Structural Vulnerability in the U.S. Revealed in Three Waves of COVID-19

Am J Trop Med Hyg. 2020 Jul;103(1):25-27. doi: 10.4269/ajtmh.20-0391. Epub 2020 May 7.


The novel coronavirus disease (COVID-19) pandemic has unveiled underlying health inequities throughout the United States. The pandemic has spread across U.S. states, affecting different vulnerable populations, including both inner-city and rural populations, and those living in congregate settings such as nursing homes and assisted-living facilities. In addition, since early April, there has been an increasing number of outbreaks of COVID-19 in jails and prisons. We describe three overlapping epidemiologic waves of spread of COVID-19 linked to three different kinds of structural vulnerabilities.

MeSH terms

  • Aged
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / transmission*
  • Crowding
  • Frail Elderly
  • Humans
  • Nursing Homes
  • Occupational Exposure
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / transmission*
  • Prisons
  • Rural Population
  • SARS-CoV-2
  • United States / epidemiology
  • Urban Population
  • Vulnerable Populations*