In early March 2020, when Bangladesh took Covid-19 as a serious threat to public health, many thought the virus would wreak havoc on the millions of slum dwellers of Bangladesh. Covid-19 presented itself to us as a disease that was both highly contagious and fatal. This made reacting to it in an extreme form vital. Now that we have a somewhat better understanding of the phenomena, it is possible to separate the economic, public health, and biomedical issues. We argue that it is both possible and desirable to separate the 'What does it do' from the 'Why does it act thus' in this case. What are the policy facts of significance? That the poor are neither as susceptible nor as affected by Covid-19 as like the middle and upper classes. Suppose this claim to be valid for the moment.
Consider the economic and public health issues first. If the impact upon the working classes is not fatal or debilitating, then is there good reason to stop the ordinary functioning of the economy? If the poor people find that infection with Covid-19 is indistinguishable from the flu, then what will motivate them to undertake special public health measures, (and why should we impose special regulations on them anyway)? These are the questions that arise from the low or negligible prevalence of Covid-19 in Bangladesh slums.
Why is this significant from an economic point of view? It permits the opening of the economy by allowing workers to engage in all their everyday activities. Since it is the middle and upper classes which appear to be susceptible to the more virulent forms of the disease, the managerial class should take measures to protect themselves from contact that may be infectious. However, this is a very different policy than the wholesale closure of fields and factories. In an international context, it makes Bangladeshi workers still eligible for global factory work. Whether it be the Middle East or China, the seeming resilience of the Bangladeshi workers makes them the best group of workers to hire.
We have now refined our understanding of Covid-19. It is highly contagious, but not due to touch, as was initially feared when we were all trying to use our elbows to open doors; nor is it as uniformly fatal as it was feared to be, since only those above 70 are particularly at risk. With this additional knowledge, what are the practical implications of the scale of coronavirus infections among slum dwellers of Dhaka?
To shed light on this question, the Center for Urban Studies and Sustainable Development at East West University, undertook a survey of 255 inhabitants from three of Dhaka's crowded slums (Duaripara, Korail, and Mohammadpur). During the interview, we also asked questions relating to ten adjoining habitations, which they could be expected to have first-hand knowledge about. Thus, our findings have potential information about 2000-2500 slum households. Our results confirm the common perception that the impact of Covid-19 is hard to detect in Bangladesh slums. None of the 255 respondents said they experienced Covid-19 like symptoms. When asked about the coronavirus-related deaths in their family or locality, none of the respondents mentioned any fatalities. The extreme crowding and togetherness of Eid-ul-Azha may change the facts of August, or they may be the acid test of Bangladesh's resilience.
The low prevalence of virulent Covid-19 among the poor is also seen across a large swath of the country, including many remote villages and townships. In private communications with our contacts in Dhaka, Cumilla, Dinajpur, Jessore, Madaripur, Mymensingh (including some Garos), and Sylhet, people have been comparatively unscathed by the pandemic. Moreover, we complemented our survey with questions sent to a broad online audience. We also requested our colleagues to talk to their domestic helpers. The finding of zero confirmed cases has again left us puzzled. If coronavirus were as deadly as predicted, then Bangladeshi slums would have been dens of death. Fortunately, Bangladesh seems to have been spared such misery.
We are aware of the findings by the Institute of Epidemiology, Disease Control and Research (IEDCR) for slums in Dhaka and the results by Niti Aayog and the Tata Institute of Fundamental Research results for slums in Mumbai. We realise that our number is different from them. It is not our intent to challenge the findings of others, but only to note that even their results have a low fatality rate and no mention of debilitating illness.
There is a common consensus that patients who tested positive for coronavirus carry a stigma, that results in social isolation. But with a population density of 205,415 people per square kilometer in the slums of Dhaka, it would be almost impossible to hide serious symptoms. Slum-dwellers also go out frequently for the very reason that their dwellings have nothing to keep them engaged at home. It is observed that in slum areas hardly anyone wears a mask; this is not because they are still unaware of the risk, but rather, the sheer cost, and the difficulty in breathing, deters them.
Are we suggesting that the poor in the slum be ignored? Not at all. Distributing masks among the slum dwellers is an excellent public health step to prevent infection from spreading since many residents of slums are frequently traveling. This requires the rich to subsidise the poor (i.e., mask, soap, and sanitation), but this is the most robust way to stop the virus from spreading, which in turn would affect the middle- and upper-class people. Moreover, this approach is also pro-growth as it would allow the poor to realise their full individual potential. Inhabitants in urban slums are the lifeblood of the country's informal economy. If workers living in slum areas are exceptionally resistant to the more virulent form of coronavirus, then this makes them a valuable labour force. Slum-dwellers are human beings, not just a percentage of the total population.
Since even asymptotic individuals can spread Covid-19, why is the daily death toll from coronavirus in slums is so low? A clear understanding of the reason for such immunity is imperative. We need to examine the biomedical and public health issues simultaneously, and the economic phenomenon arising from the low prevalence of Covid-19 in the Bangladeshi slums.
Bill Gates has hypothesised that since the bats which originated the disease in China are the same as those in South Asia, people may be more habituated to their viruses. The European version, which was subsequently transferred to the United States (US), appears to be more virulent.
There are three possible avenues to explore for the relatively low prevalence of Covid-19 in the slums of Dhaka. First, the slum dwellers may have genetically inherited immunity from parents. Second, the residents of slums may have acquired immunity from the harsh childhood environment they grow up in. This might be due to exposure to a wide variety of pathogens and lifestyle that is less sanitised (no air filtered air-conditioned rooms, being more in nature). Third, lifestyle reinforcing immunity where it is possible that they can accept and neutralise coronavirus so that it does not even infect others. This may involve food habits, such as the absence of alcohol and the presence of meat and fish.
We urge the government to simultaneously advance the economy of the poor while investigating the underlying socio-economic and, mainly, the biomedical reasons why Dhaka slums have felt the impact of Covid-19 so lightly.
Riad Uddin is a research analyst at Innovations for Poverty Action. Behtarin, Basher, and Rashid are, respectively, a research associate, professor of economics, and university professor at East West University.
Email: syed.basher@gmail.com