When paramedics rushed the pregnant Honduran woman into the emergency room, 28-year-old Chuan-Jay Jeffrey Chen stood ready to receive her. It was April, and the pandemic had already taken over his final year as an emergency medicine resident. Of all the coronavirus patients surging into Massachusetts General Hospital in Boston, this 32-year-old patient remains Chen’s most memorable.
The woman was so short of breath she could barely speak, so Chen would need to intubate her—a tricky procedure that requires precision as well as speed. Every moment without oxygen causes a patient’s chances of survival to decline; pregnancy further complicates the scenario by making airways swollen, causing blood pressure to drop more quickly. As Chen set to work and talked her through the steps in Spanish, he also tried to calm his own nerves.
“I knew I had very little margin for error,” says Chen. The woman’s husband had been barred from entering the building because of coronavirus restrictions, and Chen knew that if anything went wrong, his voice could be the last she would ever hear.
On top of the life-and-death stress, Chen has been struggling with economic woes. Caught between Boston’s astronomical rent prices and mounting student loan bills, he is now about to graduate from his residency and enter the job market, where opportunities have dwindled due to coronavirus-induced hiring freezes and hospital closures.
When it comes to Millennials and Generation Z—defined by the Pew Research Center as people born after 1982 and 1996 respectively—stories of crowded beach gatherings and house parties where guests try to infect each other with COVID-19 have made headlines. But those stories obscure the more complicated circumstances of people, such as Chen and his patient, shaped by economic and societal inequality. An August 18 briefing from the World Health Organization announced that people in their 20s, 30s, and 40s are now driving the virus’s spread, but that’s because most are just trying to do their jobs.
“In the past few decades, we’ve seen a shift in the economy toward more service jobs,” including retail, food service, hospitality, and childcare, says Sharon Sassler, a professor of policy analysis and management at Cornell University. “Young people in those service jobs are now at a greater risk of being exposed.” What’s more, emerging research is confirming what many experts have observed with natural disasters: economic vulnerability severely impairs a person’s ability to cope with catastrophe, and this burden falls heavily on younger generations.
In Boston, Chen was able to save the pregnant woman. Months later, she wrote to him and the ER team, so they might know more about the life they had saved. She had studied architecture in Honduras before coming to the United States, where her husband had gotten a job at a factory. That factory was where he caught coronavirus, which he unknowingly brought home to his wife and unborn child. Chen says the letter shocked him, and recalled the impossible choices the pandemic is forcing young adults—including him—to make every day.
Of the 22 million jobs lost since the pandemic began, only 42 percent had been recovered as of early August. This scarcity places younger adults in a lose-lose situation: If they can find employment, many feel compelled to take it even if it means putting themselves at risk. Even though people 18 to 34 are less likely to die from the coronavirus, they aren’t totally spared. In the United States, one in five hospitalized young adults has required intensive care. (Here’s how scientists know COVID-19 is way deadlier than the flu.)
“The virus itself is hitting older people much harder,” says Gray Kimbrough, an economist at American University. “But the recession has been hitting the least advantaged people in society hardest. These are people who are earlier in their careers, people who are less educated, people in certain kinds of jobs that can’t be done from home. These people tend to be younger.”
An economic Catch-22
Older generations have been known to scapegoat younger ones for the country’s economic woes. In the past decade, news stories that start with “Millennials are killing…” were so common that the phrase became a meme in 2016. But now we know millennials weren’t killing traditions such as marriage and homeownership out of spite. Due to the Great Recession, they were just too poor to afford those milestones, not to mention vacations, gambling, movie theaters, and country clubs. Millennials’ behavior was a reaction to the economic downturns they lived through, not a cause of it.
This legacy is now passing into Gen Z. When the first wave of coronavirus layoffs came in March, Jade Jackson lost her job at a clothing store where she was working to cover her college expenses for the upcoming semester. Over the next few months, the 19-year-old struggled to find new employment.
“It started to become like a race against time,” says Jackson. Determined to continue her studies as a biomedical sciences major at Arizona State University, she kept applying for work. After more than three months of applications and unemployment denials, Jackson landed a job at a different apparel store at her local mall in Chicago. Even though the store took every precaution, from installing plexi-glass shields at counters to providing hand sanitizer for customers, the risk of exposure was always in the back of Jackson’s mind. What worried her more than her own safety was the chance that she might become an asymptomatic carrier and unknowingly infect her grandmother, with whom she lived. (Face-mask recognition has arrived in some workplaces—for better or worse.)
“I would change my clothes in the car, then bring them inside and wash them every day,” says Jackson. “After I took a shower to make sure I was clean, I could finally go and greet my sister and grandma.”
Jackson’s fear—and her caution—are justified. Experts indicate that people like Jackson whose low-wage jobs or desires to attend college put them in contact with a higher number of people are more likely to contract and spread coronavirus; hence the growing number of cases in her age group.
“I see a lot of criticism being aimed at young people, especially people in college,” says Hannah Smith, a 22-year-old masters student at Texas A&M University who is studying public health and has made the difficult choice to attend her classes in person this semester. “I think that’s unfair, especially when their university is welcoming them back with open arms.”
This increased risk doesn’t come only from the high-traffic nature of a job or school. Coronavirus risk is also strongly correlated with income, which influences our ability to social distance.
Before the pandemic hit, affluent Americans moved around their cities—and beyond—far more than working-class folks. But by April, those statistics switched. According to an extensive analysis of anonymized cell phone data, 25 percent more people in wealthy areas were staying home completely, while 10 percent more low-wage earners were traveling outside their usual environs.
“The pandemic has been emphasizing a uniquely American problem,” says Kimbrough. “Our social safety net has a lot of holes.”
Falling through the cracks
When income determines one’s ability to social distance, it’s no shock that the most financially burdened across generations are catching coronavirus and dealing with severe illness at elevated rates. It’s even less surprising to researchers who predicted this trend with a metric called the social vulnerability index, or SVI.
Created by the Centers for Disease Control and Prevention in the wake of Hurricane Katrina, the SVI is a system of analysis used to measure community resilience and determine the emergency services communities will need when faced with disasters. The SVI takes into account factors such as socio-economic status, minority status, household composition, disability, housing type, and access to transportation in order to calculate how seriously people will be affected by disasters and how much government intervention their areas will need to bounce back. In the southeastern United States, the SVI is most often used to help low-income communities respond to hurricanes, because more than five decades of research has shown that poverty significantly increases one’s risk of serious injury or death in a natural disaster.
The same trends are emerging with the pandemic. A team from Harvard and Stanford noticed a correlation between social vulnerability and a higher risk of catching coronavirus as early as April.
“The most socially vulnerable people are also in the essential job market, or they cannot afford to not work,” says Arshed Quyyumi, professor of cardiology at Emory University School of Medicine in Atlanta, Georgia. “They will still go to work, often on public transportation, and they will therefore have a higher rate of exposure. Then at home, they will have difficulty socially isolating because they live in overcrowded accommodations.”
More than one in four socially vulnerable U.S. communities has experienced a high case fatality rate during this pandemic, according to an analysis that Quyyumi’s research group created and produced as an interactive map.
“One reason is treatment access,” says Aditi Nayak, a cardiology fellow at Emory and a member of the research team. “There’s an obvious disparity in access to experimental treatments, and there’s a disparity in access to testing.”
Low wages, in particular, weigh heavily among the risks for contracting coronavirus. People living in America’s poorest households are as much as 32 percent more likely to die of coronavirus than their wealthier counterparts, according to an analysis from the Imperial College of London.
So while younger generations are being blamed, in some quarters, for the pandemic’s spread, they are bearing the greatest burden of poverty and the brunt of the transmission risk that comes with keeping the economy going, all with little help in sight.
“Younger people are in the most precarious positions,” says Kimbrough. “When they lose their jobs, they lose their health insurance, but then they might have trouble getting the benefits that were supposed to be designed to catch them in situations like this. When that fails them, they’re on their own.”