Building an effective COVID-19 response: A guide for future research

The COVID-19 pandemic has resulted in significant reductions in the quality and quantity of schooling across the United States. With school closures, high school students received on average 3.9 hours of instruction versus the 6 hours per day required by most states. Reduced learning time and in-person instruction has resulted in learning loss that disproportionately harms students from low-income families and students of color.

J-PAL North America’s COVID-19 Recovery and Resilience Initiative aims to identify effective ways to support students, educators, and families in the face of COVID-19 related school closings, remote learning, and learning loss by evaluating strategies to improve educational outcomes.

Pre-existing inequity in education

In the United States, millions of students are behind grade level. In 2019, only 41 percent of fourth graders were considered “proficient” in math. This figure drops to 34 percent by eighth grade. For reading, only 35 percent of fourth graders and 34 percent of eighth graders met or exceeded the 2019 proficiency benchmark.

These numbers change drastically when examined by race and income level. Only 18 percent of Black fourth graders and 23 percent of Hispanic fourth graders met the reading “proficiency” benchmark, as compared to 45 percent of white fourth graders. Similarly, only 21 percent of students eligible for the National School Lunch Program––a proxy for students from low-income families––were considered proficient as compared to 51 percent of students who were not eligible.

Racial and economic disparities in educational opportunities start early and persist throughout school. Students from low-income families are more likely to begin school already behind their more affluent peers and face challenges catching up. Further, school districts that serve large populations of students of color and students from low-income families receive far less funding for student resources than those serving student communities who are predominantly white or affluent. The average Black or Hispanic student remains roughly two years behind the average white student, and low-income students continue to be underrepresented among top performers.

Falling behind early has long-term consequences. For example, students who are not reading proficiently in third grade are four times less likely to graduate high school than children with proficient reading skills. Further, while high school dropout rates are declining nationally, they are continuing to rise for students from families with low-incomes, and racial gaps persist.

These disparities are not limited to learning outcomes. The adoption of zero-tolerance and punitive disciplinary policies is more likely as the percentage of Black students in a school system increases. Compared with white students, Black students are less likely to be placed in gifted programs and subject to lower expectations from their teachers. These practices are linked to higher rates of dropouts and failure to graduate on time, as well as to the “school to prison pipeline.”

Education inequalities are perpetuated by the ways in which schools are funded in the US. The majority of funding for public schools comes from state and local taxes, which contributes to large resource disparities between schools in high- and low-income communities.

However, inequities span beyond school geography and community income. In 2019, researchers found that high-poverty districts serving mostly students of color receive about $1,600 less per student than the national average, while high-poverty school districts that are predominately white receive only about $130 less.

Differences in funding can affect all aspects of the K-12 education system, including per pupil expenditures, course offerings, access to counseling and other educational resources, teacher salaries, and availability of technology at school. Long-term impacts of school funding disparities include lower earnings and an increased annual incidence of poverty as children become adults.

Racial and income disparities in education are not limited to the K-12 system. Low-income, Black, and Hispanic students attend college at lower rates than their more affluent or white peers, and are also more likely to attend colleges of lower quality. For low-income students of color, attending lower quality colleges is related to their long-term earnings and lower representation in fields such as the physical sciences, mathematics and engineering.

The impact of COVID-19

As a result of nationwide school closures, 55 million students completed the 2019-2020 school year from home, and approximately 9 million (16 percent) did not have access to the technology they needed for remote learning.

These school closures are likely to result in disproportionate learning losses for low-income students and students of color, and by September many students will be behind a full academic year. The World Bank suggests that foundational learning loss as a result of school closures could lead to lower learning trajectories for a whole generation.

COVID-19 has underscored the disparities in access to essential technology between high-income and low-income schools. An EdWeek Research Center survey found that 62 percent of leaders in districts with poverty rates under 25 percent said all families had access to home internet. For leaders in high-poverty districts where the poverty rates exceed 75 percent, just 31 percent of families had the necessary access. This suggests that a significant portion of students have no way to access learning at home. For this reason, lower-income parents are much more likely to say they are concerned about their children falling behind.

Access disparities are race-based as well––a 2020 survey conducted by Pew Research found that one-quarter of Black teens reported they often or sometimes cannot do homework assignments due to lack of reliable access to a computer or internet connectivity, compared with 13 percent of white teens and 17 percent of Hispanic teens. It is clear that districts, schools, state and local governments will first need to address the issue of access in order to implement equitable and effective programs to keep students learning during the pandemic.

The numbers of students impacted by school closures and disparities in access to learning are unprecedented. However, researchers are turning to existing evidence on missing school to understand the potential learning loss for students across the US. Examining the impacts of unique events like Hurricane Katrina and the more common summer slide, analyses suggest that while most students will see significantly smaller learning gains relative to a typical school year, students who were already struggling will fall further behind. Learning loss will likely be greater in mathematics relative to reading.

The unequal impacts of the pandemic also affect access to and success in higher education. Low-income students were 55 percent more likely to delay graduation than their more affluent peers as a response to the shut down. These educational setbacks at all levels will further exacerbate long standing inequalities in not only academic achievement but also employment opportunities, earnings, and intergenerational mobility.

Research to support students, teachers, and parents

The COVID-19 pandemic threatens to exacerbate stark opportunity gaps that persist throughout the US education system. Research is needed to demonstrate how best to adapt our education practices and policies to respond to and recover from the impact of the pandemic on schools.

Turning to the evidence on what works and testing new strategies to address education inequalities is paramount in order to stem the COVID learning slide. Researchers, working collaboratively with education leaders, have an opportunity to test programs and interventions and develop generalizable lessons to inform education policy and support recovery for all students.

This post is an installation in J-PAL North America's "Building An Effective COVID-19 Response" research guide blog series. The complete series highlights the interaction between COVID-19, research, and the policy areas of education, health care delivery, and jobs and the social safety net.

The COVID-19 pandemic has placed unprecedented strain on the American healthcare system, and in doing so has brought to light many of its most persistent shortcomings. Despite spending far more than any other country on healthcare, the United States has reported the highest number of coronavirus cases and the highest number of related deaths, causing many to question the underlying structures of the nation’s health care system. Gaps in health care access, coverage, and quality based on race, socioeconomic status, and geographic location are, in the midst of a global pandemic, rapidly widening and becoming more apparent than ever.

As nationwide protests against police violence and systemic racism continue across the United States, blatant disparities in COVID-19 infections and deaths point to the pressing need to address inequities in health and a myriad of other areas. Narrowing the significant socioeconomic gaps in health care access during the pandemic and post-pandemic context is an imperative undertaking.

Better understanding and addressing the social determinants of health is critical to improving individual and population health and advancing health equity; without taking an intersectional approach to addressing health, disparities will persist and communities will be left behind in the fight to mitigate the impact of COVID-19 and recover from the pandemic.

J-PAL North America’s COVID-19 Recovery and Resilience Initiative aims to contribute to knowledge in this area by testing strategies to minimize the short and long-term public health impacts of COVID-19 and address inequities in access and care. By teaching policymakers what programs and policies work to improve health equity and access, rigorous evidence can play a fundamental role in helping the nation respond effectively to COVID-19 while building a more equitable healthcare system in the long-run.

Pre-existing inequity in health care delivery and access  

Communities of color have been hit the hardest by the COVID-19 pandemic, reflected in higher infection and death rates for Black, Hispanic, and Indigenous populations. These disparities in COVID-19 diagnoses and deaths are the result of pre-pandemic realities that have long limited access to health care and wealth. Structural factors—such as residential segregation and gentrification, workplace conditions, and economic security—have worked to reinforce and intensify health disparities by socioeconomic status, and contributed to rates of pre-existing health conditions that correlate with higher vulnerability to COVID-19.

Additionally, Black, Hispanic, and Indigenous communities in the United States often have less access to quality health care: even before the arrival of the novel coronavirus they were significantly more likely to be un- or under-insured. Immigrant communities are especially likely to be uninsured, as they are overrepresented in jobs that do not provide health insurance coverage, and undocumented individuals are explicitly barred from accessing most public and employer-sponsored plans.

There is also a history of distrust between these communities and the American health care system stemming from inaccessible care, disparities in health outcomes, a lack of Black, Hispanic and Indigenous physicians, and, for Black Americans, a longstanding history of medical exploitation and abuses dating to slavery.

Contact tracing, a public health tool that asks individuals to divulge personal, detailed information, inherently requires a degree of trust that our healthcare system has failed to earn from many communities of color. The combination of systemic distrust coupled with disparities in the quality of housing, jobs, and care available to communities of color has resulted in disastrous health outcomes for Black, Hispanic, and Indigenous communities during the COVID-19 crisis.

The impact of COVID-19

Amidst a global health crisis that has had catastrophic impacts on public health globally, the United States’ healthcare system has been hit particularly hard: the country has 4 percent of the world’s population, but about 24 percent of its COVID-19 cases and 22 percent of its COVID-19 deaths (as of September 1).

Overburdened hospitals serving the most hard-hit regions are struggling to pay for critical health services amidst rising equipment costs and declining revenues. They are also less able to provide quality primary care, mental health care, and care for chronic conditions in the struggle to funnel resources toward responding to COVID-19.

Deaths from noncommunicable diseases such as heart disease and diabetes have increased during the pandemic, possibly because individuals are afraid to seek emergency care out of fear of being exposed to the virus. On top of this, the United States is facing an unprecedented mental health crisis, with people experiencing higher rates of depression, anxiety, substance use, and suicidal ideation due to coping with the pandemic.

Nationally, Black and Hispanic populations have been disproportionately impacted by the virus, accounting for higher rates of infection and death than would be expected given their share of the national population. Of the 20 counties in the United States that have the highest level of COVID-19 deaths per capita, 11 counties have populations in which Black, Hispanic, or Indigenous people represent the largest racial group.

Adjusting for age, the coronavirus death rate for Hispanic populations is 2.5 that of white populations. For Black communities the numbers are even more harrowing, with Black populations dying at a rate of 3.6 times that of white populations. Part of the reason behind such disproportionate rates of infection and mortality stems from the fact that Black workers, Hispanic workers, immigrants, and women are disproportionately represented in essential, frontline jobs which dramatically increase one’s risk of exposure to the virus.

The economic impacts of the COVID-19 pandemic have had disastrous impacts on health inequities as well: the number of Americans living without health insurance has nearly doubled in size since late February, and families who have been financially impacted by the virus are struggling to pay for basic care. A disproportionate number of those losing employer-based  coverage have been Black and Hispanic individuals. Without coverage, these families are likely to face more barriers to accessing quality care and may face significant negative health impacts as a result.

On top of this, the pandemic has negatively impacted families’ financial stability, which in turn has drastic implications for widening health disparities. As a result of job loss, financial shocks, and reduced income, a growing share of the population is struggling to afford nutritious food, access quality medical care, remain safe and stably housed, and pay for costs related to education—factors which serve as central determinants of health. As state moratoriums on evictions come to an end, an increase in the number of individuals experiencing homelessness and housing instability will leave more communities vulnerable to the virus, as well as vulnerable to long-term negative health outcomes.

Tenants of color are disproportionately impacted by evictions, and cities across the nation such as Boston, Los Angeles, and New York are preparing to see an increase in the rate of individuals experiencing homelessness among Black, Hispanic, and immigrant communities. Within this context, it is becoming more and more clear that addressing health disparities that stem from unequal social and economic conditions is of absolute necessity to fight and recover from COVID-19.

Research to improve health care delivery and expand health care access

The COVID-19 pandemic has already placed an indelible mark on nearly every aspect of the United States healthcare system. To deal with an unprecedented crisis, we need new research demonstrating what works to adapt our health care practices, programs, and policies to best respond to and recover from the pandemic as quickly and effectively as we can.

What are effective and equitable strategies to deliver quality health care given new constraints imposed by COVID-19?

Community health workers are frontline public health workers who are trusted members of the communities they serve. Better understanding how these workers can facilitate access to health, social, and community services in a pandemic setting may be a critical component in ameliorating the impact of COVID-19 on communities with specific health needs, such as Indigenous communities and other communities of color.

Additionally, in a time of social distancing, when many health care services are no longer provided in-person or in clinical settings, it is important to better understand how interventions such as telehealth can be used and adapted to meet the needs of different communities, especially those where health care access is limited.

How can health officials increase take-up of positive health behaviors?

The widespread adoption of positive health behaviors is necessary to minimize the spread of COVID-19. Researchers should work with public health authorities to identify ways to improve take-up of positive behaviors such as wearing a mask, avoiding unnecessary crowds, and, when it becomes possible, receiving the COVID-19 vaccine. Examples of interventions to increase take-up may include information campaigns, direct encouragement to take-up services, or increased access to free masks.

What can health care delivery organizations do to provide accessible and impactful mental health care?

In a period of increased social isolation, uncertainty, and financial stress, accessible and impactful mental health services are more critical than ever. Loneliness and social isolation are linked to poor health and mental health outcomes.

Due to the closure of clinics, provision of mental health services and counseling are more difficult for individuals to access, and for many, accessing counseling is cost-prohibitive. It is critical to have data on the efficacy of innovative strategies to deliver mental health care in this new context, including telehealth and app-based mental health services.

How can health officials address the unique health needs for those experiencing major barriers to health care, including those who are uninsured, incarcerated, or experiencing homelessness?

People without insurance in the United States often minimize their use of health care due to the high cost of seeking care, and may be hesitant to seek out critical COVID-19 testing or treatment. Further, individuals who are incarcerated and those experiencing homelessness represent two groups who are at high-risk of COVID-19 infection, lack access to adequate health care, and are unable to practice the positive health behaviors recommended to limit the spread of COVID-19.

Researchers should work with community agencies and health officials to identify effective ways to encourage the take up of health care for groups who largely lack access to care opportunities. Programs to broaden the reach of mental and physical health care service (such as mobile or telehealth platforms), increase trust in health systems and services, and connect individuals with social safety net programs may be important.

This post is an installation in J-PAL North America's "Building An Effective COVID-19 Response" research guide blog series. The complete series highlights the interaction between COVID-19, research, and the policy areas of health care delivery, jobs and the social safety net, and education. 

The COVID-19 pandemic has had a devastating impact on workers in the United States, leading jobless claims and unemployment rates to skyrocket. Not only does employment provide earnings, skills development, and ties to critical resources such as health insurance, but long-term unemployment is associated with sustained earnings loss, worse health outcomes, and negative intergenerational impacts on workers’ children.

Job and wage losses have disproportionately impacted low-income workers, workers of color, and women, setting the stage for pre-existing racial and gendered wealth and wage gaps to widen. The COVID-19 Recovery and Resilience Initiative aims to identify effective ways to support workers in the face of COVID-19 related job and wage loss by evaluating innovative strategies to boost income and employment and connect workers to social benefits.

Pre-existing inequities in labor markets

In 2019, 44 percent of all workers qualified as “low-wage,” defined as those who make below two-thirds of the median wages for full-time, full-year workers. These low-wage workers earn median hourly wages of $10.22 and median annual earnings of about $18,000, compared to the median hourly wage of $19.33 per hour for all US workers. Low wage occupations include retail sales workers, cooks and food preparation workers, construction workers, and motor vehicle operators. Many of these jobs provide limited opportunities for economic mobility.

Women of all races are overrepresented in low-wage jobs, but this is especially pronounced for women of color. Low-wage jobs in which women are over-represented include food preparation and service jobs, home health aides, child care workers, and cleaning or laundry professionals, among others. Further, Black and Hispanic women in low-wage jobs are more likely to be the primary breadwinners of their families and more likely to have household incomes near the poverty line relative to their white counterparts.

In addition to job segregation by gender, the United States is home to stubborn racial and gendered wage gaps (illustrated in Figure 1). Wage gaps persist when researchers control for educational attainment, pointing to discrimination in the job market.

Workers of color not only face lower wages but also higher unemployment rates than white workers, with the unemployment rate for Black workers historically hovering at or above double the unemployment rate for white workers. Many structural factors contribute to this gap, including the mass incarceration of Black men and racial bias in the hiring process. Hiring discrimination against people of color has been well documented in the experimental literature.

Additionally, when Black or Hispanic workers face job or wage loss, they are less likely than white workers to have savings to cover three months of expenses due to systems that have long limited communities of color from wealth accumulation and access to opportunity.

Lastly, labor market outcomes are closely tied to involvement in the criminal justice system. In the United States, Black and Latinx individuals are arrested, charged, and incarcerated at a higher rate than white individuals. People who have been incarcerated are nearly five times more likely to be unemployed than those who have never been incarcerated. Further, formerly incarcerated people of color and women face even greater barriers to employment despite being the most likely to look for jobs after returning home.

The Impact of COVID-19

COVID-19 has resulted in massive job losses and has exacerbated existing racial and economic labor market disparities. By the end of May, over 40 million workers had filed initial jobless claims—meaning that they are new, not continuing, claimants for unemployment benefits—since the beginning of the U.S. pandemic in mid-March.

Though employment numbers have improved slightly, more than 28 million people were receiving some form of unemployment benefits on August 1, and the number of people applying for first-time unemployment insurance continues to hover at around 900,000 per week in early September.

These numbers do not include people who have lost their jobs but have not filed for unemployment, those who have left the labor force by not continuing to look for work, new graduates who have not found work, those who have lost work in the informal labor market, or undocumented immigrants who have lost their jobs but are not eligible for benefits.

Many businesses that implemented temporary lay-offs in the early stages of the pandemic are now shifting to permanent cuts of their employees, and over 100,000 small businesses have closed for good. Construction, leisure and hospitality, and manufacturing are among the major industries hit hardest by COVID-19 unemployment, all of which employ relatively high shares of low-wage workers.

Consequently, low-income workers have faced the highest rates of job loss. As of late July, more than two-thirds of workers earning a salary of less than $25,000 before the pandemic were out of a job—a number that has continued to rise even as higher-wage sectors have shown signs of recovery.

Over half of all lower-income adults say they or someone in their household has lost a job or taken a pay cut due to COVID-19. These job and income losses have contributed to increased hardships such as difficulty making housing payments and food insecurity.  Many low-income workers are being pushed to draw from limited savings, if available, or take on debt.

The labor market impacts of COVID-19 differ by race. Black and Hispanic workers have faced higher overall rates of unemployment and slower jobs recovery than white workers during the pandemic. Even as job numbers for white workers began to improve in May, Hispanic workers experienced much smaller job gains while unemployment for Black workers continued to rise.

Black and Hispanic workers who were not laid off are more likely to be in frontline and service jobs that increase their exposure to the virus, and more likely to rely on public transportation for jobs that cannot be done from home. This reality has likely contributed to racial disparities in the health impacts of the COVID-19 pandemic.

COVID-19 related job losses have also been gendered. Because of the persistence of job segregation by gender in the labor force, women are more likely to work in jobs eliminated by the pandemic, such those in the restaurant, leisure, and hospitality industries. In May, the unemployment rate for women was two points higher than for men, with Black and Hispanic women facing particularly high joblessness rates.

As noted above, these rates do not account for job losses in the informal labor market, such as the major job losses faced by domestic workers, over 90 percent of whom are women and most of whom are women of color.

Women who remain employed are more likely than men to have work that exposes them to the coronavirus. Further, if day-care centers and schools cannot safely reopen, many women will be unable to reenter the labor force due to the need for child care, as child care duties often fall on women rather than men.

This unequal distribution of child care expectations is exacerbated by the fact that men tend to be paid more than women. Child care closures will disproportionately harm women of color both as child care providers and as working mothers struggling to access care. Further, women who leave work to care for children are no longer considered to be “in the labor force” and will therefore not be reflected in unemployment numbers.

Research to Support Workers

The COVID-19 pandemic has caused massive economic hardship for millions of workers, and exacerbated pre-existing racial and gendered economic disparities. As the United States faces unemployment and sectoral reallocation on a massive scale, new research can identify effective strategies to connect workers to jobs, keep individuals tied to benefits, and train workers to succeed in new industries. 

How can policymakers support those who are unemployed?

One method to support individuals who are unemployed is to ensure access to financial resources to replace lost income. New research can prioritize projects that expand access to social benefits or monetary support for unemployed individuals. Potential important studies may include evaluations of unconditional cash transfers or informational campaigns to ensure tax credit or benefits take-up by eligible individuals, especially when governments grapple with unprecedented demand

Another risk of unemployment in the United States is a loss of health care coverage. To help workers retain health coverage, new research can explore the impact of portable benefits programs that tie benefits to the person rather than to a job or develop interventions to smooth workers’ transition to health insurance through the Affordable Care Act.

What strategies can keep workers connected to employment?

Important questions exist around the short- and long- term impacts of new and different forms of unemployment, including partial unemployment and work sharing strategies that keep individuals connected to their jobs rather than entirely laid off. Such programs continue to provide workers with income, albeit decreased, and keep them connected to benefits. 

Strategic employee sharing programs are also an innovative method to keep individuals connected to work in the face of layoffs. In such a program, employers collaborate to allocate their shared pool of similarly skilled workers to available opportunities. For instance, if one company has furloughed employees but another similar company has increased demand for workers, employee sharing programs can funnel furloughed workers directly into new opportunities.

New projects may also address strategies to support small business owners and enable small businesses to continue to employ staff. This may come in the form of financial training interventions or subsidized employment placements at small businesses. New interventions should also aim to support workers in informal sectors such as care or domestic work by identifying effective methods to compensate workers’ efforts.

What programs can improve the job-search process?

Re-employment will be a key element of economic recovery for families and communities in the face of the COVID-19 recession. New research can investigate effective methods to match job-seekers to available jobs and sectors that suit their skills, though these interventions should focus on connecting workers to quality jobs that support economic mobility. In-person counseling or technology-based job search platforms offer promising opportunities for matching.

Training programs may also play an important role in preparing workers for new positions in the workforce. Virtual reskilling programs can train workers on new skills who lost their jobs due to the pandemic. New research can work to identify effective training or sectoral employment programs that provide participants with valuable education and networking opportunities to shift careers.

As jobs are reallocated post COVID-19, where will opportunities for workers arise?

Researchers should work to understand what sectoral reallocation will look like following the immediate COVID-19 crisis. COVID-19 may reshape the landscape of the job market, particularly for workers in the service industry. Researchers should strive to understand where job opportunities will disappear and where new opportunities are arising. This understanding can shape sectoral employment and training programs to best prepare participants for success upon completion.

Individuals involved in the criminal justice system experience substantial barriers to participating in the labor market. As such, potential research questions to support criminal justice reform are included below.  

How can communities effectively support individuals who have been released from incarceration?

Certain states and local jurisdictions are working to decrease the population of jails and prisons to lower the risk posed by COVID-19. Hundreds of people have been released from jails or prisons early with more releases scheduled.

As individuals are released, researchers can work with community organizations to identify effective strategies for successful re-entry. Further, coronavirus-related early releases present a unique opportunity for researchers to measure labor market and justice outcomes for people who were released early to inform long-term criminal justice reform efforts.

Do decarceration strategies adopted during the pandemic have positive outcomes in a post-pandemic setting?

To reduce crowding in jails and prisons during COVID-19, policymakers turned to policies such as the elimination of cash bail and adoption of early release for people convicted of low-level crimes or people held on bail. These policies have long been the demands of criminal justice reform advocates. The adoption of these policies during the pandemic presents researchers with a rare opportunity to evaluate them. Understanding the outcomes of such policies can inform policymakers’ decisions to scale up or modify such reforms after the COVID-19 crisis has resolved.

This post is an installation in J-PAL North America's "Building An Effective COVID-19 Response" research guide blog series. The complete series highlights the interaction between COVID-19, research, and the policy areas of jobs and the social safety net, health care delivery, and education.