At Washington Monthly, Shannon Brownlee and Jeanne Lenzer explain How Mistreating Nursing Home Staff Helped Spread Covid-19.

By the end of May 2020, half of all cases among the elderly were brought in by “direct care workers,” such as nurses, nursing assistants, physical therapists, maintenance and kitchen staff. These people are among the most essential workers—and some of the worst paid. In 2019, their median hourly wage was just $12.80. Nearly half live in low-income households. More than half receive public assistance. The vast majority are women and three in five are people of color.

Add poor pay to no sick leave or health insurance, and many direct care workers can’t afford to stay home when they are sick. Jen Hurst is a critical care speech pathologist in Kansas City, Missouri. For 15 years, she’s worked for the same long-term care company, which has never given her a full-time job or benefits. She can’t afford to take time off when she’s sick. When she developed symptoms that seemed like Covid-19, she briefly thought about going into work before deciding to stay home—and that required tapping her family’s modest savings.

Note that there are a wide variety of nurses. A registered nurses has had anywhere from two or three years of classroom study in medical science to a Ph.D. in nursing. LPNs, licensed practical nurses, generally have a year or so of classrom study and clinical experience before getting licensed. But a “nurse” might also be a CNA, a certified nursing assistant, who has a high school diploma and four to twelve weeks of training, mostly to do things like giving baths and helping patients transfer from a bed to a wheelchair. I suspect these are the nurses the article is talking about.

Nursing home staff qualify as “health care workers” but are often on the periphery of medicine. They are not paid well, and some employers limit their hours in order to limit their benefits. The article explains that a lot of infections happened because people work for multiple facilities in order to make a living. One study showed that roughly half of all covid deaths in nursing homes could be traced to staff moving between facilities.

There is a direct link between low pay and benefits for nusing home staff and high rates of covid infection and death. Unsurprisingly, the for-profit nursing homes had higher rates of death than those run by nonprofit organizations. A google search brought up all kinds of articles and studies (example) saying that for-profit nursing homes tend to have lower quality of care, lower staff-to-patient ratios, are more likely to overbill Medicare, etc.

It’s also the case that there are much lower vaccination rates among nursing home staff than hospital staff. Harvard Medical School reported in February that a high percentage of nursing home staff had no plans to get a vaccine, even though their employers offered it to them. Remember, many of these workers have little to no classroom instruction in science, in spite of being classified as “health care workers,” and many don’t trust their employers.

But the bottom line here is that there is a direct link between the way nursing home staff are considered nothing but cost who must be denied sick days and a living wage for the sake of profits, and a whole lot of death. And this ought to tell us that you can’t protect a population during a pandemic if you’re not protecting all of the population during a pandemic. That includes low-wage workers stocking shelves or cleaning bedpans; this includes undocumented immigrants who may have no access to vaccines. The virus doesn’t care what documents you have or how much money you make.

This is just one way our stubborn insistence on for-profit health care got in the way of the pandemic response. See Elizabeth Rosenthal at the New York Times, We Knew the Coronavirus Was Coming, Yet We Failed, May 6, 2020.

… our system failed in its response. Heroic health care providers were left to jury-rig last-minute solutions to ensure that the toll wasn’t even worse.

But the saddest part is that most of the failings and vulnerabilities that the pandemic has revealed were predictable — a direct outgrowth of the kind of market-based system that Americans generally rely on for health care.

Our system requires every player — from insurers to hospitals to the pharmaceutical industry to doctors — be financially self-sustaining, to have a profitable business model. As such it excels at expensive specialty care. But there’s no return on investment in being primed and positioned for the possibility of a once-in-a-lifetime pandemic.

Combine that with an administration unwilling to intervene to force businesses to act en masse to resolve a public health crisis like this, and you get what we got: a messy, uncoordinated under-response, defined by shortages and finger-pointing.

The prevailing faith in the Free Market to provide for all left us vulnerable. Free markets don’t fix infrastructure (see: Texas). Free markets go where the profit is, but not everything people really need can be made profitable.