The World According to COVID-19

A challenge of being in multiple roles has been balancing the health risks with the potential benefits. In the early days of the pandemic, as an emergency physician, I was acutely aware of how little was known related to transmission of the disease. In this unknown realm, I had to think about the health and safety of my residents and balance that with ensuring they were well trained as emergency physicians, including how to take precautions and manage sick patients with COVID-19.

One advantage I had was that, in emergency medicine, we have to be comfortable with being uncomfortable. Patients, diagnoses, and their management are often not neatly packaged and laid out for us. We specialize in mystery solving and have to be comfortable with a level of chaos and risk at all times. This, as well as the fact that I was working with a group of similarly minded residents, attendings, and emergency department staff, helped me stay calm.

One issue that has really come to the forefront since the beginning of the pandemic is just how many people in the United States are food insecure, or are on the precipice of becoming food insecure. The United States is among the richest countries in the world, yet millions of people are struggling to obtain enough food to feed themselves and their families. Widespread unemployment, school closures, and changing circumstances related to social services all are contributing to an increase in the nation’s food insecurity problem.

The pandemic has highlighted how critical it is to address underlying poverty in order to improve resilience to shocks, whether they be economic, environmental, or a pandemic like COVID-19. At the same time, the pandemic has highlighted the need for food supply chains to become more resilient in order to deliver food in an efficient way with limited waste. At the beginning of the pandemic, we saw that supply chains that had been disrupted (for example, milk for schools or vegetables for restaurants) resulted in dumping of vast amounts of nutritious foods while many families were going hungry.

Community relations during a pandemic and a disaster tend to be very different. With a more typical disaster, such as a fire, flood, or hurricane, people immediately come and rally around to help. Even though people may have died, and it may be tragic, the community unification helps people through it. They feel good about helping. They raise money and donate supplies, and they know where it’s going and what it’s for.

Fear and isolation influence a community’s response during a pandemic. Even with the increase in online interactions, we lose a lot of opportunities for community unification. Immediately, people are in their houses. People are suspicious because of the mystery of an invisible agent. Much less is obvious, and that breeds a lot of distrust. With pandemics, instead of getting out and helping a neighbor to get through it, we fear our neighbor—they may be sick, and they may get us sick, and we might die.

The COVID-19 pandemic super-sized the inequalities that many vulnerable communities already were experiencing in terms of access to basic goods and services. When there are major disruptions, populations with more resources take advantage of their access and they jump to the front of the line, leaving poor communities with even bigger problems in terms of getting what they need. One area where I have seen a major issue is related to the food supply chain.

The COVID-19 pandemic and its related restrictions placed unprecedented stress on the various systems involved in getting food into stores and onto people’s tables. There are bottlenecks at the start of the supply chain, in farm labor, and the issues continue through processing, transport, and logistics, then end with enormous shifts in demand. In middle- and upper-class neighborhoods, grocery store shelves have been replenished over time, as stockpiling behavior disappeared about six months into the pandemic. However, those same stock levels are still struggling in our vulnerable communities.

The biggest risk factor for food insecurity is not food availability—it’s consumers’ access to food. Safety nets are essential to avoid an increase in hunger and food insecurity.