Social Work in Public Health

ISSN: 1937-1918 (Print) 1937-190X (Online) Journal homepage: https://www.tandfonline.com/loi/whsp20

Coronavirus Pandemic Calls for an Immediate

Social Work Response

Heather A. Walter-McCabe

To cite this article: Heather A. Walter-McCabe (2020) Coronavirus Pandemic Calls for
an Immediate Social Work Response, Social Work in Public Health, 35:3, 69-72, DOI:
10.1080/19371918.2020.1751533

To link to this article: https://doi.org/10.1080/19371918.2020.1751533

Published online: 14 Apr 2020.

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SOCIAL WORK IN PUBLIC HEALTH
2020, VOL. 35, NO. 3, 69–72
https://doi.org/10.1080/19371918.2020.1751533

EDITORIAL

Coronavirus Pandemic Calls for an Immediate Social Work Response

We are in strange and anxiety-producing times. As the media began discussing coronavirus, or
COVID19, in January 2020, their reports were an early signal that world as we had come to know it
would be changing. Fast forward two months, and many of us are under stay-at-home orders. Italy
experienced over 1000 deaths in one day. As of this writing, the world has over 600,000 confirmed
cases of coronavirus infection and 28,000 deaths, with the U.S. numbers at just over 100,000
confirmed infections and 1,600 deaths (Johns Hopkins Coronavirus Resource Center, 2020).
I anticipate that by the time this is published, that number will have grown exponentially. We are
in the midst of a public health pandemic and social workers must be a part of the response.
I am a public health law and policy social worker. I began my career as a social worker at
a pediatric tertiary care hospital. After watching families deal with systems that placed barriers in
their way, I went back to school and earned my law degree. I have been working in public health
policy for over two decades. My social work, public health, and law colleagues have been preparing
for this moment for years, in the hopes that we would not have to face it in our lifetimes. My first
article about pandemic preparedness was published in 2009 (Kinney, McCabe, Lewis Gilbert, &
Shisler, 2009). What we are watching unfold is not happening in a way that uses much of what has
been written about preparedness. Undertesting, undersupply of personal protective equipment, and
spotty coordination of national policy have all made the work more difficult (Shear et al., 2020). The
country is left in a position to deal with critical hospital surges, which may have otherwise been less
acute (How bad will the next few weeks be for California as coronavirus cases surge?, 2020; New Jersey
Hospitals Brace For Coronavirus Surge, 2020; Rothfeld, Sengupta, Goldstein, & Rosenthal, 2020). To
be fair, no matter how prepared for an emergency, it is by its nature an emergency, and some of
these issues would be unavoidable no matter how well-prepared the government is to respond.
That leads us to our role as social workers. We are needed. We are called by our Code of Ethics to
practice our social work values: Service, social justice, dignity and worth of the person, importance of
human relationships, integrity, and competence (National Association of Social Work, 2017). All are
needed in this time of public health emergency. Our work along the continuum of social work from
micro to macro levels will be crucial if we are to fulfill our professional obligations.
Some of us work at the micro and mezzo levels. As our population is increasingly isolated from
social distancing, stay at home precautions/orders, isolation, and quarantine, we are already seeing
reports of anxiety and depression increasing (Coping With Anxiety and Depression During the
Coronavirus Pandemic, 2020; Increased anxiety and depression top college students’ concerns in
coronavirus survey, 2020; CDC, 2020). A quick transition to telehealth, where available, has forced
many to completely change service delivery mechanisms in a matter of weeks. Where the field has
spent time discussing HIPAA compliance and other potential ethical issues around telehealth, the
government has now relaxed rules and encouraged the practice to move forward with great speed in
response to this emergency (Galewitz, 2020). It leaves us with the question of how to handle a new
delivery method, but also with questions of access. What do we do for our clients with limited access
to the internet? Is a cell phone enough to allow us to provide the care that is needed? Are we
reaching all of those who need us now? With mental health needs increasing, the existing referral
systems may not provide for the needs in the time of a public health emergency of this scale. We risk
especially difficult gaps for those who are already experiencing issues such as poverty, lack of access,
and those with disabilities. Are we able to provide the technology needed for those who need
accessible technology? I assert that social workers must be on the front lines not just of service
© 2020 Taylor & Francis Group, LLC
70 EDITORIAL

provision, but also at the policymaking tables for micro service delivery at all levels. How do we work
in ways that do not further exacerbate already existing health inequities? How do we use our skills to
advocate for the inclusion of those who may otherwise be left out? How do we ensure that we are
working with and alongside those impacted to amplify their voices rather than to substitute our
voices for theirs? These questions must be front and center to social work at the national and local
levels.
In addition to those working at the interpersonal levels, there is a need for increased macro level
social work. I propose that this is not simply those of us who identify as the “macro folks” but rather
all of us. We already saw a growing need for advocacy with camps on our southern border; a rise in
racial, ethnic, and homophobic stigma and violence; and an increasing divide in our country. Now
we are tasked with using our social work theories, models, and practice to actively ensure that this
public health emergency does not allow these troubling practices to play out as resources are
allocated. The list of topics and arenas where social workers are needed is extensive. I will provide
some examples, though these are certainly not exhaustive.
First, there is a divide between those who are able to work from home and those who are essential
workers. Among those who get ill, there is also a divide between those who have paid time off and
health care and those with no similar benefits (Kaiser Family Foundation, 2020). We must acknowl-
edge the disparate impact on those who are already living paycheck to paycheck or near the poverty
line. Those with paid leave or whose jobs allow them to work from home, oftentimes white-collar
jobs, are typically able to stay at home (medical workers are a clear exception) and continue to earn
money. At the same time, those who do not have similar benefits must report for work or risk losing
their job. Some may find their jobs don’t exist anymore. Those with health insurance do not need to
weigh the potentially fatal question “how bad is too bad” before seeking medical assistance and
further financial burden.
We know that socioeconomic status is correlated with increased risk of medical issues, which
could put people in the high-risk category for severe complications if they contract the coronavirus.
These factors only magnify the disparities. What are social workers and the national social work
organizations doing to advocate for change that acknowledges and works to minimize these
disparities? The NASW’s press release related to the CARES Act was a start, but a rapid response
mobilizing the social work profession to raise these issues and bring public attention to the issues is
needed ($2 trillion Coronavirus Relief Package will Support Social Workers, Clients They Serve, 2020).
It will be necessary for the foreseeable future as we move forward in rebuilding structures following
this public health emergency. The CARES Act was the third bill passed to deal with this public health
emergency, but it will not be the last. Our values call us to shine a light on the structural systems
which perpetuate inequities and work hard to make changes to improve the overall public health of
all communities during this pandemic and beyond.
There is currently a movement to advocate that governors release those who are in prison on
technical violations and nonviolent misdemeanors (Coronavirus Tracker, 2020; Klonsky, 2020).
Close confinement and living arrangements are ripe for the rapid spread of infection. Rikers
Island has already experienced an outbreak with those testing positive increasing daily. The criminal
justice system has well-documented issues with disproportionate impact of criminal laws and
enforcement by race and ethnicity (Report to the United Nations on Racial Disparities in the U.S.
Criminal Justice System, 2018; Balko, 2019). This issue also disproportionately impacts those unable
to afford bail. Judge Fuller of Alabama described the issue well in describing the order to release
those who bail was under 5000 USD saying, “A lot of people have been laid off. So let’s say, I’m
a parent who has a child who is in jail. This is forcing them to make a terrible decision about
whether to go down and pay bail to get their son out of jail or to buy groceries for the other two
kids” (A Judge Ordered The Release Of Low-Level Prisoners Because Of The Coronavirus. People Were
Absolutely Furious., A Judge Ordered The Release Of Low-Level Prisoners Because Of The
Coronavirus. People Were Absolutely Furious., 2020). The judge reports he was trying to save not
only prisoner lives but also that of the correctional officers and others. The pushback he has received
 SOCIAL WORK IN PUBLIC HEALTH 71

has been such that journalists researching whether other courts would follow suit have found no
others in Alabama considering similar measures.
Social workers and national social work organizations should be a part of the national advocacy
movement to enact these precautionary and responsive changes in large numbers. Some of this
advocacy can even be done from home by writing letters or making phone calls. This is not merely
a criminal justice reform, but a public health response. This is but one of the issues being raised.
Others include treatment for those with substance use disorder who need continued access to
methadone (Abuse, 2020) or even alcohol withdrawal in states where access to liquor stores has
been unexpectedly ended (Whelan, 2020). Homelessness or those who risk losing their homes when
they cannot afford rent after losing their jobs is another. There is no limit to the number of issues
that need social work advocacy. We must rise to the challenge.
Lastly, it is critical to discuss triage. Our hospitals will be overwhelmed. There is very little suggesting
at this time that we can completely stop this. There is still hope of flattening the curve to help minimize
this surge in hospitals, but avoiding it all together seems like a statistical improbability. Social workers
absolutely must engage in this process – first, the hotspots. We are seeing hotspots hit areas where
people are already experiencing disparities. New York City was the first hotspot outside of the west
coast; however, Detroit and New Orleans, two cities already hit by difficult past emergencies, are seeing
a rapid rise in the disease. Testing is behind, but as with much public health, it appears zip codes are
being impacted differently (Coronavirus News: U.S. Poor Hit By Virus Impact – Bloomberg, 2020).
Underlying structural racism and socioeconomic barriers will exacerbate difficulties in this public health
emergency as with health care writ large. Social workers working in hospitals have a responsibility to be
involved in the policies addressing access in this emergency. We have expertise in social determinants of
health and can be essential in identifying policies that might impact them before poor policies are
enacted. Triage decisions will need to be made in the moment. Hospitals are already discussing the
guidelines. How will we ensure that people with disabilities are not denied care simply by virtue of their
disability? How can we ensure that implicit (or even explicit) bias does not drive triage decisions? Social
workers can serve on ethics committees. We can volunteer to work on the committee designing the
policies. We can advocate for our individual patients. Hospitals are rarely allowing non-patients to be at
the bedside (Lamas, 2020). Naturally, existing family or friend advocates are unlikely to be able to do so.
How can we assist in this role? We are needed here and must ensure we do not sit on the sidelines.
Though the situation is tumultuous right now, there is hope. Social workers are experts in
working in challenging environments. We learn skills that help us be collaborators. And we view
the world through our social work social justice lens. We can make a difference. It is time to roll up
our sleeves and social work. We must use the whole continuum of social work to do so. I look
forward to partnering with many of my colleagues to do this hard work moving forward. In the wise
words of Elie Wiesel, “There may be times when we are powerless to prevent injustice, but there
must never be a time when we fail to protest.” I believe we are in these times. Let’s assert the power
of social work to work alongside communities to make a change. Let’s do this.

Disclosure statement
No potential conflict of interest was reported by the author.

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Heather A. Walter-McCabe
School of Social Work, Indiana University
Social Work and Law, Indiana University Robert H. McKinney School of Law
American Public Health Association, Washington D.C., USA
hamccabe@iupui.edu