‘A crisis for all’

With the COVID-19 wave about to engulf us, our response needs to be nuanced to the huge disparities in this country. The enhanced community quarantine, while certainly warranted, has markedly different impacts depending on where we sit on the income ladder. There is no doubt we all suffer from these measures, but we suffer to a greatly different extent.

For the 2.5 million people in Metro Manila who reside in crowded slums, or the 15.1 million poor households nationwide, community quarantining and social distancing have entirely different implications. Lost income from restricted movement matters greatly, not just to the income earner but also to the whole family dependent on those earnings. There are no savings to draw upon. Crowded in one room that may be 3 sqm, it is unrealistic to think that social distancing is possible. Collecting water or washing at communal points, walking through narrow alley ways, just stepping out to get some sunlight and less fetid air, or walking three hours to and from work because of the absence of public transport presents a whole set of risks.

Certainly, efforts to suppress transmission with strict community quarantine measures need to be in place. But what are the complementary policies and programs for the poor? Can the Administration increase the amount and frequency of social safety net payments? Can we, as we would in the aftermath of a destructive typhoon, provide emergency water, sanitation, and food aid? These are preventative and alleviation measures. But there is also a looming crisis that requires a viable contingency plan. National epidemiologists are estimating that the number of people infected could rise to 75,000 within a few months (what about the projected fatality rate?) and that is likely a conservative figure. A significant proportion could be the poor living in crowded slums.

Local governments will need to run the numbers and develop the worst-case scenarios for planning. Personal protective equipment for frontline workers, testing kits (and the WHO tells us we must test, test, test), ventilators, sanitizers, ICU beds and alternative bed space (for hospitals that may quickly reach their limits to house the sick), etc., will need to be provided and quickly. Much of this will be challenging given the huge demand on global supply. Health facilities will need to be accessible and ideally testing and health services taken directly to poor communities. Innovative approaches to tracing and isolation in crowded slums areas will need to be implemented. Assignment of health workers needs to be calibrated to where the greatest numbers are likely to be.

The President is calling for a special session to pass a supplemental budget to manage the crisis and contend with its (social) and economic impact. This stimulus is urgently required, as is an adjustment of existing programs. Spending the full budget allotment in any one year has been a problem, so a rapid review based on realistic projections of expenditure could be undertaken to realign savings to pro-poor interventions.

This is now a matter of both the quantum and quality of expenditure. At all costs, we need to avoid the ethical dilemma of choosing whose life to save or care for. Income should certainly not be the defining factor. We are about to head into not only a health crisis but a humanitarian crisis. We need to act accordingly and leave no one behind.