease, male sex, age of 65, high blood glucose and comorbidities, chronic insulin use, are all risk factors for increased risk of Covid-19 death and severe disease.

“So, I guess it’s no surprise with prevalence, such as I’ve just shared with you of both diabetes and obesity in Malaysia, that we have a higher than expected death rate among 18 to 59 year olds,” Dr Adeeba said.

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