Why the Sickest Workers May Be Among the First Back on the Job – The New York Times

Since most people in the U.S. get health insurance through work, many with pre-existing conditions fear unemployment more than they fear coronavirus.

Last month, Patti Hanks faced a wrenching decision: go back to her job, or lose her health insurance.

Ms. Hanks, 62, recently had ovarian cancer treatment. With her immunity low, she was nervous about returning to her workplace, a store where she would be drawing up financing plans and taking cash payments from customers buying furniture and large appliances.

But she was even more worried about losing her health coverage if she didnt go back. Finding a job with health benefits that allowed her to work from home felt like a pipe dream in the midst of an economic downturn.

I just got over chemo, she said. Now is not the time for me to lose my insurance."

So, despite her reservations, she returned to work. She wears a mask and makes sure customers sit a good distance away at an L-shaped desk.

Its a scary thing to go back and know you have low immunity, she said in mid-May, after two days back at her job. But when it all boils down to it, I dont think Covid-19 is going away any time soon. I dont think you can hide from it. Youve got to trust God and go back.

Ms. Hankss experience illustrates how Americas employment-based health insurance system could become another liability in the countrys fight to contain coronavirus. It could push workers at highest risk of serious illness from coronavirus back to work the fastest. Those people need coverage to treat the pre-existing conditions that make them vulnerable in the first place.

About one-quarter of American workers 37.7 million people in total are estimated to be at high risk of serious illness from coronavirus, according to a Kaiser Family Foundation study published this week.

Some are at increased risk because of age, and some have health problems like diabetes or asthma that the Centers for Disease Control and Prevention has identified as risk factors.

It is one of the many ways the U.S. health care system has made us so much more vulnerable to the effects of the pandemic than other countries, said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation and a co-author of the new study. In other countries, you dont hear about people losing health insurance when they lose their jobs.

When it comes to health care, the United States is rarely like the other countries Mr. Levitt mentions. In Canada and Britain, workers get their health coverage through the government. In many European countries, like Germany and the Netherlands, workers buy subsidized coverage individually in tightly regulated markets.

In the United States, 61 percent of working-age adults get health insurance through work. This system of employer-sponsored insurance dates to World War II-era policy decisions that encouraged companies to provide workers with medical benefits.

The federal governments most consequential decision, in the mid-1940s, was to not tax health insurance benefits. An employers dollar spent on health benefits suddenly stretched much further than one spent on wages. This laid the groundwork for what we see today: Most companies, large and small, offer health benefits to workers.

The Affordable Care Act did provide new ways for Americans to get health insurance outside of work. It expanded Medicaid to cover millions more low-income adults. It also created new private insurance marketplaces where middle-income Americans could buy subsidized coverage (and health plans could not discriminate against those with pre-existing conditions).

But that new safety net has some holes. Fourteen states, including large ones like Florida and Texas, declined to participate in the health laws Medicaid expansion. Workers who lose employer-sponsored coverage in those places may have less access to affordable coverage options.

Others may find the coverage options on the health law marketplaces prohibitively expensive, particularly those earning slightly too much to receive coverage subsidies. Whats more, the most affordable marketplace plans tend to provide less robust coverage than what employers typically offer. They require patients to pick up a greater share of their treatment costs with co-payments and deductibles.

Those shortfalls in the safety net may push vulnerable workers to do what Ms. Hanks did: go back to work before feeling entirely comfortable with the risks.

Updated June 16, 2020

The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who dont typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the countrys largest employers, and gives small employers significant leeway to deny leave.

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was very rare, but she later walked back that statement.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.

A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nations job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you arent being told to stay at home, its still a good idea to limit trips outside and your interaction with other people.

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people dont need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks dont replace hand washing and social distancing.

If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Ms. Hanks lives in Virginia, a state that expanded Medicaid, but she expects that she earns too much from other income sources to be able to sign up for the program. She and her husband (who is a few years older and covered by Medicare) own a few rental properties as well as a herd of Black Angus cattle, which they sometimes sell to meat producers or other farmers.

When the couple bought their own health coverage about a decade ago, before Obamacare, they could find only expensive options shopping on their own. Access to employer-sponsored coverage was one of the reasons Ms. Hanks took her job at the furniture store in the first place.

A month after returning to work, she generally feels safe. She and other employers sanitize their chairs and desks frequently. Ms. Hanks is careful to wipe down the pens her customers use to sign contracts.

She recently got some good news from her doctor: Her immune system seems to be recovering from the chemotherapy treatment, returning closer to normal.

Still, the store has been pretty busy since Virginia began lifting stay-at-home restrictions last month (demand for freezers appears to be especially high, possibly a sign of families stocking up on groceries). There was one episode that scared her, when a worker from a local nursing home entered the store to shop.

She didnt look like she felt good, like she was kind of sweaty on the forehead, she said. She had a mask on, but I was sitting there, looking at her, thinking this is not good.

But you cant crawl into a hole. I think weve done everything we can to protect ourselves. I know I try to. So Ill just keep going. Thats just the way it is.

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Why the Sickest Workers May Be Among the First Back on the Job - The New York Times