The SARS-CoV-2 virus

News analysis

Almost 100 years ago in a now little read short story titled “The Rich Boy,” the late American author F. Scott Fitzgerald observed that the rich “are different from you and me. They possess and enjoy early, and it does something to them, makes them soft where we are hard, and cynical where we are trustful, in a way that, unless you were born rich, it is very difficult to understand. They think, deep in their hearts, that they are better than we are because we had to discover the compensations and refuges of life for ourselves. Even when they enter deep into our world or sink below us, they still think that they are better than we are. They are different.”

Sometime later the novelist Ernest Hemingway, a writer recognized for being able to say more with fewer words than Fitzgerald, is widely reputed to have said, “Yes, they have more money.”

The SARS-CoV-2 pandemic is now proving Hemingway wrong, at least partially. The rich, or at least the wealthier among us, might have more than just money going for them. They appear to enjoy some elevated protection against the microscopic pathogen today terrorizing the globe.

English doctors who conducted the “first and largest cross-sectional analyses (of) primary care data to assess risk factors for testing positive for SARS-CoV-2” found the wealthy among the least likely to contract the disease.

“In our sample,” their paper published in the highly respected journal The Lancet, said “we found increasing age, male sex, increasing deprivation, urban location, and black ethnicity were associated with increased odds of a positive SARS-CoV-2 test.

“Other socioeconomic factors that we did not measure, such as employment in high-risk positions, education, income, and structural barriers to health care, might have contributed to this association and should be urgently explored,” they added.

Interestingly, they found no increased risk of suffering a SARS-CoV-2 infection among those already suffering from hypertension, diabetes, and cardiovascular disease, and they noted that “active smoking was associated with decreased odds of a positive test.”

These things were somewhat surprising given that 80 to 90 percent of the people dead from COVID-19 – the name for the deadly lung disease that can be triggered by the SARS-CoV-2 virus – were suffering from those so-called “comorbidities.”

The connection to socioeconomic status (SES) – or what the Brits call “deprivation” – was, however, no surprise. The link between low SES and health problems, including premature death, has long been known.

A 2017 meta-analysis of 1.8 million people in seven different countries concluded that the “strong influence of socioeconomic factors on health, morbidity and mortality is well established, with studies showing a widening in inequalities in mortality despite absolute inequalities falling in some countries.

“Our study is one of the largest to examine the effect of low socioeconomic status on premature mortality and is to our knowledge the first large-scale study to directly compare the importance of socioeconomic circumstances as determinants of health with the six major risk factors targeted in global health strategies for the reduction of premature mortality,” wrote the global consortium of doctors who conducted the study. “The association between low socioeconomic status and premature mortality was consistent across causes of death.”

Writing later in the New England Journal of Medicine, Associate Editor Dr. Bruce Soloway questioned whether World Health Organization efforts to increase lifespans by stopping smoking, reducing intakes of alcohol and salt, increasing physical activity, driving down obesity and treating high blood pressure might better be directed at simply trying to improve SES.

“Overall mortality was higher among people with low SES than among those with high SES,” he wrote. “The difference remained significant after adjustment for the seven WHO risk factors….Low SES was associated with life expectancy reduction of 2.1 years between ages 40 and 85, which was greater than that for alcohol overuse, obesity, and hypertension.”

Unspeakable problem

Socioeconomic status and the problems it causes are something few in America want to talk about, given the only way to really fix the problem is to create decent-paying jobs. Partisan political bickering makes such a discussion hard.

Democrats don’t want to talk about it because they are fixated on welfare. The political opportunists among them see that as a way to buy votes. Most see it as a way to feel better about themselves, to feel noble, to go to bed believing they did something for the panhandler they tried to avoid looking at while they drove past on the street.

Republicans don’t want to talk about it because they are fixated on protecting the successful and recognize a significant part of the capitalist economy depends on people working for low pay. The most unfeeling among them are pure Darwinists. Most just fear losing what they’ve spent their lives to gain never really recognizing that we all go out the way we came in with nothing.

Alaska knows SES well. It is second only to New York in per capita spending on welfare, and the two have something in common. Both states are troubled by areas of high unemployment or non-employment.

In New York this focuses on what New York City Mayor Bill de Blasio labeled the “Tale of Two Cities,” one rich and one poor, co-existing the country’s by far largest metropolis. De Blasio promised to fix that. The Manhattan Institute, which has been tracking his progress, reports little success.

“Income inequality is up…,” its latest report says. “There is still substantially more violent crime in public housing than in the rest of the city.”

Public housing, in general, represents the poor parts of New York, and a ground-breaking study out of Johns Hopkins University several years ago painted a vivid portrait of the problems in the pit of poverty.

Having spent 25 years following 790 children growing up in Baltimore, sociologists Karl Alexander and colleague Doris Entwisle “found poverty is deeper among poor African-Americans. Poor black neighborhoods are much worse—in terms of crime, social cohesion, and potential for social advancement—than poor white neighborhoods,” as The Baltimore Sun’s Edward Erickson Jr. reported.

“Young black men who turn to crime have a much harder time finding straight jobs than young white ex-criminals. African-Americans are paid much less when they do find work.”

“The Long Shadow,” the book in which Alexander and Entwisle presented their work, focuses heavily on race – not because black people are inherently worse than white people – but because in a white-dominated society it is even harder for black men with low SES to break into the middle class than it is for white men with low SES.

This is not a problem unique to Baltimore. It is a problem in poverty-stricken neighborhoods in major cities across the country and in rural Alaska where a majority of residents are Native.

 A Tale of Two States

The Anchorage Daily News just won a Pulitzer Prize for documenting the New York-Baltimore-Chicago-St. Louis, inner-city-style problems of rural Alaska and advocating for increased police protection there.

The issue of socioeconomic status was unfortunately never raised. It was the same when the newspaper made an earlier bid for a Pulitzer by writing about the problems of alcohol in the 49th state. Those stories focused heavily on fetal alcohol syndrome (FAS), and yet somehow overlooked one key fact about that tragic threat to the state’s unborn children.

“Although women of any socioeconomic status can bear children with fetal alcohol spectrum disorders,” researchers reported almost a decade ago, “the more severe forms of FAS and pFAS most frequently have been found in the lower SES categories in various countries. One classic study of the influence of SES in the United States found that the risk of bearing a child with FAS was 15.8 times higher for women of lower SES even with comparable drinking levels.”

The peer-reviewed study in the journal Alcohol Research Current Reviews was headlined “Maternal Risk Factors for Fetal Alcohol Spectrum Disorders – Not As Simple As It Might Seem.”

And now comes SARS-CoV-2 – Not As Simple As It Might Seem.

Or maybe, on some level, more simple than it seems. Nature appears to be targeting the weakest among our species: the old, the unhealthy and those simply less successful in achieving socioeconomic fitness within the population in which they dwell.

The Darwinists can pretty easily dismiss this as the way the world works. Survival of the fittest.

Worldometers COVID-19 tracker today reports that of the now almost 2.2 million people who’ve suffered the disease, 85 percent have survived. There is no count of how many high SES members of society are on that list, but a few of note have come to light:

• 55-year-old British Prime Minister Boris Johnson
• 56-year-old Sean Payton, the coach of the National Football League’s New Orleans Saints
• 63-year-old actor Tom Hanks and wife Rita Wilson. 
• 57-year-old Sen. Rand Paul, a Republican from Kentucky.
• 49-year-old CNN talking head Chris Cuomo.

There are, of course, those of high SES who have died. Nothing in nature – nothing – is wholly black and white. Despite what you might have been led to believe about how wolves kill only the sick and old, the reality is they sometimes kill the simply unlucky.

COVID-19 is no different, but there is a pattern of primary victims developing.

As Drs. Rachal E. Jordan and Peymane Adab from the Institute of Applied Health Research at the University of Birmingham in England noted just days ago, “some of the fundamental information about how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads in the population and who is really at risk of both infection and severe consequences is still missing.

“(But) what is fundamentally clear is that whatever the specific risk factors, the COVID-19 pandemic exacerbates existing socioeconomic inequalities.”

In New York City, the epicenter for COVID-19 horrors in the U.S., a trio of doctors writing in the Journal of the American Medical Association (JAMA) earlier this month reported NYC’s highest number of deaths in the Bronx.

“Poor health in the Bronx is due at least in part to decades of policies related to housing, education, environmental health, and criminal justice that have perpetuated racial and economic inequality,” they observed. “More than half a million immigrants live in the borough, and most speak a language at home other than English. Immigrants in the Bronx are disproportionately represented in the essential workforce at risk for exposure to severe acute respiratory syndrome coronavirus 2, including physicians, nurses, nursing aides, home health aides, subway and bus drivers, grocery clerks, and others. The limited sociodemographic data available for COVID-19 cases in New York City show that Hispanic or Latinx individuals, who constitute most immigrants in the Bronx, are considerably more likely to die of COVID-19 than white New York City residents.”

Most of those people aren’t physicians or nurses. They are the bus drivers, grocery clerks, small business owners and out-of-work restaurant and bar employees farther down the socioeconomic ladder.

They are the same people at highest risk in Sweden, which is much in the news for its failure to join most of the rest of the Western world in going into full-lockdown mode to slow the spread of the virus.

Foreign Policy magazine described Somalis, Syrians and Iraqis living in Sweden as “the hidden flaw” in the country’s “anti-lockdown strategy.”

In a northern Stockholm suburb, Somali-born Ahmed Abdirahman told Foreign Policy’s Nathalie Rothchild “more than half of Somalis live in just a single (Stockholm) district, so it’s not surprising that once the virus started spreading in that area, Somalis quickly became overrepresented in the statistics. There are also relatively high levels of ill health and household crowding in these suburbs, and multigenerational households are quite common due to low-income levels. In addition, the potential for exposure to the virus is high since many hold so-called low-skilled jobs, for instance as taxi drivers.”

They are the Swedes of lower socioeconomic status suffering the brunt of the pandemic as those of lower SES are suffering it everywhere. The link to SES is why Alaska health authorities live in fear of what could happen if the virus gets into a remote Alaska village.

A footnote

Before ending this story, it is worth a slightly more detailed look at Sweden, which has become the focus of yet another partisan tussle in the U.S. with conservatives generally describing it as a success in minimizing the economic damage of the pandemic and progressives chastising it as causing the unnecessary deaths of hundreds of Swedes.

“Fox News political commentator Tucker Carlson has argued the merits of the Swedish model, as has the conservative magazine National Review,” noted NBC News. 

“Sen. Rand Paul, R-Ky., the only senator known to have contracted COVID-19, clashed with the nation’s leading infectious disease expert, Dr. Anthony Fauci, at a Senate hearing on Tuesday, asking why the U.S. couldn’t follow Sweden in reopening schools and the economy.

“Sweden’s COVID-19 strategy leads to higher fatality rate than U.S.,” reported CBS Evening News, as have other news outlets.

“Sweden has reported a higher death rate than the US after controversially refusing lockdown measures to ward off the coronavirus pandemic, according to the latest figures,” the New York Post reported. 

Most of the stories comparing the U.S. and Sweden are badly misleading. Any comparison between the two countries is skewed by the very nature of COVID-19 in the U.S. where 59 percent of deaths have come in six states in the Northeast: New York, New Jersey, Pennsylvania, Massachusetts, Connecticut and Maryland.

The death rate there is approximately 906 per million people, by far the worst in the world and a far cry from the overall U.S. rate of 273.34. Outside of the aforementioned Northeast states, the U.S. rate is probably closer to that of California at 39.5 per million.

Most U.S. states have done far better than Sweden at slowing the disease. The Northeast states, which went into full lockdown, have done much worse. And it is the same complex picture across Europe.

Sweden’s death rate of 361.28 per million is much worse than its Scandinavian neighbors, which have all held death tolls under 100 per million. But Sweden has done much better than Belgium, 792.5/million dead; Spain, 589.91/million; Italy, 528/million; the United Kingdom, 520.93/million and France, 419.11/million.

Spain imposed an especially strict lockdown. People were only allowed out of their homes to walk a dog or get groceries. Spanish media reported that nearly 807,000 people were fined and more than 7,000 arrested between March 15 when the lockdown kicked in and May 3 when it partially lifted.

And yet the Spanish death rate was double that of Sweden and the Spanish economy is in trouble. Then again, so is that of most of Europe.

The European Union is forecasting a major recession and hoping it doesn’t become another Great Depression, the BBC reported.