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As COVID-19 cases rise again in Wisconsin and across the country, there are even fewer universal requirements than in the past to help protect people from contracting the novel coronavirus or spreading it to others.
As a consequence, people who all along have been the most vulnerable to illness are still at risk while they have fewer safeguards. Those include people with disabilities along with low-wage service and industrial workers in occupations that have been labeled as essential.
“We call them essential but we treat them as expendable,” says Tiffany Green, a health economist and professor at the University of Wisconsin School of Medicine and Public Health. “They’re less likely to be covered by benefits like health insurance.”
They are also more likely to be people of color, accounting for some of the reason that those communities have experienced higher rates of infection and severe disease, says Kelli Jones, a professor at Marquette University’s college of nursing.
Many lack paid sick days. “They’re not going to be able to stay out of work for long, or if they stay out of work for long, they’re going to lose that job,” Jones says.
Health disparities along lines of race, class and disability aren’t unique to COVID-19.
“When you’re poor, when you’re a person of color, when you have a low wage job, when you have low educational attainment — pick any health condition, it makes it harder to access care for that condition and it makes it harder to get quality care,” says Dr. Geoffrey Swain, president of the Wisconsin Public Health Association.
When the novel coronavirus first began spreading, people with disabilities were among those most severely hit, according to Beth Swedeen, a disability rights advocate. That has continued throughout the pandemic.
They are more vulnerable to infection from the virus for more than one reason. “A disproportionate number have complicated health profiles,” including weaker immune systems for a variety of reasons, says Swedeen, co-chair of the Survival Coalition of Wisconsin Disability Organizations. “They are also more vulnerable many times because they don’t have complete autonomy over the people that are around them and the setting they are in.”
According to the latest community levels report from the Centers for Disease Control and Prevention (CDC), which is updated weekly, COVID infections and hospitalizations are so high in seven counties that the agency recommends everyone wear masks indoors, whether vaccinated or not.
That is only a recommendation, however, not a requirement. When mask mandates were in place care workers were required to mask when attending to their clients, says Swedeen. Without requirements, if a care worker doesn’t want to mask, the client may have trouble making that demand.
“With the legal shift to not requiring masking, then it’s really difficult for people with disabilities to keep themselves safe,” she says. “They can mask, but often the people providing supports to them are not masking now.”
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A client may be unwilling to press the issue for fear that the person will quit at a time when the shortage of caregivers — which was already at crisis levels before the pandemic — has gotten even worse, she explains. Clients may find themselves forced to choose between acquiescing to an attendant’s refusal to mask or risk going without the support. “Yet if [clients] don’t have those supports, it can lead to illness or complete personal and social isolation,” Swedeen says.
From the earliest stages of the pandemic, the working poor have also been identified as especially endangered by the coronavirus, with jobs in the service industries “where they’re interacting with the public on a daily basis,” says Jones.
Lacking paid sick time and often lacking health insurance, they are also less likely to have an ongoing relationship with a health care provider. One reason is historic mistrust of a health system that has long marginalized them, particularly people of color, says Jones.
Because they don’t have that connection, that also contributes to continued lower vaccination rates. Anti-vaccine social media messages also play a role, she says. So does the sheer exhaustion from living in poverty.
“If you’re worried about so many other things and just the stresses over everyday life, this may not be the No. 1 priority for them,” Jones says.
The continued pandemic has also become intertwined with disruptions in child care. COVID infections have shut down child care temporarily, and the risk of COVID has contributed to the worsening shortage of child care workers.
“You already have an industry of underpaid, overworked people,” Green says of the child care field. “And now you’re asking all these people to work in facilities that, by their nature, are almost totally populated by un- or under vaccinated people.”
Vaccination rates remain low for children 5 and older, while the COVID-19 vaccine approval for children under 5 has been delayed.
As with people with disabilities, those who work in low-paid service work face higher risks when masks are optional while case rates are rising.
“Beyond getting the vaccine, our No. 1 security is that mask,” says Jones. Without the requirement, “people are tired of wearing a mask, so they don’t wear them. So no one should be surprised that we’re seeing increases.”
The current messaging in public health, from the CDC to local health departments, calls for people to consult their personal health provider on whether they should mask in their particular community and personal circumstances.
“Many of these people don’t have a regular health provider or insurance,” says Green. So advising them to simply check with their doctor “makes no sense.”
Green says the continued cycling of the pandemic, with surges that then fade, followed by new surges as the virus changes, appears likely to continue without a steady, persistent adherence to mitigation measures. She compares it to the discipline of exercise. “You don’t just run for a couple of months and consider yourself fit for a lifetime,” she says.
Fighting the pandemic “requires relentless consistency,” says Green — in mitigation, in persisting with vaccine outreach, especially to the historically marginalized. “And it requires mask mandates — and I know that those are politically unpopular.”
Solidarity has withered in the pandemic. “We just kind of have an every man for himself kind of mentality,” says Jones. “We need to think about other people, not just ourselves. We have to work as a society to keep each other healthy. That’s really been lost.”
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