Only when her shift is over at 7 a.m. and she’s driving home, along empty, “eerie” streets, does she let her mind wander: What the hell am I doing? she thinks to herself. Oh my God, this is scary.

Nursing-home employees, nurses, and home health-care workers—the majority of whom are women—are at the forefront of the coronavirus crisis, and they have long been underpaid, overworked, and under-resourced. Registered nurses can expect to make less than $72,000 annually at the median; home health- and personal-care aides earn just $24,000 a year. A quarter of home care workers are uninsured.

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These phenomena are common in majority-female industries. Women dominate 23 of the 30 lowest-paying jobs in America. In occupations where women make up more than half of the workforce, weekly compensation is roughly 15 percent lower than for jobs predominantly filled by men. In fact, as soon as women flock to any given profession, pay drops. According to Ariane Hegewisch, program director of employment and earnings at the Institute for Women’s Policy Research, care work, which “traditionally was done in the home for free by women” is particularly undervalued; these jobs pay less than others that require similar levels of education and skill.

The fact that these jobs compensate people poorly and burn them out quickly means that health-care workers have been in short supply across the United States for years. Now, it has deepened the coronavirus crisis, as staffing shortages are colliding with a huge increase in patients. “Nobody wants to stay in these jobs because you don’t earn enough and you don’t get treated well enough,” Hegewisch said. “The fact that we come into an existing underinvestment in staff [makes] it harder to respond now.”

Health-care workers are setting up COVID-19 wards and makeshift field hospitals, putting in long hours, and wearing protective gear fashioned from trash bags and swim goggles. Nurses and nursing-home staff are already starting to get sick and die, and those who haven’t contracted the virus know that they don’t have the time off or the financial cushion to cope if—when—they do. Without paid leave—and after healthcare workers were mostly exempted from Congress’s paid leave expansion in its aid package—“you’re super exposed, [but] you have much less choice about stepping back, so you have to work,” Hegewisch said.

“This layer of protection around you is super brittle,” she added. “Any little thing can pierce it.”

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When Hughes first began her career, she was responsible for 18 patients who needed hands-on care for the most basic tasks: eating, bathing, dressing, walking. Even then, she told me, “I felt like I didn’t have enough time to take good care of people.” Things have improved, but the nursing home still doesn’t have enough staff. Then came the coronavirus. Some of Hughes’s co-workers opted to stay home for fear of contracting the virus—one colleague is in her 50s and has respiratory issues; another is seven months pregnant—so when we spoke, Hughes was responsible for 16 patients. “Staffing is pretty abysmal,” she said.