Few Jails Provide Addiction Treatment, Making Release Fatal

When Tom Derbyshire woke up on the floor of his former jailmate’s house, he didn’t understand what had happened. All he knew was that he was in withdrawal — again — and needed to fix it as soon as possible.

He would eventually learn that he had overdosed while using heroin, possibly laced with fentanyl, with a couple of guys who he met during his recent stint in jail. A few days later, Derbyshire woke up withdrawing and confused again. This time, he was in the bathroom of a Wal-Mart, and he had been revived by paramedics — which meant he had to run, because if the police took down his information, he would probably go right back to jail for violating the terms of his release.

The two overdoses took place within days of each other in early April 2018, both less than two weeks after his release from Atlantic County Jail in New Jersey. Derbyshire, a 40-year-old tile setter with a history of opioid addiction, had been picked up for a bench warrant and a probation violation related to drug use.

He spent two months inside, during which he was involuntarily detoxed from opioids. He described the jail’s withdrawal protocol as two daily cups of a sports drink while being held on 23-hour lock down in a cell with two other men. Every other day or so, someone would check his vitals, and that was it. No methadone, no follow-up care after his release. And Derbyshire isn’t unique. In his case, he was not able to get methadone because he had not been incarcerated enough — one of many requirements at his facility’s program.

David Kelsey, the Atlantic County Jail warden, commented that “since its inception [the methadone treatment program] has provided services and referred to treatment eight hundred individuals.” In most other facilities, evidence-based treatment is not offered to anyone. But unlike Derbyshire, many of those who overdose after release don’t get up again.

As the nation struggles to slow the spread of the novel coronavirus, jails and prisons are beginning to release groups of people who are deemed safe for community return. Detention facilities in the United States are notoriously overcrowded, making them transmission hotbeds should the virus find a way in. Already, staff and inmates have tested positive in facilities in Florida, New York, and other places around the nation. California recently announced plans to release 3,500 people from state prisons, and New York City has already released 900. Montgomery County, Alabama, released over 300 people. The majority of people being identified for early release are those who have been accused or charged with non-violent offenses, many of which involve drugs.

A study out of Washington State found that in the first two weeks post-release, the relative risk of fatal overdose among former inmates was 129 times higher than the general population. A longitudinal study out of North Carolina found the risk of fatal overdose was 40 times higher than the general population in the first two weeks after release; for heroin users specifically, the risk was 74 times higher. And a 2019 article published in the journal of Addiction Science and Clinical Practice named post-release opioid-related overdose the “leading cause of death among people released from jails or prisons.”

The reasons behind this dramatic rise in risk are complex. The most obvious factor is that when people are forcibly detoxed from opioids but not provided adequate treatment for the underlying addiction, they return to their communities with significantly decreased tolerance but no more tools to help them deal with cravings than they had when they went in.

“They’re not cured, they’re not treated, they’re not in recovery, they just haven’t been able to use,” said Lipi Roy, a clinical assistant professor at NYU Grossman School of Medicine and an internal medicine physician who specializes in addiction. “Whether [the period of incarceration] be three months or three years, it doesn’t matter … The brain doesn’t forget.”

But new research suggests it’s not just a matter of simple tolerance. The unique social, environmental, and psychological factors faced by people who were recently released from incarceration also contribute to the enormous elevation in overdose risk. Now more than ever, as community supports shutter or limit their services in response to the pandemic and people are urged to stay home, those being released from incarceration are entering a new world filled with more stress and less stability and support than ever before.

“Decarceration without re-entry support systems is only going to be a halfway measure,” said Sheila Vakharia, the deputy director of research and academic engagement at the Drug Policy Alliance. “You can’t let people walk out the doors and assume they will be safer outside than inside.”

“If you think of a person in this situation, they may not have a place to live or the same social networks as when they went in. They might be more worried than usual of being arrested so they may be more likely to inject in hidden places and alone and to rush the shot,” said Megan Reed, a PhD candidate at Drexel University’s school of public health and the principal investigator in an NIH funded study on overdose risk after release. “Very few of the harms we associate with drug use have to do with the drug itself or the actual drug impact on the body; it’s the conditions in which somebody is using.”

The brain doesn’t forget.

Incarceration is a highly destabilizing experience that carries a host of other potential negative outcomes. While incarcerated, people are at risk of losing employment, housing, and even custody of their children, especially during long periods of detainment. Furthermore, the stigma associated with arrest and incarceration, or simply the difficulty and expense of communicating with the outside world while behind bars, can disrupt important familial and social relationships, leaving people with a smaller and weakened support system upon release.

Reed also pointed out that many people who have criminal justice involvement enter the system at heightened risk of fatal overdose. For example, people experiencing homelessness are at both heightened risk of overdose and incarceration. Rates of HIV and mental illness — both independent risk factors for fatal overdose — are also high in detention facilities. Many of these are also thought to be risk factors for severe cases of COVID-19, adding an extra source of anxiety for vulnerable people during the outbreak.

This pre-arrest susceptibility combined with decreased tolerance and the stress and uncertainty that people are facing after they have been released from jail or prison creates a perfect storm of dangerous vulnerabilities. “You have concentrations of other overdose risk factors already inside, and the communities that people are returning to are the same communities that are most impacted in the first place,” said Reed.

Exacerbating all of this is a lack of access to the most effective treatments for addiction to opioids, methadone and buprenorphine. Both are opioid-agonist medicines that reduce craving and withdrawal by filling the same receptors as short-acting opioids like heroin, but without delivering a euphoric high in patients who are properly maintained. They are both approved by a slew of licensing bodies, including the World Health Organization, which has included them on the list of essential medicines because of their proven efficacy in treating opioid use disorder and reducing harmful consequences of use, such as fatal overdose. Unfortunately, the majority of detention facilities in the United States do not offer these medications to inmates who are not pregnant.

“Because most correctional facilities still don’t offer standard of care treatment for opioid use disorder with methadone or buprenorphine, people are released not on treatment back to the community. Unsurprisingly, recurrence rates for opioid use are high and because people’s tolerance is reduced their risk of overdose increases dramatically,” said Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital and an assistant professor of medicine at Harvard University.

The federal government recently loosened regulations around the prescribing of methadone and buprenorphine during the pandemic, but did not address access to people who are currently incarcerated.

Research has shown that maintaining people on medications for opioid use disorder while incarcerated and providing low-barrier referrals upon release will dramatically reduce the post-incarceration overdose rate. Wakeman and other experts also suggest dispensing naloxone, the drug that can reverse an opioid overdose, to people who are being released back into the community.

Spurred by lawsuits and activism, an increasing number of facilities are beginning to offer access to these medicines, but the majority of detention centers remain reticent. This is unlikely to change without a major shift in the way the criminal justice system views and handles drug use and addiction.

“Our justice system is the biggest houser of people with substance use disorders and mental health disorders in this country,” said Vakharia. “[But] they weren’t built for this…they were built to house the ‘bad guys’ in the most simple understanding of how that works and what that means. They were never built or staffed to think of the long term, nuanced needs of people with these multifaceted challenges.”



COVID-19 Proves San Francisco’s Housing Crisis Is A Health Emergency

Ako Jacintho remembers when people weren’t living in tents on the streets of San Francisco. Or if there were tents, there weren’t encampments. This was back in the late ‘90s, right at the base of the first tech boom, years before displacement and gentrification, before there were SARS and MERS and the newest novel coronavirus, which causes COVID-19.

The spread of this coronavirus coincides with the greatest number of unsheltered residents living on the streets of San Francisco: about 8,000 adults, 71 percent of whom once had a permanent home in the city. Jacintho, the director of addiction medicine at HealthRight 360, a clinic that has provided comprehensive support to people experiencing homelessness for over 50 years, says health care practitioners who serve those experiencing homelessness are rushing to aid a population that has long been forgotten by the city.

Physicians and other care providers say what’s notable about the city’s response in assisting the most vulnerable San Franciscans is that the strategies deployed during the emergency are exactly the tools city leaders had been dragging their feet on implementing, such as stopping police sweeps, working with hotels to set up housing, and making sure those experiencing homelessness have access to comprehensive preventative health care.

California’s Bay Area was one of the first regions in the country to institute a shelter-in-place order, which drew ire among advocates. At first, those experiencing homelessness were exempt from the order, and later were advised to “seek shelter.” How exactly were the tens of thousands of those suffering from homelessness supposed to follow the order? And, because sheltering in place is the centerpiece of the public health response to the pandemic, how do we provide everyone with the space and security to follow these recommendations?

These are exactly the kinds of questions that Margot Kushel, a physician at Zuckerberg San Francisco General Hospital and Trauma Center, the city’s safety net hospital, thinks about. “There is no medicine as powerful as housing,” she says. “Homelessness is completely incompatible with health.” Housing stability has manifold impacts on those experiencing homelessness, and studies have shown that nearly 90 percent of recipients of organization-supported rehousing or rental assistance are housed in permanent homes a year after their initial transition.

Kushel, who has advised on what model policies should look like to help people make the transition from living on the streets to secure housing, says city medical teams are now conducting direct outreach to those living in unstable housing, like tents. Based on age and other medical vulnerabilities, physicians help those living on the streets understand what their options are for locating temporary shelter. Given that shelter is the first priority of physicians and policy makers, the epidemic has exposed how closely tied housing and health are.

The epidemic has exposed how closely tied housing and health are.

Shelters, which typically offer clients housing for a set number of months, have relaxed some of these requirements and the city is working to make 6,555 hotel rooms available. But it’s work that has to be conducted carefully; the city can’t force someone to live in a room that’s not in their neighborhood or is located away from their community. “That’s a huge thing for the homeless population,” Jacintho says, “the shuffling of them to shelters.” This temporary housing is also the first step in seeking permanent housing solutions, not an ultimate solution.

Educating those seeking aid has made some of the everyday care work more complex. In pre-COVID times, Jacintho says, he would sit face to face with a client to go over their needs, symptoms, progress, and concerns, but now he’s communicating with them via a computer or a phone. Telemedicine might be a natural shift for someone who uses devices every day, but for those experiencing homelessness, Jacintho says it’s “definitely a shift for [his clients] culturally.”

The outbreak has meant a downturn in those coming into clinics, for others. Chuck Cloinger, the chief medical officer at St. James Infirmary, an occupational and health safety clinic for sex workers in the Bay Area, says that their mostly-volunteer team has focused on street support in order to aid clients.

Cloinger and his team are focused on making sure that essential health services that may not appear to be directly related to coronavirus management don’t fall through the cracks. Though they’re no longer conducting health screenings in their mobile clinic, the St. James Infirmary van goes out once a week to facilitate needle exchange and deliver other essential goods like hot foods and groceries.

At first, the spread of COVID-19 among unhoused residents was slower than those with shelter, but as of April 13 at least 90 people at a shelter in the city have tested positive. Unsheltered San Franciscans are already medically vulnerable, and with coronavirus testing still lagging far behind the necessary levels, the true number of impacted unsheltered residents is unknown.

If anything, Kushel hopes the recognition of homelessness as a public health crisis in and of itself — and one that can be remedied or even eradicated through systemic change — is a matter of what she calls “political will.”  Even though San Francisco voters passed Measure C in 2018, which would tax large companies to fund services for those experiencing homelessness, the money is still tied up in court. With early action from the San Francisco Department of Public Health and coordination with hotels to mitigate coronavirus as a public health concern, advocates may be right to wonder when it is that living on the streets without shelter will be seen as an issue of public concern as well.

The San Francisco Homeless Outreach Team was unable to respond to a request for comment.




Food Banks Are Struggling to Meet Demand During the Coronavirus

The Community Action of Napa Valley Food Bank (CANV) stands about 15 miles down the road from the world-class vineyards that made the region famous. It primarily serves workers who keep that industry running: mostly Latinx families, many undocumented, who maintain the vineyards’ landscaping, clean their properties, and perform other kinds of “unskilled” labor that people are now discovering requires, actually, quite a lot of skill.

They are considered “working poor,” a classification that simply means they are not paid enough. Many of these families are regulars at CANV, visiting the market-style food bank once a week. Before the coronavirus crisis began in earnest, the organization served about 30 to 40 of these workers and their families a day, three days a week.

Almost overnight, that number has tripled.

Food banks, like unemployment numbers, act as a weathervane for determining the severity of our current crisis — and the crisis is severe. But they are not built to single-handedly tackle the increased demands these crises create.

As of the first week of April, 17 million Americans have applied for unemployment insurance, shattering a decades-old record and providing a clear look at the unprecedented scale of the current economic and health crisis. According to an early April estimate from the Economic Policy Institute, that number could reach 20 million by summer. Though the President signed a relief bill in late March that bolsters unemployment insurance and will issue direct cash payments to low and middle-income Americans and families with children, it will be months before most people receive that help — and undocumented families will never receive it at all.

The Supplemental Nutrition Assistance Program (SNAP), which could help people immediately, received relatively little additional funding. Food banks will be, as always, left to pick up the slack.

Food banks in Napa, Contra Costa and Solano, and Humboldt counties all report higher demand than they’ve ever seen, topping last year’s record-setting wildfires. Food is harder to track down since hoarding has decimated supply chains and shelter in place orders have constricted the supply of volunteer workers, most of whom, staff say, are over 65 and more vulnerable to complications from the novel coronavirus. As a result, demand is up, supplies are strained, and the labor needed to distribute them is increasingly unavailable.

Already-strained food banks are now left scrambling.

At Humboldt county’s main food bank location, nearby construction crews had to volunteer to help manage crowd control, freeing up the remaining regular volunteers and staff to develop and run a drive-thru model that reduced person-to-person contact. Contra Costa and Solano counties in the Bay Area are moving towards a home delivery-only system, but the labor-intensive delivery strategy is only possible with the support of the National Guard, which started providing 1,000 hours of service per week for the food bank at the end of March. Across the state, an increasing number of food banks were looking to do the same, seeking the Guard’s help with deliveries, crowd control, and assembling supplies.

But for many of the people relying on these resources, the sight of uniformed law enforcement is not necessarily a comforting one. Each food bank, regardless of location, noted the profound anxieties that uniformed law enforcement trigger in their Latinx and undocumented communities. In Napa County, Immigration and Customs Enforcement (ICE) raids have terrorized the close-knit town. In one particularly traumatic instance, ICE apprehended a father at his child’s school after morning drop-off. To many, gathering as a community at a law enforcement-run food drive-thru feels like a bigger risk than their current desperate circumstances.

Food banks are not intended to be the first line of defense in the fight against hunger, but a place to turn to when other options like SNAP, WIC, free and reduced school meals, and unemployment insurance aren’t enough. When these programs are properly funded, they work. The last time America was on the brink of economic collapse, in 2009, the most successful policy in Congress’ $800 billion stimulus package was its SNAP expansion. For every $1 in additional funding, $1.74 was generated in economic output.

Because SNAP was mostly sidelined in the COVID-19 response, already-strained food banks are now left scrambling.

Each problem these California food banks face is exacerbated by the coronavirus pandemic, but the problems themselves are not new. Increased demand, dwindling supply, and a lack of capacity to meet their communities’ need has been their daily reality long before this crisis. The overwhelming need they’ve been forced to meet so far definitively shows how catastrophic this crisis already is. The federal government’s plodding and inadequate response to it shows why these communities were so precarious to begin with.



One Way to Fight Coronavirus: End Cash Bail

Recently, I was joking with a homie who also did time that the social distancing directives around the world mean people are getting a snippet of what a prison lockdown is like. I experienced my first lockdown after less than a week inside: Two friends pummeled a third, a former friend. Within seconds of COs breaking up the fight, the rest of us were ordered into our cells until hours later.

During that time some of us did push-ups, others laid on their cots and read, some used the time to write letters or look at their legal work; a few napped, and most of us did a mixture of them all until the jail unilaterally decided that it was safe for us to come back out.

Social isolation is the current fate of most people in this country, and we are all tussling with the dual stressors of our newfound isolation and fear of the virus. But the millions of people in jails throughout the U.S. who can’t afford bail are facing a form of isolation that’s much more severe. If you think it’s hard to share your apartment with your spouse, trying stepping into your bathroom for the next two weeks, along with hundreds of other people, all while a pandemic is preventing your family from being with you during this time of crisis. And that’s just to get your day in court.

Even before the current crisis, states like Alaska, California, and New Jersey had taken the humane position of ending cash bail, so that those awaiting trial no longer have to pay up in order to leave jail while they wait to see if they are proven guilty or innocent. New York followed suit in January, but rolled back key bail reforms last week via a budget package.

Now that the country is battling coronavirus, it’s even more important to end cash bail. Jails are full of public health hazards: A large number of people share a small space, often with limited access to soap, so infectious diseases can spread rapidly. In addition, the prison population is aging quickly — the number of incarcerated people over 55 has ballooned by 400 percent since 1993 — increasing the risk of serious illness. Holding people before trial increases the likelihood that they’re exposed to the novel coronavirus, making them more likely to spread COVID-19 in the prison and after their release.

We’re already seeing this spread take place. As of April 6, more than 600 prisoners and staff members at Rikers Island have tested positive for COVID-19. Four staff members and one incarcerated person have died. Nearly 300 prisoners and staff have tested positive in Cook County, Illinois, and at least two two inmates have died of the virus in Louisiana. And while some cities, like Los Angeles, are responding by releasing, the Federal Bureau of Prisons has opted to place all 167,000 federal prisoners under lockdown. While the world is in search of a vaccine, the commonsense reaction would be to reduce places of contagion.

Humans are not viruses.

Still, some are opposed to bail reform, citing a jump in crime numbers from the first two months after New York ended the practice as evidence of the need to repeal bail legislation. Lawmakers in Alaska attempted to roll back their bail reform legislation after just a couple of months. Law enforcement and the bail bonds industry have mounted claims of an uptick in crime in the brief implementation of the new laws. Their underlying argument is that the world of criminals has been studying new bail laws and conspired to take advantage by committing more crimes while awaiting their day in court. Lies and fear cajole the public into believing that bail reform is criminal justice reform going too far. Even progressive Democrats backpeddled.

Less than six months is not enough to prove ending money bail causes any increase in crime.

New Jersey ended cash bail in 2017 and has seen major crime and pretrial populations fall by double-digit percentages. Offenses like robbery and homicide are down by 30 percent, and there were “6,000 fewer people incarcerated under criminal justice reform on October 3, 2018 compared to the same day in 2012.”

But now those statistics are backed with something: The tiniest shred of experience. The country has gone through self-imposed quarantines, governmental prohibitions on gatherings of groups larger than 10, and containment zones that could make it easier to understand the experience of incarceration even without studying those numbers.

Should innocent until proven guilty people, like you, be isolated in a cage?

Have we forgotten the motivation behind bail reform in America? A 16-year old child, Kalief Browder, committed suicide because of the trauma associated with his indigence. He spent two years in jail because he could not afford bail. Prison beat his soul physically and emotionally. The country was horrified. Jay-Z made a documentary about him. There was a collective awakening that the concept of money bail was an arcane law that penalized poor people who came into contact with the criminal legal system. Elected officials were championing the cause for bail reform. And yet for some reason, we stopped.

The inhumanity of the notion that bail reform will be rescinded, especially in the era of COVID-9, should compel us to question our civil society. We should want fewer people contained in the petri dish of incarceration in order to prevent the spread of the disease, and in order to prevent people who literally cannot escape their surroundings from being infected. There’s simply no reason to be holding people in cells where they could contract the disease simply because they are too poor to get out.

Humans are not viruses. And no segment of humanity should be considered dispensable, convicted or not. Ending money bail is efficient and humane and should be allowed more than a just a few months to prove its overall success.



Everything You Need to Know About Today’s Instacart Strike

On March 25, the U.S. became the leading country in the world for coronavirus cases. As of March 30, there were more than 140,000 confirmed cases and 2,400 deaths, according to a Johns Hopkins University database.

Cities have all but shut down in response to public health advisories. Millions of people are working from home or other non-office locations in order to honor “social distancing,” leading to a surge in home deliveries for app-based workers like Instacart’s Shoppers, who are tasked with shopping and delivering customers’ groceries. Instacart itself reported that Shoppers have seen on average a 15 percent increase in basket sizes.

However, despite the heightened risk that Shoppers are facing by doing the work that is considered too dangerous for the general public, Shoppers say Instacart hasn’t made much of an effort to protect them from potential transmission or incentivized them to cease working despite the risks it poses.

Instacart initially said it would give two weeks’ paid leave through April 8 to any Shopper who tested positive for the coronavirus, despite the fact that tests are rarely accessible . However, one Shopper TalkPoverty spoke to said that they didn’t know a single person who had received paid sick leave.

In response, Instacart Shoppers nationwide walked off the job March 30, their second strike in four months, and are refusing to return until their demands are met. Because gig workers like Instacart Shoppers work alone, they rarely have face-to-face contact with one another, highlighting how extraordinarily prepared they must be to conduct a large-scale labor action such as this.

In a Medium post announcing the strike, Instacart Shoppers working with labor organization Gig Workers Collective wrote that they were demanding an added $5 of hazard pay per order as well as provision of complimentary sanitation supplies such as cleansing wipes and hand sanitizer, paid time off for Shoppers with preexisting conditions that put them at high risk if they contracted coronavirus or whose doctors advised them to self-isolate, and an extension of these benefits beyond April 8.

“Instacart has turned this pandemic into a PR campaign, portraying itself the hero of families that are sheltered-in-place, isolated, or quarantined,” Gig Workers Collective wrote.

“Instacart has refused to act proactively in the interests of its Shoppers, customers, and public health, so we are forced to take matters into our own hands. We will not continue to work under these conditions. We will not risk our safety, our health, or our lives for a company that fails to adequately protect us, fails to adequately pay us, and fails to provide us with accessible benefits should we become sick.”

Instacart Shoppers can make as little as $7 for up to three orders or $5 for up to five deliveries only, due to the company’s opaque algorithm structure for compensation, and aren’t automatically entitled to employment benefits such as sick leave or health care due to their independent contractor status. Some have argued that they are being misclassified and should be termed employees. In a historic first, the CARES Act, which President Trump signed into law March 27, extended unemployment benefits to gig workers. However, because these benefits are taxpayer-subsidized, they relieve gig companies like Instacart of any legal obligation to provide employee benefits.

Matthew Telles, a veteran Shopper in the Chicago suburbs, said that while he makes himself available on the Instacart app to work for as many as 77 hours a week, the amount of time he actually spends working for Instacart has dwindled since fewer and fewer batches can actually cover his expenses.

“I work anywhere from about zero to eight hours a week for Instacart, and that’s [only] when they pay enough to obtain my secured services,” he said, adding that the pandemic has driven down wages even more.

He explained that since authorities began encouraging people to stay home, Instacart has essentially begun bundling three orders into one by combining multiple “orders” into one batch. That allows the company to elide per-order pricing, leading Shoppers to accept batches that may promise a large amount of money that decreases when they reach the actual register to check.

If a customer asks for, say, 20 unique items, Shoppers are guaranteed a base pay plus tip that’s a particular percentage of the entire order. However, because grocers are now limiting the quantity of particular items one can buy, such as toilet paper and wipes, Shoppers are forced to buy less of a particular item, allowing Instacart to pare down the guaranteed wage and tip for every item a Shopper can’t secure for a customer.

On top of that, Telles added, Instacart is capitalizing upon laid off workers’ desperate need to pay the bills by ramping up their operations. On March 23, Instacart CEO Apoorva Mehta announced plans to hire 300,000 new Shoppers in response to anticipated customer demand over the next few months.

“They’re not vetting who’s a Shopper now,” Telles said. “It’s pretty much — if you’re alive, you can be a Shopper.”

Vanessa Bain, a Silicon Valley-based Shopper and founder of Gig Workers Collective, agreed.

“It’s going to be a disaster if [Instacart] is successful in hiring 300,000 people,” she said. “Veteran Shoppers are breaking down. The last time I shopped, I had an anxiety attack. And that’s just speaking about veteran Shoppers who are used to the general stress of the job. I can’t imagine what it’s like for new people just getting their footing. It’s really uncharted territory, shopping during the middle of a pandemic. People aren’t respecting social distancing in grocery stores.”

Bain added that because she lives with multiple elderly people who are at high risk of contracting coronavirus, she hasn’t shopped since March 13.

We’re out here risking our lives.

Sarah Clarke, another Gig Workers Collective organizer, said Instacart was capitalizing upon the divide between its corporate employees, who are guaranteed benefits such as health insurance and remote work, and that of Shoppers, whom many cities and local governments consider “essential workers” but aren’t treating as such.

“Instacart knows there are workers who can afford to stay at home and shelter in place, and then there are workers who absolutely need the money and who will work under any conditions because they have to,” Clarke said. “But you can’t really fault someone who’s working while they’re sick if they absolutely need to [to pay their bills].”

Above all else, however, all three organizers TalkPoverty spoke to said that the strike was being conducted out of concern for Shoppers’ customers, who bear the brunt of the risks they say Instacart is forcing them to shoulder by not guaranteeing basic sick leave and protective equipment.

“If [Shoppers] get the virus, most likely we will pass it on to customers,” Clarke said. “Lots of Shoppers are living in fear because they’re terrified they’ll pass it on to customers.”

“We’re the people customers interface with,” Bain said. “Most people who have ordered [from Instacart] are doing so to comply with the shelter in place, and to mitigate the risk of spreading disease. It’s literally now a matter of public health and safety.”

“It’s reckless,” Telles stated, speaking for himself, not the strike organizers. “We’re out here risking our lives. If I were a state official, I’d bar Instacart from my state.”

Following the strike announcement, Instacart almost immediately updated its policies. In an email to TalkPoverty, the company said it had extended its paid leave through May 6 to anyone who had been ordered by a state, local, or public health official to self-isolate or quarantine, but made no mention of Shoppers’ demands for personal protective equipment (PPE) or added hazard pay. Instacart added on Sunday that it would allow customers to set their own default tip payment, but workers said it’s not enough: The company is still refusing hazard pay and expanded sick pay.

But it’s too little too late, Bain said.

“We all have the potential of becoming vectors. Everyone’s a stakeholder. The stakes are very different from normal working conditions. Nobody should be against the idea of workers having safety measures to keep their customers alive and themselves safe.”

Editor’s note: This post has been updated to clarify Instacart’s compensation structure for batch orders.