How America’s long-lived tradition of under-insuring and overworking its populace could influence the disease and treatment

Nobody quite knows what to expect right now. Some people are very concerned, some people think the concerned people are hysterical, and others (myself included) are somewhere in the middle. I am fortunate in many ways. I have a home. I have a job. I have health insurance. I work from my home. I have unlimited paid time off. On an ordinary day, under ordinary circumstances, I can count myself as lucky. That feeling is only compounded at a time like this when we’re facing so much uncertainty and a pandemic.

Over 32 million Americans do not have paid sick days

I, and others who are similarly fortunate, have a solid foundation on which to stand should we be faced with an extended sickness or a quarantine order. For many Americans, that is not the case. The most recent National Compensation Survey conducted by the U.S. Bureau of Labor Statistics shows that over 32 million Americans do not have paid sick days [1]. These people must decide between losing a day’s pay or taking care of their health. In many of these situations, that day’s pay is a critical amount of money. In the private industry, only 47% of low-wage earners have sick leave [2]. As a low-wage earner with no sick leave or health insurance, if you came down with COVID-19 you would be potentially facing weeks of lost earnings and high-cost medical bills. This is on top of the ongoing serious challenge of paying bills, as almost half of Americans are living paycheck to paycheck [1]. There’s nothing hysterical about considering these repercussions and concluding that America is not well prepared.

You can turn to the CDC’s website for further confirmation that low-wage earners in the U.S. will struggle with COVID-19’s treatment protocols.

- The CDC recommends that you call your doctor if you suspect exposure or sickness from COVID-19 [3]. Many low-wage earners don’t have primary care physicians due to a lack of health insurance and fear the costs of tests and treatment. This could accelerate the spreading of the disease to the extent that people delay implementing treatment and isolation protocols.

- The CDC further recommends that if you suspect exposure or are sick with COVID-19 you should stay home except to get medical care [3]. This is where the 32 million Americans without sick leave will have to make tough choices. They will face lost pay, and maybe even lost jobs, in order to take care of their health.

- You are advised to avoid public transportation if you suspect exposure or sickness from COVID-19 [3]. This is the only mode of transportation for many low-wage workers [4].

- If you suspect exposure or sickness from COVID-19 you should separate yourself from other people and even the animals in your home. The CDC advises people to stay in a separate room, and to use a separate bathroom [3]. Many low-wage workers may live in an apartment or home with one bathroom and limited rooms for isolation. Some have care-taking responsibility for children, parents, or other loved ones with limited options for backup.

Through the top recommendations of the CDC’s advice, low-wage earners are faced with:

- calling a doctor they may not have

- requesting medical tests for which they likely don’t have insurance

- pursuing transportation options that they do not have

- separating themselves from loved ones in homes that may not allow them to do so

- hiring pet sitters for their animals

- reneging on provider and caregiver responsibilities

Low-wage earners, who are disproportionately people of color, immigrants, and people with medical or physical disabilities, face additional barriers related to inequity in our healthcare system.

If we are to realistically address COVID-19 in the short-term, we need to be mindful of the real financial and social impacts to the half of Americans facing life-changing financial implications from basic public health protocols.

While national media focuses on people canceling vacations and conferences, telecommuting, and trying to quell the hype, there is a need for more urgent attention to realistically and respectfully address how limiting work, transportation, and healthcare access impacts the vast majority of Americans.

As a country, we ought to consider the value in instituting policies and supports for low-wage earners. Pandemics highlight our interdependencies and help us to see the common humanity and our reliance on each other. Currently only 12 states and Washington, DC have any requirements about paid sick leave [5]. While it is certainly better to have access to some sick leave rather than none, most states with sick leave legislation cap the leave required at 40 hours, which we know would not be adequate in the case of COVID-19 exposure or sickness.

If we are to realistically address COVID-19 in the short-term, we need to be mindful of the real financial and social impacts to the half of Americans facing life-changing financial implications from basic public health protocols. With more emergency measures being implemented each day, it is important to rapidly consider policies that can be initiated to provide some immediate relief to the vulnerable, low-wage earner population. From a long-term perspective I wonder if COVID-19 will be the motivator that gets us to consider Federal legislation to close the gap for all citizens. If that comes to pass, I will be sorry that it took a pandemic to usher in change, but I will be thankful for the added protections for all citizens.

Spring Street Exchange - a services firm that focuses on transformation and social needs related to healthcare

Citations:

1 – U.S. Bureau of Labor Statistics – NCS, 2019. https://www.bls.gov/ncs/ebs/benefits/2019/benefits_leave.htm

2 - Maye, A., November 21, 2019. The Center for Law and Social Policy. https://www.clasp.org/blog/low-wage-workers-least-likely-have-paid-sick-days

3 – Prevent the Spread of COVI-19 if You Are Sick. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html

4 – Governing – The Future of States and Localities, Who Uses Public Transportation in Your City? https://www.governing.com/gov-data/transportation-infrastructure/public-transportation-demographics-ridership-data-for-cities.html

5 – Brainerd, J., March 5, 2020. Paid Sick Leave. National Conference of State Legislators. https://www.ncsl.org/research/labor-and-employment/paid-sick-leave.aspx