On Wednesday, the Centers for Disease Control and Prevention warned in a press conference that there is no end in sight to the rapidly expanding novel Coronavirus outbreak. As of Friday afternoon, there were 31,530 cases worldwide, including 12 in the United States, with estimates of 638 deaths, mostly in China. Dr. Nancy Messonnier, Director of CDC’s National Center for Immunization and Respiratory Diseases, told reporters the agency is rushing to help US hospitals and health departments prepare for more cases, adding, “This is the beginning of what could be a long response.”

That experts are short on details about the trajectory of the coronavirus isn’t a surprise. As we know from the unpredictability of the seasonal flu every year, the path of a virus is hard to predict. But there is one thing that experts know for sure: The burden of disease won’t be shared equally among Americans, and social factors like income level, race, and immigration status could make a big difference in who gets the sickest.

It’s well documented that the poor bear the brunt of viral disease outbreaks. A 2016 CDC analysis of trends in seasonal flu, for example, found that people who live in high-poverty neighborhoods were twice as likely to be hospitalized for flu than those in low-poverty communities. There are many reasons for this: Poor people are more likely to work jobs that don’t offer paid sick leave. Employees feel pressure to come into work when they’re sick, increasing the risk that they’ll infect coworkers and neglect their own health. Low-paying jobs—customer service, restaurants, factories—are also less likely to offer health insurance. There’s a shortage of primary care doctors in poor neighborhoods, so residents often wait until their illness is severe to seek medical care. On top of all that, there’s good reason to believe that doctors might be more likely to prescribe medicine to affluent people: A 2014 study of 56 million people in the American Journal of Public Health found that people in the two highest income categories were about twice as likely as their lower-income counterparts to get the antiviral drug Tamiflu.

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