COVID Update July 23: If you don’t know many people who have Coronavirus, its because you don’t know the people who pick the food you eat.

Yes many of the people getting sick are working for us. 1/
I hate to put this in terms of privilege— which I have in massive amounts— but the luxury to say “I don’t like masks” or “I’m tired of staying at home”— & dictating how we live & work are very different around the country. 2/
I talked to an ICU doctor in a state with large number of hospitalizations & asked him to tell me about the people in the ICU.

“Mostly black. Also Hispanic.”

Old or young?

“Older but some young. All essential workers or their parents.” 3/
I got a call from a health secretary in a state getting hit reasonably hard right now.

Where is the biggest challenge?

“No question. Latinx population. Migrant workers. People picking crops.”

Work conditions? Living conditions? Transportation?

“We have traced to all 3.” 4/
I called 4 border states. 2 returned my call. They are getting more worried about rural & border towns & less about cities.

They expect bar closures, masks & people taking better care to flatten out cases (but not lower for a while).

Rural communities worry them more.
Why? 5/
Rural communities have hospitals that aren’t as experienced in COVID in general and are harder to get to. Death rates are much worse in ICUs with less than 50 beds.

Rural hospital utilization climbing & now almost equal to urban. 6/
The virus is becoming more predictable. At least until it gets inside the human body.

It goes to big cities where it finds cluster until people get their act together. Then it goes to smaller cities. It preys on locations where people are forced together indoors. 7/
Since it will spread anywhere people congregate (faster w poor ventilation without good masks), many who can avoid those places will.

After stops & starts more bars will close. More masks will be required. People will stay home.

But this is only true for those who can. 8/
Are migrant farm workers in 114 degree Yuma, AZ picking the beautiful melons we eat wearing masks? 1/3 are.

5 in a Ford F-150 up at 6 to earn & send money home.

Then to Imperial County, to Salinas, to Fresno, to Wachata, WA. Picking strawberries, lettuce, grapes & apples. 9/
In these migrant camps, high percentages are sick. And then travel from farm to farm. Across Florida, Arizona, Texas, California.

Agriculture may seem a million miles from how you live (or I) & it may not be the first thing you think of when you think of California, say. 10/
But during the “Stay Home” orders, 60% of Californians were forced to go to work. Much in agriculture or in related service areas.

Even without agriculture large portions of the workforce never stopped. 11/
To everyone who complained about the stay at home orders, for a large chunk of the country, they would have felt lucky.

Any grocery worker, trucker driver or day laborer now sick with COVID didn’t have the choice. 12/
Surprisingly, case growth on a per cap basis is now higher in Alabama, Arkansas, Mississippi, Louisiana, Idaho, Kansas, Kentucky, Nevada & South Carolina are higher than California, Texas & Florida.

Idaho, Montana, and Oklahoma are showing signs of hospitals rapidly filling. 14/
As Miami, Houston, Charlotte, Los Angeles, Miami & Phoenix peak, rural parts of those states are at risk. And they will get lost in the numbers as they are smaller & less visible.

This problem will compound as governors rush (again) to open up their economies & remove masks.15/
Contact tracing is also challenging in immigrant communities as valid concerns over ICE create challenges to public health.

A mistrustful government has significant costs.
The lack of a humane & national approach means people on the margins suffer first and most. 16/
What to do?
-Prioritize testing in farm & rural communities
-Give resources to OSHA & farms, meatpacking plants, distro centers, trucking
-Airlift cases from rural areas to bigger hospitals
-Reconsider which services are essential 17/
Nothing works without reduction in cases & more testing. That may require a serious converation about a harder lockdown. 18/
This is also why there’s no such thing as innocent, harmless cases. Given the rate of spread, we eventually harm others without as much choice.

Often the very people who feed is. /end
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