COVID-19: US federal accountability for entry, spread, and inequities—lessons for the future

Abstract

The United States (US) has been among those nations most severely affected by the first—and subsequent—phases of the pandemic of COVID-19, the disease caused by SARS-CoV-2. With only 4% of the worldwide population, the US has seen about 22% of COVID-19 deaths. Despite formidable advantages in resources and expertise, presently the per capita mortality rate is over 585/million, respectively 2.4 and 5 times higher compared to Canada and Germany. As we enter Fall 2020, the US is enduring ongoing outbreaks across large regions of the country. Moreover, within the US, an early and persistent feature of the pandemic has been the disproportionate impact on populations already made vulnerable by racism and dangerous jobs, inadequate wages, and unaffordable housing, and this is true for both the headline public health threat and the additional disastrous economic impacts. In this article we assess the impact of missteps by the Federal Government in three specific areas: the introduction of the virus to the US and the establishment of community transmission; the lack of national COVID-19 workplace standards and enforcement, and lack of personal protective equipment (PPE) for workplaces as represented by complaints to the Occupational Safety and Health Administration (OSHA) which we find are correlated with deaths 16 days later (ρ = 0.83); and the total excess deaths in 2020 to date already total more than 230,000, while COVID-19 mortality rates exhibit severe—and rising—inequities in race/ethnicity, including among working age adults.

COVID-19 and Essential Workers: A Narrative Review of Health Outcomes and Moral Injury

“…In the U.S., there has been no systematic collection of occupational data for COVID-19 illnesses and deaths [ 26 ]. This is, in fact, a global problem.…”

“…Interestingly, a recent review of OSHA complaint data showed that the distribution of complaints since early March 2020 mirrored the epidemic curve. The data also showed a strong correlation between the number of complaints filed and COVID-related deaths that occurred 16 days later [ 26 ]. As suggested by Hanage and colleagues, these findings may indicate that the concerns expressed by workers regarding potential health and safety violations in their workplace are real and proper investigation into these concerns can provide an opportunity for intervention [ 26 ].…”

“…The data also showed a strong correlation between the number of complaints filed and COVID-related deaths that occurred 16 days later [ 26 ]. As suggested by Hanage and colleagues, these findings may indicate that the concerns expressed by workers regarding potential health and safety violations in their workplace are real and proper investigation into these concerns can provide an opportunity for intervention [ 26 ]. However, enforcement data show that only a small percentage (2 to 4%) of worker complaints related to COVID-19 have been investigated at either the state or federal OSHA level [ 26 ].…”

Witnesses and Victims Both: Healthcare Workers and Grief in the Time of COVID-19

“…Basic elements of infectious disease prevention and containment have become highly politicized, leading to policies, practices, and distribution of resources (including PPE and vaccines) inconsistent across the US. 26 Such national contention likely contributes to US COVID-19 cases and deaths out-of-proportion to population, US public mistrust of healthcare institutions and workers, as well as a sense of anger and abandonment among US HCWs.…”

“Freedom to Breathe”: Youth Participatory Action Research (YPAR) to Investigate Air Pollution Inequities in Richmond, CA

“…Susceptible sub-groups include the very young, the very old, those with respiratory diseases and those who face high levels of socio-economic disadvantage and other chronic social stressors. Emerging findings indicate that air pollution may exacerbate both the incidence and harm of COVID-19 [ 14 , 15 ], a disease that disproportionately affects communities of color [ 16 , 17 ].…”