Health and Primary Care

Short Commentary ISSN: 2515-107X

Socio-cultural determinants of the spread of Covid 19

The spread of covid 19 as well as its projected fatality is showing Second important characteristic of covid 19 is the possibility of
different pattern in different countries though the uniform response close contact across population with those infected owing to the mode
to the pandemic, namely, lockdown and physical distancing to ensure of spread of the disease as close contact with a case is identified as the
quarantine, is considered as the most appropriate option by several mode of transmission. This is where the culture of the susceptible
governments across the world. Concerns have been raised in terms population become evident and their behavior need detailed scrutiny.
of the technical competency and social feasibility countries possess For instance, Italy was attributed to have a culture of close interaction
in order to accomplish the goal of flattening the epidemic curve. The (physical intimacy) as compared to Japan (culturally maintaining
social, economic and ethical implications of such an intervention to greater physical distance) . This human behavior of maintaining or not
the social fabric of nations are also pondered upon by social scientists. maintaining physical distance is an outcome of a nation’s culture which
What is crucial in the spread of covid 19 is the fact that those having has deeper roots in their national heritage and tradition. In LMICs
travel history to the infected country has a greater chance to get the where there is poor living and working conditions the very possibility
infection and their primary contacts are the ones who are at immediate of maintaining physical distance even during pandemics like Covid is
risk. One of the most important characteristic that explains the spread impossible. Any effort to suddenly change the behavior to avoid spread
of covid cases is the ‘travel behaviour’ of people across nations. The is not feasible and will face resistance from the people as demonstrated
in several countries. This further gets complicated when there is a
current intervention of contact tracing of those individuals with travel
failure to understand that physical distancing in a given social context
history is premised on this assumption. The mathematical projection
is unaffordable for a huge population by virtue of their engagements
of cases and its spread which is the sole ‘evidence’ available on the
as part of their daily living and working conditions. Any attempt to
potential spread usually focus only on the numerator, those cases and
trivialize human behavior change as that which can be accomplished
the ones they will immediately infect with the denominator taken in
by manipulating individual consciousness without changing the social
thousands or millions. In other words the susceptible population for context has always failed miserably in Public health. Failure to follow suit by
which the projection is made is always represented as mere numbers people should not result in ‘victim blaming’ and any attempt to introduce
(usually for denominator) which is assumed to possess common punitive acts through legal means will have serious ethical implications as it
biological characteristics as human species and is considered as is the most deprived and vulnerable who will be at the receiving end.
homogeneous across the globe. A population level perspective which
has to be the core of any public health approach call for a more in-depth Third important factor of a population characteristic that is crucial
analysis of this susceptible population in terms of their social, political, in any epidemic spread is the level of ‘natural immunity’ among
economic, cultural and epidemiological characteristics. There is a need susceptible population. It is a well-known fact that immunity status
for more in-depth analysis to understand the heterogeneity of this of a population decides the pace at which epidemics spread or not. In
susceptible population which might explain the dynamics of spread of the current situation, it is important to acknowledge how countries
epidemic in populations. There are at least three crucial socio-cultural like India in terms of its exposure to infections at the population level
and epidemiological characteristics that need to be focused upon in the interact with the occurrence of covid 19. This will be the key to decide
context of covid 19. the extent of community spread in low and middle income countries.
Will the spread of epidemic changes when the susceptible population
First and foremost is the proportion of population that potentially has a history of exposure to a range of epidemics like influenza, malaria,
engage in international travel across nations in a given time period. For dengue, TB and pneumonia? If so, will it be similar to other South
instance going by the immigration data, the proportion of immigrant Asian population with similar disease history. Recent epidemiological
population to the total population for countries in the Europe and US study identifies correlation between universal BCG vaccination policy
are much higher than it is in the Eastern countries like China, Japan, of nations and reduction in morbidity and mortality for covid 19. What
Korea and India. This is in the range of 9-17 % for Europe whereas are the critical population characteristics of African nationals that will
for Eastern and Asian countries, it hovers in the range of 0.4 to 3%. interfere with covid spread having exposed to the recent Ebola outbreak
Adding on to this is the purpose of international travel across nations in the region? There is a clear paucity of evidence in this regard. It is
whether it is part of trade, employment, tourism and sporting activities, necessary to consider the heterogeneity of the susceptible population in
the latter two is high in the western population, especially for Italy and terms of their social, political, economic, cultural and epidemiological
Spain. Thus it is obvious that at any given point of time the proportion
of population engaged in international travel is much higher in the
European, US and other western countries where the pace of spread was *Correspondence to: Mathew George, Professor, Centre for Public Health,
faster than in Asian, African and middle eastern region. There seems to
School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai,
be an association which one can attribute to the pace of spread of covid
India, Tel +22 25525512/+91 9969607444; E-mail: mathewg@tiss.edu
19 in a country and the proportionate population with international
travel history. Received: April 13, 2020; Accepted: April 21, 2020; Published: April 24, 2020

Health Prim Car, 2020 doi: 10.15761/HPC.1000189 Volume 4: 1-2

characteristics while interpreting the spread of epidemics. This calls 3. Sander N, Abel GJ, Riosmena F (2013) The future of international migration:
Developing expert-based assumptions for global population projections. Vienna
for more population level interdisciplinary studies to understand the
Institute of Demography Working Papers, ECONSTOR.
dynamics of disease transmission within the family, workplace and
community settings across nations. This is all the more relevant during 4. Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD (2020) How will
country-based mitigation measures influence the course of the COVID-19 epidemic?
epidemics as it deals with life and death decisions of people [1-7]. The Lancet 395: 931-934.

Disclaimer 5. https://www.liverpoolecho.co.uk/news/uk-world-news/six-reasons-coronavirus-
spread-fast-17901773
Views expressed in the article are personal.
6. https://www.businessinsider.in/science/news/japan-only-has-924-coronavirus-cases-
References this-may-be-from-a-lack-of-testing-and-there-are-more-cases-of-infection-than-
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2. http://theconversation.com/which-countries-have-the-most-immigrants-113074 COVID-19: an epidemiological study. medRxiv.

Copyright: ©2020 George M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.

Health Prim Car, 2020 doi: 10.15761/HPC.1000189 Volume 4: 2-2