As Coronavirus Hits Wyoming, Healthcare Disparities Come Into Focus

Mar 13, 2020


The official recommendation for people who might have COVID-19 - the coronavirus you've been hearing about - is to stay home. But that's easier said than done for many in the state.

The lack of paid sick leave could make a coronavirus outbreak spread farther and faster.

COVID-19 has come to Wyoming, as state officials confirmed the first case Wednesday. But the virus might have been here much longer - and could be far more widespread already.

"I think we should act and assume like it is," said Christine Porter, a researcher at the University of Wyoming who studies healthcare disparities.

When it comes to infectious diseases, Porter said having health insurance and especially paid sick leave can be game changers. But many Wyomingites have neither.

"So, if you do not have paid time off, then you're going to go to work sick," Porter said.

As the number of cases and deaths continue to rise throughout the United States, state health labs are gaining the ability to test for COVID-19. Wyoming began testing last week.

The Department of Health is not charging for lab tests, but that doesn't mean they're being handed out freely.

A person who thinks they might have the coronavirus must go first to their medical provider, who is tasked with ruling out or identifying other possible ailments. If the provider thinks it could be COVID-19, they can take a sample swab and send it to the state lab.

Porter said this is a start, but it's not sufficient. She said testing should be basically barrier-free.

"When you have a public health emergency, like COVID-19 spreading, we should be having public clinics and public screenings at no cost, everywhere, for this issue," Porter said. "That's what other countries are doing."

People can be infected with COVID-19 long before they start showing symptoms. Porter said waiting to test until people feel they need to go to the doctor allows the coronavirus to silently spread. You can't know if you need to self-quarantine if you haven't been tested and don't feel sick.

"If other people cannot get healthcare or if other people cannot get time off, it will hurt you," Porter said. "It will hurt them, it will hurt us all as this spreads. I would argue that hurts us all, all the time, it's just more subtle."

Stopping the spread of an infectious disease is no easy undertaking. In addition to washing hands and avoiding hugs or handshakes, one of the most effective ways of stopping the spread is self-quarantine. In other words, staying home from work when there's a chance you've been exposed.

But for many, staying home means missing work and wages.

"If you go to work sick, then you're really spreading contagious illness to your customers, to your coworkers," Porter said. "I was not able to find rates in Wyoming, but in general, about 25% of Americans working in the private sector have no paid time off at all."

The stats are even more dire for those working in restaurants or hotels - places that could be powerful vectors for spreading disease.

Ask around restaurants in Laramie, and you'll find a lot of workers without any paid sick leave. I did just that.

"Paid leave? I believe we have paid leave after a year."

"Do we have paid leave?"

"No, we do not."

"I do not have paid sick leave."

"No."

"Paid sick leave? No, I do not."

I'm not naming the workers I talked to, or their places of employment, in an effort to protect their identities.

With or without paid sick leave, most cooks, servers, and delivery drivers are expected to stay home if they're showing symptoms - and most people interviewed said they would. But those missed shifts add up. For some more than others.

"I'm on salary so it doesn't affect me but it does affect everyone else who works here."

"A little bit, but not too bad. I do have another job. If I was sick, I would have to take time off for that one obviously, too, but that one does let me work from home so it compensates a little bit."

"It would put me in a tight spot."

"There's a lot of opportunity to get overtime and extra hours, so whatever time I miss, I can just make up."

"This is the second shift that I've made today."

"I live solely off of this job, so not only can I not be sick just because it's hard for me to get the shifts covered, but I financially can't really afford to take time off."

Like sick leave, health insurance is also out of reach for a lot of people.

The Downtown Clinic in Laramie serves locals without insurance. It's one of only a handful of such places in Wyoming, despite the state having one of the most uninsured populations in the country.

The staff here is preparing for COVID-19 to hit their community. They've cleared out the waiting room and installed plexiglass between patient and staff areas. Executive Director Pete Gosar said the clinic will start doing everything it can through telehealth, meeting with patients over the phone.

"Absent a test or absent understanding if a person is infected, you have to act like everyone is infected," he said. "We want to be part of this community, giving health all through whatever this outbreak looks like here."

The inability to know who is carrying the virus, and who isn't, encouraged the Downtown Clinic staff to make the alterations they did. Grace Gosar, Pete's sister and the clinic's co-medical director, said it was necessary.

"The reality is if we don't take the reasonably non-symptomatic folks as possible means for spreading the virus, it's very likely we'll have to shut our doors for a bit - we'll be sick," she said.

Pete Gosar says the best way to keep the clinic open is to keep the staff healthy. If the largely volunteer staff had to take sick leave themselves, it could leave the clinic's 500-odd patients with nowhere else to turn.

"I am worried for our people to get sick," Gosar said. "When you are in poverty, you don't have much room for things to go wrong - one thing that would really go wrong for all of our clients is if we couldn't provide care."

Have a question about this story? Contact the reporter, Jeff Victor, at jvictor@uwyo.edu.