Fight against COVID-19 should focus on most vulnerable, including First Nations

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 Fort McPherson (Tetlit Zheh), N.W.T. Image: Tetlit Zheh Gwich'in band council, 2017

Health-care experts and public health officials are expressing a high degree of concern over the potential impact of the COVID-19 virus on poor and vulnerable populations.

From the onset of this disease, the rich have made sure to take care of themselves, as the New York Times reported last week. Those for whom money is not an object are using private jets rather than commercial flights, vacationing in remote and isolated tropical paradises, stocking up on costly designer masks, and signing up for concierge medical services (or, as the Times calls them, "VIP emergency rooms"). 

The picture for poor and marginalised communities is the opposite. 

Low-income people do not have the means to stock up on food and medical supplies. Workers on minimum wage, very often in precarious employment situations, do not usually have sick leave benefits. They cannot afford to stay home when they experience symptoms of a dangerous and highly infectious new virus. 

The poor are less likely to have family physicians than the rest of the population. As well, they are less likely, in general, to feel connected to medical services. That is true even here in Canada, with our universal coverage for basic health services; but it is much worse south of the border in the U.S., where health care is a commodity to be bought and sold, not a public service. 

The Organization for Economic Cooperation and Development (OECD) puts out an annual Health at a Glance report, comparing health services and outcomes among its 36 member countries, which range from Turkey and Mexico to most of Europe to the U.S. and Canada. 

The OECD provides a myriad of statistics on everything from the prevalence of obesity to life expectancy. A measurement in the 2019 report that should send shivers of fear down the spines of Americans, in the context of the current crisis, is the one for access to care. In 22 of the OECD's 36 countries, 100 per cent of the people are eligible for core health services. 

Those 22 countries include not only Canada, Japan, the U.K., Italy and Germany, but also some less likely suspects, such as the Czech Republic, South Korea, Greece, Latvia and Slovenia. 

For the U.S., however, only 90.8 per cent of the population is eligible for basic, necessary health services. Among OECD countries, only Mexico is a worse performer, at 89.3 per cent. 

Now, assuring service to nine out of 10 people who need medical care might seem pretty good, until you consider that in the U.S. that means leaving out more than 30 million people. 

Those 30 million souls without access to care are people who, if and when they contract a dangerous and contagious disease, will have little choice but to walk around -- and perhaps even go to work -- sick, endangering everybody else with whom they come into contact.

Indigenous communities experience crowding and lack of clean water

And so, people in the U.S., with its outlier private enterprise model of health-care delivery, should brace for the worst.

Regardless of their health-care systems, however, there are social conditions in many countries, including Canada, that will inevitably exacerbate the outbreak. 

People living in crowded, inadequate housing will have a difficult time isolating themselves if they get sick. In Canada those are the kind of conditions that prevail in a great many Indigenous communities.

Decades ago, I got a glimpse at how an epidemic can ravage an isolated First Nations people.

In the 1970s, my wife and I lived in the Gwich'in community of Fort McPherson (Tetlit Zheh), in the extreme northwest corner of the Northwest Territories. 

The hamlet lies on the east bank of the lower Peel River, just upstream of the Mackenzie River delta, about 200 kilometres southwest of Inuvik. It is north of the Arctic Circle, but still within the treeline. 

McPherson was, and is, proud and resilient, with a long and fabled history that includes the stories of the Mad Trapper of Rat River and of the Dawson City boys, who, in the early years of the 20th century, would "commute" to the Yukon Gold Rush town 600 kilometres to the south.   

Tetlit Zheh was also a small community, with fewer than a thousand people. There were resident nurses, an Anglican priest, RCMP officers, a social worker and a school (where we taught). For many essential services, however, the community had to turn to volunteers. 

Among those services was gravedigging -- which explains how I found myself, on a cold winter's evening, helping dig the grave for the late Reverend James Simon, an esteemed member of the community. My colleagues in this task, all local people, were good natured, and leavened our grim enterprise with jokes. 

The joking stopped, however, when, every once in a while, our shovels hit a long-forgotten coffin, buried in an unmarked grave. The other gravediggers explained to me that those coffins contained the remains of people carried away by the flu epidemic that ravaged the community four and a half decades earlier, in 1928. 

During that contagion so many died, and so quickly, they said, that the few remaining able-bodied people, who were not themselves debilitated by illness, barely had time to bury the dead. In the midst of this catastrophe, the living certainly had neither time nor energy to worry about such niceties as grave markers.

I later learned that the 1928 epidemic that struck Canada's North was a kind of sequel to the so-called Spanish flu that swept the world following the First World War. The 1928 outbreak killed more than a tenth of the people of McPherson, and had a similar devastating effect throughout Canada's North.

Worse than its immediate impact, the flu epidemic diminished the people of the North's resistance to other illnesses from the outside world that were about to attack with full fury. Most notable among them was the scourge of tuberculosis. 

Some of the people of Tetlit Zheh who grew up in the 1920s and 1930s told me they figured they had to have been made of really strong stuff, because so many of their contemporaries perished in what seemed, in retrospective, to have been a never-ending series of epidemics. 

Government must not forget Indigenous people in its planning

Today, in the 21st century, Indigenous communities, with their weak infrastructure and services and lack of access to first class medical services, are still sitting ducks when contagious disease strikes. 

In 2009, when the hitherto unknown H1N1 flu bug attacked Canada, it was Indigenous people, particularly those in the North, who paid the highest price.

The average H1N1 infection rate across Canada was 24 per 100,000. Among First Nations people in Manitoba, however, the rate was 130 per 100,000. In Nunavut, the infection rate was a whopping 1,070 per 100,000.

On March 6 of this year, NDP Leader Jagmeet Singh wrote the prime minister a letter, in which he cited those figures. Singh implored Justin Trudeau to show that he and his government have learned the lessons of 2009. 

"Public health officials have advised individuals to avoid transmission of the novel coronavirus through measures such as frequent hand washing, self-isolation, and social distancing," he says in his letter. "This is sound, evidence-based guidance. Unfortunately, it is of little assistance to First Nations communities without running water or adequate housing."

As a first step, the NDP leader asks that the prime minister include his minister of Indigenous services on the special cabinet committee he has named to deal with COVID-19. 

It would only be a first step, but it would be something.

It should be part of a larger strategy that focuses, deliberately and intensely, on those who will be least able to cope with the impact of this new strain of the coronavirus, for which there is neither a vaccination nor a known cure.

Karl Nerenberg has been a journalist and filmmaker for more than 25 years. He is rabble's politics reporter.

Image: Tetlit Zheh Gwich'in band council, 2017​

Editor's note, March 11, 2020: The image on this post has been changed.

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