When a stone is thrown into a pond, it causes the water to immediately awaken. The initial impact is disruptive, as are the ripples that are closest to the splash. Like the ripples from the stone, we are scrutinizing videos and photographs from recent events to see what potential exposures may have emerged from the White House cluster. The problem is that we are judging its impact as we have throughout the COVID-19 epidemic in the United States: on the surface and only by who and what we want to see.
The untold story of the White House cluster — the unseen ripples — are those individuals who were not photographed in the Rose Garden, but who keep the White House operational. They are more than 350 full-time White House employees. They are the 96 full-time and 250 part-time service staff who work in the Executive Residence, where the president and first lady live. They are butlers, maids, plumbers, florists, doormen and cooks. They are the workers who perform duties that put them in close contact with the president and first family. These are the people who will be most impacted by this cluster, but who will receive the least attention.
And if the White House doesn’t release a count of infections in its ranks, as it said it would, we will never know how many of them contracted the virus.
COVID perspective of ‘have-nots’
Giving little attention to those most impacted by this pandemic is not limited to the coverage of the White House cluster. When shelter-in-place orders were enacted, the businesses that were allowed to stay open were generally those that people able to work remotely needed to stay comfortable. And when we present risks associated with different activities, it is nearly exclusively from the perspective of the “haves” rather than the “have nots.”
When we talk about grocery delivery being the safest way to get food, we do not stop to ask, “safest for who?” When we explore testing strategies, we have given limited consideration to how testing can best serve shift-workers who cannot get paid time off or transportation support. And when we give advice for those confirmed as positive to prevent onward transmission, we have paid limited attention to those living in multi-generational households or who have to work to meet their basic needs or that of their families. Collectively, we have experienced this entire pandemic through the eyes of the people of means.
On Aug. 9, 2020, in Washington, D.C.
And now, we will judge the impact of the president’s diagnosis by the number of high-profile people who are or are not ultimately affected. We will gauge our response by how quickly those people were identified, tested, and isolated. We will congratulate ourselves by thinking we have done well when, in reality, we will have merely transferred the risks and burden of disease onto those who keep the White House (and society) afloat.
We will not think to remember the doorman who was exposed repeatedly, but lives in a space too small to safely isolate from potentially vulnerable family members. We will not provide child care for the kitchen helper who may also be the primary caregiver for their family. We will not protect the job of part-time gardener who falls ill and must take leave.
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And the White House will not even complete an outbreak investigation including contact tracing. So those of lesser means, and their contacts, are likely to suffer in silence.
These people will suffer, like millions of other Americans, because we refuse to admit that their suffering is our fault. Despite clear evidence that Black and Latinx people are disproportionately affected by COVID-19, we have done nothing to improve access to their health care. In fact, we have relentlessly tried to protect the status quo and, worse, take away affordable health insurance.
On the economic margins, giving up
Despite evidence that people in congregate settings are at increased risk of infection, we have done little to expand affordable housing or improve shelter conditions. Instead, we threaten to end the eviction moratorium and deny people entry to shelters. Despite knowing that all people — regardless of race, religion, sexual orientation, or gender identity — are at risk of infection, we have failed to enact a comprehensive national strategy that includes rapid testing, contact tracing, paid leave, universal access to care, and safe voluntary isolation and quarantine facilities. Instead, we have created a system so complex that those who are economically marginalized have given up.
We are increasingly shaming and blaming those exposed and infected. Yet it is we who have failed, not them. We continue to focus on how this epidemic affects us individually, not on how it affects us collectively. We have invested millions of dollars in testing at colleges and universities, but very little in testing in homeless shelters, domestic violence shelters and substance use treatment facilities. We have pulled our children from public schools instead of working to improve conditions for all students. We have moved ourselves from cities to suburbs instead of reinvesting to improve the situation better for everyone.
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And while we continue to blame people for new COVID-19 clusters and float the idea of targeted lockdowns, we refuse to acknowledge that structural inequities and racism are actually to blame for the continued spread. We, as a nation and as individuals, only focus on the ripples that we want to see.
The president has told America not to be afraid, but the news of his diagnosis should be our societal awakening. We cannot allow this news cycle to end when all of the high-profile names have been tested. We must also follow the ripples into places below the surface where we do not and, worse, refuse to look.
Joshua Barocas (@jabarocas) is an infectious diseases physician and public health researcher at Boston Medical Center and Assistant Professor of Medicine at Boston University School of Medicine. Stefan Baral (@sdbaral) is a public health and family physician working in homeless shelters and an Associate Professor in the Department of Epidemiology at the Johns Hopkins School of Public Health.
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This article originally appeared on USA TODAY: COVID pandemic goes deeper than rich, famous headline makers like Trump