Photograph by Ted S. Warren, AP Images
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Workers from a Servpro disaster recovery team wearing protective suits and respirators enter the Life Care Center in Kirkland, Wash., to begin cleaning and disinfecting the facility, Wednesday, March 11, 2020, near Seattle. The nursing home is at the center of the coronavirus outbreak in Washington state.

Photograph by Ted S. Warren, AP Images

Why some people are more vulnerable to catching coronavirus

For certain professions and communities, public health recommendations are difficult, if not impossible, to follow.

With each new day of the growing coronavirus pandemic, a chief concern is how to keep the rate of transmission down.

Humans are both reservoirs where the virus thrives and causes destruction, and also the main spreaders of the disease. Once human carriers contaminate objects—known to medical professionals as fomites—there’s a new challenge of cleaning surfaces and washing hands to stymie the spread of the coronavirus.

Even with such precautions, those who are most vulnerable—people who are older or have underlying health conditions—are advised to take extra care. But research on the coronavirus outbreak and past epidemics indicates it’s even harder to prevent transmission among people in certain jobs and those experiencing homelessness and poverty.

The lessons learned in early epicenters, such as Seattle, and in past epidemics offer some guidance for the rest of the country.

Uneven risk

Early estimates from the University of Washington show 14.4 million workers in the United States are employed in jobs where exposure to or infection with COVID-19 could happen with greater frequency.

Unsurprisingly, people working in health care have the highest estimated risk of exposure to respiratory infections akin to the coronavirus. In China, where the outbreak began, more than 3,000 health care workers had been infected with the coronavirus by late February. In Washington, there have been a number of cases at nursing homes, affecting both patients and staff members.

But a number of other groups were also shown to be at high risk of exposure on a weekly or monthly basis: police officers, firefighters, and transportation security screeners; personal care workers like nannies and aides; and those in “productive occupations” like laundry and dry cleaning workers, wastewater treatment operators, and dental technicians.

Race and ethnicity matter, too. For example, in a survey conducted during the H1N1, or swine flu, pandemic, Spanish-speaking Hispanic respondents were far more likely than white or black respondents to say that their job could only be done at their workplace, or that they would have difficulty staying home from work for seven to 10 days. Black and Hispanic respondents were also more likely to say they would have difficulty avoiding public transportation.

University of Maryland professor Sandra Quinn, who led that study, says that she worries about elevated risk for low-income workers—who may live in more crowded conditions, struggle to take off work, or have more underlying untreated conditions that make them more susceptible to COVID-19. (Learn how these underlying conditions make coronavirus more severe.)

“It’s the perfect storm for a catastrophe that will really be felt by the most vulnerable amongst us,” Quinn says. “The most important thing that people often forget in a situation like this is that an infectious disease by itself is not the disaster. It’s when it happens in a particular context.” In the U.S., the coronavirus is spreading through a country where racial and ethnic minorities, rural towns, and other communities already experience significant health disparities.

At the entrance to the University District Food Bank in Seattle, there’s now a handwashing station. The food bank serves about 1,300 families per week, and executive director Joe Gruber says that they haven’t noticed a decline in the number of shoppers since the public health crisis began. But about a third of the volunteers who staff the food bank are seniors, and some regulars have chosen to forgo their weekly shifts to protect their health.

“Appreciating that we have a lot of vulnerable populations that we touch with, it’s really paramount that we think about how we can preserve the integrity of our services as long as we can,” Gruber says.

Homeless people are a particular concern in Seattle, which is not only the U.S. region hardest hit by the new coronavirus, but also a city with one of the largest homeless populations in the country. A high proportion of Seattle’s 11,200 homeless residents are unsheltered, meaning that they sleep outside rather than in a shelter or transitional residence. Many are older or suffer from chronic health issues.

“Managing your health and staying healthy is so impossible when you’re homeless, under the best of circumstances, let alone the outbreak,” says Margot Kushel, a professor of medicine and director of the Center for Vulnerable Populations at the University of California, San Francisco.

During the SARS outbreak in Canada, homeless agencies struggled to find cleaning and safety supplies and would have benefited from explicit hygiene guidelines. Screening for SARS was tricky, as many in the homeless community already exhibited one or more of the key symptoms. Many service providers also did not know how and where sick homeless individuals could be quarantined.

Infections “are a kind of litmus test for inequality,” says Jon Zelner, assistant professor of epidemiology at the University of Michigan.

Social distancing

Official recommendations to help protect vulnerable people will be familiar to anyone who has been following the news: Wash your hands frequently with soap and water, cover your mouth when you cough or sneeze, and stay home if you are sick.

Many workplaces and city centers are also taking “social distancing” measures, temporarily keeping people apart in an effort to slow the spread of the virus. Many companies across the nation have asked all employees who can do so to work from home for the next few weeks. The NBA season was suspended after a player caught the virus, and numerous universities and events have been postponed from coast to coast, including the Boston Marathon and the Masters Tournament.

While other cities are catching up, the effects of these social distancing measures can be felt around Seattle. Road traffic is lighter, and small businesses are struggling. Before public schools decided to officially close, attendance had dipped, according to Tim Robinson, a spokesperson for Seattle Public Schools.

However, for the city’s poorest and most vulnerable residents, keeping away from other people is not always an option. And as more people will contract the virus, Seattle is grappling with what can be done to care for them.

In a press conference on March 5, Gov. Jay Inlsee said that the state intends to cover the costs of coronavirus testing for the uninsured. The state insurance commissioner has also ordered insurers to waive the costs of testing. Medicare has been expanded to cover telemedicine—doctors’ visits by videoconference or over the phone—in outbreak areas, and officials have purchased a motel to quarantine coronavirus patients.

“The last line of defense is often going to be people under pretty severe economic constraints,” Zelner says. “People are going to stay home, but they still need to go to grocery stores. Who works in grocery stores? You’re going to order something online so you don’t need to go out. Well, who delivers your packages?”