TRANSFORMING HEALTH — As two dozen Pennsylvania counties begin to reopen, bringing many people out of their homes and back into the workplace for the first time in weeks, those living with a wide range of preexisting health conditions are scared they won’t be protected.
With no guarantee that they can continue to collect unemployment if they refuse to go to work, this segment of workers — including those with chronic lung conditions, a history of heart disease, or whose immune systems are compromised — fears a near-impossible choice:
Risk losing their jobs, or risk losing their lives.
State officials said Monday that people receiving unemployment compensation in counties where stay-at-home orders have been lifted must return to work if called upon. People cannot stay on unemployment compensation out of fear of getting the virus, said Jerry Oleksiak, state secretary of Labor and Industry.
“If they are called back to work, and the work is there, then they are expected to go back,” Oleksiak said during a conference call.
State officials said they will consider requests to extend benefits due to preexisting conditions on a case-by-case basis but offered no clear guidance on what would qualify. And without a guarantee of coverage, workers must essentially roll the dice, said Dr. Faoud Ishmael, an immunology specialist at Mount Nittany Medical Center in Centre County, one of the first 24 counties allowed to reopen.
Ishmael said his patients include people on chemotherapy, cancer survivors, and people who are immunosuppressed due to drugs they take for conditions like rheumatoid arthritis or irritable bowel syndrome.
“These are people who may look fine on the outside, but if they get infected, this could be fatal,” Ishmael said.
People who are immunocompromised tend to “catch everything,” he said. But what’s different with the coronavirus is that doctors lack the typical treatments — vaccines and antivirals — that increase the odds that their patients will survive.
Even for his patients who don’t work, opening up businesses means family members may also be increasing their interactions with sick people at work, potentially bringing the virus home.
Ishmael said he’s been calling patients to help them work through these decisions — and he’s getting plenty of calls from them, as well. He’s become an expert on the federal Family Medical Leave Act, which allows people to get unpaid time off due to an illness.
Often, his patients can’t afford not to work.
“Many of them feel that they don’t have a choice,” Ishmael said, adding that some of his patients rely on employer-based health insurance to pay for the medications that keep them healthy.
Every case is different and will need to be reviewed individually, said Susan Dickinson, director of the state Office of Unemployment Compensation Benefits Policy.
“There is no blanket yes or no,” Dickinson said. “If part of the reason why they’re not going back is because they have a compromised immune system or someone in their family has a compromised immune system, we would look at that as more of a relevant reason than that they were just making more money on unemployment, or something like that.”
However, the department declined to provide specific guidelines for what conditions, if any, would exempt someone from returning to work during the pandemic.
The department also declined to say whether common health conditions that are risk factors for COVID-19 like diabetes, which affects 1.4 million Pennsylvanians, or heart disease, the leading cause of death in the state, would be among the “relevant reasons” Dickinson mentioned.
For those who don’t return to work, a Labor and Industry spokesperson said there’s no rule stopping an employer from firing them — a move that may compromise unemployment.
“Employment in Pennsylvania is ‘at-will,’ unless you have a contract with your employer, or you are a member of a union with a collective bargaining agreement,” spokesperson Jahmai Sharp said.
Pennsylvania officials have ordered employers to protect their workers by providing personal protective equipment and mandating proper social distancing. However, some workers say those rules aren’t followed, and Gov. Tom Wolf admitted the order can’t be widely enforced.
Talking to reporters Tuesday, Wolf said workers whose complaints are ignored “have the ultimate sanction, which is just to say, ‘Well then, I’m not coming to work.’ ”
For most people, going more than a few months without income isn’t an option, said Joyce Vonada, a registered nurse at a long-term care facility who lives with an autoimmune disorder and is treated by Ishmael.
Vonada is considered an essential worker, but she’s been out on unpaid, federally guaranteed leave since March because of an illness. When her unpaid leave runs out in June, she’ll have to decide whether to return to work or quit.
That’s a question complicated by her illness, which leaves her susceptible to common respiratory infections. She found a medication that worked, but her insurance stopped paying for it and the out-of-pocket cost is prohibitive — $1,500 a week.
While the coronavirus made its way across Pennsylvania, Vonada has been home, fighting a severe respiratory infection. It isn’t COVID-19 — she’s been tested — but she fears that, for her, getting the virus would be a death sentence.
“Do I take care of my health, or do I go back to work and help pay the bills that continue to pile on?”
State officials are in the unenviable position of figuring out how to prevent people from getting sick while also balancing the economic toll the pandemic has wrought, said Gene Barr, the president and CEO of the Pennsylvania Chamber of Business and Industry.
The impact of widespread closures has been “cataclysmic” on the service industry, he said, with 3 in 10 restaurants expected to close within a year. Barr added almost every sector has seen precipitous revenue losses.
Businesses can and should make accommodations for people with serious health problems, Barr said. However, they need people to show up for work.
Ishmael said the vaccine and medications people will need to beat the coronavirus could take more than a year to develop, and he understands that businesses can’t stay closed that long. But thinking about the people he sees every day, he knows some may not survive long enough to see those treatments if they have to go back to work.
He said he’ll offer them his recommendations, and help them as best as he can, hoping to keep them safe until the coronavirus is effectively contained or a treatment is available .
“You have to earn a living, but you need to balance that with the potential of a virus that doesn’t care what you want to do.”