Essential or Expendable During the COVID-19 Pandemic? A Student-Lived Experience on Grieving the Unjust and Early Deaths of Vulnerable Populations.

On June 13, 2020, my tio (uncle) passed away as a result of complications caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He spent his life taking care of his family and, through his work, contributing to the wellness of his community. As an adolescent, my tio emigrated from Mexico to Texas and Florida to work in the agricultural fields. Eventually, my father joined him to work the citrus fields of southwest Florida. For more than 35 years, they worked the fields together. As the coronavirus disease 2019 (COVID-19) pandemic, caused by SARS-CoV-2, escalated in the United States, their jobs positioned them as frontline workers, in charge of feeding the country.

At age 67 years, my tio continued to work as a migrant farmworker. After the Florida orange season, he migrated to the Midwest to work in the corn and sweet potato fields. My tio's chronic diabetes and high blood pressure made him vulnerable to SARS-CoV-2. Despite the risks of contracting the virus, the opportunity to provide for his family during "off season" attracted him to work temporarily in Wisconsin. Shortly after arriving in Wisconsin, my tio started to feel ill but continued to work because this job required his daily presence and offered limited flexibility to take sick days. He was not admitted to the hospital until he fainted. He passed away in Wisconsin more than 1500 miles away from his family in Florida.

Unfortunately, my tio's story is the reality of many individuals working in agriculture, poultry- and meat-processing plants, cleaning services, and other workspaces where lives have been treated as expendable during the COVID-19 pandemic in the United States. At the beginning of the pandemic, COVID-19–positive cases were surging in poultry- and meat-processing plants, specifically throughout rural America.[1] As of mid-October 2020 in Immokalee, Florida, a rural agricultural town in Collier County, more than 2364 people had positive test results for COVID-19.[2] In response, organizations like Doctors Without Borders and Partners in Health mobilized to work alongside the local health department.

Despite worker-led organizing to demand testing and paid sick leave for people experiencing COVID-like symptoms, agricultural corporations and state and local health departments, as well as the federal government, have done little to protect workers and residents. According to the US Department of Homeland Security, agricultural workers are considered "critical infrastructure workers within the Food and Agriculture sector,"[3] but agricultural businesses are not mandated to conduct screening activities and are not equipped with testing services for their workers before arriving at, after leaving, or while working at the farms. The compromised or less-than-optimal health status caused by years of working in the fields, living conditions of migrant farmworkers, inequitable access to health care services, varying immigration statuses, packed buses from labor camps to the fields, language barriers, and unbalanced power structures between corporations and farmworkers intersect to create unique challenges for this population during the pandemic.

As cases surged across the United States (and globally), the Centers for Disease Control and Prevention revised their guidance on critical infrastructure workers, stating that those potentially exposed to the virus could continue to work provided they remain asymptomatic.[4] This does not prevent transmission of SARS-CoV-2. Public health professionals should be doing more to save lives and protect people from health threats. We must treat the deaths and illnesses of farmworkers from COVID-19 as workers' rights cases.

In a culture rooted in family, it was difficult to accept that my tio passed away without anyone at his side. How could we move forward without being able to have closure? As I prepared for my tio's service, I found myself experiencing an internal conflict. As a public health professional and medical anthropology doctoral student, it was important to respectfully voice my concerns about COVID-19 transmission in enclosed spaces. I wanted to dissect various interrelated and complex issues: the implications of agribusiness and the lack of COVID-19 testing for contracted employees; what it meant to be a migrant worker during a pandemic; the reality of US imperialism that ultimately drove my family to migrate to the United States for economic stability; how structural racism within the United States caused COVID-19 to disproportionately affect Black or Indigenous people and other people of color; how accessibility (or lack thereof) to good health care intersected with socioeconomic status; and, ultimately, the lack of US government leadership in the COVID-19 response.

Yet as my tio's niece, I accepted that my professional background would be secondary to our mourning process. With masks, gloves, and an overwhelming amount of hand sanitizer, we held the funeral services and burial ceremony. We gathered, we hugged, and we honored his memory. The thought of contracting the same virus that unexpectedly brought us together lingered in our minds. As a family separated by political borders, we found alternatives to provide remote grieving spaces for my abuelita (grandma) and family members who were unable to attend the service. Public health reports on the COVID-19 pandemic seldom address transnational grieving. How do we cope with loss when traditional ceremonies cannot occur?

We must reiterate that the COVID-19 pandemic is not the great equalizer.[5] The pandemic is revealing the social inequalities in the US health care system. In public health reports, we discuss rates of COVID-19 cases and deaths as if each number does not represent a human life. The longer we fail to change the US health care policies and to confront how gender, immigration status, socioeconomic status, and racialization affect health in the United States, the longer we participate in an unjust system. It is necessary to strategize how we listen to and act for communities disproportionately affected by the COVID-19 pandemic in the United States.

Following the work of Kimberlé Crenshaw,[6] we must take an intersectional approach to the pandemic. Through this lens, we learn how systems of oppression work together to produce social inequality. The role of structural factors is masked by cultural explanations in the public health literature on immigrant health.[7] Viruell-Fuentes et al.[7] concluded that the lack of integration of intersectionality theory into immigrant health literature is a gap that must be closed to address inequality. When we take an intersectional approach to health in the context of the COVID-19 pandemic, we see the systems of oppression acting together.

Aftermaths are for the privileged because those disproportionately affected by the pandemic will continue to live in its presence. Too many of us will live with mourning the unjust and early deaths of loved ones because of the lack of policies to protect the health of the most vulnerable during the pandemic. Unfortunately, the effects of the pandemic will persist beyond the availability of a vaccine. As public health professionals, we must demand the equitable distribution of resources, quality of life, health care, and vaccines for all people living in the United States. For a successful vaccine distribution, we must reflect on the intersections of identity. What will large-scale vaccination look like for vulnerable communities? What strategies could we use to reach equitable vaccination rates? Without considering these questions, there will not be an aftermath to the pandemic.

I would like to thank the AJPH Student Think Tank for offering a space of conversation on the severe acute respiratory syndrome coronavirus 2 pandemic and public health futurity. I would also like to thank the reviewers, my advisers, and my friends for their feedback and comments. Most of all, I would like to honor my family and the two tios we have lost as a result of coronavirus disease 2019 complications—I am forever indebted to their years of joy and perseverance.

The author has no conflicts of interest to disclose.

See also Watts Isley et al., p. 63, and the Student Perspectives on COVID-19 section, pp. 62–87.