As America focused on the presidential election, COVID-19 cases surged. This alarming trend underscores the task now before President-elect Joe Biden and his COVID-19 task force: to “listen to science” and implement strategies that minimize pandemic-related suffering for Americans — particularly those living in poverty.
The pandemic has hit poor communities like much of Philadelphia hard. Low-income individuals are the least able to forego work to care for high-risk loved ones, creating a trade-off between bringing home money to keep the heat on and bringing home the virus to loved ones. Virus-related hospitalizations and death have been higher in areas with greater poverty.
Despite these disproportionate harms, prioritizing the poor is easier said than done. Some scholars, such as those behind the Great Barrington Declaration, suggesting doing so via a “reopening based” strategy that applies restrictions to high-risk individuals, such as nursing home residents and other elderly individuals, while allowing herd immunity for everyone else. Other experts, such as those behind the John Snow Memorandum, counter this notion, arguing for a “restriction based” strategy that protects the vulnerable by extending closures until reopenings can be justified.
In reality, neither accounts specifically for low-income communities or proposes measures to protect them. Consider the Great Barrington Declaration, which calls on leaders to rapidly reopen everything from sporting events to restaurants to schools. In that exhortation, there is no acknowledgment of poverty as a form of vulnerability, or low-income individuals as the workforce in low-wage, frontline jobs with higher infection risk. Despite invoking a compassionate approach, the Declaration is silent on the actions needed to achieve it.
Aggressive restrictions are no panacea either. For instance, the John Snow Memorandum invokes the need to protect the vulnerable with financial and social programs. But it stops there. There is no guidance about whether such programs should target the direct economic strain on low-income workers who cannot do their jobs remotely, or the indirect harms they face as a result of business closures (e.g., loss of health insurance), or school closures (e.g., loss of a critical means for feeding and caring for their children). The Biden team must overcome these issues to achieve its express goals of listening to science and protecting high-risk individuals.
» Here are Philly’s current COVID-19 guidelines: inquirer.com/phillyguidelines
The task force can do so by implementing a two-step approach that first directly considers and then prioritizes low-income communities. For instance, the Biden team could identify geographic areas with large numbers of low-income individuals, prioritizing those communities as it creates its Nationwide Pandemic Dashboard to give Americans real-time information about viral transmission. Similarly, in reopening or closure plans, Biden officials could identify and then prioritize widely used economic sectors that workers rely on for employment, such as public transportation, and other benefits, such as education as a means of child care.
To do that effectively, the task force must spearhead an aggressive push to generate new data. Officials cannot protect low-income communities in reopening or closure decisions without more detailed data about viral transmission in sectors such as public transportation or schools; the economic impact of closing them; and how both viral transmission and economics are affected by modifications (e.g., reducing the number of individuals allowed to take public transportation; teaching through hybrid in-person/virtual classrooms). These currently unavailable data are vital to a robust, scientifically informed strategy.
Information about critical geographic areas and economic sectors can also help direct resource allocation and economic relief. For example, the Biden plan has proposed using the Defense Production Act to ramp up production of personal protective equipment, particularly for areas serving the vulnerable. The task force could directly consider poverty and provide priority access — to protective equipment, as well as other resources like rapid testing — to low-income communities.
To achieve its goal of economic measures to help hard-hit workers, the Biden plan could create “leave support” programs like the one used in New Zealand, which provide financial support for people who can neither go to work or work from home due to COVID-19. Together, these steps would serve to alleviate economic burdens and limit harms in low-income communities.
Of course, there are no silver bullets in addressing poverty or the pandemic. The steps proposed here may vary by local settings. A focus on vulnerable groups also does not obviate the need for comprehensive, population-wide public health measures. However, it is also likely infeasible to implement measures at once everywhere, so a prudent strategy to rollout that prioritizes the vulnerable is paramount.
COVID-19 has laid bare the inequity facing low-income communities, as well as the inadequacy of our strategies for addressing it. President-elect Biden now has a chance to remedy both problems by meaningfully prioritizing the most vulnerable.
Joshua M. Liao is director of the Value & Systems Science Lab and associate professor of medicine at the University of Washington. Amol S. Navathe is director of the Payment Insights Team and assistant professor of medicine and health policy at the University of Pennsylvania.