PhD, Assistant Professor, UW DEOHS
I am so honored to be able to say some words at this important event this year. As I struggle to comprehend what work looks like during COVID-19, and how our workplaces will fundamentally change moving forward, I am comforted to not feel alone in my struggle. I feel the warmth of a virtual community of people who share the same concerns and struggles as me, and I know that you will be my colleagues, friends, and support system as we work together to understand how to continue to protect all workers in the near future and in perpetuity.
I come to speak to you today with conflicting emotions. I feel somber and am feeling grief—for the lives lost at work last year and in years past, and for the lives that will be lost in this upcoming year at work, many of which will be due to the COVID-19 pandemic. However, I also feel a sense of ambition, purpose and motivation to use this public health emergency to catalyze protections for all workers moving forward. Protections that will protect workers not only from another pandemic, but from any other anticipated hazard in the workplace.
I am going to leave you with three important points to think about today. I challenge you not only to think about them passively, but also to think about how you can actively help to meet the challenges of the workforce during this unprecedented time and as we move forward. No matter your role, there are things that you can do to promote safe and healthy working conditions for all workers.
Trained as a researcher, in the early days of COVID-19, I turned to data to attempt to make sense of the impact the pandemic would have on workers. Using existing Bureau of Labor Statistics Data, I found out that the large majority of the United States workforce—a full 75%--are in jobs that likely cannot be done from home. Being able to work from home is the ultimate privilege during a pandemic time. Not only are you able to protect yourself from exposure to disease at a workplace or due to commuting to a workplace, you are also able to continue to work, perhaps avoiding job displacement or job insecurity. The workers who cannot work from home will largely fall into two categories—those who will be asked to continue to work due to their essential nature, and those that will end up displaced or furloughed from a job. With the exceptions of physicians, my data show generally workers who cannot work from home have much lower median annual incomes than those workers who can work from home. Workers who cannot work from home may not have employer-provided healthcare coverage. They may not be protected by a union. They may not have access to appropriate and ample paid sick leave or immediate access to unemployment insurance. They may have to move out of their house and no longer see their loved ones so they don’t bring infectious disease home. They may have to choose between quitting their job to stay home with a child who is out of school, or going to work and risking exposure to disease and infection, but at least being able to pay rent. They are our neighbors, our friends, and the cogs that keep our society running.
My first important point is that COVID-19, and other public health emergencies and disasters, tend to exacerbate existing disparities in society. COVID-19 has further exemplified the importance of work as a social determinant of health, and specifically the ability to work from home as a social determinant of health. COVID-19 reminds us how important it is to understand which workers are in the most vulnerable jobs, and the risks and challenges these groups face. My thought to you is—how do we protect these workers? The guidance to “work from home” does not apply to the large majority of the U.S. workforce. We need to do better to protect the workers who are serving us, and while calling them heroes and cheering for them is a nice symbolic gesture, it doesn’t protect them. We need to be devoting our efforts to ensure all workers have livable wages, the ability to unionize, appropriate protections at work against known and anticipated hazards, and social safety net protections outside of work, including access to ample paid time off, family leave, comprehensive unemployment, and health care. Let’s strive to ensure all workers have access to the protections of those lucky few workers who are still able to continue working from home.
There are two important people I’d like to briefly introduce you to. First, Ms. Samina Hameed. Ms. Hameed was a metro bus operator, here in King County, WA. She had been an operator since 2017, and her husband is also an operator. Ms. Hameed loved her job—interacting with customers, and fellow bus drivers. Adorably, she and her husband would try to work the same schedules on nearby routes so they could have breaks and lunches together, and be home at the same time for dinner with their family, which consists of three children. April 16, 2020 she died from COVID-19, one of over 80 bus drivers (so far!) who have been taken by this pandemic across the United States.
Querubin Eusebio Dizon Quitlong, better known as Sonny, had his last day of work on March 2, 2020. Sonny worked two essential jobs—he was a mail handler for the US Postal Service, and also worked at the Rainier Beach Safeway here in Seattle. He said the best part of his job was interaction with the customers, and was known for his distinctive laugh and photographic memory. Sonny was an immigrant from the Philippines in the 1980s, with a masters degree in electrical engineering, but came to Seattle with his extended family, looking for a better life and additional economic opportunity. He passed away on April 6, 2020 due to COVID-19. He is one of at least 30 grocery store workers that have died due to the novel coronavirus in the United States.
Whether or not these will be determined workplace-related illnesses is far from settled, but we know that these individuals, and others like them, are workers. Workers who continued to work, sometimes with limited protections, during a global pandemic, and they contracted a disease which led to their death. Workers who were serving their community and providing services to us. This leads us to my second important point: We can and we must learn from this to protect workers moving forward. The hundreds of workers who have already died due to COVID-19 across myriad essential fields, and the workers whose names we will honor today are the lasting reminder: no one should die at work. Not during a pandemic. Not during times of normal operation. Not during anytime for any reason. Businesses must take responsibility for the working conditions their workers’ face and be held harshly accountable when they do not and tragedies occur. It may be uncomfortable, and it may be hard, but for workers like Sonny, Samina, and all others, we must continue to pressure businesses to raise the bar.
My last point is that we must change the conversation around the importance of all workers. This pandemic has reminded the world how important the workplace, and the worker is to public health. It has created a realization that all workers and all jobs matter. Going forward, we cannot forget this. We must remember this when we vote, when we contact our congressional leaders, and when we advocate for policy changes. We must instill this in our children from a young age and preach it in our classrooms. We must use this to ensure that all workers are provided a living wage, appropriate protections both on and off the job, and are treated with dignity and respect, regardless of their origin, status, or occupation.
My hope is that the class divide ravaging America, a large part of which is driven by work, will begin to be lessened as we are reminded how we all need to work together to keep our communities strong and healthy, and as we realize the important role all workers play in our society.
I am hopeful that going forward, we can think of all workers as Aarvi Shah has. Aarvi is a 6th grade student in Birmingham, Alabama who wrote a poem entitled “An Ode to Essential Workers.” I’d like to close my time by reading this to you:
the world would
of these people.
In the garden of earth
being the water.
As They nourish
Known as life.
In a hospital
deserving standing ovation.
Pharmacists in Walgreens
& Cashiers of Walmart
risking their lives.
keeping us stocked.
The UPS guy
Becomes best friend
Delivering the package.
to flatten the curve.
So students can learn.
Without a mask
Being savior of the world.
Easing the toothache
Without face shield
A Cook in restaurant
So we can
do takeout for the family
A Lab Technician
Touching the vials
To confirm the infection
Roaming the streets
Enforcing the law and keeping us safe
Still pulling in
An unknown driveway
The Ambulance worker
Doing CPR on someone
Who might be already infected.
Making sure our lifelines-
The Internet and Utilities are not down
To cure diseases.
Operating with no supply
so that pain will be no more.
An essential worker
like a God,
No matter –
In times of tragedy
In times of worry
In times of stress
They are the front-liners.
That without them
Our world will
And it gives
When you see one
Tell them thanks
Or Give them
a virtual hug
Or in the least
Even though without them-
Our society will not flourish,
They are still
Associate Professor, Department of Family Medicine
Director, Center for Health Workforce Studies
Thank you for the introduction, Dr. England.
Thank you for inviting me to this special event. I am grateful and humbled to have this opportunity to honor our health care heroes on Worker Memorial Day. Full disclosure, I am not a health care worker but I am a health workforce researcher who has long been concerned about the health and well-being of our health care workers and have tried to bring that to light with my team at the UW Center for Health Workforce Studies. We believe that a strong and resilient health workforce is needed to fully realize the potential of our health care system.
Today I will share with you my concerns about the risk that our health care heroes are facing on the frontline of this COVID-19 pandemic including those here in King County. I will be spending the next several minutes telling you why and where I think things need to go to protect our health care workers. As of April 14, the Centers for Disease Control and Prevention reported that 27 health care workers have died from COVID. Another 10,000 health care workers have been tested positive. We know these numbers are a vast undercount. I fear that these numbers will grow as testing becomes more commonplace for essential workers in health care. Early on in the pandemic, I estimated that 1 in 6
health care workers may be infected with COVID and 20,000 to 60,000 may die if we do not continue to curb the infection rates through good public policies such as social distancing and shelter in place as well as increasing the availability of personal protective equipment, otherwise known as PPE. There are 16.5 million people who work in health care including those who do clinical work as well as those who support the infrastructure including custodial staff, food service workers, and office administration staff. Not all of them are working on the frontline right now. In fact, there are thousands of workers being furloughed including here in our state as many elective procedures and routine care
has been postponed. However, millions ARE working in hospitals and long-term care settings who are actively managing and treating patients with COVID.
Health care workers are being asked to step up in ways they have never been asked to step up before. Of course, health care workers are in the field because they are dedicated to helping the sick and keep us all healthy and well. But this time, many health care workers are facing new and unique challenges where their own lives are at risk and they have to decide whether to help patients or protect their own health and that of their families. Many of our doctors and nurses are moving out of their homes and into hotels so not to bring home COVID to their families. Some of our health care workers are struggling with the fact that they themselves may fall into the “at risk” category based on their age and/or having their own health problems. In particularly, as we try to fill in the gaps by asking former health care workers to come out of retirement, these retirees are weighing their strong sense of duty to serve the sick while fearing their own health.
But does it have to be like this? Do health care workers have to be so fearful? The center of media attention as well as policy attention at the beginning of the COVID pandemic focused on hospitals and big medical centers who were preparing for a surge of COVID patients. They rapidly got their infrastructure and protocols in place to protect workers, including UW Medicine. However, many still struggle to get the adequate amount of PPE and COVID tests that they need due to challenges in the supply chain.
Nursing homes are increasingly getting attention due to the incredible number of deaths occurring in this setting. According to public reporting by public health departments, nursing homes are responsible for about 25% and sometimes up to 50% of COVID deaths in some states like Oregon, Colorado and Utah. Nursing homes are particularly problematic not only because the vulnerability of the patients but also because they tend to be lower on the list of priority for policymakers and do have as good access to the supply chain to get the proper PPE gear and training. These works are also particularly vulnerable. Prior to COVID, turnover was high – with wide variation ranging from 30 to 60% - in any given year. These jobs are tough and low paid with few opportunities to move up a career ladder. COVID has exacerbated these issues. Nursing home staff are scared and rightfully so as they do not have the protection that they need, so turnover is even higher than usual.
This is only the beginning of the fears about the safety our health care workers. An increasing number of stories are also emerging about the challenges our emergency medical service responders and paramedics are facing on the frontlines and the lack of PPE. And soon home health will likely face similar challenges are we expect them to help keep our elderly safe and in their homes and out of hospitals. So what can we do? First, track the numbers. Kaiser Health News and the Guardian have joined forces to document health care workers getting sick on the frontline and tell their stories. The stories reflect the range of workers who are at risk – a neurologist, a nurse, a social worker, surgical technician, clinical coordinator. CDC is doing some data collection by occupation but we also need to see more up to date reporting. It’s not clear if CDC or local public health departments have the capacity or even the mandate
to capture occupation level data. A recent report by Kaiser Health News shows that many states are collecting data on COVID deaths and cases among residents and staff, but Washington is not listed among those publicly reporting. But we need to know these numbers so we can know whether we are doing a good job or not protecting these at risk workers.
Second, we need to get health care workers the PPE that they need. We need to get ALL health care workers protection including those on the frontlines as well as those running the business behind the scenes including our food staff and custodial workers. But we need to go beyond PPE and training to use PPE. We also need to test our workers regularly so we don’t have them infecting the patients and also each other. This should have been happening since day 1 but this pandemic has highlighted the gaps in our public health infrastructure. Part of the problem has been the supply chain as I mentioned earlier. I know that there are many good people in this state who are working hard with the government to get the protection and testing that we need so hopefully it is right around the corner. But protection needs to extend beyond PPE and testing. Third, we need to protect our health care workers mentally and financially. Many of our health care workers are feeling burned out and scared. The mental toll of struggling to keep patients alive while also fearing for their own lives and not feeling heard or taken care of by other leaders will have repercussions for years to come. This risks the supply of health care workers available to care for patients. Financially, we need to make sure all of our health care workers have health insurance. Too many of our health care workers, particularly part time workers and those in long term care do not have health insurance and cannot get the care that they need. Many of our health care workers, particularly home health aides, are barely making minimum wage and are living in poverty yet we ask them to risk everything they have to take care of patients. And many of them will since it is the only life line they have. However, when unemployment insurance looks to be a better deal then the wages they make on the job, that is a problem.
Taking care of health care workers is important. We need workers to care for our COVID and non-COVID patients. Health care workers were in high demand before COVID and they are likely to continue to be in high demand post-COVID. We need to make sure we can replenish the health workforce when those on the frontlines get sick and/or die. But with news stories highlighting the incredible risk of working in health care, recruiting new people to the frontlines to help in the battle against COVID is going to be tough. The stories of our health care heroes are heart warming, uplifting and inspirational, but it also reflects the immense sacrifice we are asking of our health care heroes. While I hope that young people as well as those who are furloughed in other non-health care industries will be inspired to want to step up and help, many may be thinking twice given the risks involved. But I don’t think working in health care has to be a risk. It doesn’t have to be the sacrifice that it is if we have good strong public policy measures such as social distancing and if we distributed the PPE and testing we so desperately need to all health care workers. This is a solvable problem and as others have quoted elsewhere, one life lost is one life too many. We can do better.
Thank you to the sacrifice by all of our health care workers, thank you to our health care heroes here in the county, state, nationally and internationally. Without you, the impact of COVID would be much worse.
Thank you for listening.