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Covid mural in Seattle, Washington

‘The Country is Bleeding’: Covid-19 in the US

Leaders Should Plan to Better Protect Everyone During Future

A pedestrian walks past coronavirus-themed artwork of a person wearing a mask and gloves that was painted by street artists @theydrift and @ksra_ksra on a boarded-up business in Seattle's Capitol Hill neighborhood, Tuesday, April 7, 2020. Street art has sprung up on boards covering the windows of many businesses in the area closed temporarily due to the outbreak of the coronavirus. (c) 2020 Ted S. Warren/AP Photo

As the Covid-19 pandemic rocks the United States, it is exposing cracks in the system. The differences often split along not just socio-economic but also racial lines. Who gets to work from home and still receive a paycheck? Which kids have computers they can use to access school online? And, crucially, who gets the best – or even adequate – health care? US program executive director Nicole Austin-Hillery talks with Amy Braunschweiger about the United States response to Covid-19, and how a rights-based approach to address this public health crisis could help keep people safer well into the future.

What are your biggest concerns about Covid-19 in the US?

My biggest concerns are around the intersectionality of health, poverty, gender, class, and race. We’re seeing all the inequities manifesting themselves in how Covid-19 is being addressed in the US. The people suffering disproportionately are low-income wage workers, part-time workers, who depend on these jobs to support families. People living in poverty, in crowded homes where social distancing is a privilege, are often unable to follow the guidelines from the US Centers for Disease Control and Prevention (CDC). Also, Black and Brown communities are the heaviest hit.

These communities were already behind the rest of the country in terms of access to health care and having underlying health issues linked to race and class.

Take, for example, the African American community. The latest data indicates they’re the hardest hit. They have historically had higher rates of diabetes, high blood pressure, asthma, and obesity. They live in neighborhoods with higher rates of air pollution, putting their health at risk. They are more likely to have no health insurance. Pregnancy is more likely to kill Black women, as is cervical cancer. Our work in Tulsa, Oklahoma found differences in life expectancy of greater than 10 years between whiter, wealthier neighborhoods and poor neighborhoods where more Black people live.

People who have these types of health issues, who are in lower-income economic groups, and who have harder times accessing quality care, are now dealing with Covid-19 on top of these pre-existing conditions.

Unfortunately, the first data on Covid-19 cases and deaths did not include information on race, as many states didn’t report it, and some didn’t even collect it. It’s only in the last few weeks that the information exposing these disparities is beginning to be reported, and it is sounding a very loud alarm bell. In Milwaukee, we see the number of African Americans testing positive and the number of deaths. We see numbers coming out of Michigan, focusing on Detroit. All states should be collecting this data and sending it to the CDC, so we can see what’s happening nationwide.

Emergency room doctors and nurses wear personal protective equipment while manning desks due to COVID-19 concerns at St. Joseph's Hospital, Monday, April 20, 2020, in Yonkers, N.Y.  (c) John Minchillo/AP Photo

Who else in the US is most likely to be adversely affected?

Our firefighters, our police officers, other first responders. This is also true for our healthcare workers at all levels, from the richest doctor with 10 degrees from Harvard to the workers cleaning and sanitizing floors. Thankfully, some of these groups, like emergency workers and healthcare workers, are receiving some additional assistance to help them better protect themselves. But, the workers at the lower levels of our economic chain, the grocery store workers, the food delivery service personnel – are highly exposed with less support in place to help keep them safe.

We have grave concerns about communities of people who either require care or who can’t provide for themselves. People who are detained in jails and prisons. People who are homeless, who live in shelters. People who live in nursing homes and psychiatric institutions. All of these people have to depend on others to care for them, to house them, feed them. The US as a nation is failing to protect them. We are seeing this manifesting in the nursing homes, with the number of deaths, and the Covid-19 cases identified in jails and prisons. In terms of the homeless community, we don’t have enough data, but we know many live in crowded shelters in unsanitary conditions. They don’t have the privilege of self-quarantining or social distancing, or even necessarily being able to access sufficient water to wash their hands. Now, often with the threat of criminal enforcement, homeless people are being pushed into these shelters where infections are beginning to emerge.

This goes for people in our immigration detention centers, who are also at risk. Our previous work shows that people in these centers often have limited access to regular bathing, are held in close quarters, and are living in unsanitary conditions. These conditions don’t allow for social distancing and regular handwashing, to say the least.

Children from low-income and poor performing school districts are at particular risk. These children, who were already struggling to receive a good education, now depend on family members and remote learning to continue their studies. Many of these are the children of the low-income workers who must continue working during this time and have limited ability to oversee homeschooling. These children may not have access to the internet, home computers, and other technology to learn at a high level while schools remain closed.

Signs made by prisoners pleading for help are seen on a window of Cook County Jail in Chicago, Illinois, April 7, 2020, amid the spread of Covid-19. © 2020 REUTERS/Jim Vondruska

Women are also extremely vulnerable to human rights abuses during this time. Early data points to a rise in reports of domestic violence since the start of this crisis. Many of the support mechanisms that are usually in place to support these victims are limited and overstretched as a result of the pandemic. Mothers – especially those who are single – are particularly challenged as they must now balance even more demands with, for some, a loss of income and limited ability to homeschool their children. We also see some state governments using the pandemic as a pretext for limiting women’s access to needed health care, like safe abortions. 

Low-wage workers are often in multiple at-risk groups. For example, many workers in the food supply chain, like farm and meatpacking workers, are people of color, immigrants, and women. They are subject to potentially unsafe living and working conditions. One massive cluster of infections in the country right now is in a South Dakota pork processing plant, which highlights the importance of protecting workers and ensuring safe working conditions throughout food supply chains, which may otherwise be disrupted. And the situation for these workers has worsened now that the US president has issued an executive order, requiring meat plants to remain open and in production despite the risks to the health of workers.

How has the US reacted to the virus in ways that are harmful to rights?

Where do I begin. There is a failure of leadership. The fact that the leader of the US ignored the early-warning signals from experts about how the disease was developing, how it would travel – this is unacceptable. The fact that the leader failed to take precautionary measures to protect Americans’ rights to health and life was a travesty. It’s the reason we are at this point right now in terms of the number of cases and deaths in the United States.

Related to that, the fact that our local health departments and healthcare providers and hospital systems are understaffed, underfunded, and don’t have the tools that they need to address this disease to care for the people who are infected, is also a rights issue. Given the wealth of this nation, this should not be.

It’s late April, and we had our first case of Covid-19 in January, yet many of these issues have yet to be addressed.

And, despite some steps in the right direction, President Donald Trump muddies the waters on an almost daily basis by sputtering inaccuracies and even promoting unsupported science regarding treatment options for the virus.

Amid social distancing during the Covid-19 outbreak, a cashier wears a mask while working behind a clear barrier between her and a customer at El Rancho grocery store in Dallas, Thursday, March 26, 2020.  (c) LM Otero/AP Photo

There are also economic issues. With millions of people now out of work, as evidenced by the record-breaking applications for unemployment assistance, officials should be focusing on how to protect those most at risk. If you’re a low-wage worker waiting tables, delivering meals, cleaning office buildings, and servicing grocery stores, you can’t take that work home with you, but you also may be unable to pay for housing, food, or health bills. We also have not done enough to ensure that workers who do remain employed can do their jobs safely.

However, relief packages have fallen short on protecting low-wage workers, unemployed people, and immigrants. There are steps that state governments could take and the federal government could encourage, such as moratoriums on evictions, utility cut-offs, and debt collection, and there are still no guarantees that people can access affordable medical treatment for Covid-19. Inadequate payments from the government mean many still cannot afford basic necessities.

How have US states reacted to the virus in ways that respect rights?

Certain state governors in the US have been providing much-needed leadership during this crisis. I live in Maryland, and long before the White House issued orders, the Maryland governor said we’re going to shut down the schools and non-essential businesses. That was his way of saying we’re going to help people stay in place. But he also looked out for the working poor. The state isn’t going to allow any evictions, any foreclosures, or any utilities to be cut off. That includes “luxury” utilities like cell phones – which for many may be the way their children access schooling now. He found ways to ensure that the most essential government services were still available, while taking additional steps to protect people working there. For instance, early on, he ordered workers in the Motor Vehicle Administration to work remotely utilizing systems that were put in place to ensure their safety while meeting the demands of the public.

The governor of California is another good example. He has focused on supporting unemployed low-wage workers and others by expanding unemployment office hours to handle the groundswell of applications. He also allocated an additional $125 million dollars to help up to 150,000 immigrants without legal status receive unemployment assistance.

In other cases, governors have acted with apparently little regard for public health concerns. Alabama, Louisiana, Florida – their governors ignored warnings from the CDC and the World Health Organization about the virus. Georgia’s governor decided to partially reopen the state, focusing on bowling alleys and hair salons, against the advice of public health experts.

A window of the Wesley House across from New York-Presbyterian/Brooklyn Methodist Hospital displays words of gratitude for all essential workers on April 16, 2020, in Brooklyn, New York.  (c) 2020 Gabriele Holtermann-Gorden/Sipa via AP Images

How prepared are US states in terms of infrastructure to deal with Covid-19?

We had infrastructure problems long before Covid-19. Many people in the US do not have health insurance, and local healthcare departments have had their budgets slashed in the past decade. Before coming to Human Rights Watch, I was working for a nongovernmental organization on policy issues around human rights and social justice. I advocated with congress, pushing them to shore up infrastructure, from health care to roads and bridges and water systems. Right now, Human Rights Watch is pushing Congress for safer water and wastewater infrastructure, and to ensure everyone has running water – which is essential to preventing the spread of Covid-19 – even if they can’t pay. But the country has simply not done a good job responding to this. Our failure to do so is compounding the problems around Covid-19.

I think it’s crucial for the US to look at what comes next. There’s a rush right now to identify what problems exist at this moment. And I understand that, we’re in triage. The country is bleeding. But in some ways, there’s a greater need to look beyond Covid-19. What does a post Covid-19 US look like, and what changes do we have to make to do a better job to protect the rights of all people in the US in the future?

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