Andreas Laupacis is Editor in Chief of CMAJ.


The coronavirus has done a great job of highlighting the obvious. The poor and disadvantaged always get screwed.

A headline in the Guardian recently asked, “If coronavirus doesn’t discriminate, how come black people are bearing the brunt?” Writing about the UK, Afua Hirsch pointed out that 35% of people who died early in the COVID-19 pandemic were black, Asian or from another ethnic minority, more than double the UK prevalence. Although there were no studies examining the ethnicity of health care workers dying from COVID-19, the first four physicians who died were Muslims of African or Asian heritage.

I am not aware of Canadian data that shows how COVID-19 is affecting different groups of Canadians but I’d be shocked if we are any different from the UK or the United States, where blacks are much more likely to die from COVID-19 than whites.

It is pretty clear that the frail elderly living in Canadian long-term care (LTC) homes are more likely to die from COVID-19 than the elderly living in the community. I’d be surprised if staff working in those homes don’t have a higher risk of getting infected with coronavirus than staff working in hospitals. And almost none of the clinical staff caring for my mother in her LTC facility are white.

Today I am reading about residents in a LTC home in Quebec apparently being abandoned and something similar in a home for persons with disabilities in Ontario. When this pandemic is done, I think we’ll see a higher death rate among the homeless too. To my knowledge a coronavirus outbreak in an isolated indigenous community has not occurred yet, but it would likely be devastating.

This shouldn’t be a surprise. We know poverty and disadvantage kill through a variety of mechanisms such as unhealthy food options, insecure housing, psychological and social isolation and poor access to health care. But because coronavirus kills more quickly than other diseases, it makes the inequities in our society that lead to death much more starkly visible than usual.

We can’t address the underlying structural causes of inequity in the middle of a pandemic. However, we can make sure that the response to the pandemic is equitable – for example providing those working in LTC facilities and homeless shelters and indigenous communities the same access to personal protective equipment and testing as those working in hospitals. And doing everything we can to allow the homeless to practice social distancing.

The question that is depressing me this Easter weekend is whether we will learn from this disaster.

When this is over, will there be a Marshall Plan to deal with our society’s inequities or will we go back to the world as usual? I fear the latter. Post coronavirus, I think we (me included) will retreat to our own parts of society and make well-intentioned but self-serving arguments about how better funding of our sector (e.g. hospitals) would have made us better prepared, without addressing the root causes.

I hope I am wrong. Just maybe we will all be so embarrassed by how we have funded our long-term care sector that we’ll seriously address that, and maybe other areas of inequity too. But I am not optimistic.