COVID-19, the disease caused by the novel coronavirus, has not been an equal opportunity pandemic. In the United States, the hardest-hit areas all have one feature in common: a large, nonwhite, underprivileged population, living in crowded conditions, for whom working from home is often not an option. Infectious diseases often discriminate based on income, hitting those who have less access to medical care, work jobs without sick leave, use public transport, and reside in high-density settings. But even by that standard, the coronavirus’s outsize impact on the destitute and vulnerable is striking. African Americans are already 67 percent more likely than non-Hispanic whites to be hospitalized for influenza. In the case of COVID-19, that figure jumps to 227 percent.
In the early stages of the pandemic, the virus’s devastating impact on the poor in the United States led many—including us—to predict disaster in the developing world, where poverty and overcrowding prevail and where physical distancing is rarely feasible. And yet the situation in most developing nations so far is puzzling. Most have not, for the time being, experienced the massive, nationwide outbreaks that many observers anticipated. Their public health systems have not been overwhelmed. Fears of a coming wave persist, and already several countries throughout Latin America, in theMiddle East, and on the Indian subcontinent have suffered severe outbreaks and high mortality rates, but so far these are relatively isolated hot spots.
