Nurses and essential workers: the “sacrificial lambs” of American pandemics in 1918 and 2020

Nurses and essential workers: the “sacrificial lambs” of American pandemics in 1918 and 2020

The COVID-19 pandemic has claimed the lives of more than 6.5 million people worldwide. Although it contains only 4.25% of the world’s population, the United States is responsible for 16% of these deaths, or more than one million. Mortality was significantly higher among young Americans than in comparable countries. But it’s not like this country hasn’t been warned. A century ago, the United States recorded around 675,000 deaths from the “Spanish flu”. So why weren’t we better prepared this time around?

Beatrix Hoffman, PhD, professor of history at Northern Illinois University, explored this question in her recent Yale School of Medicine lecture, “The Necropolitics of US Pandemic Responses: Expendable Workers in 1918 and 2020.” Necropolitics is the power to determine who lives and who dies. In her speech, she explored how America’s willingness to sacrifice its “essential workers” in 1918 and 2020, particularly nurses and low-wage workers, contributed to mass deaths. “I can’t find a better word [necropolitics] to capture what was happening and what is still happening in the politics of COVID,” she said.

“The research and analysis presented in Professor Hoffman’s presentation is a cautionary tale,” says John Warner, PhD, Avalon Professor of History of Medicine and Professor of American Studies and History. “Weaving the history of labor with the history of medicine, public health and the history of politics, it is in part a statement about the lessons that could have been learned from the pandemic of 1918 but who, like the pandemic itself, were largely and quickly forgotten as Americans. put the flu pandemic and World War I behind them.

Nurses as “sacrificial lambs” in 1918 and 2020

The Spanish flu killed more soldiers during and after World War I than died on the battlefield. In the absence of effective tests, treatments or vaccines, doctors have watched helplessly as patients turn blue, suffocate from fluid buildup in their lungs, and die.

The American government quickly realized that the role of nurses was essential. As these nurses worked tirelessly to provide hydration, nutrition, fever control, rest, ventilation, emotional support, and more, they became the patients’ main hope for survival. Within weeks, the Red Cross mobilized 21,000 nurses to various national army camps, and up to half would fall ill themselves. While the organization advised the public against sleeping in the same room as someone with the flu, nurses frequently found themselves in crowded and poorly ventilated rooms with highly infectious patients. They were 50% more likely to die than doctors.

Witnessing the devastation of the pandemic on the front lines, nurses were also on the front lines calling for relief efforts and preparedness for future outbreaks of respiratory disease. After families lost caregivers and many children were orphaned, the Visiting Nurses Association in Philadelphia, one of the hardest-hit cities, advocated for continued social supports. The head of the Chicago Visiting Nurse Association called for better ventilation systems to protect nurses in the event of another outbreak.

But their pleas fell on deaf ears. Nurses were celebrated for their sacrifices, but little effort was made to ensure their safety in the workplace. And as the pandemic finally ended, it was quickly forgotten. “In the history of the pandemic, deaths of nurses are either erased or mentioned in passing,” Hoffman said. “And when we remember it, the deaths of health care workers in the flu pandemic were valued as a wartime sacrifice, not an occupational hazard.”

During the summer of 2020, Hoffman participated in an oral history project in which she spoke to Latinx healthcare workers about their experiences during the first wave of the COVID pandemic. Their complaints echoed many experiences nurses had in 1918. Many were forced to expose themselves without proper protective gear like n95 masks. Hospitals expected nurses to be in rooms with COVID patients, while doctors waited outside. A nurse told her that “it was like we were a bit of a sacrificial lamb”.

Their perception was not far off the mark, Hoffman said. More than 3,600 healthcare workers lost their lives in the first year of the pandemic alone, with nurses and support staff at much higher risk. Healthcare workers in nursing homes, who are often paid less and are more likely to be immigrants or people of color, were twice as likely to die as someone who worked in a hospital. Once again, the expectation of low-income nurses and healthcare workers to heroically come to the front lines has resulted in disproportionate numbers of illnesses and deaths among these groups.

The lowest paid workers pay the highest price

A common myth surrounding the Spanish Flu was that it was so deadly that it killed rich and poor alike. This was not the case – workers of lower socio-economic status were more at risk of dying. Coal miners, for example, have experienced particularly high mortality due to inhalation of airborne particles and crowded conditions. Manufacturing was another high-risk occupation. To supply the army during World War I, factories remained open while many other businesses closed. When we closed, it was because too many employees were sick. “Only the inability to produce, not the endangerment of workers, led to plant closures,” Hoffman said. The pandemic was also particularly dangerous for Mexican migrant workers in the sugar beet industry, who lived in overcrowded public housing.

These disparities highlight the need for policy changes and better treatment of low-wage workers. “Just like today, the 1918 pandemic was a moment of possibility for worker protection, health insurance and sick pay,” Hoffman said. In 1919, compulsory health insurance was actually passed in the New York State Senate, but was ultimately struck down by the Speaker of the State Assembly as “foreign” and “socialist.”

In 2020, as stay-at-home orders emptied many offices, in industries deemed “essential”, many employees once again did not have the luxury of being able to work safely from home. These workers were nearly twice as likely to die from COVID as others in their age group, with those in the lowest income groups most at risk.

One of the most dangerous occupations was food production. Farmworkers, for example, were four times more likely to contract COVID. Like nurses, they lacked adequate protective equipment and the ability to socially distance. And the Trump administration’s response to a COVID outbreak at a South Dakota meatpacking plant, Hoffman said, highlights the priority the United States places on industry over welfare. of its workers.

In early April 2020, just weeks into the pandemic, county health officials planned to close the Smithfield Park processing plant in Sioux Falls because many of its employees had fallen ill, but the U.S. Secretary At the time Agriculture, Sonny Perdue, pressured the authorities to reopen the factories. Two weeks later, the administration declared the meatpacking plants “critical infrastructure.” The factory reopened on May 7. After it opened, more than 1,200 workers fell ill and at least four died. “We see from this example how highly infectious industries can be designated essential and exempt from public health protections like shutdowns, regardless of the cost to workers,” Hoffman said. The meatpacking industry employs about half a million workers nationwide, and most of those employees are people of color.

A call for reform

Throughout the 20th century, Hoffman reminded his Yale audience, Washington government leaders refused to embrace universal health care, opting instead mid-century for a private insurance system in which Americans are mainly covered by their employment. The COVID pandemic, she said, presented a new opportunity for workplace and health care reform. But while the health care safety net is more comprehensive than what Americans had a century ago, Hoffman noted that in 2020, nearly 28 million people, or 11% of the U.S. population, n were still uninsured, and many were low-wage essential workers. Less than half of workers in the agricultural sector, for example, had medical coverage. And many insured Americans have had to choose between going to an unsafe workplace or losing both their jobs and their insurance coverage. And the mass layoffs left three million people without access to employer-provided care in the first months of a deadly viral outbreak.

Hoffman argued that the United States also failed to provide other necessary workplace protections. In January 2022, for example, the Supreme Court struck down President Biden’s vaccine or testing mandate, ruling that the Occupational Safety and Health Administration (OSHA) lacked the authority to establish extensive public health regulations. And as emergency protections expire, uninsured Americans may struggle to access tests and vaccines.

The interview ended with Hoffman calling on Americans to follow the example of the new labor movement. Amazon workers in Staten Island, New York, for example, participated in a strike led by former employee Christian Smalls in 2020 to demand paid sick leave. And nurses across the country, she noted, are once again calling for continuous improvement in workplace safety standards.

“Much of the 1918 pandemic has been forgotten, and it’s just beginning to be rediscovered now,” Hoffman said. “We are starting to forget 2020 now. How can we commit to ending the systemic inequalities that have led to so many deaths in these pandemics? »

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