Coronavirus: Why systemic problems leave the US at
risk
By Aleem Maqbool BBC News, Arizona
- 38 minutes ago
Sebastian shows me his hands. His
skin is dry and cracked through over washing.
"I've always been obsessed with
washing my hands because growing up I knew if I got sick I wouldn't be able to
see a doctor," he tells me.
Sebastian has lived in the US since
he was three years old, after having been brought here from Mexico by his parents.
He is one of the estimated 11 million people in the country who are
"undocumented".
No US citizenship means no US
healthcare.
Even the language of Barack Obama's
Affordable Care Act makes it very clear that undocumented immigrants are
excluded.
"I never went to a doctor, if I
got sick my mom would always try to treat it at home, but I remember getting
very sick sometimes and missing a lot of school," says Sebastian.
Image caption Sebastian says
undocumented immigrants like him are concerned about asking the authorities for
help
The day we meet is the day the first
coronavirus case has been confirmed in his area, but Sebastian says that while
his family have seen all the news about the virus, their reality remains the
same.
"Being undocumented it's hard
to get medical attention. There's the aspect of presenting yourself to the
legal system at medical facilities and that runs the risk of deportation,"
he says.
"My family may not be
criminals, but they sure are undocumented and seeing a doctor scares
them."
For everyone in the US, whether they
are undocumented or not, there is also the huge expense involved in even just
seeing a doctor.
More than 27 million people in
America have no medical insurance at all, a number that has been growing
dramatically during the Trump presidency.
A consultation with a doctor for
someone without insurance costs hundreds of dollars.
But there are tens of millions more
who are classed as being "underinsured" - having basic insurance that
often only covers a fraction of the cost of any check ups or treatment.
"During the flu season we are
getting sick a lot, but taking my children to see their paediatrician costs
$100 each visit just for a check," says Lisa Rubio, 28, who has basic
health insurance through her employer.
"I started with a cough and a
sore throat a week ago, but if the doctor tells me they can't prescribe
anything, that it's just a virus, I have to decide whether it's worth it to
take away money from my bills and my children's other needs."
Image caption Lisa Rubio says she
has avoided treatment before because of her limited insurance
Last year, being underinsured
contributed to a devastating episode for Lisa.
"I got sick. I felt pain coming
in my chest. But for me to go see a doctor even though I am insured, I couldn't
afford it so I tried to ignore the pain."
"Two weeks later, in the middle
of the night, my lung just collapsed completely. They had to do intensive care
but said if I had caught it sooner, it would have been better," she says.
Lisa suffers these problems even
though she herself is an administrator in a hospital in Tucson.
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And while public health workers are
one of the groups with the highest risk of infection, they also fall foul of
another systemic issue in the US under the spotlight during this crisis; the
fact that there is no requirement for American employers to offer paid sick
leave.
"I'm really worried for my
patients that can't take time off work to come and get care and who will go to
work even when they are sick because they have no other way to pay for their
food and utilities. Coronavirus does not change that," says Dr Ravi
Gravois Shah.
Dr Shah is the director of a mobile
health clinic that is run on charitable donations. Driving around Tucson, the
clinic treats around fifty patients a week who cannot normally access any
medical care.
But Dr Shah admits that that is only
a drop in the vast ocean of need in the community.
"All the time we come across
patients who are going through pregnancy without seeking care, or people who
for months and years can't get care, diagnosis and treatment for their pain or
chronic disease," he says.
Image caption Dr Shah helps
uninsured patients from a mobile treatment centre
Dr Shah says that even before the
coronavirus, the huge number of patients going undiagnosed with HIV or other
sexually transmitted infections was just one example of the public health
crises being exacerbated because so many have no access to healthcare.
"I have not seen any evidence
that anything is going to be different with the coronavirus," he says,
unconvinced by the promises from Washington.
"For decades, we've been okay
as a society knowing that there are so many in our community who are uninsured,
underinsured, undocumented and unable to take sick leave," he says.
"These individuals without
access to care are going to get sicker, are going to spread the disease more
frequently because they're not getting care or isolating, or getting diagnosed
and treated. https://www.bbc.com/news/world-us-canada-51840233And we are going
to pay the public health price because of what our society is okay with."
As it sweeps across nations, the
coronavirus is exposing systemic flaws. In China, it was freedom of
information; here in the US it is the massive disparities in the way people are
treated depending on their economic circumstances and their immigration status.
The coronavirus of course does not
discriminate on those grounds and having large sections of society being unable
to see a doctor is suddenly in focus as not just being bad for the individuals
themselves, but for the country a whole.
