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  • Written by Chen Reis, Associate Clinical Professor and Director, Humanitarian Assistance Program, University of Denver

How is the COVID-19 crisis impacting the most vulnerable among us?

Tens of millions of Americans fit that description – the poor[1], the homeless[2], immigrants[3], the detained[4] and incarcerated[5], the precariously employed[6] and the uninsured[7]. Nearly one-quarter of adult Americans do not have access[8] to medical benefits, paid sick leave or access to medical care.

Already, the virus has revealed the faults, cracks and inequities in the U.S. health care system. As scholars in humanitarian[9] aid[10], we’re keenly attuned to these inequities. Here’s a look at the challenges the U.S. faces to protect the health of everyone in our communities.

1. Mental health

Approximately 20% of U.S. adults have a mental health condition[11]. More than 4 million endure serious mental illness[12]. COVID-19 has the potential to make things much worse; isolation[13] exacerbates depression and anxiety. Those with mental health issues who are self-isolating may find it difficult to get proper medication and therapy. As a result, some may turn to alcohol or drugs to self-medicate. Not only does this hurt the individual, it greatly increases the risk of violence in the home.

2. Domestic violence

Intimate partner violence, pervasive in the U.S., touches 1 in 4 women[14] and 1 in 9 men[15]. Studies suggest[16] that a crisis only increases its incidence and severity. Often, the increases last well beyond the crisis[17]. In China, there’s evidence[18] that intimate partner violence went up when COVID-19 forced people to stay at home.

Then there’s an added risk factor: guns. COVID-19 brought with it a jump[19] in the number of gun purchases. Studies show gun ownership is a key factor[20] in deadly domestic violence; the risk of homicide goes up 500%. On average, 600 women are shot to death[21] by a partner each year, and gun-related domestic killings rose more than a quarter between 2010-2017, a significant increase after four decades of decline.

These groups are among the most vulnerable during the COVID-19 pandemic School closings, though necessary, can create problems for families. Getty Images / Boston Globe[22]

3. Child abuse

In the U.S., up to 4 million children receive services for child abuse[23] every year. Every day, five children die from abuse and neglect. Social isolation, economic fallout, closing schools and the stress resulting from families constantly in close quarters puts them at even higher risk. And with more guns in homes, the number of children killed by firearms will likely go up. It’s already the second-leading cause[24] of death for them.

There are also millions of low-income children that face school closures. Many of them are without home computers, so unlike most of their classmates, they can’t do the online assignments. Other children, enrolled in Individualized Education Programs, are also often left behind[25], both in online and home-school scenarios.

4. Pregnant women

When emergencies occur, the needs of pregnant women suffer[26]. Call it the “tyranny of the urgent,” and it is not a uniquely American problem. During the COVID-19 outbreak in China[27], and the earlier Ebola pandemic in Africa[28], maternity care sometimes ceased altogether. In other cases, pregnant women were moved out to make room for pandemic patients.

In the U.S., as hospital resources are diverted, women who miscarry in early pregnancy may face delays, even for emergency procedures, with Black and Native American women particularly at risk[29]. The U.S. already has the highest maternal mortality rate[30] of any high-income country in the world.

These groups are among the most vulnerable during the COVID-19 pandemic With the coronavirus, hospitals may struggle to provide ongoing services for other patients. Getty Images / Misha Friedman[31]

What can people do?

People can work within their communities to identify needs[32]. That includes, along with our neighborhoods, our virtual, religious and professional communities. One approach that’s working in remote African communities – called Champion Communities[33] – targets the needs of the most vulnerable. The program can be adapted in the U.S. to provide online tools (like Google forms) to collect information on needs and resources. Social media –like neighborhood-focused apps[34], messaging groups on text, WhatsApp and FB Messenger – can also be used to check on the most vulnerable; #ittakesavillage is being used on social media to highlight these efforts.

And a footnote: Every telemedicine call should screen for intimate partner violence and child abuse. Every call needs to record the presence of firearms in the house. Providers, in cooperation with intimate partner violence and child abuse help lines, need to come up with protocols for identifying and safely checking in on those at risk. During this crisis, the coronavirus is not the only thing we have to fear.

[Deep knowledge, daily. Sign up for The Conversation’s newsletter[35].]


  1. ^ poor (
  2. ^ homeless (
  3. ^ immigrants (
  4. ^ detained (
  5. ^ incarcerated (
  6. ^ precariously employed (
  7. ^ uninsured (
  8. ^ do not have access (
  9. ^ humanitarian (
  10. ^ aid (
  11. ^ mental health condition (
  12. ^ serious mental illness (
  13. ^ isolation (
  14. ^ 1 in 4 women (
  15. ^ 1 in 9 men (
  16. ^ Studies suggest (
  17. ^ beyond the crisis (
  18. ^ there’s evidence (
  19. ^ jump (
  20. ^ key factor (
  21. ^ shot to death (
  22. ^ Getty Images / Boston Globe (
  23. ^ child abuse (
  24. ^ second-leading cause (
  25. ^ left behind (
  26. ^ pregnant women suffer (
  27. ^ China (
  28. ^ Africa (
  29. ^ particularly at risk (
  30. ^ highest maternal mortality rate (
  31. ^ Getty Images / Misha Friedman (
  32. ^ identify needs (
  33. ^ Champion Communities (
  34. ^ neighborhood-focused apps (
  35. ^ Sign up for The Conversation’s newsletter (

Authors: Chen Reis, Associate Clinical Professor and Director, Humanitarian Assistance Program, University of Denver

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Metropolitan republishes selected articles from The Conversation USA with permission

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