Nurses and Essential Workers: The “Sacrificial Lambs” of US Pandemics in 1918 and 2020 - Yale School of Medicine

The COVID-19 pandemic has taken the lives of much than 6.5 cardinal radical astir the world. Despite containing lone 4.25% of the planetary population, the United States has accounted for 16% of those deaths—more than 1 million. There was importantly higher mortality among younger Americans than successful comparable nations. But it's not arsenic if this state hadn’t been warned. A period ago, the U.S. saw astir 675,000 deaths owed to the “Spanish Flu.” So wherefore weren’t we much prepared this clip around?

Beatrix Hoffman, PhD, prof of past astatine Northern Illinois University, examined this question successful her caller lecture astatine Yale School of Medicine, “The Necropolitics of U.S. Pandemic Responses: Expendable Workers successful 1918 and 2020.” Necropolitics is the powerfulness to find who lives and who dies. In her talk, she explored however America's willingness to sacrifice its “essential workers” some successful 1918 and 2020—especially nurses and debased wage workers—contributed to wide deaths. “I can’t find a amended connection [necropolitics] to seizure what was happening and what is inactive happening successful the authorities of COVID,” she said.

“The probe and investigation presented successful Professor Hoffman’s speech is simply a cautionary tale,” says John Warner, PhD, Avalon Professor successful the History of Medicine and prof of American studies and of history. “By weaving unneurotic labour past with the past of medicine, nationalist health, and argumentation history, it is successful portion a connection astir lessons that could person been learned from the 1918 pandemic but—like the pandemic itself—were largely, rapidly forgotten arsenic Americans enactment the influenza pandemic and World War I down them.”

Nurses As “Sacrificial Lambs” successful 1918 and 2020

The Spanish flu killed much soldiers during and pursuing World War I than died connected the battlefield. With nary effectual testing, treatment, oregon vaccine, doctors watched powerlessly arsenic patients turned blue, suffocating connected the fluid buildup successful their lungs, and died.

The U.S. authorities rapidly realized that the relation of nurses was critical. As these nurses worked tirelessly to supply hydration, nutrition, fever control, rest, ventilation, affectional support, and more, they became patients’ main anticipation for survival. Within weeks, the Red Cross mobilized 21,000 nurses to assorted home service camps, and arsenic galore arsenic fractional would autumn sick themselves. While the enactment advised the nationalist against sleeping successful the aforesaid country arsenic an idiosyncratic with influenza, nurses were often successful overcrowded, poorly ventilated rooms with highly infectious patients. They were 50% much apt to dice than doctors were.

Witnessing the devastation of the pandemic astatine the frontlines, nurses were besides astatine the forefront of calling for alleviation efforts and preparedness for aboriginal respiratory illness outbreaks. After families mislaid caregivers and galore children were near orphaned, the Visiting Nurses Association successful Philadelphia—one of the hardest deed cities—argued for continuing societal enactment measures. The caput of the Chicago Visiting Nurse Association called for amended ventilation systems to support nurses successful the lawsuit of different outbreak.

But their pleas fell connected deaf ears. Nurses were celebrated for their sacrifices, but small effort was made to assistance support them harmless successful their workplaces. And arsenic the pandemic yet came to an end, it was rapidly forgotten. “In pandemic history, nurses’ deaths are either erased oregon mentioned successful passing,” said Hoffman. “And erstwhile they are remembered, the deaths of wellness attraction workers successful the influenza pandemic person been valorized arsenic wartime sacrifice, but not arsenic an occupational hazard.”

During the summertime of 2020, Hoffman participated successful an oral past task successful which she talked to Latinx wellness attraction workers astir their experiences during the archetypal question of the COVID pandemic. Their complaints echoed galore of the experiences nurses faced successful 1918. Many were forced to exposure themselves without due protective cogwheel similar n95 masks. Hospitals expected nurses to beryllium successful the rooms with COVID patients, portion physicians waited outside. One caregiver told her that “it felt similar we were a small spot of a sacrificial lamb.”

Their cognition was not acold from reality, said Hoffman. Over 3,600 wellness attraction workers mislaid their lives successful the archetypal twelvemonth of the pandemic alone, with nurses and enactment unit being astatine importantly greater risk. Health attraction workers successful nursing homes, who are often paid little and are much apt to beryllium immigrants oregon radical of color, were doubly arsenic apt to dice arsenic idiosyncratic who worked successful a hospital. Once again, the anticipation of nurses and low-income wellness attraction workers to spot themselves heroically astatine the frontline led to disproportionate amounts of unwellness and decease among these groups.

Lowest Paid Workers Pay the Highest Price

A communal story surrounding the Spanish flu was that it was truthful deadly that it killed the affluent and mediocre alike. This was not so—workers of little socioeconomic presumption were astatine greater hazard of dying. Coal miners, for example, experienced particularly precocious mortality owed to the inhalation of airborne particles and overcrowded conditions. Manufacturing was different high-risk occupation. To proviso the subject during World War I, factories remained unfastened arsenic galore different businesses unopen down. When 1 did close, it was due to the fact that excessively galore employees were ill. “Only the inability to produce, not the endangerment of workers, led to factories closing,” said Hoffman. The pandemic was besides particularly unsafe for Mexican migrant workers successful the sweetener beet industry, who lived successful overcrowded institution housing.

These disparities shed airy connected the request for argumentation changes and the amended attraction of debased wage workers. “Just similar today, the 1918 pandemic was a infinitesimal of anticipation for idiosyncratic protections, wellness insurance, and sick pay,” said Hoffman. In 1919, compulsory wellness security really passed successful the New York authorities legislature but was yet struck down by the talker of the authorities assembly arsenic “foreign” and “socialist.”

In 2020, portion stay-at-home orders emptied galore offices, successful industries deemed “essential,” galore employees erstwhile again were not afforded the luxury of being capable to enactment safely from their houses. These workers were astir doubly arsenic apt to dice of COVID than others successful their property group, with those successful the lowest income groups astatine the top risk.

One of the astir hazardous occupations was nutrient production. Farm workers, for instance, were 4 times much apt to travel down with COVID. Like nurses, they lacked capable protective cogwheel and the quality to societal distance. And the Trump administration’s effect to a COVID outbreak successful a meatpacking works successful South Dakota, Hoffman said, highlights the U.S.’ prioritization of manufacture implicit the well-being of its workers.

In aboriginal April of 2020, conscionable weeks into the pandemic, region wellness officials planned to adjacent the Smithfield Park processing works successful Sioux Falls arsenic galore of its employees fell ill, but then-U.S. Secretary of Agriculture Sonny Perdue pressured authorities to reopen the plants. Two weeks later, the medication declared meatpacking plants “critical infrastructure.” The works reopened May 7. Following its opening, much than 1,200 workers got sick and astatine slightest 4 died. “We spot from this illustration however highly infectious industries tin beryllium designated indispensable and exempt from nationalist wellness protections similar shutdowns, nary substance the outgo to workers,” Hoffman said. The meatpacking manufacture employs astir a fractional cardinal workers nationwide, and astir of these employees are radical of color.

An Unheard Call for Reform

Throughout the 20th century, Hoffman reminded her Yale audience, authorities leaders successful Washington refused to follow cosmopolitan wellness care, opting alternatively successful mid-century for a strategy of backstage security successful which Americans mostly person sum done their employment. The COVID pandemic, she said, offered yet different accidental for workplace and wellness attraction reform. But portion the wellness attraction information nett is much broad than what Americans had a period ago, Hoffman noted that successful 2020, astir 28 cardinal people, oregon 11% of the U.S. population, were inactive uninsured, and galore were debased wage indispensable workers. Fewer than fractional of employees successful the agriculture industry, for example, had aesculapian coverage. And galore insured Americans faced the prime betwixt going to an unsafe workplace oregon losing some their occupation and security coverage. And wide layoffs near 3 cardinal without entree to employer-provided attraction successful the archetypal fewer months of a deadly viral outbreak.

Hoffman argued that the U.S. has besides failed to supply different needed workplace protections. In January 2022, for example, the Supreme Court struck down President Biden’s vaccine-or-test mandate, ruling that the Occupational Safety and Health Administration (OSHA) did not person the powerfulness to acceptable wide nationalist wellness regulations. And arsenic exigency protections expire, uninsured Americans whitethorn conflict for entree to investigating and vaccines.

The speech concluded with Hoffman calling for Americans to travel the pb of the caller labour movement. Amazon workers successful Staten Island, New York, for example, participated successful a walkout led by erstwhile worker Christian Smalls successful 2020 demanding paid sick leave. And nurses crossed the country, she noted, are erstwhile again calling for permanently improved workplace information standards.

“So overmuch of the 1918 pandemic was forgotten, and it’s conscionable starting to beryllium rediscovered now,” said Hoffman. “We’re starting to hide 2020 now. How tin we perpetrate to ending the systemic inequalities that person led to truthful galore deaths successful these pandemics?”