We’ve Never Protected the Vulnerable

Let’s learn from the pandemic and protect those who need it most—and not just from COVID-19.

Artwork of sharp blue and bright violet crystals and glass shattered with silhouettes of people.
Simone Noronha

About the author: Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine.

When the pandemic first hit, everyone appeared to be in danger. Because of this, we engaged in widespread behaviors that protected one another. We made huge changes to society and daily life because it appeared that almost everyone, and especially older adults, was at real risk from COVID-19. It’s hard to overstate how novel this was. I was honestly surprised that so many complied.

Now, as more and more people get vaccinated, much of the country is returning to normal. Some people point to decreased hospitalization and mortality rates among the immunized, or argue that COVID-19 is here to stay but manageable and that restrictions are unnecessary. Some further argue that most who aren’t vaccinated have chosen that path, and so if risk remains, it’s on them.

Such thinking ignores a third, not-insignificant group: those who would like to be immune but aren’t. Some people are still at risk because they can’t yet be vaccinated or because vaccines don’t work for them. They hope that their fellow Americans will take care of them. They hope that the rest of us will agree to sensible precautions or protections to keep them safe until they, too, can be immunized, or until the danger from exposure eventually subsides.

Much of the public is refusing. That’s not new, though. In America, it’s always been like this.

A few years ago, one of my best friends was diagnosed with cancer. As soon as he started chemotherapy and became immunocompromised, those who love him (including me) set up a protective bubble around him because infections that most people would shrug off became huge issues. If your white-blood-cell count is low, leaving you more susceptible to infection—a common side effect of chemotherapy—any fever is an emergency requiring labs, antibiotics, and a hospital stay. We knew that we had to do this ourselves, because no policies existed to do it for him.

The Americans With Disabilities Act provides for some accommodations for people with disabilities or diseases in certain situations, but those are extremely limited. They also apply only to the afflicted. My friend’s wife, a teacher, couldn’t tell her school that she needed special treatment because someone was vulnerable in her life. The school implemented no precautions to reduce her chance of being exposed to illness and getting sick, in order to keep her husband safe at home. Neither could his kids demand changes at their schools. Asking schools to alter their behavior to protect relatives of students may seem like a big ask, but I couldn’t even persuade all of our close friends to get vaccinated against the flu to protect him.

COVID-19 has exposed these gaps in our public solidarity, not caused them. The way we handle influenza is the best example, as the infectious disease that usually causes the highest number of deaths each year. Even though the young and the old are at real risk from flu, along with the immunocompromised, we’ve almost never engaged in any special protections for these groups. I’ve begged people for years to get immunized to protect others, and most don’t listen. Other countries mask more during respiratory-virus seasons; almost no one even thinks of masking here. Few distance from others, even though that’s a more palatable option for most Americans. To the contrary, many people consider it a mark of pride to “tough it out” and come to work while sick, potentially exposing others.

Our current situation with COVID-19 is especially difficult because so many Americans believe they’ve already given more than enough. Any further adjustments to their life, even if they seem small, feel like too much to bear. It’s natural that Americans want to get back to normal, and I’m not arguing that we should lock down until no risk remains. I’m asking that we think about others more in specific settings. We don’t all have to wear a mask all the time, but we could get used to always carrying one. That way, if we are around people who might live with others at high risk, we could mask around them and stand a little farther away. We could cancel our evening plans or miss a concert if we’re sick. Is it really that hard to get a flu shot every year?

Certain changes to work and school policies would also increase our ability to care for one another. We could provide better sick leave so that Americans aren’t encouraged or even compelled to go to work or school if they’re ill or infectious. We could provide better family-leave policies so that people caring for high-risk Americans have more options to protect loved ones at home. We could offer more flexible schedules or work-from-home policies for caregivers.

We could also recognize that Americans spend tens of thousands of dollars a year to care for and protect loved ones, and none of that is reimbursable by insurance.

Fixing any of this would require real change and some sacrifice. But it would make a remarkable difference not just against COVID-19, but against so many other infectious diseases as well.

Part of my job, both as a writer and as a chief health officer, is to explain how much less-risky most activities are now compared with last year. Many of the people I talk with, though, have others in their life who aren’t yet safe, and they are horrified that we can’t create exceptions or come up with policies to protect their vulnerable loved ones. I share their frustration, but I’m puzzled by their surprise. America has never cared enough. People just didn’t notice before.