Demographic Data Disparities: 
Analyzing the Pandemic on Demographic Factors



COVID-19 has affected the lives of millions of people across the world. It has left hospitals inundated with ill people, governments scrambling to find solutions to economic crises and prevent further cases, and individuals daily lives largely altered to adjust to a more isolated reality. In the midst of the pandemic, everyone has had to cope with major changes to normalcy in order to prevent exposure. However, even with many changes, many individuals on the frontlines cannot stray drastically from their normal routines due to the nature of their occupations. Therefore, without further protections implemented, these essential workers are at more risk for contracting COVID-19. Further many social determinants, such as race and education, can dictate which individuals employed in high risk settings are more likely to be exposed. While reviewing the literature on occupational disparities, it is important to understand how these workers put themselves at risk for the greater well-being of their communities, and they should be given the best quality of protection.





The novel Coronavirus which first emerged in November 2019 has seen millions of lives adversely affected globally. When the first case was reported in Wuhan, China , expectations for the containment of the virus varied, however, the rapid spread of infection engendered one of the deadliest global epidemics observed in the past century, along with the Spanish Flu of 1918, the many returns of Cholera, and the H1N1 Virus (Medical News Today). Commonly compared with SARS and MERS, COVID-19 similarly has led to respiratory issues and has disproportionately affected individuals with underlying health conditions and older people. However, it is different in that COVID-19 has led to a far greater amount of deaths due to a significant amount of cases reported, despite both SARS and MERS having a higher case-fatality ratio (Wu and McGoogan.,2020). According to the World Health Organization, to date, there have been 55, 928, 327 confirmed cases, 220 countries/area/territories affected, and 1, 344, 003 deaths.

The infection rate as well as number of hospitalizations have been closely monitored. Viral respiratory infection tends to follow a seasonal outbreak cycle (Lim et al.,2020), and from the spike in cases observed within the past month, it appears that COVID-19 has also been following this cycle.  Different countries have had various responses to the epidemic, but in the past few months the United States has become a major hotspot for the outbreak. With the plethora of cases seemingly never ending, it begs the question of how has the country been adjusting to make sure the public stays safe? The CDC has made many suggestions for communities as well as individuals including the implementation of social distancing, wearing masks in public, and establishing guidelines for businesses to maintain in operation. 

While classroom education and many occupations moved to a remote online format, many essential workers have had to continue to perform their work in person. This includes healthcare workers, food industry workers, and emergency services workers. Given the unpredictable nature of this virus, having extensive safety measures in place is critical to diminish the possibility of contracting coronavirus at work. Since few studies have looked at occupational risk of exposure to COVID-19 (Mutambudzi et al., 2020), this literature review aims to identify the disproportionality of coronavirus infection amongst occupations, specifically focusing on frontline workers. In describing the findings, the review will also characterize the essential workers that are more likely to contract COVID-19 in terms of race and socioeconomic backgrounds. 




As with most airborne viral infections, development of Covid-19 occurs after an individual has been in close contact with an exposed individual. Therefore, personal protective gear, including masks, can greatly reduce the risk of infection. While major symptoms of coronavirus include fever, cough, and fatigue (Wu and McGoogan.,2020), the symptoms present themselves in a large variety of ways. Infected people may lose sense of taste and smell or they may be completely asymptomatic. In the latter case, it becomes very difficult to be sure that any individual has not contracted the disease and cannot potentially pass it on. Given their work setting, healthcare workers come into contact not only with sick individuals, but also with individuals who may be asymptomatic carriers. Similarly, other workers who maintain any kind of contact with individuals are also more at risk. 

Unfortunately, because of the perennial community transmission amongst asymptomatic individuals, the need for frontline healthcare workers to work directly with patients will continue to grow (Ngyuen et al.,2020). Workers have increased likelihood of contracting the virus based on how much contact they have with others, proximity to possible infected individuals or diseases they encounter at work (Billingsley et al., 2020). Given the nature of their work, healthcare workers who work long hours in close proximity to patients are more at risk of infection. With so many health-care workers on the job longer than before, a shortage in personal protective equipment (PPE) may occur, and therefore increase the risks. General hospital systems are prepared for average patient load rather than global pandemics (Cavallo et al.), and much of the U.S healthcare system has seen itself overwhelmed by the extensive need for hospital beds and other medical equipment. On average, patients with severe COVID-19 require 13 days of respiratory support, and the lengthy amount of treatment causes stress on resources (Cavallo et al.)

One explanation for the major outbreak at the beginning of the year is a lack of preparedness. A study conducted by Nayashanu et al. (2020) in the U.K determined that a majority of frontline workers felt  preparations for a pandemic, as well as lack of strategic policy pertaining to infectious disease, were major factors leading to increased exposure. They also identified that a shortage of PPE made it difficult for frontline workers to properly do their jobs and protect themselves. In addition, many frontline workers reported staying in their respective workplaces to look after patients as well as to avoid possibly going out and bringing back COVID-19 to those patients (Nyashanu et al., 2020). Finally, the study noted that participants felt that delays in testing results made it difficult to know if their coworkers were infected, and therefore they may have been unknowingly exposed. 

Evidence of high infection rates and high morbidity amongst “low-skilled occupations” such as “social, transport, food, sales, and retail workers” exists (Mutambudzi et al., 2020). It is likely that these occupations are also at increased risk of exposure to COVID-19 due to the people-oriented nature of these jobs. A prospective cohort study performed by Mutambudzi et al. (2020) concluded that as compared to non-essential workers, “healthcare workers (RR 7.43, 95% CI:5.52,10.00), social and education workers (RR 1.84, 95% CI:1.21,2.82) and other essential workers (RR=1.60, 95% CI:1.05,2.45)” were at more risk for contracting coronavirus. Based on the measures of association, (relative risk), while all frontline workers were at more risk for contracting COVID-19, healthcare workers were statistically most likely to be exposed, according to this particular study. Further, Ngyuen et al. (2020) stated that “frontline healthcare workers could account for 10-20 % of all diagnoses” of COVID-19. Overall, many studies show support for the fact that frontline workers, especially those in healthcare settings have increased risk of exposure. Unfortunately, many of these workers cannot afford to abandon their jobs, and will continue to work without financial support. This is due to the fact that our healthcare system relies on thousands of minimum wage workers to continue providing environmental and operational services despite increased risks (Larochelle et al., 2020). 



Multiple studies suggest that black, asian and ethnic minorities as well as elderly and patients with pre-existing illnesses are more at risk to contract COVID-19 for a variety of reasons. A study conducted by Aldridge et al. (2020) found that ethnic minorities had increased risk of morbidity from COVID-19 possibly due to the fact that minorities work in occupations that involved more “social mixing and less ability to work from home.” Drefahl et al. (2020) and Niedzwiedz et al. (2020) further demonstrated that individuals with low socioeconomic status, low education, low paying jobs or no jobs, or living in low-income countries increased risk for developing the disease, and these characteristics are often correlated with being an ethnic minority. In addition, older individuals, and people with pre-existing or chronic conditions such as “ diabetes, hypertension, and obesity,” have faced higher mortality from contracting coronavirus (Larochelle, 2020). While traditional media has underscored the high possibility of exposure for representatives of these groups with weaker immune systems, the higher rate of exposure for minority groups has only been lightly discussed. Low wage jobs that require on-site work and a lot of contact are overwhelmingly dominated by women and minorities, and according to Larochelle (2020), “nearly half of black and latina healthcare workers earn less than $15 per hour.”

In an article by Kirby (2020), the author synthesized evidence that COVID-19 disproportionately affects  “black, Asian, and minority ethnic (BAME) communities.” After analyzing the U.K Institute for Fiscal Studies report, along with other literature, Kirby stated that the mortality rate for individuals of African descent was 3.5 times higher than for white people in the U.K, and similarly the mortality rate for those of Carribean and Pakistani descent was 1.7 and 2.7 times higher respectively. Further, Kirby (2020) found that in the United States, African Americans represented 33% of COVID-19 hospitalizations while only making up 18% of the population. Indigenous communities have also been affected  disproportionately. These ethnic groups may be at more risk not only because they are more likely to have chronic conditions, but also because of workplace conditions. Interestingly, Kirby (2020) asserts that according to a survey of BAME,  “BAME doctors were twice as likely as white doctors to feel pressured to see patients in high-risk settings,” even without having proper PPE. 

Moreover, in a study conducted by Hawkins (2020), data about employment by industry in the U.S was combined with information about the essentiality of each occupation, as well as the potential risk of exposure for each occupation. He determined that BAME communities were more likely to be employed in essential industries, and due to occupational segregation, marginalized groups were more likely to deal with occupational injuries, illness, and deaths. Specifically, black workers overall were most likely to be employed in essential occupations, black and asian workers were likely to be employed in healthcare and social assistance, and black and hispanic workers were likely to be employed in the animal slaughter industry which has had notable COVID-19 cases (Hawkins, 2020). 


Protecting Frontline Workers


Because a majority of essential workers are employed in environments that pose higher risks for contracting COVID-19, the protection of these workers is crucial. Cavallo et al.(2020) addressed various problems that were encountered by workers in the pandemic in Italy, and from analysis of the situation, they presented new insights to move forward with. They found that by observing where regional outbreaks occurred they could model and anticipate “both what the ultimate capacity to provide care will be and when that capacity will be exceeded.” This is important because throughout the pandemic numerous healthcare systems around the world found themselves overwhelmed and unsure what to do, therefore putting the healthcare workers at more risk. Additionally, planning ahead can allow hospital workers to prepare for worst-case scenarios in the future, as well as work on developing preventative measures. Similarly, before an effective vaccine is delivered, preventative measures, such as relocating the public health emergency response from the hospitals to other locations, can be used to protect frontline workers before more serious waves of COVID-19 take place (Chirico et al., 2020). Finally, Mason and Friese (2020) recognized the lack of preparedness and assembled a list of recommendations to help protect essential workers in the future. The list included recommendations such as the federal government making sure an adequate supply of PPE for workers is available, developing production sites for PPE  rather than rationing PPE, and health leaders demonstrating competency when it comes to public health emergencies. 




A thorough review of the existing literature surrounding COVID-19 and frontline workers reveals numerous insights. Because of the rapid spread of COVID-19, many have recognized the importance of social distancing and personal protective equipment when having to come into contact with others. Given this understanding of the virus, the literature also recognizes that many occupations entail close contact with others, including healthcare workers, food industry workers, environmental service workers, and other essential on-site workers. A majority of the literature analyzed found that minorities are more likely to be employed in essential services; however, Billinglsy et al. (2020) did conclude at the end of their study that minority workers were not more likely to be exposed to COVID-19. Given their conclusion, it is also important to note that this particular study was done in Sweden and may not be generalizable to the global population of workers. Further, their research analyzed mortality rates instead of infection rates. All the other studies that examined race, occupation, and exposure to COVID-19 concluded that minority groups were more likely to be exposed to COVID-19. 

This review may be limited in that the research has all been recently conducted and published since major outbreaks of COVID-19 occurred earlier in 2020, and while studies from around the world were analyzed a majority of the literature was focused in the United States. The research presented in this review, however, does advocate for stricter preventative measures in order to protect frontline workers. Overall it is important to understand that frontline workers are at more risk for being exposed to COVID-19, but still continue to report to work to effectively do their job and ensure the safety and wellbeing of other individuals in their communities. In addition to the physical risks their job entails, frontline workers have put their personal lives on hold and have undoubtedly dealt with mental health ramifications of the pandemic. Going forward it is important to properly prepare for public health crises and well as physically and mentally support our essential workers. 




Maliha Ashraf




(1)  Aldridge, R. W., Lewer, D., Katikireddi, S. V., Mathur, R., Pathak, N., Burns, R., Fragaszy, E. B., Johnson, A. M., Devakumar, D., Abubakar, I., & Hayward, A. (2020). Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: Indirect standardisation of NHS mortality data. Wellcome Open Research, 5

(2)  Billingsley, S., Brandén, M., Aradhya, S., Drefahl, S., Andersson, G., & Mussino, E. (2020). Deaths in the frontline: Occupation-specific COVID-19 mortality risks in Sweden.

(3)  Cavallo, J. J., Donoho, D. A., & Forman, H. P. (2020). Hospital Capacity and Operations in the Coronavirus Disease 2019 (COVID-19) Pandemic—Planning for the Nth Patient. JAMA Health Forum, 1(3), e200345.

(4)  CDC (2020, February 11). Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention.

(5)  Chirico, F., Nucera, G., & Magnavita, N. (2020). COVID-19: Protecting Healthcare Workers is a priority. Infection Control & Hospital Epidemiology, 41(9), 1117–1117.

(6)  Coronavirus disease (COVID-19) – World Health Organization. (n.d.). Retrieved November 19, 2020, from

(7)  Drefahl, S., Wallace, M., Mussino, E., Aradhya, S., Kolk, M., Brandén, M., Malmberg, B., & Andersson, G. (2020). A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden. Nature Communications, 11(1), 5097.

(8)  Hawkins, D. (2020). Differential occupational risk for COVID-19 and other infection exposure according to race and ethnicity. American Journal of Industrial Medicine.

(9)  Kirby, T. (2020). Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities. The Lancet Respiratory Medicine, 8(6), 547–548.

(10)  Larochelle, M. R. (2020). “Is It Safe for Me to Go to Work?” Risk Stratification for Workers during the Covid-19 Pandemic. New England Journal of Medicine, 383(5), e28.

(11)  Lim, R. K., Wambier, C. G., & Goren, A. (2020). Are night shift workers at an increased risk for COVID-19? Medical Hypotheses, 144, 110147.

(12)  Mason, D. J., & Friese, C. R. (2020). Protecting Health Care Workers Against COVID-19—And Being Prepared for Future Pandemics. JAMA Health Forum, 1(3), e200353.

(13)  Mutambudzi, M., Niedzwiedz, C. L., Macdonald, E. B., Leyland, A. H., Mair, F. S., Anderson, J. J., Celis-Morales, C. A., Cleland, J., Forbes, J., Gill, J. M., Hastie, C., Ho, F. K., Jani, B. D., Mackay, D. F., Nicholl, B. I., O’Donnell, C. A., Sattar, N. I., Welsh, P. I., Pell, J. P., … Demou, E. (2020). Occupation and risk of severe COVID-19: Prospective cohort study of 120,075 UK Biobank participants. MedRxiv, 2020.05.22.20109892.

(14)  Nguyen, L. H., Drew, D. A., Graham, M. S., Joshi, A. D., Guo, C.-G., Ma, W., Mehta, R. S., Warner, E. T., Sikavi, D. R., Lo, C.-H., Kwon, S., Song, M., Mucci, L. A., Stampfer, M. J., Willett, W. C., Eliassen, A. H., Hart, J. E., Chavarro, J. E., Rich-Edwards, J. W., … Zhang, F. (2020). Risk of COVID-19 among front-line health-care workers and the general community: A prospective cohort study. The Lancet Public Health, 5(9), e475–e483.

(15)  Niedzwiedz, C. L., O’Donnell, C. A., Jani, B. D., Demou, E., Ho, F. K., Celis-Morales, C., Nicholl, B. I., Mair, F. S., Welsh, P., Sattar, N., Pell, J. P., & Katikireddi, S. V. (2020). Ethnic and socioeconomic differences in SARS-CoV-2 infection: Prospective cohort study using UK Biobank. BMC Medicine, 18(1), 160. 16) Nyashanu, M., Pfende, F., & Ekpenyong, M. (2020). Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: Experiences of frontline workers in the English Midlands region, UK. Journal of Interprofessional Care, 34(5), 655–661.

(16)  Occupational risk for COVID-19. (2020, May 25). News-Medical.Net.

(17)  Wu, Z., & McGoogan, J. M. (2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72, 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA, 323(13), 1239.