How could the world have handled COVID-19 better

Two faculty members propose solutions to health inequality among underserved communities.

As COVID-19 spread across the globe, its ravages revealed another, hidden pandemic: one of health inequality. Even in the earliest days of lockdown, disease burden and death rates disproportionately affected underserved populations, including racial and ethnic minorities, rural inhabitants, indigenous communities, and low-resource nations.

Faced with these systemic disparities, two Adelphi University College of Nursing and Public Health faculty members, Associate Professor Maria-Pilar Martin, MD, and Assistant Professor Sabena Thomas, PhD, wondered what we could do to better prepare for the next global public health crisis.

Dr. Martin decided to study the failure of government messaging in urban and rural communities in Ecuador. The misinformation that ran unchecked, she writes in "An assessment of the impact of formal and informal messages about COVID-19 on the knowledge and practices for prevention and control among rural and urban communities in Ecuador" (International Journal of Population Studies, 2023),¹ "promoted dangerous, unsanitary, and ineffective home practices that may have … resulted in worse physical and mental health outcomes."

During the height of the pandemic, Dr. Martin and her colleagues conducted focus groups over Zoom using a qualitative approach. "Qualitative studies provide information about participant experiences that quantitative data does not," she said. "They answer the hows and whys instead of how many."

Taken together, the focus group interviews reveal a striking absence of culturally congruent communications. While government campaigns promoted frequent handwashing with soap and water, for example, both commodities are in short supply in rural Ecuador. In response, Dr. Martin's team calls for policymakers to listen more closely to local community members-specifically, about their "perceptions, motivators and barriers"-when developing communications. "I hope governments and health leaders can design tailored culture-sensitive strategies to provide effective communication and better health outcomes next time," she said.

Dr. Thomas tackled the problem through a broader lens. Her recent co-authored paper, "Global COVID-19 case fatality rates influenced by inequalities in human development development and vaccination rates" (Discover Social Science and Health, November 2022)², investigated the effect of different social factors on COVID-19 incidence and case fatality rates (CFRs) country by country.

According to Dr. Thomas, CFR provides a useful frame for determining resource allocation for healthcare infrastructure. The higher the CFR, in other words, the more resources a country will need to mitigate fatalities. "We know that resource-rich countries have a greater capacity to handle the effect of COVID-19 in terms of public health infrastructure and associated resources," she said. "In resource-limited countries, that's not the case."

A cross-sectional study and regional analysis demonstrated that variables such as age, vaccination rates and inequalities in human development could predict COVID-19 CFRs. While improvements in these areas pose a sweeping challenge for public health officials, researchers and policymakers, Dr. Thomas has a clear view of the path forward. She recommends "building and maintaining efficient public health systems that can accommodate at-risk populations in times of crises," with an emphasis on proper training for healthcare staff.

Like Dr. Martin, Dr. Thomas is also a champion of grassroots community engagement and education, which have a proven track record of success in low-resourced countries. These efforts can empower community members to develop preventive techniques and contribute to crisis management solutions if-or when- another pandemic strikes.

Biography

Maria-Pilar Martin, MD

Maria-Pilar Martin, MD, associate professor in the College of Nursing and Public Health, focuses her research on health inequalities among minorities, specifically in Hispanic and Haitian populations; migration and health; global health; and the teaching of public health in medical professions. Dr. Martin was named to the Long Island Business News 2022 Healthcare Power List and is the founder and executive director of International Health Connection, a nonprofit devoted to public health and health education.

Sabena Thomas, PhD

Sabena Thomas, PhD, is an assistant professor of public health in the College of Nursing and Public Health. Her research focuses on health disparities, immigrant health, minority health and cardiovascular health among Black immigrants. Having lived and worked in developing countries, Dr. Thomas' public health expertise spans local and international spheres. She is passionate about improving the health of marginalized populations, specifically immigrants and racial/ethnic minority groups.

^{¹Pisco, K., Ortega, F., Martin, P., Obioha, C., & Curtis, D. (2023). An assessment of the impact of formal and informal messages about COVID-19 on the knowledge and practices for prevention and control among rural and urban communities in Ecuador. International Journal of Population Studies, 9(1). doi:10.36922/ijps.406}

^{²Nuhu, K., Humagain, K., Alorbi, G., Thomas, S., Blavos, A., & Placide, V. (2022). Global COVID-19 case fatality rates influenced by inequalities in human development and vaccination rates. Discover Social Science and Health, 2(1). doi:10.1007/s44155-022-00022-0}