This article was updated at 3:00 a.m. EDT, April 27, 2020.
ROME—There are problems, and then there are “snoblems,” as social media like to call certain first-world personal issues during the pandemic. And almost anyone with a pen and a platform—myself included—has written about the latter, with harrowing tales of everything from long grocery lines during the lockdown to bad hair and awkward Zoom dates. But just as the privileged appear to be moving down the back side of the global coronavirus pandemic, it is those people in the margins, almost always ignored by society, that we need to be most worried about, not only for the sake of compassion, but for self-interest.
The curve has been flattening in most of the hardest hit areas of the global coronavirus crisis, from New York City to northern Italy, where fewer than 500 deaths in a single day now feels oddly victorious. Wuhan is opening for business and Italy will slowly come out of its own coronavirus hibernation in early May.
But as Singapore has learned, premature celebrations of containment can easily backfire if success is only measured among those being counted. The rigorously managed city-state has suffered a recent spike in new cases simply because it wasn’t watching those who are easiest to ignore.
Migrant workers forced into lockdown in tight dorms are now emerging to help kickstart the Singapore economy, but during the height of the crisis, they were largely untested, and the virus ran wild among them. They now account for a huge increase in cases taxing the health care system and causing leaders to enforce a partial lockdown for the first time in the pandemic.
The same is likely to happen across Europe, where migrant workers and seasonal laborers are desperately needed to harvest winter crops. Special dispensation to cross closed borders is now being considered for Romanian harvest workers to come to Italy, where they will move into barrack-style lodgings and work side by side. In Great Britain, after calls for furloughed workers from non-agricultural sectors to step up and work in the farm industry were largely ignored, the government chartered flights to bring Romanian fruit and vegetable pickers in, despite travel bans.
Romania has had just over 11,000 positive cases, but as of the weekend had carried out only around 115,000 tests, meaning a large part of the population probably is infected without knowing. Italy does not have the capacity to test seasonal farm workers, who could introduce the virus in the southern regions of the country where winter agriculture is based, and which have largely escaped the brunt of the pandemic.
The more than 71 million people displaced by war and conflict worldwide, as tallied by the United Nations High Commissioner for Refugees, have also been locked down without the sort of testing carried out on other populations. Human Rights Watch warns that as nations lift restrictions, many of the migrants will start moving again without any proper care during the critical early stages of the pandemic.
On Greek islands where thousands of refugees from the Middle East live in horrific conditions awaiting rulings on their asylum requests, testing is virtually nonexistent. A spokesperson for Doctors Without Borders told The Daily Beast that at the notorious Moria camp on the island of Lesbos, where 19,000 migrants and refugees live in a space meant for just 3,000, there is just one water tap for every 1,300 people and no soap at all.
“Families of five or six have to sleep in spaces of no more than three square meters [about 32 square feet],” Dr. Hilde Vochten, MSF's Medical Coordinator in Greece, said recently. “This means that recommended measures such as frequent hand-washing and social distancing to prevent the spread of the virus are just impossible.”
As the world has learned from watching COVID-19 tear through cruise ships, aircraft carriers and New York City, tight living arrangements are the perfect breeding ground for the virus. In so many parts of the marginalized world—from refugee camps to labor farms—social distancing cannot be enforced effectively and blanket testing for the virus is just not a priority.
These also are the environments where other health issues are rampant, from malnutrition to a lack of hygiene, which will complicate even mild cases of COVID-19, and where asymptomatic carriers could easily spread the disease to thousands of people before a single case is confirmed.
Moria, like other camps, is serviced by staff who live on the island and come and go from the camps, making it easy for them to spread the disease, and holes in the fences make it easy for many of the people there to move freely and return.
Writing in The Nation, author and human rights advocate Sasha Abramsky warns of a storm on the horizon. “So preoccupied are we by our own fears and by the U.S. pandemic calamity that we risk forgetting the misfortunes piled on misfortune of the 70 million people around the world currently displaced by war and social collapse,” he writes, warning that in the United States, Donald Trump’s policies on immigration have caused a bottleneck in facilities where those who may be carrying COVID-19 are neither treated nor released.
In the United States, where there are an estimated 11 million people Trump likes to call “illegal aliens,” many work in the sectors that solve the snoblems for the rest of us. A lack of access to health care could be deadly, not just for “them” but for “us,” too. Out of fear of deportation, these vulnerable undocumented workers are likely to avoid hospitals, and instead stay on the job, working in those businesses that are opening up in some states, like restaurants, massage parlors, and bowling alleys.
The stark degrees of suffering and vulnerability to COVID-19 have largely focused on the elderly and unwell in the developed world, the strain on normally well-developed health systems that should have been far better prepared, and the shocking lack of preparedness in the world’s richest economies. But, writing in The Economist, Bill Gates warns that as the pandemic slows in developed nations, it will accelerate in developing ones.
“Their experience, however, will be worse,” says Gates. “In poorer countries, where fewer jobs can be done remotely, distancing measures won’t work as well.” He notes that, “COVID-19 overwhelmed cities like New York, but the data suggest that even a single Manhattan hospital has more intensive-care beds than most African countries. Millions could die.”
Gates goes on to say he hopes wealthy nations include poorer ones as they move to a post-pandemic world. “Even the most self-interested person—or isolationist government—should agree with this by now,” he says. “This pandemic has shown us that viruses don’t obey border laws and that we are all connected biologically by a network of microscopic germs, whether we like it or not.”
But if nothing is done to integrate the needs of those vulnerable populations on the margins—whether at home in the “first world” or abroad in less affluent societies—experts warn they may contribute massively to the second wave of COVID-19. And they won’t be as easy to ignore the next time around.