The national medical bureaucracy needs to make one change to its data collection about COVID-19 that will be disruptive in the short term but very productive in the medium and longer term. It may save lives, reduce morbidity, protect social cohesion and help save the economy. But it hasn’t. Why is that?
What can be discerned at this data-scarce stage in investigating the ethnic dimension of COVID-19 in Australia? From discussions with and statements from various officials ranging from ministerial advisers through NHMRC committee members to parliamentarians, multicultural agency officers, ethnic community workers, and frontline health personnel, a knowledge framework that has bits of information associated with its nodes does exist, though in an uncoordinated and fragmentary form.
The three knowledge networks that co-exist in the COVID-19 space encompass: a) epidemiological understandings; b) political economy understandings and c) social communication understandings.
Culture and epidemiology
The cultural epidemiology suggests in Australia that the primary entry of the virus came via five or six pathways. The first were individual arrivals into Australia from countries where the infection had already taken hold. The people came from China, Iran, Italy and maybe South Korea, from which entry was soon shut down. However a second early source, through uncontrolled intake, a case of institutional racism lit large and lethal, allowed people from Britain and the USA to enter without control until all entry was shut down later in March. Of the Anglo sources the UK appears to have been the most prolific with the USA not far behind – Tom Hanks and Rita Wilson being the most infamous examples. The Bondi outbreak among American backpackers was another example of this phenomenon.
However of all the early cases Anglo-Australians were the most likely patients (either travelling home or acquired locally), not only because they are a large majority of the population, but because in the older age cohorts Anglo-Australian or British reflect the make-up of the population forty to fifty years ago, and to some degree the class structure, where more middle class and White populations survive longer than people of colour from working class backgrounds. Then of course there was the Ruby Princess, with its 2500 passengers (the majority apparently Anglo-Australian) and unknown number of its multicultural crew with their Sydney contacts, amongst whom the virus was reproducing with gusto, that flooded into Sydney and spread out from there.
Political economy of ethnic groups
It is at this point we need to understand the cultural political economy of Australia. Ethnic groups are not distributed randomly across either the economy or the landscape, but rather clumped into certain occupations, localities and socio-economic classes. In the USA and the UK higher rates of infection and death among certain ethnic groups reflect the social power of those groups or the lack of it. For those groups concentrated in more poorly paid, casualised, and under-unionised sectors of the economy the onset of the pandemic and the lockdown regimes imposed, especially among women, created catastrophic consequences. Extended and multigenerational families moved in together, overcrowding became more common, domestic violence rose and the possibility of social distancing in the domestic environment significantly reduced. The conditions for self-isolation at home effectively disappeared for many.
This picture of Australians society has been described as one based on a division between primary and secondary labour markets, first identified fifty years ago by Jock Collins in his “Migrant Hands in a Distant Land”. In simple terms, the primary labour market can be expressed as the larger pool of workers with recognised skills, fluency in English, and stable jobs, protected by the trade union movement and with associated benefits. In the pandemic these have been the workers most likely to have been protected to some extent by the JobKeeper and JobSeeker schemes. The secondary labour market reflects the opposite characteristics – lower pay, casualisation, few benefits, poor workplace protection, and in some cases they are undocumented status and highly exploitable. The overwhelming members of that market are immigrant or refugee, or asylum seekers who are the most marginalised. While the majority of migrants are not in the secondary market, the majority of secondary market members are migrants. They are the ones effectively abandoned by the national government with some support from the states and ethnic communities.
As should be clear by now, we have very limited information about what has been happening in Australia in relation to ethnic groups, other than that the same social processes and parameters are likely to have been activated here as in the USA and elsewhere. However we do know from anecdotal responses around some hotspots such as retirement, nursing homes, and quarantine hotels that particular ethnic groups are more likely to be employed in those facilities, at various level of skill. For example nursing homes in the west of Sydney employ many Filipina workers, from cleaners and assistants to nurses. In the north of Sydney Iranians may be more likely to work in those facilities, while in the south it may be Nepalis. On the cruise boats the multinational work forces also fell ill, but we do not know what their socio-cultural networks might be in Sydney and Perth. News reports of the cases at Cedar Meats in Melbourne point to the high level of non-English speaking background workers (especially from the Middle East), their low educational backgrounds and fluency in English, and the hazardous work environment. Infected workers have passed on the infection to an aged care worker and a nurse, as well as a school child. The reports of Melbourne’s MacDonald’s infections refer to extended families – most likely immigrant and refugee background. The network of private security guards contracted to patrol the quarantine hotels are typically sourced through companies focussed in Middle East or Pacific Islander communities.
Social communication and ethnic networks
These networks of vulnerability already exist in Australia, though are cloaked with a barrier to identification. Why should this be of concern if identification and tracing can be pursued on a locality basis through voluntary and extensive testing? We have no idea what the rate of testing is, and who may be missing out – and for what reasons. In discussion with frontline health workers they have described the sorts of issues that have arisen that suggest clusters of people who are rarely tested though they may be vulnerable. Three dynamics may be at work.
Most health communication messages are originated in English and then translated by Health translation services or the State Translation agency, (in NSW directed by Multicultural NSW) – targeting vulnerable communities with limited English skills. Multicultural NSW has a seconded officer working in State Emergency Operations Command with authority to ensure sensitive coverage of ethnic communities. In Victoria ethnic community networks on social media have been widely used to get messages through, though additional resources were allocated when it became clear that the practices previously adopted were insufficient. Social media penetration declines as the population gets older.
There has been considerable commentary on how different messages from state and federal authorities can cause significant confusion even for fluent English speaking native born Australians. In NSW state messages get processed through state agencies and follow state policies, while the same communities may also be exposed to Federal messages translated by the National health agencies, and through SBS, and get other information from social media. Moreover, many immigrant communities follow social media in their own languages and media streams from overseas, deluged with the variable nature of those messages. (For instance, if you are an elderly Greek what would be your information sources to decide whether to wear a mask or not when going to church, with that option now open?)
For many communities, their social conservatism clearly displayed in their voting during the Same Sex marriage poll, religious leaders provide a guide to appropriate behaviour. Early on in the pandemic messages were delivered in some faith communities about the role that religious piety might play in protecting people from infection, while medical explanations and advice went unheard. In NSW MSNW moved quickly to activate its religious leaders’ forum fortnightly, usually a quarterly event, to ensure that across the range of beliefs in NSW the message of the government was delivered clearly. It also provides grants of $5000 -$10000 to community groups providing essential support services to culturally and linguistically diverse groups. Ethnic community clubs, forced into lockdown and soon on the verge of closure, were also provided with support to survive through the initial period of closure and economic collapse.
Social media has become a space of contestation, as messages ranging from bot trolling and overt racism to academic medical research struggle for the attention of audiences and their networks. Fear and anxiety has grown, with hate speech dividing communities from each other, and fear and “fake news” feeding each other. Communities especially of faith are also seeking ways to protect their members from harassment, through reinforcing social solidarity online, as shown in a recent Scanlon Foundation report detailing the response by religious bodies around the country.
Testing regimes have proven a difficult terrain with unknown impacts. Knowing the ethnic or linguistic dimensions of people who have been tested would allow some scoping of the people who have not been tested, and are therefore at greater risk as both patients and transmitters. Frontline workers told me of such situations. Young Afro-Australian men in western Sydney feel that the surveillance of COVID19 lockdown behaviour by police soon became yet another form of harassment, exacerbated by their overcrowded living conditions and poor incomes. Single mothers with children, still working on limited incomes, feared that they would lose what work they had, as slow test processing times meant they had to stay at home in self-isolation until cleared: they feared the self-isolation regimes.
Why we have to do “multicultural” properly
The resurgence is already with us, at least in Victoria. Yet official after official told me, becoming astonished in the telling to realise it, that there was no data about ethnic diversity. We are on the edge of something very complex with potentially major “downsides”. It is not just the abandoned asylum seekers whom I see searching for cans in the bins on my local street in order to collect a few coins, or the refugees fed by charities shivering in the cold as winter comes on, or the international students riding through the night for Deliveroo, but the whole edifice of multicultural Australia that has been overcome with shadows. Multiculturalism provides a shorthand for social cohesion among culturally diverse populations: its basic cement is trust and the sense of reciprocal obligation that holds societies such as Australia together.
Hopefully someone will work out that some authority needs to say, “let’s do this right”, and open up the illumination. This must begin by redefining the Notifiable Diseases strategy to recognise Australia as a multicultural society, and soon, so that if/when wave 2 arrives the country is rather better prepared to respond, resist and recover. As Minister Hunt and his NIR Division has written to me, for this to happen it would need to be initiated by one of the Network members (Commonwealth or states) and “its broader utility and consistency of collection would need to be confirmed with the states and territories.” Which of them will move first?