Every day, Constance Warren stands behind the cold cuts counter at a grocery store in New Orleans, watching the regular customers come and go.
They thank Ms. Warren and tell her they do not like being stuck indoors, waiting out the epidemic. She wraps their honey-smoked turkey and smiles.
It is good to have a job right now, the mixed fortune of being deemed an essential worker. But she wonders whether, once everyday life is safe again, people will remember the role she played when it was not.
“Don’t forget that we were open to serve you in your time of need,” she said on a break one recent workday afternoon. “You never know when you might need us again.”
From the cashier to the emergency room nurse to the drugstore pharmacist to the home health aide taking the bus to check on her older client, the soldier on the front lines of the current national emergency is most likely a woman.
One in three jobs held by women has been designated as essential, according to a New York Times analysis of census data crossed with the federal government’s essential worker guidelines. Nonwhite women are more likely to be doing essential jobs than anyone else.
The work they do has often been underpaid and undervalued — an unseen labor force that keeps the country running and takes care of those most in need, whether or not there is a pandemic.
Women make up nearly nine out of 10 nurses and nursing assistants, most respiratory therapists, a majority of pharmacists and the overwhelming majority of pharmacy aides and technicians. More than two-thirds of the workers at grocery store checkouts and fast food counters are women.
In normal times, men are a majority of the overall work force. But this crisis has flipped that. In March, the Department of Homeland Security released a memo identifying “Essential Critical Infrastructure Workers,” an advisory guide for state and federal officials. It listed scores of jobs, suggesting they were too vital to be halted even as cities and whole states were on lockdown. A majority of those jobs are held by women.
Among all male workers, 28 percent have jobs deemed part of this essential work force. Some of the biggest employers of men in the United States are building trades, like construction and carpentry — lines of work that are now, for the most part, on hold.
Men do make up a majority of workers in a number of essential sectors, including law enforcement, transit and public utilities, and millions face serious and unquestionable risk as they head to work every day. But there are simply not as many of these jobs as there are in the industry at the forefront: health care.
There are 19 million health care workers nationwide, nearly three times as many as in agriculture, law enforcement and the package delivery industry combined.
Long before the outbreak, in an aging and ailing country, the demand for health care was almost limitless. The size of this work force has ballooned over the decades as medical advances extended the lives of the sick and well alike.
There are now four registered nurses for every police officer, and still hospitals raise alarms about nursing shortages. Within this massive, ever-growing and now indispensable part of the economy, nearly four out of five workers are women. This is reflected in another grim statistic: While male doctors and nurses have died on the front lines, a recent report from the Centers for Disease Control and Prevention found that women account for 73 percent of the U.S. health care workers who have been infected since the outbreak began.
The nation’s health care industry spreads far beyond hospitals, encompassing a vast army of people who tend to the young, old, sick and infirm. This “care work force,” said Mignon Duffy, a professor at the University of Massachusetts Lowell who studies women and labor, “is part of the infrastructure of our whole society. It holds everything together.” Yet it has long been undervalued, she said, a neglect that is as obvious as ever right now, with acute shortages nationwide of basic safety gear.
“But now we’re being forced to identify who the essential workers are,” Dr. Duffy said. “And guess who they are?”
Aurora Ozanick, the 5-year-old daughter of a nurse and a construction worker in Pittsburgh, makes sense of her parents’ jobs this way: “Mommy fixes people,” she says. “Daddy fixes things.”
These days, Bobbi Ozanick — “Mommy” — continues to report to work at the hospital. Her husband, who was laid off when his job site was shut down, stays home with Aurora. Fixing things can wait. This has been hard to digest for both parents.
“The concept of it was one of the weirdest conversations we’ve ever had,” Ms. Ozanick, 33, said. She told her husband that if things got bad, keeping her at work for long hours and putting the health of those around her in jeopardy, he should go with their daughter to a relative’s house. He wanted none of that. “His plan is to go apply for what’s deemed essential. He used to work in a hospital cafeteria years ago.”
But being essential does not at all mean being well compensated or even noticed.
While women have steadily increased their share of high-end health care jobs like surgeons and other physicians, they have also been filling the unseen jobs proliferating on the lowest end of the wage scale, the workers who spend long and little-rewarded days bathing, feeding and medicating some of the most vulnerable people in the country. Of the 5.8 million people working health care jobs that pay less than $30,000 a year, half are nonwhite and 83 percent are women.
Home health and personal care aides, jobs that earn little more than minimum wage and until recently were even exempt from basic labor protections, are two of the fastest growing occupations in the entire U.S. job market. More than eight in 10 of these aides are women.
“We’re still a part of health care and we’re not recognized at all,” said Pam Ramsey, 56, who has gone years without health insurance working as a home health aide in rural Pennsylvania.
Ms. Ramsey did not set out to do this. In her 20s, she earned a degree from a trade school in auto body and mechanics, one of just three women in her graduating class of 115. But her father was badly hurt working in a coal mine, and the duty of taking care of him fell to her rather than her brothers. She has been taking care of people, paid and unpaid, ever since.
If protective equipment is in dangerously short supply at big city hospitals, it is virtually nonexistent in Ms. Ramsey’s job. She goes to work with no gear beyond what she can find at the dollar store. She does not have a formal letter, like many others have, identifying her as an essential worker. A policeman recently stopped and questioned her when she was out buying medicine.
“People don’t look at us because we have no license, no certificate, no proof that we’re as good as they are,” Ms. Ramsey said. But still she goes to work, bringing whatever rubbing alcohol and peroxide she can get her hands on.
Ms. Ramsey is not alone in having to improvise. While some child care centers are still open for the children of essential workers, this is not true everywhere.
And though educators nationwide are spending long and demanding days teaching online, a young student at home needs an adult there, too. (The federal classification of educator jobs is unclear, so they were not included in the analysis of the essential work force; if they had been, the women’s share of the work force would have been substantially higher.)
As a result, many single mothers who have essential jobs are also facing the added emergency of 24-hour child care.
“This one is helping watch this one’s child while she works the night shift, then she watches hers for the 7-3 shift,” said Keshia Williams, 44, a certified nursing assistant at a nursing home in Scranton, Pa., where the staff members — “99.9 percent of them” women — are trying to cover an ever-growing list of rotations left unfilled by infected or quarantined co-workers.
“Now we are apparently essential,” Ms. Williams said dryly, before describing the critical lack of protective gear where she works. Some N95 masks recently arrived, but she is limited to one a week, an uneasy regimen given that she spends each morning screening residents for the virus. Still, dealing with people face to face is what drew her to her job in the first place. The pandemic has not changed that.
That millions of care workers are “driven by incentives other than purely economic incentives” is in part why this work has traditionally been so undervalued, said Gabriel Winant, a labor historian at the University of Chicago.
It is a type of work that does not produce an object that can be traded or sold, he said; it is simply work that has to be done. “There is a whole system in place to make us not think of this as critical infrastructure,” he said.
Until that system gets a shock.
“I didn’t sign up for a pandemic,” said Andrea Lindley, 34, an I.C.U. nurse at a Philadelphia hospital where scores of coronavirus patients have been admitted. “But I am not going to walk away when people need me.”
Growing up, she wanted to become a doctor, watching her mother come back exhausted and back-sore from long hours as a licensed practical nurse. Health care is harder physical work than people realize — workers in health care and social assistance suffer nonfatal injuries on the job at a rate higher than workers in construction or manufacturing. Ms. Lindley’s mother described the job to her this way: “You work too hard and you don’t get paid enough.”
But Ms. Lindley was attracted to the personal, hands-on practice of nursing. “We are in the rooms way more than the doctors,” she said. It is what she still loves about the job. These days, with her husband unable to find carpentry work and her daughter recovering from leukemia, it is also what makes the job so dangerous.
“I have horrible nightmares knowing I’m going into the hospital the next day,” she said. She felt a sense of deep relief when, on a recent shift, she was transferred to the burn unit.
Across the state, in southwestern Pennsylvania, Crystal Patterson heads to work. Her stepfather was laid off from his airport job, and her parents are unsure what they will do.
For Ms. Patterson, 30, a home health aide, there is less uncertainty. Yes, she has to manage caring for her son, but there is a client in her 90s who is depending on her. So for around $10 an hour, she stays on the job. There is a fundamental question before her, one faced by countless other women keeping the country alive: If she does not do this, who will?
“As a woman, this is nothing new to me,” Ms. Patterson said. “That’s how it’s always been in this country: ‘When we’re sick, get us through this.’”