Pandemic has illuminated vast health disparities
Connecticut’s COVID-19 data reveals a disturbing trend that is unfortunately in line with the rest of the country — the virus is disproportionately affecting African American and Latinx individuals.
In New Haven, African American and Latinx people make up just over 60% of the population, but represent nearly 80% of the city’s COVID-19 positive cases with known race. Preliminary data also shows that virus outbreaks are largely concentrated in under-resourced, lower-income communities of color.
New Haven Mayor Elicker recently announced three new COVID-19 testing sites in the predominantly African American and Latinx neighborhoods of Dixwell, Fair Haven, and Dwight, aiming to bring essential testing to some of the most affected communities in New Haven. At a recent press conference, Gov. Ned Lamont highlighted several plans to support the state’s most at-risk and vulnerable groups through the reopening and recovery. Yet, continued focus is needed to remedy the alarming disparities resulting from structural inequalities that predate the pandemic.
Evidence clearly shows under-resourced communities are at the highest risk of becoming virus hot spots. People of color and low-income earners are overrepresented in many essential occupations, less likely to have jobs that can be done from home, and more likely to use public transportation, increasing their risk of COVID-19. Many also live in crowded urban areas and multigenerational homes, where dense living spaces make physical distancing or isolating difficult, if not impossible.
Here’s what needs to happen:
We must ensure federally qualified health centers (FQHCs) weather the economic storm for our collective benefit. Testing is critical to identify asymptomatic cases and limit community spread, and partnerships with neighborhoods and community, faith, and other leaders are essential to identify priorities, disseminate accurate information, and offer containThe ment support. Our state’s FQHCs must also play a leading role in making testing and follow-up accessible.
Connecticut should prioritize the contributions of community health workers for public health interventions. The United States is falling behind in recruiting the estimated 100,000 to 300,000 contact tracers it needs to be effective, and while volunteers are integral to the process they cannot meet all anticipated needs. Community health workers — community members who work with local agencies and hospitals as advocates, health educators, and outreach organizers — are ideally suited to fill this gap, as they are uniquely familiar with community needs and resources.
We must encourage those who test positive for COVID-19 to separate from others when they can to avoid further spread. This also means that Connecticut’s residents need to be connected with the tools necessary — access to basic food and housing needs, clinical care, and employment protection — to safely and effectively isolate or to quarantine when advised.
Isolation should not be forced on those who test positive, nor should quarantining be mandatory for those who are exposed, but everyone should have the option to do so if they choose.
Cities and organizations throughout the state already partner with hotels, motels, and repurposed facilities to decompress homeless shelters and offer isolation options to people experiencing homelessness who test positive for COVID-19. Connecticut should similarly continue to partner with lodging facilities to offer short-term accommodation for people who test positive for COVID-19 and wish to isolate away from high-risk household members.
Connecticut must also make isolation economically feasible. People of color and low-wage workers have been unequally impacted by the COVID-19 associated economic crisis, as they are more likely to have been laid off, less likely to have access to paid sick leave, and less likely to have financial resources to fall back on due to racial wealth gaps, making it difficult for people in hot spot communities to step away from financial responsibilities.
Families First Coronavirus Response Act, building on Connecticut’s Paid Sick Leave law, has made progress in this regard, guaranteeing paid sick leave and partialsalary family and medical leave. But under current regulations, businesses with fewer than 50 employees or in the healthcare sector may be exempted, leaving millions potentially without coverage.
Connecticut must expand state-wide sick leave provisions, supporting small businesses in establishing sick leave policies and developing supplemental paid leave programs for essential workers, thereby ensuring coverage for employees who may not otherwise qualify. The Coronavirus Aid, Relief, and Economic Security (CARES) Act has also expanded unemployment insurance, but workers in Connecticut have experienced significant delays in receiving unemployment benefits and the legislation notably excludes certain vulnerable populations such as non-citizen residents. The state should ensure timely receipt of benefits and expand unemployment insurance to the estimated 120,000 non-citizen residents living in Connecticut to ensure the financial feasibility of isolation for all residents.
We must provide education and outreach regarding the essential value of masks. Cloth face coverings keep asymptomatic and pre-symptomatic carriers from spreading the virus and are especially valuable tools in dense population centers where social distancing may be difficult. It would be ideal to provide face coverings at testing sites and to distribute them widely within the most affected neighborhoods.
Addressing health care disparities must be a state-wide priority that is put into motion now. It’s time we begin partnering with and supporting our neighbors so that everyone has the ability to live through this pandemic.
Juliana Lawrence is a medical student at Yale University. Howard P. Forman is a professor of Public Health, Management, and Radiology at Yale University. Marcella Nunez-Smith is a professor of Medicine, Public Health, and Management at Yale University and chair of the community committee of the governor’s “ReOpen Connecticut Advisory Group.”