In the spring of 2020, the coronavirus pandemic first gripped the world by the throat and its deadly menace continues to unfurl with renewed ferocity. In the United States, medical and scientific experts issued a series of early recommendations to slow or halt the spread of the virus that causes the disease COVID-19. Such public health measures are clearly warranted. As of this writing, over 285,000 Americans have perished from COVID-19 and the infection numbers are soaring across much of the country. Recommendations to combat the virus spread include handwashing, covering the face when coughing and sneezing, wearing a mask when in public spaces, and social distancing. The most challenging anti-virus measure was the lockdown or stay-at-home orders issued by state and local governments. In many communities, people rushed out to stock up on food, water, and household supplies before they began sheltering in place. The lockdown preparations and implementation clearly highlighted the pervasive and persistent inequalities impacting every aspect of American life that are attributable to social determinants of health (SDH). The World Health Organization defines SDH as “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.” During the current public health crisis one key question for researchers, policymakers, and clinical providers alike to ask is: Which populations in the U.S. are most likely to experience adverse effects from SDH?

As an academic nurse researcher with expertise in health disparities, I closely monitored news about how the spring lockdowns were impacting various population groups. I paid special attention to the dramatically different experiences of white-collar employees, many of whom had the privilege of safely sheltering in place while working from home, and front-line essential workers who had no such option. This later group, often employed in grocery stores, meat-packing plants, bus stations, and other crowded environments, had higher risk of exposure to the coronavirus. Many of these essential workers are people of color and the devastating consequence of this reality was all too predictable. According to the U.S. Centers for Disease Control and Prevention, communities of color have experienced considerably higher rates of infection, severe illness, and death from COVID-19. This population includes approximately 100,000 individuals, largely African American, with sickle cell disease (SCD), an inherited red blood disorder. The major symptom of this disease is persistent, disabling pain, including excruciating episodes known as a pain crisis. SCD is a lifelong illness with a life expectancy of 48 years for women and 42 years for men.

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