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COVID-19: exposing and amplifying inequalities
  1. Michael Marmot,
  2. Jessica Allen
  1. Correspondence to Michael Marmot, Department of Epidemiology and Public Health, UCL, UCL Institute of Health Equity; m.marmot{at}

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Exponential growth is difficult for people to grasp. But that is what has happened to sales of Albert Camus’s The Plague, first published in 1947. According to Jacqueline Rose, it is ‘an upsurge strangely in line with the graphs that daily chart the toll of the sick and the dead’. She reports that, from the start of the COVID-19 pandemic, sales had grown 1000%.1 It may not be worth dwelling on those statistics. More interesting for Rose, and for us, is that a key theme of Camus is that ‘the pestilence is at once blight and revelation. It brings the hidden truth of a corrupt world to the surface’. In the same way, the pandemic of COVID-19 exposes and amplifies inequalities in society. The myth of the pandemic as the great leveller was given air when early cases included elites: a prince, a prime minister, a Premier League football manager and the actor Tom Hanks. It was, and is, most likely that as the pandemic took hold and society responded we would see familiar inequalities, of two sorts: inequalities in COVID-19 and inequalities in the social conditions that lead to inequalities in health more generally.

It was not always thus with epidemics. The plague came to Northern Italy in 1630, killing 35% of the population, including 38% in Bergamo, and an astonishing 59% in Padua. One effect of killing so many people was a temporary slowdown in what had been a steep rise in economic inequality in Italy. In the aftermath of the plague, work was plentiful—so many workers had died—and real wages increased. …

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  • Contributors The co-authors are Professor Sir MM and Dr JA from the UCL Institute of Health Equity, Department of Epidemiology & Public Health.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. The Marmot Review 10 Years On was supported by The Health Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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