The spread of the novel coronavirus and the disease it causes, COVID-19, is driving massive disruption of financial markets, exposing huge gaps in government preparation and focusing worldwide attention on citizen health. Amid the upheaval, however, we still find that those who are far too often unseen and unheard are once again in the crosshairs of disease and death. These are truly our most vulnerable communities: lower-income people, people of color and indigenous peoples.

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After 20-plus years of working at the highest levels on responses to both natural and man-made disasters, I know firsthand what can happen to vulnerable communities when their lives and unique challenges are ignored while governments struggle to react. We must prioritize underserved communities by being willing to place the resources and expertise in the areas that are most at need.

Public health pioneer and former Army Surgeon General William C. Gorgas explained it best when he said, "In times of stress and danger such as come about as the result of an epidemic, many tragic and cruel phases of human nature are brought out, as well as many brave and unselfish ones." We are now at the eve of the coronavirus epidemic and it provides an opportunity for us to be brave and unselfish. If we fail, our most vulnerable – those always hit first and worst – will unfortunately pay a higher cost.

Let me break it down for you: There has been a health crisis in vulnerable communities for decades.

Yes, the elderly are among those most in danger from infection by the COVID-19 virus. But people in communities that have been impacted by pollution for decades are also in danger, because they face an elevated risk of underlying conditions that increase vulnerability to the coronavirus.

Front-line communities feeling the disproportionate impacts of pollution are dealing with serious chronic medical conditions and underlying health problems, and no one seems to be talking about them in a substantive way. These communities are more at risk of cancers, high blood pressure, chronic respiratory disease, diabetes and liver and kidney disease – just to name a few daily realities of the public health crisis, in the absence of environmental justice.

These communities are also dealing with a serious lack of trust in their government, spurred by numerous rollbacks of basic protections needed to protect their health and their lives. And trust is essential in an epidemic, when individuals are asked to make sacrifices for the greater good.

To compound the public health challenges already facing front-line communities, we have more than 80 million people in our country who are uninsured or underinsured and forced into unacceptable choices between purchasing their medicine versus putting food on the table. As the economy slides, workers face layoffs and unpaid sick days, threatening to push an untenable situation over the brink. What can low-income folks do, without insurance and financial resources to draw on in a crisis?

Many of our communities of color – in both rural and urban areas – are also living in medically underserved areas, needing to travel great distances to reach basic health care. Research has highlighted that there is racial bias in medicine that leads to worse care for black and brown people and that the treatment often received is substandard. Having this knowledge means we have to put safeguards in place as doctors are deciding who will and will not get testing for the virus, and who may be left exposed to unnecessary harm.

The question for many communities of color is quite simple: Why would we trust an administration that has never prioritized our lives in the last three years to do so now? Former President Barack Obama shared with the country that "if the people cannot trust their government to do the job for which it exists – to protect them and to promote their common welfare – all else is lost."