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Lessons From Wuhan: The Role of Social Workers During the COVID-19 Pandemic
By Liana Petruzzi, LCSW; Nicole Milano, LSW; Weiwen Zeng, MSSc; and Qi Chen, MSW

A social worker helping children set up an online learning app during COVID-19 crisis in Shantou, China. Photo Credit: Jiechun Yang 

In December 2019, cases of pneumonia with unknown causes were detected in Wuhan, China. By February 11, COVID-19 had been identified as the virus causing these symptoms, and by March 11, the World Health Organization announced that COVID-19 was an official pandemic due to its rapid spread across Europe. It is now clear that we are facing the most dangerous public health crisis of our lifetime. The U.S. political system is struggling to implement effective tracking and prevention strategies to contain the spread of the disease, while the U.S. health care system is struggling to treat the rapidly growing number of people who require treatment. As we face this unprecedented crisis, our health care workers are an essential component of adequately responding to the crisis at hand. However, the role that social workers can and must play during this pandemic has not been clearly outlined.

Research suggests that only 10% to 15% of health outcomes such as mortality are influenced by medical care; the remainder is predicted by environmental factors such as access to income, education, food, and housing. There is also ample evidence that racial discrimination and systemic oppression have a negative impact on health. These environmental factors are sometimes referred to as the social determinants of health (SDOH) and health care systems have been rapidly trying to address them to improve population health. SDOH are particularly important to consider during a public health crisis, because it means that already vulnerable populations are at higher risk of being adversely affected. For example, early data suggest that black Americans are being disproportionately impacted by COVID-19 in terms of higher rates of exposure and death. There have also been reports of black patients who are symptomatic being denied tests and cities opening clinics or drive-through testing sites in historically white neighborhoods but not black neighborhoods. Similarly, national data suggest economic disparities exist in terms of who can social distance; people in the top 10% of income have been able to social distance at a faster rate than those in the lowest 10% of income, which significantly impacts exposure. Finally, people experiencing homelessness or multigenerational families that live together are not able to social distance and are at higher risk of contracting COVID-19.

While SDOH has become a buzz word within health care systems over the past decade, social work has long recognized that the social environment has a significant influence on health. Now more than ever, health care systems and public health departments need to identify which populations are at an even higher risk of exposure to COVID-19 due to social context, and whether preventive measures and as medical treatment are being provided equitably. Therefore, we need to address the SDOH of COVID-19 with downstream interventions such as accessible clinical care, midstream interventions such as community resources, and upstream interventions such as policy changes.

Social Work Response in China
Given the success of controlling COVID-19 with new infections in China, it would be beneficial to review their public health response to the crisis, particularly the social work response, to inform our own national response.

In Wuhan, the epicenter of the outbreak, the priority for social workers is to support the community in COVID-19 prevention. A group of social workers at Wuhan University created a community-based intervention model that differentially handles cases based on the patient’s risk: residents sheltered in place, quarantined contacts, and COVID-19 patients. The model was implemented by an interdisciplinary team of social workers, community workers, medical workers, and volunteers. They used telehealth interventions to provide health education, online screening, volunteer coordination, crisis intervention, and emotional support to the community. Social workers assessed the needs of each household using mobile apps, coordinated volunteer teams to help purchase necessities at local grocery stores and pharmacies, and offered home delivery to minimize human contact. Residents monitored their own health using mobile apps as well. If anyone reported COVID-19 symptoms or had other health and mental health concerns, a social worker would call the person to provide immediate interventions or referrals.

Social workers in China have also prioritized the needs of vulnerable populations such as people with chronic illness, unaccompanied minors, elderly people who live alone, and those who lack access or don’t know how to use technology. First responders including volunteers are also an important target group as they have higher rates of exposure. Other services included online support groups for pregnant women, taking care of newborn babies or children with disabilities who are quarantined from their parents, connecting patients who are quarantined at home with free medical supplies such as pulse oximeters and oxygen generators, creating and distributing a palliative care handbook, and holding virtual funerals for affected patients and families.

Downstream
Social workers are often at the forefront of crisis intervention, offering social structure and support through crisis resolution. During this pandemic, social workers are not only responding to the health crisis but also offering skills and resources that will restore individuals’ normal patterns of functioning. They are capable of providing solutions for issues related to SDOH, such as lack of financial resources or limited access to food, with a special focus on vulnerable populations. Social workers are also able to help promote disease prevention and provide individuals guidance through the abundance of COVID-19–related information.

Utilization of practice-based skills to provide person-centered care is another attribute unique to social workers. Media and consistent news coverage surrounding this public health crisis may elicit feelings of traumatization and anxiety among individuals regardless of whether they are personally affected by COVID-19. Many clinicians are increasing the parameters of their practice to directly address these feelings of grief, anxiety, and trauma through teletherapy. Likewise, social workers in hospital-based settings or community organizations directly dealing with COVID-19 patients may hold the responsibility of calming distressed patients, supporting caregivers, and discussing end-of-life care.

Social workers also play an important role in supporting peers or other members of interdisciplinary care teams during this surge in health care demands. Support can include promoting individual well-being among health care professionals who may be experiencing fear, guilt, or exhaustion. Social workers can also help by facilitating effective communication between health care professionals and clients to reduce mutual frustrations or anxieties.

Midstream
In the midst of the COVID-19 pandemic, a safe working environment is essential for health care workers, social workers, and the clients they serve. Social workers may find different ways to continue working with individuals, groups, and organizations while keeping everyone safe. Telecommunication has become a new norm for communication, and health care systems have quickly started adopting telehealth technology. More patients are seeking medical advice through online consultation, as in-person appointments become less accessible. Meanwhile, Medicare and Medicaid are temporarily reimbursing providers for eligible telehealth services, while the Office for Civil Rights has waived the requirement for health care professionals to use encrypted technology. China’s experience is that online support groups improved patients’ access to care by providing information, medical and psychological consultations, and channels to receive proper care. In this new era of telecommunication, social workers and colleagues should make sure to update their consent forms and standard safety guidelines for conducting telehealth. In addition, social workers can coordinate mental health and other social resources for their coworkers in addition to guiding mutual aid efforts in the community to improve health care access for clients affected by COVID-19.

For those whose presence is essential in health care settings, a safe working environment can be secured by implementing standards outlined by the Occupational Safety & Health Administration. In conjunction with these standards, social workers and colleagues need to develop an outbreak preparedness and response plan that highlights more stringent infection prevention policies and procedures that may include the following:

• practices to prevent exposures and infections, e.g., providing adequate personal protective equipment, particularly in hospital settings;

• flexible work arrangements for staff and clients; and

• prompt identification and isolation of suspected and confirmed cases, when applicable.

Upstream
While providing clinical care and community resources to patients currently impacted by COVID-19 and health care professionals on the front lines, social workers can also play a role in advocating for local, state, and federal policy changes. As previously discussed, the current COVID-19 pandemic has exacerbated preexisting inequalities and the best way to address them is through local, state, and federal policy initiatives. Policy changes can make sure that people’s basic needs such as housing, health care, income, and food are not being further reduced. For example, cities such as Austin and Atlanta have suspended evictions and rent payments for 60 days. Additionally, cities such as Los Angeles have expanded paid sick leave to ensure that workers are financially able to stay home and self-quarantine as opposed to risk exposing others.

More specifically, social workers have an opportunity to get involved with local, state, and even federal advocacy when it comes to expanding health care rights. Fourteen states have refused to expand Medicaid, which leaves our most vulnerable uninsured. For example, with the highest uninsurance rate of 18%, approximately 5 million Texans are uninsured—and this estimate was before Texas unemployment claims soared to 600,000. Additionally, there has been advocacy at the federal level for the health care marketplace to have a special, open enrollment period so anyone can purchase health insurance—not just those who are eligible due to a qualifying event. Considering that the United States has one of the weakest social security nets when it comes to health care, child care, and unemployment, these are essential steps to reducing the spread of COVID-19, and social workers have the ethical obligation to get involved. Additionally, we need state and federal public health agencies to start collecting more detailed population data regarding COVID-19 cases and deaths, specifically racial and economic demographics, in order to accurately understand the current disparities in care. Finally, this is an opportune time for social workers to get involved with organizing around longer-term policy changes such as Medicare for All to improve our social safety net in the future.

Final Thoughts
It is important to incorporate social workers at all levels of health care response. Social workers are needed to navigate the uncharted territory of a global pandemic and assist with individual and community experiences of grief, anxiety, trauma, and confusion. Social workers are also needed to better understand where systems are breaking down, what community resources are becoming available in a rapidly changing environment, and how policies can be changed or modified to improve public health and safety. Moreover, social workers will be vital during the recovery process when the immediate threat of COVID-19 has passed. Not only can social workers help as individuals try to rebuild social connections and adapt to life after the outbreak, but they can also support political and health care systems better prepare for future public health crises by ensuring that people have access to basic needs such as income, food, housing, and health care.

— Liana Petruzzi, LCSW, is a doctoral student at the Steve Hicks School of Social Work at The University of Texas at Austin. Her research interests include health equity, social determinants of health, and social work interventions in health care settings. She received her MSSW from UT Austin.

— Nicole Milano, LSW, is a doctoral student at Rutgers, The State University of New Jersey, School of Social Work. Her research interests include health disparities with a specific focus on integration of behavioral health into primary care settings.

— Weiwen Zeng, MSSc, is a doctoral student in the Steve Hicks School of Social Work at The University of Texas at Austin. He has extensive experience in working with people with intellectual and developmental disabilities. His current research centers around evidence-based treatments for underserved individuals with autism spectrum disorder and their families. He received his MSSc from the Chinese University of Hong Kong.

— Qi Cheng, MSW, is a doctoral student in the Steve Hicks School of Social Work at The University of Texas at Austin. She is from China and her research focuses on psychosocial functioning of cancer patients and their caregivers. Chen earned her Master of Social Work with a concentration in direct practice from the University of Pittsburgh.