As physicians, we have increasingly found ourselves advising patients to do what seems impossible: to stay home and protect themselves in public.
“I can’t afford to stay out of work for two weeks. How will I feed my children?” worried a young grocery store worker, after listening to detailed instructions about how to self-isolate until her COVID-19 resolved.
On another tele-visit, a nursing assistant reported that the nursing home where she worked had no protective equipment and asked for a letter to stay home after two other co-workers tested positive for COVID-19.
A third patient, with asthma, explained how she must go to the methadone clinic daily for her dose, but how could she socially-distance while waiting in line?
The examples go on and on.
We’ve all seen the reports of food bank lines winding around the block. And it’s hard to tell people to stay home from work, when they have no paid sick leave and are at risk of losing their jobs. Responses, such as what we’re seeing in Chelsea, to expand testing, food distribution and access to safe quarantine are important, yet it won’t be enough to prevent the virus from spreading more widely. It’s become increasingly clear that the safety net is failing all of us.
It seems Massachusetts has managed to stabilize the rates of new COVID-19 infections, but the cumulative total cases have continued to rise. What are we missing?
Perhaps we can look to frontline workers at Amazon, Whole Foods, Target and Instacart, who recently organized a strike, for an answer. They demand paid sick time (regardless of diagnosis and for the duration of illness), adequate protective equipment, enforced distancing measures, hazard pay, childcare subsidies and transparency around COVID-19 workplace exposures. We ought to listen to the building trades, who called for a moratorium on non-emergency construction over a month ago. Or the GE workers, who requested their company re-open, institute safety measures and allow them to produce much-needed ventilators.
Essential workers are telling us what they think they need — to stay safe and continue providing critical services. In March, for example, nursing home workers complained about inadequate protective equipment, but people in power didn’t listen to them (Massachusetts leads the nation in nursing home deaths). Now, essential workers aren’t represented in the state’s COVID-19 Response Command Center or the new Reopening Advisory Board.
As other states reopen, against the advice of public health experts, and President Trump discusses disbanding his COVID-19 taskforce, we applaud Governor Baker’s decision to extend the stay-at-home advisory.
But Massachusetts ranks fourth in the nation for COVID-19 deaths per capita. Washington and California issued their stay-at-home orders much earlier than Massachusetts, and as a result, have controlled the pandemic more effectively and saved thousands of lives. The commonwealth's piecemeal response has left each city and town to make its own recommendations regarding construction, distancing, even rent-freezes. Essential businesses do not have sufficient means, or direction, to adequately protect workers and patrons and working people can’t afford to stay home if they’re sick.
Before we think about reopening the economy, we need to think about the essential workers who are actually making it run.
If Governor Baker wants to cut infection rates, the state must issue very specific guidelines regarding social distancing in essential businesses, limiting the number of people per store and increasing availability of curbside pickup and other forms of contactless shopping. The state must also secure necessary protective equipment for all essential workers — health care, grocery, sanitation, transportation and so on.
Failure to do so exacerbates an already unequal city-by-city, racial and socio-economic landscape.
Even with incomplete data on race and ethnicity in Massachusetts, we can see that Latinx and Black residents are two and a half to three times more likely to be infected with COVID-19 than whites. People of color are disproportionately more likely to be essential workers. They are at increased risk for severe infections given their increased rates of chronic illnesses and have been egregiously under-protected by decades of income inequality, institutional racism, lack of a social safety net, environmental hazards, and now a vastly inadequate response to the pandemic at a state and federal level.
The Baker administration must take urgent action to improve data collection on race, ethnicity, language and other demographic factors and make data publicly available to improve care and preventative measures for these communities. We join Massachusetts lawmakers in urging Governor Baker to integrate representatives from the most affected groups, including frontline workers and their unions, communities of color, indigenous people and people living with disabilities into his Reopening Advisory Board, and call on him to include them in his COVID-19 Response Command Center as well.
No one wants to see the economy open more urgently than working people who were already living hand to mouth before the pandemic, and now struggle to pay rent, without a paycheck in sight. In the last month, more than 30 million Americans filed for unemployment benefits while billionaires amassed an extra $282 billion. That money, redirected to the government’s response, would go a long way to help bail out working people.
As millions lose their employer-sponsored health insurance, it becomes glaringly obvious that we need universal, single-payer, government-sponsored healthcare for all. We need to expand the CARES Act to pay workers regardless of their immigration status (because immigrants represent 22% of all workers in the food industry and 17% of all health workers). We need to cancel rent, mortgage and other utility and debt payments for the duration of the crisis. And we need to make sure that populations at the highest risk of infection — because of overcrowded living conditions — can be safe, by releasing nonviolent and aging prisoners, people detained by ICE, and making sure the homeless have access to safe quarantine.
Before we think about reopening the economy, we need to think about the essential workers who are actually making it run. We need to make sure our patients, and others like them, can feed their families, care for their health, and prevent the spread of illness by paying them to stay home when they are sick.
Massachusetts legislators have already put together a slate of bills that would start to address some of these issues. Singapore has showed us the way COVID-19 can resurge when a society overlooks its most vulnerable workers. The only way out of the COVID-19 pandemic is to correct the social and economic inequities that made our society more vulnerable to it.
We must integrate affected communities in the response and build an equitable society that puts people before profit, in which each and every member is able to protect themselves from infection and has access to food, water, shelter and medical care.
Lara Jirmanus, MD MPH is a primary care physician at Cambridge Health Alliance, a fellow at the Harvard FXB Center for Health and Human Rights and a part-time clinical instructor in medicine at Harvard Medical School. Rose Molina, MD MPH is an obstetrician-gynecologist at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School. Regina LaRocque, MD MPH is a physician in the division of infectious diseases at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School. Avik Chatterjee, MD MPH is a primary care physician in Boston and an assistant professor at Boston University School of Medicine. All the authors are members of Massachusetts Health Workers for Equity, a growing coalition of physicians, nurses, public health advocates and community leaders.