Isolate vulnerabilities, not people

COVID-19 is a spatial issue. Like any other health crises global in scale, the spread of COVID-19 does not respect political boundaries. The predictable patterns of spread of most common epidemics have shown the importance of spatial interaction in understanding potential disease outbreaks. In medical geography, we refer to these patterns as spatial diffusion to help us understand the behavior of spread between infected patients and vulnerable populations.

However, this interaction may vary depending on people’s concentration, such as in mass gatherings like mañanitas and on the movement of infection over distances. This behavior partly explains why we normally see higher concentrations of COVID-19 cases in urban areas where travel and social interactions are more pronounced.

To help understand the spread and distribution of COVID-19, governments are now using technologies such as geographic information systems to inform prevention and response decisions.

“Social distancing” is considered a geographical strategy that targets people’s mobility to slow down the spread of infectious diseases. To be effective, this strategy may be practiced alongside travel restrictions, isolation, and quarantine. However, the use of such term should be taken with caution as it could promote further social and spatial segregation during lockdown.

While the intention is clear, “social distancing” reveals not only the health impacts of pandemics but also the existing social inequalities and their consequences on people’s well-being. It is also crucial that implementing movement restriction measures should consider the potential harm on people’s well-being and anticipate the stigma on infected places or populations, such as naming the disease by location of origin, e.g., Spanish flu, Wuhan virus.

Risk reduction is key. As COVID-19 affects people disproportionately, addressing vulnerability is fundamental to implementing risk reduction measures. Putting this into a disaster risk reduction perspective, it is important that we understand risk as a product of an individual or a system’s exposure to hazard, vulnerability, and adaptive capacity.

Exposure refers to the elements or processes such as distance, urbanization, migration, and population density in which hazard events may occur. Vulnerability is the lack of capacity to withstand a hazard due to social, economic, and political factors. Typically, income groups that lack access to health services or have chronic medical conditions are likely more vulnerable to diseases. In contrast, adaptive capacity is the ability to use skills and resources to anticipate and manage hazards. In this case, we are not only looking at the capacity of a patient’s immune system to recover from the disease, but also the ability of a health care system to accommodate more patients in health facilities and protect our frontline health workers.

Addressing the risk of COVID-19 is more than just “social distancing” and “community quarantines.” Until a vaccine is widely available, large-scale testing will be crucial to reduce further risks. At present, our testing capacity is still far from the target of 30,000 tests a day. Several studies have already established evidence of transmission from asymptomatic carriers. Without mass testing, long and intense lockdowns could kill more than the pandemic.

In the long run, risk reduction means ensuring that access to health and social services are within the reach of vulnerable people, and tackling the dismal state of our current health care system. This includes increasing the carrying capacity of our health facilities, ensuring better pay for health workers, and increasing the budget for health services.

Ultimately, we never learn from the past mistakes of managing disaster events. The scale of impact from disasters in the past decade reveals our obsession with response, as if we have hardly come to terms with disaster risk reduction when Republic Act No. 10121 was passed 10 years ago. We remain fixated on the convenience of relief to attract foreign and private aid, and to legitimize civil defense and military presence in times of crisis.

We need to isolate vulnerabilities, not the people.

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Luigi Toda is the program manager of Arup’s International Development team in Southeast Asia.