Gaurab Basu, M.D. is a primary care physician and instructor at Harvard Medical School. He is the co-director of the Center for Health Equity Education & Advocacy.
Harvard Political Review: COVID-19 has been active in the U.S. for at least a few months. What do you think is most interesting about the pandemic?
Gaurab Basu: I think what is on my mind is that the virus has cast a die, in a lot of ways, on broken systems and structures in our society. It has enabled us to see more clearly the ways in which there’s issues of equity, both in our healthcare system and in our society in terms of ecological health and environmental justice. This pandemic has animated and activated a lot of those inequities and injustices we see every day as primary care doctors and as a safety net system.
HPR: What are some examples of those inequities and injustices?
GB: I think of the COVID-19 pandemic as an everything issue. We have very specific things we need to do from a medical perspective in order to tamp down the number of infections and then hopefully, ultimately, be able to eliminate the threat of this pandemic more broadly. But in the midst of it, we can see the ways in which the virus touches upon nearly every element of society and our healthcare system. I’ll give you an example: Chelsea, Massachusetts, a city just north of Boston in the Metro North area, is seeing about six times the average cases of the rest of the state in terms of COVID-19 infection. So six times the number of COVID-19 infections as the rest of the state per hundred thousand in the population. That’s remarkable: Chelsea is predominantly Latinx, has an industrial background, and has had such a disproportionate devastation from this virus. Why is that? Well, there’s a lot of hypotheses, and we’ll have to do a lot of studies to further understand this. But there’s a lot of inquiry into a variety of different structural determinants of health that I think are very likely at play. For example, consider housing. What we know in Chelsea is that because of the housing crisis in our state — there’s an issue of overcrowding and high density housing — a lot of people are living in the same place. If someone gets infected, they can pass the infection more easily around. Poverty, obviously, is something on my mind in regards to the fact that if you are an essential worker or you are feeling like you have to work to try to avoid economic devastation … that increases your exposure risk.
My advocacy work is in climate change, and air pollution is a well-studied intersection with the COVID-19 pandemic. There’s a very big study that came out of the Harvard Chan School of Public Health showing that communities that have higher air pollution levels experience increased mortality of people who get infected. And what we know in Chelsea is that it exceeds the EPA levels of safe pollutants by 20%. The city sits right by the Tobin Bridge and gets a lot of exposure to pollutants from cars — there’s petroleum storage right into Chelsea Creek — and historically it has had numerous exposures that put the community at risk at baseline. So you have those exposures and then you have an exposure to a dangerous virus, and it all compounds each other.
Immigration is another piece of this. If you are undocumented, and you feel like you can’t go to get health care regularly because you’re concerned about your immigration status, there’s a chance that you could have a baseline for health. Of course, that increases your risk of poor outcomes if you were to get infected. And also, if you are showing signs of the COVID-19 virus itself, there are numerous stories and reports of people who were concerned about seeking care because of their immigration status.
HPR: From your advocacy and research on the connection between health and climate, is there anything else you haven’t already mentioned that we should bear in mind when thinking about the pandemic?
GB: The pandemic was a big awakening for me. I’m a primary care doctor with a background in human rights, health equity, and global health. To be honest, I wasn’t thinking a lot about climate change and the health of our planet very much until a couple years ago, and now I see it everywhere. That’s helped me see very clearly what role it plays in pandemics. We have no evidence that climate change directly was a factor in this pandemic, so I want to make that clear. But we need to be able to articulate the complexity of the fact that decimating our ecological health, making ecosystems unstable, and the problem of a profound decrease in our biodiversity has direct implications for the risks of future pandemics. There are dangerous viruses that are passed around wildlife all the time. So in equilibrium, there is a natural state in which animals like bats are able to tolerate viruses that would be very dangerous to the human population. But as we encroach into natural habitats, as we engage in deforestation, in the warming of our planet, in pollution, in wildlife trade and agricultural practices that are not sustainable or healthy — all of these things fundamentally disrupt the equilibriums in nature, such that the buffer that nature has provided us to separate from viral spillover to the human population decreases. In the future, if we continue to harm the stability of our ecosystems, there’ll be an increased risk that these viruses that have stayed contained within other species have a better opportunity to get into the human population. I want to just highlight one study: there’s the U.N. Intergovernmental Science Policy Platform on Biodiversity and Ecosystems, a major U.N. report that came out in 2019. It showed that 1 million species are going extinct right now. We’re in a major crisis of species extinction and a major crisis of planetary health. So it’s important that we think about the health of our planet not only through climate change — which is caused by the emissions of greenhouse gases that cause warming in our planet and now have a whole number of health implications — but also that when our ecosystems become unstable and our biodiversity is decimated, that has profound implications for future human health too.
HPR: What’s the impact of climate change specifically on the spread of pandemics?
GB: What we know is that climate change absolutely has a connection to infectious diseases. We know already that mosquito-borne illnesses and tick-borne illnesses have a deep connection to the warming of our planet and climate change. What climate change also does is that it causes breaks with natural equilibrium, and it causes people to be displaced, and when species get displaced, those species move to different places where they weren’t before. The ability to transmit infectious diseases and their pathways change in a very complex way. So when we start disrupting the very delicate equilibrium of these vector-borne diseases — such as zoonotic diseases like COVID-19 which are passed from animals to humans — you can have profound implications on disease states for humans.
HPR: You once wrote that “clinicians have a professional responsibility to develop their capacity to be agents of social change.” What does it look like to be an agent of social change within the clinical field? And what is it about the clinical professional equipped to effect social change?
GB: A lot of my work is in health education and advocacy, asking students and residents to explore their role as advocates. What I believe is that the systems and structures we have in place have profound implications on the health of our communities, and particularly health equity for communities of color and impoverished communities. My experience as a doctor has been that when I see patients in my clinic and they have diabetes out of control, or their blood pressure is high, or there are other medical issues they are facing, so often it’s the manifestation of a lot of upstream structural problems that enabled those things to happen. So as a doctor, I love taking care of patients … but I also feel a deep sense of responsibility to speak to those structures and policies that could enable healthier outcomes, and to improve health equity. I think the vantage point for healthcare professionals is that we get to hear these stories of people’s lives — the ways in which they’ve struggled or suffered, the ways some of these structures have inflicted pain in their lives. We have a unique and special opportunity to collect those stories and articulate them in the public forum, and to explain to the public the ways in which sound, compassionate, scientific policies can help us be a society where we take care of each other, where we look out for each other, where we feel everyone has dignity and worth, and where we have a common humanity. There’s so much public policy that can help us be a care-seeking society. That’s what advocacy means to me: to speak and enter the public forum, to fight for our patients, to say that when we create structures in our society and in our public policy, we can do better to honor every person’s dignity.
Image Credit: Gaurab Basu