The Covid-19 pandemic has rapidly disrupted our everyday life. Cities and states are on lockdown in a desperate effort to flatten the curve. Worst-case scenario projections are dire, with the potential for millions of deaths in the absence of immediate, decisive, and coordinated action. The virus threatens to overwhelm our health care system while frontline medical professionals lack the equipment needed to protect themselves from infection.
It’s a bleak scenario. And it won’t get better any time soon. Yet we have high hopes for how the U.S. health care system will emerge from this crisis. Why? In the past two weeks, the nation has adopted new policies to protect the health of vulnerable populations – policies that public health professionals and advocates have been pursuing for decades.
We are finally protecting workers. For the first time, the federal government is providing paid sick leave so employees do not have to choose between their paychecks and their own health. Some states have reopened health insurance exchanges under the Affordable Care Act and others are expanding Medicaid, broadening access to health care as unemployment skyrockets and the markets collapse.
Other barriers to health care are evaporating. Medicare beneficiaries can now use a wide range of telehealth services, making it easier for people to get the care they need and minimizing non-urgent visits to strained health care facilities. On top of that, health care providers can now be reimbursed for providing services via telehealth, adding another incentive to use and expand remote care. Arcane restrictions are being lifted on methadone and buprenorphine, medications for opioid use disorder that are highly effective in reducing the risk of overdose and death but that have been vastly underused because of unnecessary barriers to access.
We are embracing protections for persons who face housing insecurity. Cities have enacted moratoriums on evictions and foreclosures. They are keeping electricity, gas, and water services running even for customers who cannot pay, which ensures that basic needs are met regardless of financial hardship. Unprecedented care is being provided to people who are experiencing homelessness: Heated structures are being outfitted to provide a safe space for testing, quarantine, and isolation, keeping the virus from spreading like wildfire in shelters and on the streets.
Policy changes have also extended to the criminal justice system. Nonviolent offenders are being released from prisons and jails to reduce overcrowded conditions that can facilitate disease transmission. These include people arrested for drug possession and sex work, activities whose criminalization has disproportionately impacted sexual and gender minorities and people of color.
These policies matter, and not just because they make us feel good about doing the right thing. They matter because health is a human right and because health is deeply interdependent. Collectively, we are realizing that we cannot flatten the curve without protecting the health of people who our government — and our society as a whole — have historically neglected. These include low-wage workers, people of color, people who are uninsured, people in unstable housing situations, people with substance use disorders, sexual and gender minorities, and people who are incarcerated. Without protecting these populations, our health care system will collapse, just as it has in Italy, leaving all of us at risk.
Many of these sweeping policy changes are meant to be temporary, with expiration dates timed for when the immediate danger from the coronavirus is anticipated to fade. But when rights are expanded, it becomes very difficult to claw them back. Our system has the potential to be forever changed — for the better.
It’s imperative that we remember these lessons. In more stable times, when new progressive policies are proposed, we must not forget the shared vulnerability we feel so acutely in this moment. We hope that partisan infighting and politicking are lessened by the clarity of now. And we hope that there is continued advocacy to sustain policies that increase access to care and protect the health of marginalized populations.
We’re far from achieving health equity, to be sure, and the policy changes we’re seeing now won’t be enough to keep vulnerable populations from being hit hardest by Covid-19. But the Covid-19 pandemic has exposed a truth we can no longer ignore. It’s clearer than ever before that our health — indeed, our survival as a species — depends on the health of the most vulnerable among us. In the face of excruciating human suffering, we still find hope in what may lie on the other side.
Julia L. Marcus, Ph.D., is an infectious disease epidemiologist and assistant professor at Harvard Medical School. Joshua Barocas, M.D., is an infectious disease physician and assistant professor at Boston Medical Center and Boston University School of Medicine.