COVID-19 isn’t the great equalizer

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I am an internal medicine doctor on the frontline of the COVID-19 pandemic in Oakland, California. Before the first confirmed case at my hospital, I could sense the fear and anxiety of the impending disaster with every interaction I had with colleagues and my patients. This was largely due to the uncertainty of what was to come, and we were mainly looking towards the overwhelmed health care systems of countries like Italy and Spain as premonitions of our future.

I reached out to Italian doctors on a networking application before the surge of COVID patients hit California. They explained how Italy underestimated COVID and warned us not to repeat their mistake while detailing several horrifying stories about elderly patients being denied access to ventilators due to a lack of resources. One doctor astutely reflected that COVID was the great equalizer: that everyone, both rich and poor, young and old, could be severely hurt by the virus.

However, this has largely not been the case at my hospital. Unlike in New York, where the health system is overburdened in all imaginable aspects, we luckily acted early enough with the leadership of people like Governor Gavin Newsom, though there are still several enclaves being overrun like in San Jose and Los Angeles. My hospital has had an uncharacteristically low number of total patients, with a slow, steady increase in COVID positive patients. So far, we are projected to not run out of hospital beds or ventilators, at least not in this first wave of the virus.

Despite how well we have fared thus far, I noticed a troubling trend that COVID is not the great equalizer that it was initially deemed to be. Our COVID positive patients requiring hospitalization and ICU level of care are disproportionately people of color and those from lower socioeconomic groups. It’s easy to attribute the unequal effect that COVID has had on these populations to traditionally identified barriers and disparities, such as lack of access to medical care and higher rates of pre-existing medical conditions. However, this pandemic has brought to the surface so many more inequalities and inherent privileges that are systemic to our society.

Weeks before the shelter-in-place order was instituted in the Bay Area in mid-March, many tech companies had already instructed all of their employees to work from home. Others in high-income jobs had a relatively smooth transition to quarantining. In contrast, people with low-income jobs have had a much more difficult time. Several have lost their jobs and now cannot afford to support their families, leading them to homelessness or forcing them out of their homes into danger to look for work. Or they are essential workers, who are predominantly in low-income jobs, such as janitors, bus drivers, or farmworkers. Thus, the income level has a direct effect on exposure to the virus, which accurately reflects the types of patients I’ve seen in the hospital. This has led to an even wider gap in health disparities based on socioeconomic status compared to before the pandemic. To make things worse, several of these essential workers are not provided adequate personal protective equipment or even any, for that matter. Many workers, like those in Amazon’s warehouse, are not even offered paid sick leave.

Furthermore, people who are in a position of privilege are largely removed from the ramifications of COVID. People with higher incomes have better access to preventative medical care, gyms, and healthy food and are, not surprisingly, healthier at baseline. Hence, if they or their loved ones do catch the virus, they are less likely to have severe symptoms. I’ve also seen that the majority of people in my gentrified, mostly Caucasian neighborhood are wearing N-95 masks, which should be reserved for healthcare workers and other essential workers more exposed to the virus. It is privilege that allowed them access to these scarce resources.

I have also noticed an increased sense of entitlement in some members of the community. I met several patients with white-collar, non-essential jobs who did not meet criteria for testing, due to the initial need to ration tests for those with severe symptoms. Several of them refused to strictly self-quarantine unless they received a test despite having mild symptoms. Moreover, there have also been several reports of the super-rich paying their way to accessing tests, many of whom did not even have any symptoms. This is a gross miscarriage of appropriate medical care in a resource-limited system.

As a millennial, I have witnessed several displays of careless disregard for the shelter-in-place guidelines on social media. Despite admonitions from the United States Tennis Association to not play tennis, several members of my Facebook tennis group plotted to meet despite current regulations. I also have several friends who are traveling for leisure to take advantage of the current cheap travel costs and a few who went to a secret underground night club with more than 150 people in attendance in San Francisco. When people in a position of privilege leave their house for non-essential reasons, they are disproportionately putting underprivileged people at risk. They have the luxury to shelter for most of their time, unlike essential workers who are almost constantly exposed to the elements.

I recognize that it is necessary for our sanity to leave our homes occasionally. However, all of us — especially those who are privileged like me — should think twice before leaving our house, if not for our own well-being, then for those at higher risk due to their disadvantages in life. Our responsibility does not end with simply staying at home. We need to recognize that essential workers do not become less essential once the pandemic is over. We have an obligation to give these workers their appropriate dues financially and with regard to benefits and healthcare. And then we need to go further and initiate extensive protections of their health, especially when the second wave of this virus hits and when future pandemics arise.

Shankar Mundluru is a hospitalist.

Image credit: Shutterstock.com

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