The SARS-CoV-2 (COVID-19) pandemic has expanded globally. The public health guidelines have included hand hygiene, respiratory etiquette, physical distancing, and self-isolation in case of showing symptoms (1). Going to work has been limited only if physical presence is essential, setting working from home and distant schooling as a “default” option in many regions. These measures have unfolded with extreme speed and have sparked fears of an impending economic crisis and recession, as they have led to a reduced workforce across many economic sectors (2). The scale of ongoing containment and mitigation public health policies is unprecedented in the modern era and, while needed, they are impacting the economy and social life. Together with the fear of COVID-19 as a new disease, this is increasing the sense of uncertainty and impacting the wellbeing of populations (3).
The pandemic is having sustained effects on income and consumption. According to a global study (4) this will increase poverty levels. In some regions the adverse impacts could result in poverty levels similar to those reported 30 years ago, hence profoundly impacting the fulfillment of the Sustainable Development Goals (SDGs) and reversing decades of progress in poverty global reduction. Sumner et al (4) estimate that even a small contraction of 5% in income as a result of the COVID-19 pandemic, would increase the incidence of income-based poverty, although the impact will most likely not be evenly distributed across regions.
International agencies and academic communities alike have warned that food insecurity will most likely be a key consequence of the COVID-19 pandemic (5–7). In the US, studies have documented that the pandemic has disrupted food access and impacted food insecurity. For example, in Vermont a cross-sectional survey showed a 33% increase in household food insecurity; with 35.6% of food insecure households classified as newly food insecure due to the pandemic and job loss being a main predictor (8). A study of five repeated online surveys of the Supplemental Nutritional Assistance Program recipients (SNAP), when compared to a similar period in 2018, identified that food insecurity and debt had worsened significantly between April and June 2020 (9). A longitudinal survey collected in Southern California –the Understanding Coronavirus in America cohort– found that 40.5% of those living in households earning less than $75,000 and employed in February 2020 lost their job during the COVID-19 − 31% of them reported food insecurity. Moreover, they estimated that receiving unemployment insurance ($600/week) was associated with a decline in food insecurity (10).
The effects of the pandemic have also been documented in other countries. An online cross-sectional survey conducted in two favelas in Sao Paulo, Brazil, 89% reported uncertainty to access food, 64% were eating less than they should, and 39% skipped a meal (11). Other studies have documented effects of the pandemic in food insecurity as well as in mental health. For example, in Bangladesh, a study of families in a rural area based on an interrupted time-series design with a probabilistic sample identified that before the pandemic, 5.6% and 2.7% experienced moderate and severe food insecurity, respectively, and during lockdown it raised to 36.5% and 15.3%. Overall, food insecurity increased by 51.7% (12). On the other hand, depression symptoms increased 6 percent points during lockdown, reaching a prevalence of 10%. Another study using Amazon´s Mechanical Turk collected a convenience sample of 1,517 Americans with household food insecurity and found they were 2.09 and 1.88 times more likely to report anxiety and depression, respectively (13).
Other studies have centered in solely documenting the toll of the pandemic on mental health. For example, a cross-sectional study in Italy found that after the first wave of the pandemic, 5.1% of the population showed post-traumatic stress disorder symptoms and 48.2% lower psychological wellbeing linked to the COVID-19 (14). Similarly, a cohort study in the United Kingdom comparing tendencies pre and post COVID-19 first wave, showed that mental health deteriorated (15). This coincides with a panel of experts who suggested that due to the pandemic and its associated economic downturn there is a risk that the prevalence of people with anxiety, depression and engaging in harmful behaviors will rise, as this has been a trend in prior epidemics (16). Furthermore, it is important to consider that the pandemic can have an unequal effect on societies, as the crisis can increase disproportionately unemployment, financial insecurity and poverty among those who were already vulnerable, hence, placing them at higher risk of mental health conditions.
In terms of the inequities that are unfolding with the pandemic, it is of key relevance to underline that following the recommended public health measures in low- and middle-income countries is challenging, due to factors such as high rates of informal employment, suboptimal housing conditions, and low quality basic services such as running water, drainage and waste collection amongst others (17). When such social determinants are in place, complying with social distancing and quarantine is more difficult. For example, for many who are informally employed there has been no option rather than showing up to work, as their daily wages are used for subsistence. Not recognizing these dynamics jeopardizes the survival of large segments of vulnerable populations (17).
Mexico is an upper-middle income country facing one of the highest COVID-19 mortality. According to data from Worldometer on May 26, 2021, more than 222,000 deaths had been reported, only below the US, Brazil, and India. Excess mortality data analyses suggest that the mortality has been underestimated, most likely, due to the low levels of testing in the country (18). Households in Mexico, as in other low- and middle-income countries, share social determinants that can magnify the impact of the crisis in wellbeing such as a fragmented health system with lack of adequate public investment, large income inequalities, high levels of poverty, a large informal economy, and high levels of unplanned urbanization with low quality basic services.
While other Latin American countries expanded social assistance to offset the impacts of the pandemic (19), in Mexico there has been a very slow and limited expansion of social assistance (20), exposing the population to undesirable side effects of the lockdown measures implemented. The aim of this study is to describe the association of the first wave COVID-19 crisis in four wellbeing indicators in Mexico – employment, income, anxiety and food security – and assess the role of pre-COVID vulnerabilities (i.e. socioeconomic level) on such outcomes.