Keep Petri Dishes in the Lab

COVID-19 is changing the landscape of our healthcare system, and, indeed, of our entire society, in ways that we hadn't been prepared for and with implications that we won't fully grasp for some time. 
As we grapple with how to reshape our healthcare system and our society in the wake of the pandemic, though, I worry we're going to focus on the wrong problems. 

Take, for example, nursing homes, prisons, and the meatpacking industry. 

Anyone who has been paying attention to the pandemic will recognize that each of these have been "hot spots," and have been called "petri dishes" for coronavirus (as are cruise ships, but that's a different article).  These institutions aren't the only places where masses of people congregate, but they seem to do so in ways that create fertile territories for COVID-19.  And that's the problem.

Credit: NASH JONES / KUNM

We knew early on that nursing homes were going to be a problem.  We knew COVID-19 was a problem in Wuhan, but that was far away -- until a few cases emerged in late February in a skilled nursing home in King County, Washington.   We know now that these were not the first cases, nor the first deaths, but we were stunned by how quickly it spread in that facility.  By mid-March experts were already calling nursing homes "ground zero," and that has been proven right. 

It is now estimated that as many as a third of all U.S. coronavirus deaths have come from nursing home residents or workers.  That is (as of this writing) almost 30,000 deaths, and over 150,000 cases. 

It took us longer to realize that prisons were also going to be a problem, although it shouldn't have.  The U.S. incarcerates far more people -- absolute numbers or per capita -- than any other country, and many of those institutions are overcrowded, dangerous, and less than sanitary.  Worse yet, they are disproportionately populated by people of color, who have been found to be disproportionately impacted by COVID-19.  It was a disaster in waiting and the disaster didn't wait. 

COVID-19 is "spreading like wildfire" in several prisons; one prison in Ohio has found eighty percent of inmates -- that's 2,000 people -- have tested positive.  Seventy percent of inmates in a California prison tested positive.  The Marshall Project estimates over 20,000 cases have been identified among prisoners nationwide.  States that are aggressively testing are, no surprise, finding mass infections in their prisons, including among the staff. 

Meatpacking also took us by surprise.  States that thought they were successfully avoiding the pandemic suddenly had major outbreaks tied to meatpacking plants, including ones in Iowa, Nebraska, Minnesota, and South Dakota.  Meatpacking plants across the country started to close, promoting the President to invoke the Defense Production Act to keep them open, despite the ongoing concerns from workers.  Plants are continuing to close despite the order.

Samantha Gillison described the dangerous working conditions of meatpacking plants in Think, and concluded:

But no one really paid attention to the brutal working conditions until it turned out that they also make the people who work there particularly susceptible to being infected with COVID-19.  

The fact that these jobs tend to be low wage ones, often filled by immigrants and definitely with no work-from-home options, add to the risk. 

---------

There are things that can be done to mitigate the spread even in these three industries, starting with much more testing, but the very nature of each industry makes them susceptible to this and other public health hazards:

Nursing homes: Nursing homes (and their cousins, assisted living and other congregate care facilities) are the stepchildren of our healthcare system.  They're generally crowded, understaffed, underpaid, without sophisticated personal protective equipment (PPE), and not well-versed in nor well regulated on infection control measures.   According to the CDC, out of 4 million nursing home residents each year, there are typically between 1 to 3 million serious infections every year, with some 380,000 deaths from them.  That's without a pandemic. 

We can, and we should, address the pay and safety issues inherent in the nursing home model, but those are bandaids.  The model itself is the problem.  Too many people who are in nursing homes and other facilities are there because they lack the resources -- financial, family, support options -- to stay in the community.  We need to invest in developing and supporting a 21st century approach to aging in place. 

Prisons: We may still use term "correctional facilities," but at best it is ironic: few get "reformed."  We imprison far too many people, for far too long, especially for substance abuse or mental health issues that in other countries would merit treatment and support.  Worse yet, after leaving prison many find that their lives can never be normal again, shut out of many professions, living options, even voting.  We say we're addressing criminal justice problems but we're actually creating  significant socioeconomic, racial/ethnic public health problems.

Norwegian prison cell.  Credit: Stringer/Reuters

Other countries - take, for example, Norway -- manage their society in ways that result in far fewer people being locked up and in safer conditions when they are.  Certainly the U.S. can do better than we are.   

Meatpacking:  We like our meat and we like it cheap, so as a result much of it is raised under horrific conditions and processed under equally bad ones.  We should be willing to pay more for more humane conditions for the animals and much safer conditions for the workers, and find ways to automate much more of the work.  If that means our meat consumption drops and our meat budget rises, well, how many lives is that worth to us?

As Ms. Gillison wrote: "Industries famously don't regulate themselves, and the meatpacking industry isn't going to be an outlier...Things won't get better until there is the real political will to change how the meatpacking industry handles worker safety."  Do we have that will?  

------------

It's not going to be enough to try to minimize the pandemic in these industries; in each case, the pandemic isn't the problem, but rather is the result of the problem.  We need new models for these industries that take advantage of available technology and safeguards, reimagining them for the 21st century...and, along the way, making us all safer.  

I'm all for petri dishes to help find new drugs or to teach science, but not as places to live or work.