Almost no concrete worker protections were put in place when the nation entered its tortuous lockdown phase. The Occupational Safety and Health Administration issued some guidelines, such as mask, social distancing and infection control programs that were advised by the C.D.C. But federal agencies left it to the states to make binding rules — and in turn most states left it to the companies themselves. Some employers have done far better than others at providing personal protective equipment, honoring paid sick leave edicts and supporting workers who express concern.
Dr. Fernandez says that unions can make the difference. “Data shows that for nursing home workers, being in a union was associated with better protection and less infections,” she told me. Anecdotally at least, the same seems to be true of farms. According to the United Farm Workers Foundation, nonunionized farmworkers (who make up 99 percent of all farmworkers) are less likely to receive masks and other protective gear from their employers, less likely to be informed about outbreaks where they work and more likely to face retaliation if they voice concerns.
Kenia Peregrino, an undocumented college student who migrated from Mexico to Washington’s Yakima Valley when she was 4, saw this disparity firsthand, when her mother developed Covid-19 after months of sorting apples in a packing warehouse. Her mother’s employers did not provide their employees with masks, nor offer routine testing, nor implement any social distancing protocols, even as outbreaks hit a string of neighboring farms.
The virus debilitated Ms. Peregrino’s mother, who lost a month and a half of work, which she wasn’t paid for, and who has yet to fully recover. “She used to be very high energy,” Ms. Peregrino said. “Now she gets tired a lot and has to go slow.” She still considers her family lucky. Her mother did not need to go to the hospital — a terrifying prospect for undocumented workers — and she did not lose her job altogether, something that often happens to those who get sick or complain. But Ms. Peregrino, who volunteers with the United Farm Workers Foundation and recently addressed Congress about the plight of migrant farmworkers, said that if her mother had belonged to a union, she might not have gotten sick at all.
Another tool for closing the health gap is even simpler: better Wi-Fi. When a tidal wave of coronavirus swept through New York City this past spring, Mount Sinai Medical Center where Dr. Fields works, shifted as many patients in as many departments as it could to telehealth. “We were doing more telehealth visits per day in the spring than we did in all of 2019,” he said. “With regulatory changes and the latest technology, it became this powerful tool for providing a comprehensive access point for all health care needs.”
Community health centers that serve low-income predominantly Black and Latino populations were not able to do the same, in part because they didn’t have sophisticated I.T. departments or sufficient cash reserves, but also because their patients did not have reliable enough broadband to participate. Widespread telemedicine checkups could be the key to reducing chronic diseases like obesity and diabetes in hard-hit communities, which would in turn reduce the risk of complications for those who catch the virus.