Essential workers are in critical condition

Essential workers are in critical condition
© Greg Nash

As our government debates COVID-related legislation and an economic stimulus, it must specifically address the needs of the essential workers that are keeping our country and economy afloat. Throughout the nation, COVID-19 is exerting profound damage to the essential workforce. These workers deserve protection and support commensurate with the jobs they are performing. As critical care and community health physicians in Texas and New York, respectively, we strongly believe that if our essential workforce is unsupported, the rest of the country will suffer. 

Construction workers, warehouse staffers, meat processors, and mass transit operators are falling ill. Nursing home workers and home health aides have repeatedly raised alarms over working conditions that pose a risk to not only themselves but also the patients they serve. These frontline workers are disproportionately low-income, Black and Latino, and increasingly rural. Their job requirements and conditions contribute to the profound racial disparities seen in COVID-19 death rates across America. 

Essential workers are not simply undertaking personal risks to keep our country in operation — they assume risk on behalf of everyone who can avoid settings where COVID-19 transmission is heightened. Moreover, they have no choice but to bring this elevated risk into their families and communities, often in living situations that are more crowded than their work-from-home counterparts. Even beyond the medical risk of contracting COVID-19, they carry the anxiety of potentially passing the disease to their loved ones and struggle with inextricable childcare hurdles.

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Essential workers should receive prioritized COVID-19 diagnosis and treatment, be guaranteed health care coverage for their families, and provided family support such as childcare. 

In Travis County, Texas, construction worksites have proven a nidus for infection, and county statistics reveal significant COVID-related devastation in the Latino community. And yet, unsurprisingly, a significant percentage of these and similar workers are ineligible for state and federal aid given their immigration status. Lack of guaranteed, protected sick leave means they are more likely to work while ill and infect colleagues. Lack of health insurance inarguably leads to delays in diagnosis and care, potentially placing more vulnerable community members at higher risk of exposure.  

Similarly, we know firsthand that health workers sounded the alarm early on their own infection risk, including many of our colleagues. Yet health care providers were specifically excluded from the Families First Coronavirus Response Act, and there is concern this could be interpreted to include nonmedical hospital personnel. Nonmedical hospital employees comprise the lowest paying jobs, and the deaths of these patient transporters, cooks, and janitors are often as invisible as the workers themselves. 

Workplaces across the country have sprinted to find solutions that safeguard their employees while working to mitigate litigation that could result from work-associated COVID-19 related infections. In practice, managers struggle individually to gain access to timely testing and personal protective equipment (PPE) alongside attempts to maintain operations. We have left individual businesses and managers to safeguard workers with inadequate means to do so. 

There is time to address this essential worker emergency if we focus on three urgent goals:

First, any worker that is designated as essential should have priority access to timely and regular testing commensurate with their occupational hazard, as well as no-questions-asked treatment if they get become infected. Many workplaces still do not offer health care insurance to their employees that cover costs of testing and treatment, and even if they did, they would face the same delays the rest of the nation currently does. However, by being “essential,” this capability should be secured by taxpayers who depend on the national network of essential services that make our economy and society function.

We know, for instance, that prioritized testing is possible — the NFL is testing all of its players daily to safeguard the players, staff and families. We simply need to refocus on who we consider a priority.

Second, essential workers and their families should have access to health care services, including and beyond COVID-19 specific needs. Like other Americans, essential workers and family members are deferring non-COVID-19 related care, including management of chronic conditions, which leave them more vulnerable to serious illness from COVID-19 and worsening of their underlying medical conditions, all of which translates into increased costs of care. This vicious spiral of illness and economic hardship is simply waiting to take hold in low-income households that are most likely to have essential workers. Tying health care to employment does not fit the reality of how disease spreads. Let’s focus on ensuring health care coverage for essential workers and their families on the way to ensuring health care coverage for all Americans.

Third, essential workers do not exist as an island. They require support systems to function, and they also have obligations to their chosen families that they need to fulfill. Especially since the majority of essential workers in health and human service professions are low-income women, support to care for children or other family members, which often falls on them, must be seen as a requirement in any support package. There have been many legislative proposals to address this gap. However, the litmus test is a basic one – are the families who contribute essential workers to the economy able to care for themselves without crushing anxiety and stress? This question should be table stakes for a functioning modern society; however, we are concerned that even this basic requirement will be left off the table.

Over the past decade, we have worked together in both urban and rural settings, in both public health and health care capacities. What has remained the same, regardless of context, is that the health of communities depends upon a core network of people to show up to work every day to do things that make life possible for the rest of us. They are the heartbeat of a healthy country, and today, essential workers are in critical condition. It’s time for all of us to act like our lives depended on them.

Marissa Wagner Mery, M.D., MBA, is a critical care physician and assistant professor at Dell Medical School and the University of Texas at Austin. 

Prabhjot Singh, M.D., Ph.D. is a physician focused on health system design, associate professor of medicine and global health at the Icahn School of Medicine at Mount Sinai, and host of the podcast Should I Take Off my Shoes?