Turns disease

In the wake of the novel coronavirus Covid-19 pandemic that is currently sweeping the planet, nations across the world have responded in many different ways. Non-pharmaceutical interventions (NPIs) to combat Covid-19 cover the entire spectrum of what is termed physical distancing—which is a set of methods to reduce frequency and closeness of contact between people to contain the spread of disease [1]. Some nations have issued advisories advocating that people maintain a minimum distance between each other as daily life goes on largely uninterrupted, while others have banned all large gatherings and enforced distancing norms more strictly, and yet others have even gone into ‘lockdown’ mode, requiring people to stay home and only allowing them to venture out to get basic supplies [2]. The spread of Covid-19 is being termed a pandemic, but most outbreaks are much more restricted to specific geographical locations, particularly in urban areas with greater contact density [3]. From the perspective of developing nations, therefore, attention needs to be focused on the impact of epidemics on those that are most vulnerable—the urban poor. Prior work on understanding the link between poverty and epidemics indicates strong positive correlation between poverty and the fractions of population with communicable diseases across nations [4, 5]. While poverty is often considered to be a driver of disease, the nature of the relationship between poverty and communicable diseases does not suggest one-way causality, but rather a more complex relationship based on positive feedback [6, 7]. Poverty is found to create conditions for the spread of infectious diseases by forcing high density living and preventing access to medical infrastructure and care, which in turn means that diseases spread more easily in these communities and contributes to an exacerbation of poverty due to illness induced job losses, health costs, and mortality risks [6]. Infectious diseases have been found to have systematically affected economic development, with increasing burden of infectious diseases driven by falling biodiversity [7]. While these studies suggest that poverty and infectious disease reinforce each other, the relationship is largely explored at the level of nations. However, we are concerned about the spread of disease at finer-grained levels, specifically in cities of the developing world where a substantial proportion of the population is poor. In this context, the poor are characterized by a lack of sufficient economic resources that manifests in inability to meaningfully follow norms of distancing and contact reduction, or lack of access to the health services and pharmaceutical interventions; while the non-poor are able to follow norms and access health services.