Essential Workers — Including Those in Health Care — Hit Hard by COVID-19 and Environmental Health Threats

by Jadenne Cabahug

Edna Cortez has worked as a registered nurse at Seattle Children's Hospital for the past 30 years — and she received a commemorative pin to mark the occasion. Cortez wears another pin these days during the pandemic: she places a button with a picture of her face on top of her scrub hat to help her young patients feel less afraid.

She usually keeps her face covered while working, like all nurses do during the pandemic. Cortez has to wear full personal protective equipment (PPE), including masks, goggles, face shields, and gowns. Not everyone has access to the same equipment, or the right kind.

Cortez is among the state's essential workers — in health care and other professions — who have been put at higher risk from COVID-19 and other environmental health factors in 2020.

During the course of this pandemic, Seattle Children's Hospital had a number of issues with PPE. It had to switch mask vendors due to certain allergies and struggled to find gowns that were protective enough, Cortez said.

Cortez, who is also a Washington State Nurses Association chairperson, told her staff that there might be a shortage of gowns and that the gowns might not protect them enough. She witnessed some of the environmental services staff — people who clean patient rooms, surgery units, support facilities, and the general environment in hospitals — with gowns falling off of their shoulders and inadequate PPE.

"They're not well protected," Cortez said.

Environmental services workers are essential to manage infection and ensure a safe workspace. They're also overwhelmingly People of Color. At Seattle Children's, more than 70% of environmental service workers are People of Color, Cortez said.

After some time, Children's Hospital improved and was able to provide sufficient PPE for staff. Still, People of Color often work positions like these and others outside the health care realm that put them on the front lines of a pandemic: grocery workers, Uber drivers, childcare workers. Working these jobs mean women and People of Color are more frequently exposed to COVID-19 and at a higher risk of contracting the virus. This can be seen in the rates of COVID-19 infection in Washington State, which are higher than average for People of Color, especially among Hispanic and Black populations.

More often than not, People of Color are also disproportionately exposed to harmful environmental health issues, such as PM 2.5 fine particle exposure or toxins in the water, which can lead to long-term health complications or viruses. COVID-19 is no different, making it just as much of an environmental justice issue as exposure to pollution.

Nationwide, Asian American, Hispanic, and Black communities have already been hit hard in 2020, with higher rates of death. Each population experienced a 30% increase in death rates compared to an average of the last five years, according to an analysis by The Associated Press and The Marshall Project.

Women and People of Color disproportionately work in essential occupations, work that must continue even in the midst of a global pandemic. In a survey conducted by the Economic Policy Institute, there are more than 55 million people in the U.S. who work in essential occupations. Women make up 76% of essential health care workers and 73% of government and community-based services. Among all essential workers, 55% are non-white. By comparison, non-white people make up only 33% of Washington's population.

According to a study by the Economic Policy Institute, these essential workers — with the exception of some health care workers — tend to have low wages and are generally younger, more ethnically diverse, and female.

Dr. Marissa Baker, Assistant Professor at the University of Washington Department of Environmental & Occupational Health Services, says that during any public health emergency, groups hit hardest are communities that historically have less access to health care or less power in their communities to protect themselves.

Many workers are forced into higher levels of exposure by the nature of their jobs, which are low paying. Baker said only about 25% of the workforce can work from home, leaving 75% forced to leave their homes to maintain their income.

In addition to exposure to COVID-19, other environmental justice factors can put marginalized communities at risk. PM 2.5 are fine particles that can embed in the lungs and worsen medical conditions such as asthma and lung and heart disease. People who have these pre-existing health conditions often are at higher risk for catching COVID-19 and of having additional complications if they catch it.

The Washington Health Disparities Map tracks the factors that create health and environmental inequities across the state. It includes, among other things, PM 2.5 levels. According to the map, there are high concentrations of PM 2.5 in South King County (Seattle, Renton, Kent, and Tacoma) with lower concentrations found north of Seattle.

Baker said she sees a possible overlap here, but it's not clear that one predicts the other.

"There tends to be increased exposure to PM 2.5 [in] lower income communities, communities of color, and we've seen that those are also some of the communities that are hit hardest by COVID-19," Baker said.

David West, labor policy researcher at Washington Labor Education and Research Center said many factors add to the risk that People of Color and women face in the COVID-19 pandemic.

Some workers struggle to access proper PPE. Workers at Harborview Medical Center, which is run by the University of Washington Medical Center, put up their own plexiglass barriers temporarily to protect themselves against patients who later tested positive for COVID, West said. Later the hospital replaced the temporary barriers with permanent ones. A new cluster outbreak of COVID-19 among workers and patients occurred at Harborview in October.

Other factors that could harm workers of color working during the pandemic include poor housing conditions, living with multiple generations in one household, transit dependency, and the inability to work from home — not to mention the low wages many earn.

But just the kind of job they hold has a huge impact. The Washington Labor Education and Research Center found that more than 900,000 people are working jobs it considers "hazardous and economically precarious" in Washington State. It found that People of Color took up 35% of those jobs, even though they make up only 30% of the total work force. In that same study, researchers also found that women make up two-thirds (66.5%) of those same jobs, even though they make up 48% of the total labor force.

"It's important to look at both [on the job] hazard risk but also question whether those workers are economically secure." West said.

The risks are clear, and the outcomes are already showing that People of Color and women are highly impacted by the virus, according to the Centers for Disease Control (CDC).

Nationally, People of Color are dying of COVID-19 at disproportionately high rates. According to the CDC's provisional COVID-19 death counts, White people make up 60% of the U.S. population, but only 51.3% of COVID-19 deaths. Black people, however, make up 13% of the population but 25% of total COVID-19 deaths as of July 2020.

The trend varies state-by-state, and according to the CDC's data, COVID-19 death rates in Washington follow racial demographics more closely.

White people account for 67% of COVID-19 deaths in Washington as reported by the Washington State Department of Health. This corresponds closely to their total percentage of the population (68%).

While the COVID-19 death total in Washington State follows its racial demographic by raw count, this is not the case for total COVID-19 cases. Hispanic people comprise 42% of confirmed cases even though they make up only 13% of Washington's total population.

But a closer look at the numbers shows disproportionality even in deaths. Native Hawaiian, Native Americans, and Pacific Islanders have the highest age-adjusted rate of COVID-19 deaths per 100,000 in Washington, with a rate of 108 per 100,000, more than 5 times the rate among white people.

These numbers emphasize that there is still more to do.

There are no easy solutions. Many need these jobs to survive, leaving them stuck between the rock of COVID-19 and the hard place of their own economic security. The risk that People of Color and women experience in this pandemic, however, highlights a need for change.

"Washington State does not have a real standard or regulation that deals with COVID safety in the workplace or all workers, whereas a couple other states have done that recently," West said.

Got Green, an economic and environmental justice advocacy organization, pushes the idea of characterizing COVID-19 as an issue of environmental justice. It released a petition titled Emergency Justice in Response to COVID-19. A list of demands they penned includes suspending rent and housing payments, increasing accessible testing, childcare for essential workers, suspension of immigration raids and deportations, decarceration of inmates, and other steps to be taken post-pandemic.

Baker said it all gets down to COVID-19 being a matter of economic justice. Any populations that are already vulnerable are now experiencing amplified risk amid the pandemic.

"It's getting more devastating," Baker said. "There are some parts of Seattle that are going to … have much longer lasting effects."

Jadenne Radoc Cabahug is a journalist in Seattle. She formerly participated in KUOW's RadioActive Youth Media program and was a fellow for the Seattle Globalist's Environment Justice Investigative Journalism Fellowship. She is attending the University of Washington, studying journalism and public interest communication.

Featured image: Edna Cortez by Jadenne Radoc Cabahug.