JAMES THOMAS & KAULINE CIPRIANI: An 'essential' lesson from COVID-19

Posted May 5, 2020 5:00 a.m. EDT

Store employee Luis Gabriel stocks produce at a Pioneer Supermarket in the Bronx on March 25, 2020. (Desiree Rios/The New York Times)

EDITOR'S NOTE: James Thomas, MPH, Ph.D, is associate professor of epidemiology, and Kauline Cipriani, Ph.D, is the assistant dean for Inclusive Excellence and associate professor in the public health leadership program, at the University of North Carolina Gillings School of Global Public Health.

During this pandemic, we offer each other words of encouragement: “Stay safe” and “We are all in this together.”

We proclaim that workers providing essential services are “heroes.” But we can’t all stay safe if some of us are exposed to infection while providing essential services. Grocery store and post office employees, for example, are face-to-face with a steady stream of clients. Some workers are potentially exposed by their co-workers.  The U.S. Occupational Safety and Health Administration has received thousands of complaints about the lack of workplace COVID precautions.

As states begin to relax social distancing and open businesses, contact between people will increase and transmission will inevitably increase. People with a secure income and able to work from home will be able to sidestep the resurgence, while those in need of money to pay rent or put food on the table will be the ones who return to work, whether they fear infection or not.

Once they are infected, low income people – who are disproportionately racial and ethnic minorities – are more likely to die of the infection because they often have one of the underlying conditions like diabetes or hypertension, that enhances their vulnerability.

More likely to have a low wage, more likely to have an underlying condition, more likely to get infected, and more likely to die from an infection. The cascade is a sad one that demands a response. Our consciences and a desire for justice have often motivated us to lessen inequities.  These motivations and the actions they give rise to are important, but this pandemic is revealing to us another reason to act: Essential personnel are our safety net.

Before the pandemic, we might have viewed a company CEO as essential, reflecting this view with an exorbitant salary or annual bonus. But when a society is brought to its knees by a pandemic, it turns out that what we need most is a long-distance trucker or a grocery store shelf stocker. The biblical statement that the last shall be first now rings truer than ever.

The essential role of previously invisible workers is also coming to light with this pandemic. Several meat packing plants have closed because of rampant transmission among workers standing shoulder to shoulder with inadequate protective gear and without the option for sick leave. The plant closures will have effects up and down the food supply chain.  The growers will have no place to sell their stock and the consumers will find empty shelves.  In some countries, disruptions to the food supplies are expected to result in mass starvation.

How do we ensure that our essential services, and the workers who make them possible, remain secure in this pandemic or the next one? We can start with three steps:

(1) Protect their safety by enforcing workplace regulations. OSHA has been faulted for neglecting COVID-related workplace safety. They need to be held accountable for their mandate.
(2) Provide frequent testing so essential workers can be treated promptly and isolated quickly to minimize the risk of infecting co-workers.
(3) Provide health care for those who get infected so they can live to work another day. Medicaid insurance may be an important part of this as some employers avoid providing health insurance by giving their employees too few hours to qualify for an employer-provided plan.

Once we have made it through this pandemic, and while our memories are still fresh, we can review where workplace regulations need to be improved, and whether there are longer-term solutions to keeping a vital work force for our essential services. Ensuring the ability of our essential workers to both survive and thrive is essential to our national security.

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