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Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security, talks with USA TODAY’s Jayne O’Donnell about isolation, reopening and COVID-19 vaccines.

USA TODAY

As many governors choose to reopen their economies, states that attempt a premature return to ‘normal’ are sacrificing those with the fewest choices.

One might think it’s good news that more than half of all states are either partially reopening or have plans in place to reopen after a nearly two-month COVID-19 shutdown. 

If those states were truly ready, this would be good news. But many of the plans being rushed out now are almost certain to fall hardest on those people who will not be able to protect themselves or their families. Whether because of lack of access to health care, low household income, immigration status, racial discrimination, disability, lack of safe or affordable housing or myriad other factors, millions of people are going to pay for our nation’s entrenched inequities that have existed for generations but have become even more apparent and appalling during this pandemic.

As I reflect back on my time as acting director of the Centers for Disease Control and Prevention during the 2009 H1N1 pandemic, I can see the disconnect that can occur between well-intended government pronouncements and the actions people are expected to take. CDC or state recommendations are only effective if people can follow them.

Advice disconnected from reality

For example, the latest CDC COVID-19 advisory on “What to do if you are sick” says stay home, consult your doctor, don’t take public transportation, isolate in a room away from family members. That would be impossible for a front-line worker without health insurance or a car and living in a cramped apartment with extended family.

For months, in states and cities that have chosen to collect and share data, we’ve seen sobering reports of the disproportionate impact the novel coronavirus has had on communities of color and other vulnerable populations. In the CDC’s home state of Georgia, for instance, a study released just days ago showed that African Americans accounted for 83% of COVID-19 hospitalizations despite making up only 32% of the state’s population. Even so, without a clear understanding of these numbers or a path to reducing risk to the most impacted communities and workers, Georgia has forged ahead with reopening the state in a phased approach that began last month.

In the best of circumstances, each state would have a public health-driven checklist in place before considering reopening, and the most vulnerable citizens would be considered as decisions are made. As more states begin planning to reopen, here are a few core questions that must be answered first, with particular attention paid to communities of color and low-income workers:

►Does the state have enough hospital beds for both COVID-19 patients and all the others with medical issues like heart disease, diabetes, cancer and the like whose medical needs currently are not being met?

►Is there sufficient testing capacity for the entire population and protocols for intensifying testing in the highest risk settings and among the highest risk individuals?

►Does the state have the ability to identify, contact trace and provide support to safely isolate all those infected with or exposed to the novel coronavirus?

►Do industries have in place protocols for returning workers as well as adequate personal protective equipment for the foreseeable future?

►Does the state collect and share data on cases by race, ethnicity, disability and income to understand what populations are being hit hardest and why?

►Does the state include representatives from communities of color and other marginalized groups in helping to inform and shape its decisions?

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Hasty decisions will cause more deaths

There are other questions regarding schools, housing, public transportation, food access and other priorities that governors will need to consider in the weeks and months ahead, and the people weighing these decisions face some challenging trade-offs that will vary greatly from state to state. Our federalist system largely gives states the authority to reopen when and as they please. This being the case, people across the country will experience this next phase of the pandemic very differently, and hasty decisions and incomplete planning will almost certainly lead to more deaths that could have been prevented and a continuation of the disparate impact we are currently seeing. It’s critically important that we learn from the different approaches taken, so states yet to reopen can benefit in learning from those that are doing it well.

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Despite these variations, we can predict who will fare worst, no matter the state. Front-line health workers, grocery store employees, factory workers, delivery drivers and public transportation operators will face greater exposure as states reopen. Immigrants and people in nursing homes will be endangered even further. African Americans, Latinos and Indigenous people — who are dying in some places at rates significantly higher than their proportion of the population — will continue to suffer disproportionately.

More people without paid family leave, health insurance or access to food will have to make impossible and often life-threatening decisions. The homeless and the incarcerated will languish, and people with disabilities will continue, in many cases, to fend for themselves.

History could judge us unkindly 

Wave after wave of federal aid legislation has moved through Congress to address this unprecedented national crisis. As the death toll continues to climb and the economic suffering extends into more and more households — with more than 30 million people having filed for unemployment benefits in the past six weeks — the nation is now preparing for a future that no one can see. Everyone has a need and a one-time federal payment is insufficient. Recurrent support for those most in need is essential.

A risk decision: With coronavirus still rocking, reopening states are rolling blindly

Yet for all the uncertainty of this moment, we are certain of one thing: Those who have been historically marginalized in our country must not be marginalized again in our rush to reopen. A painful truth we are seeing in real time is that how well people navigate this pandemic depends largely on the color of their skin and the amount of money they have. It’s that stark.

We cannot undo generations of racism, discrimination and inequality in one season, one year or even one decade. But each governor and legislature feeling the urge to accelerate a reopening must identify and address the inequities of this pandemic to ameliorate the suffering in the communities feeling the greatest impact.

Every person living through this moment understands that we are living through history. We are called now to see beyond the injustices of our past to a more fair, just and inclusive world that lies before us. History will not judge our response with kindness if we fail to ensure that everyone’s life has the same value in this time of crisis.

Dr. Richard E. Besser is president and CEO of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention. He is a member of the Multi-State Council to Restore the Economy and the New Jersey Governor’s Restart and Recovery Commission. Follow him on Twitter: @DrRichBesser

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