COVID-19 and the ‘curb-cut effect’

Focusing the COVID-19 response on the most vulnerable will trickle up to everyone else.

A healthcare worker helps an elderly man at a nursing home, where many residents and employees have been infected with COVID-19, in San Antonio, Texas, on April 4, 2020 [Reuters/Go Nakamura]

In nearly every White House press briefing on the COVID-19 pandemic through the first week of March, healthy young members of the general public were reassured that if they were infected, they would be likely to have mild symptoms. Some briefings included additional information on how “individuals with underlying health conditions can protect themselves using common-sense precautions”.

Yet, it is healthy, young people who have enabled the transition of this novel coronavirus from an outbreak to a pandemic.

When another strain of coronavirus, known as MERS-CoV, broke out in 2012, it was estimated to have a 65 percent death rate. Because nearly everyone infected immediately displayed severe symptoms, the vast majority were hospitalised and therefore identified, making this strain of the virus easier to contain.

This, however, is not the case with COVID-19.

A significant percentage of people infected with COVID-19 do not display any symptoms; many also have symptoms that are mild enough that they can continue to engage in social activities and Yet, they can still spread the disease.

Healthy, young people are significantly more likely to be asymptomatic carriers. At the same time, wealthier white people are less likely to have the underlying conditions that make COVID-19 more fatal, and are more likely to be able to self-isolate and have protective gear and access to better medical care.

And just like the concentration of wealth, the concentration of healthcare, resources, protection, and peace of mind do not trickle down.

By contrast, it has been demonstrated that help for the most vulnerable does trickle up.

The “curb-cut effect” is the idea that programmes designed around the needs of the most vulnerable end up benefitting everyone else. The term was coined by Angela Glover Blackwell based on research that found that after the Architectural Barriers Act of 1968 mandated that buildings be more accessible, the resulting ramps had benefits not only for people who use wheelchairs but also for parents pushing strollers, workers pushing heavy carts, and even “unencumbered pedestrians”.

In the context of an infectious disease pandemic, it would make sense to take care of the most vulnerable first – but that has not been the case.

For most Americans who did not feel particularly at risk, early responses ranged from apathy to caution against panic. Spring break trips and activities for college students continued well into March.

While some were right to point out that problems such as starvation, mosquitoes, and heart disease have killed more people than COVID-19, there is unfortunately too much overlap among the populations most vulnerable to all of these issues as well as COVID-19.

“First-world” arrogance of believing ourselves to be immune to a pandemic, the smug comfort of racist discourses that fix particular illnesses to particular bodies, and the imagery reproduced in repeated references to the “China virus” or the “Wuhan virus” undergirded our slow public health response in the United States.

By contrast, countries that anticipated devastating effects and had a general sense of vulnerability to the pandemic due to past experiences with SARS or Ebola, like Singapore and Nigeria, have had much more immediate public health responses and more success at containment and not just mitigation of COVID-19.

When the US authorities finally started taking the pandemic seriously, the actions they took did not focus on protecting the most vulnerable parts of the population.

They called on people to stay at home, but not take into account the fact that staying at home for the majority of Americans means becoming unemployed. So while industries like Big Tech were quick to unroll work-from-home-plans, millions of Americans – many working in the gig economy – lined up to file unemployment claims.

Testing has also been a problem and has been slow to pick up. Some states are finally offering free testing for COVID-19, but only to people with a verified doctor’s note ordering the test, a barrier to access for the uninsured.

Federal and state authorities have pushed for domestic production of needed protective gear, equipment and disinfectants, but have not always made the effort to protect the workers who would be manufacturing these goods. In New York, for example, prisoners are tasked with making hand-sanitiser, but they themselves have been forbidden from using such products because of the high concentration of alcohol.

Universities are shifting towards remote teaching, but some have failed to offer housing, food, and internet access plans for students who rely on financial aid

To address these problems, we need immediate action on all levels. We need immediate free, widespread testing and paid sick leave for everyone. We need to demand public healthcare for all, including the availability of treatment that is not driven by profit and is not delayed by negotiations with insurance companies.

We needed a state response less concerned with blocking entry to the US and more concerned with the community spread that has been taking place for more than a month. We need to demand the abolition of carceral institutions that have long been a threat to public health and particularly incarcerated people, whose unpaid labour produces the hand-sanitiser with which we keep ourselves safe.

We need a redistribution of resources that does not leave some people more susceptible to pandemics than others.

Alongside these demands, instead of relegating “common-sense protections” to people with “underlying health conditions”, everyone should be tasked with the same level of concern and degree of vigilance.

Before the US became the centre of the pandemic, healthy, young people, even without symptoms, should have been encouraged to cancel non-essential gatherings and travels and stay inside as much as they could afford to do so.

While panic might be counterproductive, the situation is serious enough that anxiety is clearly warranted. The appropriate response is not to tell people to be calm but to harness that anxiety as a political resource.

Defensive pessimism is a cognitive strategy identified by psychologist Nancy Cantor in the 1980s. Some people with anxiety expect and envision the worst possible outcomes of a situation, and harness their anxiety into planning and preparation that helps to ward off the worst-case scenario and prepare the person to deal with negative outcomes.

It is considered an effective cognitive strategy; people with anxiety who use this strategy perform as well on anxiety-inducing tasks as people without anxiety, and are better prepared than people without anxiety for negative outcomes.

It is also a cognitive strategy that can, I think, be used politically in situations where history and evidence suggest a negative outcome is likely: The slippery slope from nationalist discourse to full-blown fascism, climate change, or an infectious disease pandemic.

This strategy might enable the seemingly impossible task called for by critical race theorist Derrick Bell: “A recognition of both the futility of action … and the unblinking conviction that something must be done, that action must be taken.”

Though costs of immediate, drastic action might be high, the cost of belated action is inevitably higher. Rather than telling ourselves we will probably be fine individually, and allowing that sentiment to assuage our fears and temporarily alleviate our anxiety as the situation continues to worsen, perhaps we should learn from people who live with anxiety all the time and approach this situation with defensive pessimism.

If we exercised caution as though we were all as vulnerable as the most vulnerable among us then, just maybe, we could find true relief upon the discovery that we were over-prepared.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.