Coronavirus Pandemic Calls for an Immediate Social Work Response

We are in strange and anxiety-producing times. As the media began discussing coronavirus, or COVID19, in January 2020, their reports were an early signal that world as we had come to know it would be changing. Fast forward two months, and many of us are under stay-at-home orders. Italy experienced over 1000 deaths in one day. As of this writing, the world has over 600,000 confirmed cases of coronavirus infection and 28,000 deaths, with the U.S. numbers at just over 100,000 confirmed infections and 1,600 deaths (Johns Hopkins Coronavirus Resource Center, 2020). I anticipate that by the time this is published, that number will have grown exponentially. We are in the midst of a public health pandemic and social workers must be a part of the response.

I am a public health law and policy social worker. I began my career as a social worker at a pediatric tertiary care hospital. After watching families deal with systems that placed barriers in their way, I went back to school and earned my law degree. I have been working in public health policy for over two decades. My social work, public health, and law colleagues have been preparing for this moment for years, in the hopes that we would not have to face it in our lifetimes. My first article about pandemic preparedness was published in 2009 (Kinney, McCabe, Lewis Gilbert, & Shisler, 2009). What we are watching unfold is not happening in a way that uses much of what has been written about preparedness. Undertesting, undersupply of personal protective equipment, and spotty coordination of national policy have all made the work more difficult (Shear et al., 2020). The country is left in a position to deal with critical hospital surges, which may have otherwise been less acute (How bad will the next few weeks be for California as coronavirus cases surge?, 2020; New Jersey Hospitals Brace For Coronavirus Surge, 2020; Rothfeld, Sengupta, Goldstein, & Rosenthal, 2020). To be fair, no matter how prepared for an emergency, it is by its nature an emergency, and some of these issues would be unavoidable no matter how well-prepared the government is to respond.

That leads us to our role as social workers. We are needed. We are called by our Code of Ethics to practice our social work values: Service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence (National Association of Social Work, 2017). All are needed in this time of public health emergency. Our work along the continuum of social work from micro to macro levels will be crucial if we are to fulfill our professional obligations.

Some of us work at the micro and mezzo levels. As our population is increasingly isolated from social distancing, stay at home precautions/orders, isolation, and quarantine, we are already seeing reports of anxiety and depression increasing (Coping With Anxiety and Depression During the Coronavirus Pandemic, 2020; Increased anxiety and depression top college students’ concerns in coronavirus survey, 2020; CDC, 2020). A quick transition to telehealth, where available, has forced many to completely change service delivery mechanisms in a matter of weeks. Where the field has spent time discussing HIPAA compliance and other potential ethical issues around telehealth, the government has now relaxed rules and encouraged the practice to move forward with great speed in response to this emergency (Galewitz, 2020). It leaves us with the question of how to handle a new delivery method, but also with questions of access. What do we do for our clients with limited access to the internet? Is a cell phone enough to allow us to provide the care that is needed? Are we reaching all of those who need us now? With mental health needs increasing, the existing referral systems may not provide for the needs in the time of a public health emergency of this scale. We risk especially difficult gaps for those who are already experiencing issues such as poverty, lack of access, and those with disabilities. Are we able to provide the technology needed for those who need accessible technology? I assert that social workers must be on the front lines not just of service provision, but also at the policymaking tables for micro service delivery at all levels. How do we work in ways that do not further exacerbate already existing health inequities? How do we use our skills to advocate for the inclusion of those who may otherwise be left out? How do we ensure that we are working with and alongside those impacted to amplify their voices rather than to substitute our voices for theirs? These questions must be front and center to social work at the national and local levels.

In addition to those working at the interpersonal levels, there is a need for increased macro level social work. I propose that this is not simply those of us who identify as the “macro folks” but rather all of us. We already saw a growing need for advocacy with camps on our southern border; a rise in racial, ethnic, and homophobic stigma and violence; and an increasing divide in our country. Now we are tasked with using our social work theories, models, and practice to actively ensure that this public health emergency does not allow these troubling practices to play out as resources are allocated. The list of topics and arenas where social workers are needed is extensive. I will provide some examples, though these are certainly not exhaustive.

First, there is a divide between those who are able to work from home and those who are essential workers. Among those who get ill, there is also a divide between those who have paid time off and health care and those with no similar benefits (Kaiser Family Foundation, 2020). We must acknowledge the disparate impact on those who are already living paycheck to paycheck or near the poverty line. Those with paid leave or whose jobs allow them to work from home, oftentimes white-collar jobs, are typically able to stay at home (medical workers are a clear exception) and continue to earn money. At the same time, those who do not have similar benefits must report for work or risk losing their job. Some may find their jobs don’t exist anymore. Those with health insurance do not need to weigh the potentially fatal question “how bad is too bad” before seeking medical assistance and further financial burden.

We know that socioeconomic status is correlated with increased risk of medical issues, which could put people in the high-risk category for severe complications if they contract the coronavirus. These factors only magnify the disparities. What are social workers and the national social work organizations doing to advocate for change that acknowledges and works to minimize these disparities? The NASW’s press release related to the CARES Act was a start, but a rapid response mobilizing the social work profession to raise these issues and bring public attention to the issues is needed ($2 trillion Coronavirus Relief Package will Support Social Workers, Clients They Serve, 2020). It will be necessary for the foreseeable future as we move forward in rebuilding structures following this public health emergency. The CARES Act was the third bill passed to deal with this public health emergency, but it will not be the last. Our values call us to shine a light on the structural systems which perpetuate inequities and work hard to make changes to improve the overall public health of all communities during this pandemic and beyond.

There is currently a movement to advocate that governors release those who are in prison on technical violations and nonviolent misdemeanors (Coronavirus Tracker, 2020; Klonsky, 2020). Close confinement and living arrangements are ripe for the rapid spread of infection. Rikers Island has already experienced an outbreak with those testing positive increasing daily. The criminal justice system has well-documented issues with disproportionate impact of criminal laws and enforcement by race and ethnicity (Report to the United Nations on Racial Disparities in the U.S. Criminal Justice System, 2018; Balko, 2019). This issue also disproportionately impacts those unable to afford bail. Judge Fuller of Alabama described the issue well in describing the order to release those who bail was under 5000 USD saying, “A lot of people have been laid off. So let’s say, I’m a parent who has a child who is in jail. This is forcing them to make a terrible decision about whether to go down and pay bail to get their son out of jail or to buy groceries for the other two kids” (A Judge Ordered The Release Of Low-Level Prisoners Because Of The Coronavirus. People Were Absolutely Furious., A Judge Ordered The Release Of Low-Level Prisoners Because Of The Coronavirus. People Were Absolutely Furious., 2020). The judge reports he was trying to save not only prisoner lives but also that of the correctional officers and others. The pushback he has received has been such that journalists researching whether other courts would follow suit have found no others in Alabama considering similar measures.

Social workers and national social work organizations should be a part of the national advocacy movement to enact these precautionary and responsive changes in large numbers. Some of this advocacy can even be done from home by writing letters or making phone calls. This is not merely a criminal justice reform, but a public health response. This is but one of the issues being raised. Others include treatment for those with substance use disorder who need continued access to methadone (Abuse, 2020) or even alcohol withdrawal in states where access to liquor stores has been unexpectedly ended (Whelan, 2020). Homelessness or those who risk losing their homes when they cannot afford rent after losing their jobs is another. There is no limit to the number of issues that need social work advocacy. We must rise to the challenge.

Lastly, it is critical to discuss triage. Our hospitals will be overwhelmed. There is very little suggesting at this time that we can completely stop this. There is still hope of flattening the curve to help minimize this surge in hospitals, but avoiding it all together seems like a statistical improbability. Social workers absolutely must engage in this process – first, the hotspots. We are seeing hotspots hit areas where people are already experiencing disparities. New York City was the first hotspot outside of the west coast; however, Detroit and New Orleans, two cities already hit by difficult past emergencies, are seeing a rapid rise in the disease. Testing is behind, but as with much public health, it appears zip codes are being impacted differently (Coronavirus News: U.S. Poor Hit By Virus Impact – Bloomberg, 2020). Underlying structural racism and socioeconomic barriers will exacerbate difficulties in this public health emergency as with health care writ large. Social workers working in hospitals have a responsibility to be involved in the policies addressing access in this emergency. We have expertise in social determinants of health and can be essential in identifying policies that might impact them before poor policies are enacted. Triage decisions will need to be made in the moment. Hospitals are already discussing the guidelines. How will we ensure that people with disabilities are not denied care simply by virtue of their disability? How can we ensure that implicit (or even explicit) bias does not drive triage decisions? Social workers can serve on ethics committees. We can volunteer to work on the committee designing the policies. We can advocate for our individual patients. Hospitals are rarely allowing non-patients to be at the bedside (Lamas, 2020). Naturally, existing family or friend advocates are unlikely to be able to do so. How can we assist in this role? We are needed here and must ensure we do not sit on the sidelines.

Though the situation is tumultuous right now, there is hope. Social workers are experts in working in challenging environments. We learn skills that help us be collaborators. And we view the world through our social work social justice lens. We can make a difference. It is time to roll up our sleeves and social work. We must use the whole continuum of social work to do so. I look forward to partnering with many of my colleagues to do this hard work moving forward. In the wise words of Elie Wiesel, “There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” I believe we are in these times. Let’s assert the power of social work to work alongside communities to make a change. Let’s do this.

Disclosure statement

No potential conflict of interest was reported by the author.