Slowing the spread of COVID-19 the right way

Four recommendations for helping the marginalized

THE COVID-19 PANDEMIC is rapidly evolving. Massachusetts, like the rest of the world, is working to hone its response to this novel coronavirus. State residents have accepted physical distancing, work and school closures, and other measures necessary to slow this disease.

Yet for all our efforts to stop Covid-19, the difficult truth is that, in many ways, we opened the door to its spread. We did this by accepting the conditions that create health inequities.

Conditions like racism, poverty, xenophobia, and other forms of discrimination create pockets of marginalization, which lead to poor health. We often ignore them, thinking they only affect “certain” people. But health is connected. When a child in Roxbury is at greater risk of asthma, our own health is at risk. When poverty and poor education lead to more obesity among people with less money, we gamble with our collective wellbeing. This is especially clear during outbreaks of infectious disease, when we see how the sickness of some threatens the health of all.

Earlier this week, the Massachusetts Public Health Association convened an Emergency Task Force on Coronavirus and Equity. This Task Force, first and foremost, is concerned with the health and safety of all Massachusetts residents, including those who face marginalization and discrimination every day and in the midst of this epidemic. More than 100 organizations endorsed four policy recommendations that the Task Force released on Friday..

We launched this work with the understanding that ending health inequities should be at the heart of our Covid-19 response. But we should not stop there. Our focus on the health of the marginalized should form the basis for a new approach to health, to build a better society and prepare us for the next large-scale challenge, which we know will come.

On Friday we presented recommendations to state lawmakers on how we can slow the spread of Covid-19 while laying the long-term foundations for a healthier state, country, and world.

First, the Legislature should pass emergency paid sick time, allowing for a longer duration of coverage, and greater eligibility.

Physical distancing is key to slowing Covid-19, but it can only work if everyone has the wherewithal to observe it. Without a guarantee of paid sick time many workers are unable to do so. These include part-time workers, contractors, municipal workers, adjuncts, and undocumented immigrants. Expanding paid sick time can help ensure that workers will continue to have income for basic needs as well as be able to do their part to slow disease transmission and support public health.

Second, the state should ensure immigrants can access testing and treatment.

Stopping Covid-19 depends on being able to quickly identify who has it, so they can take steps to recover and avoid spreading the disease to others. This depends on being able to access testing and treatment. It is no secret that anti-immigrant rhetoric in recent years has created anxiety among this population about seeking health care, due to fear of deportation. The state should reach out to these communities to say that all Massachusetts residents will have access to testing and treatment, regardless of immigration status, and that care providers may not share personal information with immigrant enforcement authorities. The state should also assure immigrant communities that accessing state-funded services will not be used against them under new federal “public charge” rules. The state can take these steps by investing in trusted community organizations and local media to take the lead on messaging campaigns.

Third, the state should pass a moratorium on evictions, foreclosures, and termination of public benefits such as SNAP, MassHealth, and disability benefits.

To stay in place, people need places to stay. Evictions and foreclosures are devasting events in normal times. In times of public health emergency, they are a disaster. People also need reliable access to the resources necessary for health—nutritious food, disability benefits, and health care. We should ensure they get them.

Finally, the state needs to ensure everyone has access to safe, dignified quarantine.

In the context of Covid-19, it is more important than ever that the state’s homeless population can take the same precautions against disease available to everyone else. Life on the street is challenging in the best of times, and homeless shelters are not always able to observe physical distancing protocols. The state should identify alternative housing, so people experiencing homelessness do not have to live in congregate facilities with higher risk of disease transmission.

Meet the Author

Carlene Pavlos

Executive director, Massachusetts Public Health Association
Meet the Author

Cheryl Bartlett

Guest Contributor, Greater New Bedford Community Health Ctr
Meet the Author

Sandro Galea

Dean, Boston University School of Public Health
This public health crisis has already led to many examples of extraordinary solidarity — locally, nationally, and globally. We are beginning to see that the only way through this is by helping each other, with compassion, as a community that cares about all of its members, not just those with privilege. Massachusetts can play a leadership role in this. By focusing on the marginalized, our response to Covid-19 can lay the groundwork for a healthier world, in both the near- and long- term.

Carlene Pavlos is executive director of the Massachusetts Public Health Association. Cheryl Bartlett is president and CEO of the Greater New Bedford Community Health Center and former commissioner of health for the Commonwealth of Massachusetts. Sandro Galea is dean and Robert A Knox Professor at the Boston University School of Public Health and chair of the board of the Association of Schools and Programs of Public Health.