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The great sickly slums which will soon be screaming

This is a chilling warning from Mike Davis in The Monster Enters. My understanding is this hasn’t been borne out by events since the time he was writing this (pre-June 2020) however I’d welcome any suggestions of literature on this topic which readers might have.

It seems inescapable that the great sickly slums of Africa and South Asia—Khayelitsha, Kibera, Dharavi, Makoko, and so on—will soon be screaming. Up until now, the coronavirus infections in East Asia, Europe, and North America have been only marginally more deadly than the flu among healthy, well-fed people under 50. But immunologically there are two distinct humanities. In the first, only the elderly and chronically ill have been led up the pyramid steps to be sacrificed to COVID-19. In the other, where malnutrition, disease, and contaminated water compromise the immune systems of people of all ages and respiratory ailments are legion, the carnage is likely to become more widespread and indifferent to demography. Poverty, density, and hunger, in other words, will likely reshape the pandemic.

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Throttled by neocolonial debt since the 1980s and by a quarter century of wildly destructive civil wars in west and central Africa, much of the continent’s medical infrastructure is in ruins and five of the six nations judged to have the world’s worst health care are in Africa. One of them is Nigeria, where medical treatment for 206 million people is now almost entirely privatized and beyond the reach of the poor.45 With exception of South Africa, moreover, none have the existing capacity to treat more than a handful of critical COVID-19 cases. Kenya, a country well-known for exporting nurses and doctors, has exactly 130 ICU beds and 200 certified ICU nurses to treat 50 million people. Sudan, with a similar population, has but 30 beds.

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There’s also some possibility that mass infection in slums and poor countrysides could flip a switch on coronavirus’s mode of infection. In the veterinarian research mentioned earlier that looked at coronavirus epidemics among domestic animals, the investigators discovered two different routes of infection: fecal-oral, which attacked stomach and intestinal tissue; and respiratory, which attacked lungs. In the first case there was usually very high mortality, while the second generally resulted in milder cases. Multiple studies confirm that SARS-CoV-2 is being shed copiously in feces and accumulated in sewage.46 In African and South Asian slums, of course, fecal contamination is everywhere: in the water, in homegrown vegetables and as windblown dust. (Yes, shit storms are real.) In addition, most of Africa’s slum communities are built in low-lying areas that flood during the rainy season. Raw sewage, often in open ditches, then spreads everywhere, even into homes. All of this favors the enteric route and raises the question of whether, as in the case of animals, this will lead to more lethal infections, possibly across all age groups?

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