Would coronavirus disproportionately hurt low-income people? Yes.


March 3, 2020

The coronavirus does not discriminate based on income or class. Just ask the more than 700 passengers aboard the Diamond Princess who became ill.

One could probably surmise that most passengers aboard that cruise ship boasted above-average wealth (and the crew members, generally in the opposite income category, also were affected).

But for reasons that have absolutely nothing to do with the virus itself, we know that even a moderate pandemic could hurt lower-income people more than others. This fact was borne out in recent days by news articles reported by three major publications.

People in medical masks in New York City. About 100 Americans, in 26 states, are being tested for the virus. Photograph: Justin Lane/EPA

Last Friday, in a story headlined, “The Americans who can’t hide from coronavirus,” Axios detailed some of the most obvious ways poor people could be hurt.

“People in service jobs or low-wage workers could disproportionately lose some income, compared to those with advanced education or more-skilled professions,” wrote Axios reporter Marisa Fernandez.

Other ways Axios said low-income people could be adversely affected: Kids on free and reduced lunch may risk going without meals if schools close. Parents may have to scramble as children get pulled out of school and day care. Undocumented immigrants are less likely to call off work or check into a health care facility due to lack of health insurance and ICE fears. Health care workers risk getting sick if an outbreak brings in an influx of patients to the emergency room. Public transit users could be left high and dry of trains and buses shut down.

Also, some experts are starting to advise people to consider stockpiling non-perishable food items at home in case of quarantine conditions. But that will be difficult for some low-income people, who may not have the extra money to lay out for longer-term food supplies. In the Washington, D.C. area, one food pantry is starting to make available larger quantities of staples. It is uncertain how many food pantries across the country will be able to do this.

The day before the Axios report appeared, Vox weighed in with a story headlined, “America’s bad sick leave policy could make the coronavirus outbreak worse.”

“Employees in the service industry especially, like food workers or personal care assistants, are much less likely than their peers in more lucrative fields to have paid time off if they get sick,” notes Vox’s Dylan Scott. “But they also make less money in general, meaning a lost day of work hurts their families’ budgets more. That gives them a strong motivation to go into work — even if they’re not feeling well.

“And because these workers come in close contact with the rest of humanity, they are a potent vector for spreading contagions, particularly those as infectious as coronaviruses,” Scott continues. “It’s a recipe for making a bad outbreak even worse, all because America hasn’t decided to guarantee paid sick leave for all workers.” Vox points out that the current variant of the coronavirus (now named Covid-19) is “pretty contagious,” with each sick person likely to infect more people than the seasonal flu.

Vox and others raise an obvious point: we need to protect low-income people from coronavirus not only because everyone should be protected from disease, but because the entire community is at risk if some people are not protected – and the risk is even greater when those left unprotected are in close contact with the rest of the community through their work in restaurants, hospitals, nursing homes.

Unlike every other developed nation, the U.S. has no federal law guaranteeing paid time off for illness, and paid sick leave is comparatively rare for lower-wage workers. Just 63 percent of people working in service occupations have paid sick leave, versus more than 90 percent of people in management positions, Vox reports. For people working part-time, just 43 percent can get sick leave from their employer.

Finally, the Washington Post on Monday published a thoughtful piece by public health professionals Mary T. Bassett and Natalia Linos that suggested “patterns of marginalization, exclusion, and discrimination,” including racist policies and the criminalization of poverty, could make the epidemic now arriving on our shores even worse.

Bassett and Linos point out that almost  half of Americans between the ages of 19 and 64 have inadequate health insurance. Many may avoid seeking care because of the potentially devastating financial burden. Despite the wealth of this country, close to 13 million children are living in poverty.

“Around 2 million Americans, including a significant number of Native Americans living on reservations, live without running water and basic indoor plumbing, hindering access to our most important prevention tool: hand washing,” they write. “And over 2 million Americans — a disproportionate number of them people of color — are incarcerated, often forgotten in emergency preparedness plans and left particularly vulnerable because of overcrowding and poor conditions.”

Bassett and Linos note that not only is the risk of contracting an illness such as Covid-19 greater for low-income people, but so is the subsequent likelihood of death. They point to high Covid-19 mortality rates among the elderly and those with pre-existing health conditions, such as cardiovascular disease, diabetes, chronic respiratory disease, high blood pressure and cancer.

“Because Americans, on average, are not as healthy as our peers in wealthy countries, we may expect a higher fatality rate here,” they say. “If this becomes a widespread outbreak, such an epidemic would probably be most devastating for the poorest Americans and for communities of color, who already are dying at younger ages and at higher rates from these common conditions.”

No, the coronavirus does not discriminate on the basis of income and class. But the underlying factors that help determine who gets sick and why, and who recovers and who doesn’t, are every bit influenced by pathogens of a more social nature – such as poverty, inequality, and institutional racism.

“We have to think about the vulnerable population,” Chris Coughlin, a law professor at Wake Forest University told Axios. “How can we support everybody because if you can’t afford to stay home, and there is an outbreak? Is that just gonna lead to more spread?”