No one is immune from the coronavirus, but low-income and other marginalized groups of people face a higher risk of impact.

No one is immune from the coronavirus. Famous actors, musicians, athletes, politicians and even royalty have been diagnosed with COVID-19. But low-income and other marginalized groups of people face a particularly high risk of impact.

According to the World Health Organization, older people and those with underlying conditions such as high blood pressure, heart problems or diabetes are more likely to develop serious illness as a result of the coronavirus. Other social determinants of health can increase the vulnerability of the already vulnerable. Gaps in the social safety net include factors such as housing, transportation, education, employment, food insecurity and social support.

Lack of Insurance Is Major Concern

Limiting the spread of COVID-19 necessitates testing and treating people who may have been exposed. Unfortunately, according to Kaiser Family Foundation, the uninsured are likely to face significant barriers to testing and treatment, and that raises everyone’s risk.

The sheer number of nonelderly Americans without health insurance (nearly 28 million in 2018) is a major concern, especially if healthcare facilities become overwhelmed. Many of those uninsured work in service-oriented jobs or in retail sales positions requiring face-to-face interaction with customers, thus increasing their risk of exposure to COVID-19. Uninsured workers who test positive for the coronavirus, or who must stay home from work to care for a sick family member, could be hit with severe financial consequences. Newly enacted legislation requiring paid sick leave during the pandemic will not cover all workers.

Other barriers to diagnosis and treatment include the likelihood that many people without health insurance will not know where to go for help because they don’t have a primary care physician or because they fear the out-of-pocket cost. What’s more, those who do seek and receive care are likely to amass large medical bills that they cannot pay.

Efforts to address these barriers include the Families First Coronavirus Response Act, signed into law March 18. It gives states the power to provide free testing for the uninsured using federal money but does not provide for COVID-19 treatment. Individual states are reviewing their options for expanding comprehensive coverage options to uninsured people seeking treatment. Medicaid flexibility is possible using Section 1115 or Section 1135 waivers. Also, states with their own health insurance marketplaces could provide a special enrollment period in response to the coronavirus outbreak. Finally, under the Coronavirus Preparedness and Response Supplemental Appropriations Act, funding or reimbursement could be paid directly to providers to expand services to uninsured people requiring coronavirus care.

Social Barriers Complicate Care for Vulnerable Populations

Homelessness makes it difficult to follow social distancing guidelines. Where do you “shelter in place” if you have no place? The Centers for Disease Control and Prevention (CDC) recommends that municipalities stay in touch with local health authorities, step up community education and outreach, use fewer staff and volunteers, and limit visitors. It also asks local homeless agencies to space mats and beds at least 3 feet apart, make cleaning supplies accessible, stock bathrooms with plenty of soap, watch for COVID-19 symptoms in individuals, confine clients who show symptoms and refer those with severe symptoms to nearby healthcare facilities.

Food insecurity, which also affects many homeless people, poses logistical and other challenges. Some seniors are physically or financially unable, or merely reluctant during the pandemic, to go shopping for groceries or stockpile nonperishables. Social distancing requirements can deter people from food distributions at senior centers or food banks. Proposals for addressing this issue include new meal delivery systems, amnesty for those who miss utility payments, awareness campaigns and increased funding for food assistance programs such as SNAP.

Rural access to healthcare can be an especially acute need during a pandemic. While social distancing is not an impossibility, the distance that rural residents must travel to a provider can be an obstacle to testing and treatment. Additionally, remedies such as telehealth rely on broadband and internet connections, often unavailable in remote areas.

Many payers are offering free telehealth benefits and certain testing-related products and services. In addition, some are investing in efforts to address the social determinants of health, with donations earmarked for necessities such as food, at-home support, housing, transportation and medical supplies.

“Individuals who were already struggling with food insecurity and financial need are particularly exposed right now as businesses reduce shifts or close altogether in response to quarantine and social distancing efforts,” said Walter D. Woods, CEO of The Humana Foundation, which recently announced it would donate $500,000 toward coronavirus relief and recovery. “Lost wages translate to an increased reliance on food banks, which is why our support of Feeding America is so critical.”

COVID-19 is a highly public yet stealthy threat, spread person to person, sometimes by carriers who exhibit few to no symptoms. The virus can linger on exposed surfaces for a few hours or several days. It is in everyone’s best interest that everyone have as much protection as possible; that each of us, in our daily activities and choices, respectfully consider the risk we might pose to others; and that anyone who contracts the coronavirus have access to adequate treatment.

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