To defeat the coronavirus, we must address the needs of the...

To defeat the coronavirus, we must address the needs of the socially vulnerable, including those who are homeless— both for ethical reasons and because if infection rates remain high among this population, it will be harder to bring the epidemic under control. Credit: Getty Images/iStockphoto/sabelskaya

Americans are doing a heroic job of fighting COVID-19, from the health care workers risking their lives to the leaders setting policies to reduce transmission of the virus. But there’s something we’re missing, and it’s putting all of us at risk.

We’ve been focusing on protecting the medically vulnerable among us: older people and people with underlying health conditions. That indeed is crucial. But the socially vulnerable are just as high risk. We must address their needs — both for ethical reasons and because if infection rates remain high among this population, it will be harder to bring the epidemic under control.

What do I mean by socially vulnerable? These are people whose lives are marked by conditions that make it more difficult to get and stay healthy. People who are on the edge financially, who don’t always have enough to eat or lack access to affordable medical care.

These conditions matter, because while you may have heard that this virus knows no race or class, poverty is a risk factor for getting infected, becoming severely ill and dying. One reason is that financial hardship and chronic health conditions, such as asthma, diabetes and high blood pressure, tend to go hand in hand. According to a recent estimate, COVID-19 is twice as deadly for the disadvantaged.

This has many implications. For starters, many people on the lower rungs of society can’t follow the public health guidance on social distancing — if one family shares an apartment with relatives or another family, they’re all trading exposures.

The problem is more extreme for Americans who don’t even have a home. People can’t “shelter in place” if their homeless shelter has a policy — as many do — that they must vacate the premises by a certain time each day. Even when they’re allowed to stay, tight sleeping quarters, shared bathrooms and communal meals optimize the transmission of the virus.

Diagnosis is also a greater hurdle on the lower end of the economic spectrum. In metro New York, if you meet the criteria for testing, having a car can make the process safer: With drive-through testing, it’s easy to avoid contact with others. If you lack a car, you may have to wait shoulder-to-shoulder with others who may be carrying the virus.

In addition, the pandemic is disproportionately affecting the disadvantaged even if they don’t fall ill. Many live in food deserts, where it’s difficult to find nutritious, affordable food. Reduced schedules for public transportation compound this issue. Social isolation can also worsen behavioral issues, from depression and anxiety to substance use.

So what can we do to address these extra risks and burdens? There are many ways that state and local governments, as well as hospitals and health systems, can make a difference. Experts in public health, housing and other fields suggest:

  • Revoking policies or ordinances that require homeless shelters to close for a period each day. This would allow sick people to rest and prevent healthy people from having to risk infection by riding public transportation or being on the street. Also, find ways to house the homeless in less-crowded conditions, such as tapping vacant hotels. (New York City has taken steps in this direction.)
  • Broadening the new federally mandated sick-pay policy to cover more of America’s workers, especially as jobs return. It is critical to support people in staying home while contagious. A 2017 study found that influenza rates were 40 percent lower in states that required businesses to offer paid sick days.
  • Creating numerous small testing sites in economically disadvantaged areas, rather than fewer larger ones. Ten sites with one nurse each provide greater access to people with limited transportation than one site staffed with 10 nurses.
  • Improving access to nutritious food. When New York City closed its schools, it began providing grab-and-go meals for schoolchildren across the city — then expanded the program to include any resident in need. Local governments could even consider subsidizing home delivery of groceries or meals.

These are just some of the steps we can take. There are many others to consider. Committing to protect the socially vulnerable from the worst impacts of the coronavirus may be difficult and costly, but it will pay enormous dividends. Equally important, it’s the right thing to do.

Ram Raju, MD, is senior vice president and community health investment officer at Northwell Health. He previously served as president and chief executive of NYC Health + Hospitals, the largest public health care system in the United States.

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