In late May of 2020, the U.S. hit one of what has become so many grim pandemic milestones: our first 100,000 dead from COVID-19. I remember how heartbroken I was then—and how frustrated. The novel coronavirus, a stealthy pathogen, was bound to take a toll no matter how perfect Americans’ response was to the crisis. But Americans’ response was far from perfect. I was frustrated by people who refused to wear a mask. It made me feel like the lives of my patients—and my own life, as a health-care worker—were disposable. I was frustrated that patients weren’t getting the treatments they needed—like care for heart attacks and strokes—because hospitals across the country were overrun. And I was frustrated by the basic needs going unmet: food, housing, and paid leave so people with COVID could isolate, as well as a safety net for those who’d lost their livelihoods to the pandemic.
What made all this frustration even more painful was the clear picture forming of who would suffer the most. Our essential workers—caregivers, domestic workers, agricultural workers, restaurant workers—are disproportionately immigrants and people of color, and they were given a false choice between going to work, thus risking their health, and staying home but not being able to feed their families. Other race-related health disparities, such as access to COVID testing, were beginning to emerge. The virus was spreading out of the big cities, including New York and Seattle, which were hit hard early on, into rural areas, which weren’t prepared to handle so many and such sick patients. Indigenous communities, which have suffered from centuries of disempowerment and disinvestment, sustained some of the highest COVID death tolls. COVID-19 was following the well-trodden path of other infectious diseases—at first a threat to the general population, but then concentrating among vulnerable populations—such as tuberculosis, HIV/AIDS, and others before it.
We know where that path has led us. Today, more than 800,000 Americans are dead. It’s an enormous, hard-to-fathom number. Americans seem to have become numb to this scale of loss. But one thing that’s especially easy to overlook is who these deaths are. COVID-19 has been especially deadly for the elderly in the U.S. and around the world. About 75 percent of COVID deaths in the U.S.—600,000 lost lives—have been among people ages 65 and older. Latino, Black, and Indigenous people are twice as likely to have died from COVID as their white counterparts.
America has made meaningful progress against the virus over the past year, and certainly vaccination efforts among vulnerable communities have saved many lives. At the same time, these deaths speak for themselves, again and again, every time we march by yet another horrible marker. We do not value the elderly. We do not value Black and brown Americans. Where there is structural violence and systemic racism, infectious diseases will flourish.
We did not need COVID-19 to teach us that the elderly are more vulnerable to disease. We’ve had the tools to help protect them since the early days of the pandemic. Even before we had vaccines, we had masks. We could open doors and windows. We have HEPA air-filtration units for homes and businesses (though they don’t come cheap). By definition, elder caregiving is infrastructure—that which is needed to support social and economic functions. America needs to offer affordable, reliable care options, and while paying our caregivers living wages and providing them with safe working conditions. Instead, the country’s long-term-care system was broken long before the pandemic even started. A staggeringly small percentage of older Americans receive care at home compared with their counterparts in other developed countries. Instead, we ask a workforce largely made up of poor women of color to shoulder this burden in nursing homes and other long-term-care facilities. We hide away disease, disability, and death.
Societies more known for valuing their elders, as is the case in many East Asian countries such as Singapore, South Korea, China, and Japan, have fared much better than the U.S. throughout the pandemic, with fewer cases and deaths from COVID and some of the highest COVID vaccination rates. In the U.S., we value individualism, self-reliance, and productivity. We derive our status and identity from our work. When people stop working and become dependent and unproductive, they can be seen as disposable. The tension in this kind of thinking is obvious. The American population is graying, with 16 percent of Americans now age 65 or older. The burden of caring for our elders weighs more heavily than ever before. Parents find themselves spread thin between caring for their children and for their own aging parents. Caregiving has traditionally fallen to women, which means that it’s often unpaid, unsupported, and unvalued. And with elders living longer, their needs are only becoming more complicated.
COVID-19 also did not have to teach us that communities of color are at greater risk. It was no surprise to me that the U.S. hit 100,000 deaths from COVID at the same time that George Floyd’s murder was so widely broadcast. Americans have stood by watching as people of color die over and over again during the course of the pandemic. Many have watched at a distance, in the news headlines and in the stats, but not up close. It’s not the people they know, because America is as segregated as it’s been in decades. We are segregated in our housing, in our schools, in our work, and in our health. Black and brown communities are more likely to live in dense, multigenerational homes. Their neighborhoods are underserved by health-care facilities and pharmacies. Many schools serving majority Black or Latino student populations have health and safety problems such as poor indoor ventilation, facilitating transmission of SARS-CoV-2. Many essential workers remain excluded from New Deal–era federal laws and do not enjoy adequate health and safety protections on the job, or decent wages.
Earlier this week, the journalist Matthew Walther argued in The Atlantic that many Americans do not care about COVID. This, sadly, is true. But it’s also callous. What it really means is that many Americans don’t care about the people who have died from COVID, and who will keep dying of COVID. To those who do not care, I say: COVID not only is worth fighting, it’s something we have to fight, whether we all want to or not. Even if you don’t care about dying strangers, those deaths—and all the complications that come with rampant disease spread—take a toll on all of us. A total of 7 million Americans are currently unemployed. According to a U.S. Census Bureau survey of American households this fall, almost 4 million Americans said they weren’t working because they were caring for someone or sick themselves with COVID symptoms; almost 2.5 million, because they were concerned about getting or spreading SARS-CoV-2; about 4.5 million, because they’d been laid off or furloughed due to the pandemic; and more than 3.2 million, because their employer had closed temporarily or permanently due to the pandemic.
Employers are anxious to get people back to work and back in the office. But any argument that everyone merely should throw up their arms and learn to live with COVID as we continue down our path toward endemicity dismisses very real fears. People will resume their lives when they feel safe. Right now, more than 1,000 Americans are dying from COVID per day, and as people gather for the holidays and the Omicron variant spreads, those numbers will trend up in the coming weeks. To communities where people are dying, these are not acceptable losses. They should be scared of dying from COVID, especially when they know their lives aren’t valued.