“We are all in this together.” That slogan was ubiquitous in the early days of the pandemic. Health care workers were heroes, and yard signs honoring them populated neighborhood lawns from Seminole Heights to St. Pete. Perhaps there was benign neglect to the possibility that the worst was yet to come. That months later, 282,000 would have died and we would still be talking about masks, hand washing, social distancing and staying safer at home during the holidays.
Or perhaps there was a rational belief that federal leaders would act to save American lives and that people would put on masks to help out their health care worker heroes. Taking care of patients every day in the emergency department, I hear stories of job loss, unsafe jobs, evictions, hunger, moving in with elderly parents and fear, leading me to question the idea that everyone is truly all in this together.
The reality is that Black and brown faces have filled hospital beds at disproportionately higher numbers than white ones. We see a lot of African-American and Hispanic patients in the emergency department, especially for conditions like high blood pressure, diabetes and kidney failure. Those conditions have been overrepresented in minorities for so long that many of us working on the frontlines forget to ask “why?”, assuming, perhaps, that there must be a genetic propensity for these diseases in minorities. (There is not.) However, with COVID, we remember to wonder, witnessing an obvious reality during a clinical shift at a time when the reported numbers — four times higher rates of cases in minorities — confirm, instead of point out, a real time health inequity.
I recently diagnosed a musician with COVID. He is Black, and his primary care doctor was keeping a close eye on his mild hypertension, which is well controlled with one medicine. Until recently, he had been out of work. My musician patient lost all revenue last spring and got by into the summer with the help of expanded unemployment insurance.
In March, Congress performed a rare feat of duty and passed the $2 trillion CARES Act, providing hope that perhaps we really were “all in this together.” The CARES Act directed higher amounts of weekly unemployment benefits and even support for the self-employed, contract and gig workers. If Congress doesn’t act soon, those benefits will expire.
People will make short-term survival decisions that lead to increased viral transmission, negating our public health strategies to flatten the curve. If we are really all in this together, now is the time to act. The musician I took care of, reluctantly, picked up one of the only available jobs as a server at a Tampa restaurant, known for turning into a bar and nightclub as the day turns to night. Asked if people wore masks and stayed seated, the musician looked at me, laughed, and, with a knowing smile, replied “Sure, all the time.”
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Moon-landing level scientific breakthroughs like mRNA vaccines are promising developments. If candidate vaccines are given emergency use authorization by the FDA, we may reach population level immunity in early summer 2021 — but that is impossibly distant for those who have been out of work throughout this pandemic and are struggling to pay bills, buy groceries and to cover rent and mortgages today.
In the meantime, we should do our best to treat patients with all available medicine and care. Supportive efforts and available treatments for patients with COVID have improved. The current case fatality rate in the United States is less than 2 percent even as the number of diagnosed cases per day has exponentially surged. For now, the familiar public health recommendations remain our best chance to stay healthy, to keep others healthy and to continue flattening the curve so that staff, stuff and space remains available to each patient needing care.
These recommendations are easier said than done though when your survival depends on social gatherings, setting up your equipment to play some songs or DJ a set a few nights every week. If we are all in this together, how do we find equity across the population that ensures ability to implement and carry out public health guidelines that have the side effect of reducing incomes and quickly draining personal savings, leading some to pay rents on credit cards or pay rent not at all?
I have seen what happens: the younger patients with nowhere else to go who move back in with their parents, then worry that their positive diagnosis will lead to a death sentence for their mom or dad. I have seen that death sentence play out, admitting a 75-year-old critical patient, hospitalized alone with newly diagnosed COVID, only to later die in the ICU. She told me over and over how she had stayed at home, wore a mask on the very rare occasions she ventured out of her house, only to become infected by the virus after her daughter, a recently evicted woman who was picking up more shifts as a bartender, was forced to move back home.
The best medicine against COVID remains a prescription for a structural solution of social and financial support to keep the curve flattened while we ramp up the largest vaccination program in history. I think about my musician patient, African-American, diabetic, working in a restaurant, knowing his risks, scraping by to avoid eviction, doing his best to survive.
How do we show that “we are all in this together”? Approve a relief package, wash your hands, practice social distancing, avoid crowded indoor spaces, ensure access to medications, support and participate in widespread vaccine distribution so that we can reach the other side of this curve.
Jason Wilson is an emergency medicine physician and medical anthropologist at the University of South Florida, Tampa General Hospital.