The Essential Business Conundrum in COVID-19 Hotspots.

On my way home from the hospital last week, I decided to stop at the grocery store. Although I live in Roxbury, a lower income neighborhood of Boston, I generally choose to do my food shopping at a well-known premium grocery store in an abutting neighborhood. However, as I pulled into the parking lot surrounded by luxury condos, high-rise upscale apartments, and trendy restaurants, I immediately noticed a long and weaving line of masked patrons each rigorously standing at least 6 feet apart. After sitting for a moment, I instead decided to drive to my local grocery store, where I would perhaps simply walk in and grab items for dinner instead of waiting for an hour to safely shop in an establishment with stricter social distancing practices.

Upon entering the local and popular grocery store in Roxbury, I was surprised, almost disquieted. There were no lines or employees limiting the number of customers allowed to occupy the store at one time. While most customers were wearing improvised homemade masks and doing their best to adhere to social distancing practices, it was virtually impossible to not come into close contact with one another due to the congestion in the aisles and checkout lines. Though I am young, healthy, and lucky enough to not have any of the medical comorbidities associated with the severe complications of COVID-19, I felt uncomfortable with the lack of social distancing throughout the store.

After leaving the grocery store, I called my fiancé and colleague, both of whom are residents at Boston hospitals, to discuss my experience and concern. The three of us have personally observed the striking overrepresentation of socioeconomically disadvantaged people among confirmed COVID-19 cases, particularly the more severe forms. Our observation resonates with the national trends emerging from the Centers for Disease Control (CDC). The higher rates of comorbid medical conditions, suboptimal access to care, more mistrust of the healthcare system, as well as factors limiting social distancing (e.g. inability to work from home and living in multigenerational households) may all be contributing to this. There are environmental and economic constraints that make it difficult for members of these communities to practice strict isolation and social distancing. Indeed, highly endemic COVID-19 hot-spots that arguably stand to benefit the most from rigorous social distancing might paradoxically be the areas that struggle the most with adherence to infection control measures. As we reflected on the two dissimilar shopping experiences, is it possible that the more lax enforcement of social distancing precautions in essential businesses in these areas is one reason for the intensification of COVID-19 infections and fatalities among the vulnerable?

The next day, the three of us set out to survey major grocery stores in the neighborhoods hardest hit by COVID-19 in Boston to assess the degree to which these particular essential businesses employed social distancing. We had no clear methodology as to how to do this, but strong curiosity to find some answers. We traveled to East Boston, Hyde Park, Mattapan, Dorchester, and Roxbury. Throughout the 5 different neighborhoods, only one grocery store chain noticeably enforced social distancing by limiting the number of customers inside at a given time. Most grocery stores across these neighborhoods did not employ social distancing practices. Customers were allowed to enter these stores without limitation. And for the grocery stores that evidently posted a maximum occupancy in light of the pandemic, there was no employee presence at the entrance counting the number of patrons entering and exiting in an effort to enforce this policy. Upon entering these grocery stores, we noticed that while most of the customers were wearing homemade masks, we felt the same chaotic energy of trying to socially distance in a crowded store, just as one of us had experienced the night before at the local grocery store in Roxbury.

Accessing an essential business such as a grocery store is unavoidable, but during a pandemic the visit anticipates an enhanced level of risk. It is fundamental that the degree of exposure in these public spaces can be reduced by exerting more influence over social, or perhaps better put, “healthy” distancing.” If we expand our understanding of vulnerable communities to include those residing in “food deserts,” it is necessary for businesses – local grocery stores, mom and pop stores, bodegas, sandwich and fast food shops alike – to see their sustainability as being linked to the health of their customers. This shared interest, expressed to their customers with empathy, will make it easier for the businesses to request the proper distancing in their stores.

Just as many of the residents residing in low-income neighborhoods might benefit from enhanced protections, businesses operating in these hard-hit communities are likely experiencing immense financial pressure that would only be further amplified by limiting customer access. These pressures might make store owners less inclined to “slow” the pace of customers visiting their shops through the use of proper distancing. Some of these businesses may be at a crossroads between the public health obligation to keep the community healthy and safe, and the financial solvency concerns about withstanding this pandemic. Perhaps with more federal support (e.g., low interest loans), essential businesses serving COVID-19 hotspots would be able to provide the protections that their communities desperately need without risking insolvency. As our society slowly begins to re-open, we must ensure that public health efforts to minimize transmission risk and prevent resurgence are deliberate and strategic.

Conflict of interest

No author of this manuscript has any conflict of interest.