The COVID-19 global pandemic has wreaked havoc on the lives of millions of individuals and families. And while we continue to see confirmed cases of the virus increase rapidly in the United States, we are also seeing people grapple with severe disruptions of their day-to-day activities, whether because of school or child care closures, or the loss of jobs or paychecks.

For many people, the threat that COVID-19 presents to their lives and livelihoods is compounded by the fact that they do not have access to the types of resources that would help them weather the storm, such as paid leave, health insurance, stable housing, emergency savings, or adequate food. And these deficiencies weigh particularly heavily right now, because the U.S. public health response to the spread of the virus has been sorely deficient and a health care system that excludes millions due to high uninsured and underinsured rates, putting these very same people at risk to suffer the worst consequences of the virus.

No One Is Immune, But Some Populations Are Having a Harder Time

No one is immune to being exposed to COVID-19. The virus does not discriminate. Based on the most recent available data from the Johns Hopkins Coronavirus Resource Center, the United States now has the most confirmed COVID-19 cases of any country—as of now, 86,012 across all fifty states, the District of Columbia, and three U.S. territories.1 Of these cases, 1,301 people have died. People of different races, ethnicities, ages, and social backgrounds have been exposed to COVID-19. However, the elderly, people with other serious health conditions, and those with compromised immune systems are most likely to experience severe illness and death due to the onset of the virus. Some racial and ethnic groups, including African Americans and Latinx people, are more vulnerable due to their likelihood of having underlying health conditions, experiencing long-standing, historical barriers to accessing quality health care, and racial discrimination and inequality. Pregnant women may also be vulnerable, as they are generally at-risk for serious viral illnesses, although more research is desperately needed to assess the health impacts of COVID-19 on this particular population.

Social Factors That Contribute to Vulnerability

Certain social factors can also increase vulnerability to COVID-19’s worst health and economic impacts, such as type of employer or employment, wealth, or type of residence.

The workers whose health is perhaps most at risk are health care workers—doctors, nurses, physician assistants, medical technicians, and other hospital and health care staff. Charged with keeping people and communities free from COVID-19, they are treating those who have been exposed to or have already contracted the virus. Working on the frontlines of this pandemic—with shortages in personal protection equipment (PPE), including N45 respirators, gloves, and protective robes makes them extremely vulnerable. Many health care workers lack paid leave or the ability to telework, and based on reports, some have been told to report to work despite falling ill. Many of these job categories are dominated by women, usually women of color, who also bear the primary responsibility of caring for children and family members, so the lack of paid leave is doubly problematic for them. The Families First Coronavirus Response Act signed into law gives the U.S. secretary of labor the authority to exempt these frontline workers from paid leave.

Millions of low-wage workers and workers classified as independent contractors (including those misclassified as such) can be at higher risk—both physically and economically—because they often lack paid leave and health insurance coverage. The second COVID response package from Congress created new paid leave provisions, but left out employees of large businesses and created room to exempt small businesses and health care providers, too.

Domestic workers, including child care workers, home health care aides, and housekeepers, are being particularly hard hit, as not only are they part of this low-wage workforce, but also because they often are employed via informal work arrangements that are easily severed by the employer during a crisis (even though many of them are tax-paying immigrants). Similarly, those in food service, delivery, and key retail jobs are struggling. And as with the health care workforce, many of these domestic workers are women, primarily women of color. Many of them are the sole breadwinners in their families.

Workers in these professions are being buffeted by a range of interrelated factors as the COVID-19 pandemic worsens. Lack of paid leave means not only that the option to quarantine or self-isolate may not be available, making these workers susceptible to exposure to COVID-19, but also that, during this pandemic, they must decide between earning a living and caring for their children. And the frequent lack of health insurance among this workforce means that health care access could be a challenge, and the out-of-pocket costs associated with health care could instigate economic insecurity for individuals and families. Furthermore, these workers’ financial responsibilities—including the need to stave off housing and food insecurity—make it impossible for them to take leave without pay. They may also risk losing their jobs if they are out of work for long periods of time due to serious illness or the need to provide family care.

One troubling aspect of the COVID-19 pandemic that has received scant adequate attention is vulnerability of some residence communities, particularly people in nursing homes, the homeless, and incarcerated people. Individuals in these groups do not have the option to quarantine or self-isolate. Dwelling in close living quarters with others, as well as the challenges of keeping common areas clean and sanitary in high-density residences, makes for environments that breed health risks and exposure to viruses such as COVID-19. And sadly, there have been reports of entire nursing home communities testing positive for COVID-19, which is a national travesty. A report recently released by researchers from UCLA, Boston University, and the University of Pennsylvania asserts that more than 1,200 homeless people in California will likely die from COVID-19. The report goes on to note that the U.S. health care system is not ready to meet the needs of the homeless population, recommending emergency facilities to better support physical distancing for this population. Incarcerated individuals, the homeless, and people in nursing home populations are also more likely to be living with chronic illnesses, and they often lack access to the specialized care needed to address comorbidities if exposed to COVID-19. Some have called for the release of elderly and nonviolent offenders from incarceration as a strategy to manage the spread of the virus within the nation’s prisons, but these calls have mostly fallen on deaf ears.

An Inadequate Response

The U.S. public health response to COVID-19 has been woefully inadequate. President Trump ignored intelligence reports of a pandemic as far back as January of this year. He reorganized the National Security Council’s pandemic relief team, and called for funding cuts to the CDC in his budget proposals. He has also actively downplayed the severity of the spread, as well as people’s fears in the face of it.

These actions—or lack of actions—in the federal response to the COVID-19 pandemic have squandered several weeks of precious time to get out ahead of this public health crisis to help reduce or at least attenuate its impact. Failure to implement physical distancing and isolation early on has made it difficult to contain the virus; failure to “flatten the curve” has swamped hospitals in the most affected regions. One New York City hospital reported a chilling thirteen deaths of people with severe COVID-19 illness in one day; others are overwhelmed and running out of available beds in intensive care units. Long lines of people can be seen outside of hospitals and clinics, waiting desperately for care.

Amidst this public health crisis, worry for the nation’s economy worsens. The Department of Labor reported that almost 3.3 million unemployment claims have been filed since just March 15; many of these workers have lost not only their jobs, but also the employer-sponsored health insurance that went along with it.

One thing the impact of the COVID-19 pandemic has done is tell the tale of two Americas—one, protected by resources and privilege, such as adequate wealth, health care, and the ability to physically distance; and another, rendered vulnerable by social status, needs, and obligations.

There has been some action to slow the spread of the virus and recover the economy in recent weeks—for both Americas. The Trump Administration and Congress have worked together on bipartisan legislation that would not only shore up some of the needs of our strained health care system, but also would make investments in food and nutrition programs (including SNAP and food pantries); free COVID-19 diagnostic testing; relief for renters from eviction; aid to the homeless; paid leave for a limited share of U.S. workers; access to mental health services; and expanded unemployment insurance. However, the stark contrast in bailouts for big businesses versus meaningful relief for everyday people is nothing short of questionable as millions continue to suffer.

The emergency package by Congress is a start, but more must be done to ensure a sustainable economy and health care system that is responsive to vulnerable communities over the longer term. Daily, COVID-19 cases and deaths continue to rise. Millions of jobs have been lost. Inequalities are magnified. The U.S. Virus Plan anticipates an eighteen-month pandemic, with continued widespread shortages of health care services and products of all kinds. How vulnerable communities will fare over this time is something that Congress, as well as state and local policymakers, should be seriously concerned about.

Header photo: Willie Mae Daniels makes melted cheese sandwiches with her granddaughter, Karyah Davis,6, after being laid off from her job as a food service cashier at the University of Miami on March 17 as the university joins in the effort to fight the coronavirus in Miami, Florida. Source: Joe Raedle/Getty Images


  1. This number may be an undercount as diagnostic testing of COVID-19 is not yet widespread or up to scale in the United States. Some states are also experiencing major shortages in the availability of testing kits.