This article, in a slightly edited form, first appeared on Pain News Network on May 2, 2019.

The Titanic carried 20 lifeboats. Only about half of the fabled ship’s 2,207 passengers and crew members could fit in them. Anyone who didn’t get a seat on a lifeboat almost certainly would not survive.

Women and children were saved before the men, but there was social and economic stratification, too. The policy aboard the Titanic was to look after the first-class and standard-class passengers first. Even when the ship was sinking and all passengers were in equally imminent danger, the highest-ranking passengers were given priority during the lifesaving efforts. Third-class passengers, who were situated farthest away from the lifeboats, were left to find their own way to safety.

The outcome was sadly inevitable. Of first-class Titanic passengers, 61 percent survived. Of standard-class passengers, 42 percent lived. Only 24 percent of third-class passengers made their way to safety. Your survival depended on who you were, and on the value others placed on your life.

Some People Are Still Marginalized

Today, we are undergoing a very different disaster, but the same disparities are still in play. Our socioeconomic status, as defined by our education, income, and occupation, is an important factor in the opportunities we are given. It also determines the quality of our lives and our ability to cope with setbacks. The fate of the Titanic passengers is a metaphor for the trajectory of the coronavirus victims today.

During this pandemic, socioeconomic status partially determines which cities and towns get hit the hardest, which populations face the greatest risk, and who endures the highest sickness and death rates.

Wealth Trumps Merit

Business Insider reports, “Many wealthy families are having their private chefs and housekeepers procure and sanitize their groceries.” They may not worry much about coming into contact with the coronavirus, because they can afford to hire people to take nearly all the risk for them.

That said, the Wall Street Journal reports that nearly one-fifth of the population in some states have lost their jobs due to the pandemic. Lower-income workers are most affected.

Essential workers, including health care workers, first responders, law enforcement, grocery clerks, delivery workers, and others, are seen as the heroes of the pandemic. They are keeping the gears of our society running so we can all survive. However, just like the cooks, cleaning staff, and ship maintenance personnel on the Titanic, the humblest workers today face the greatest risk of being left behind or most exposed to the danger.

Some of these heroes have inadequate health insurance, or none at all. Only 47 percent of the bottom 25 percent of wage earners have sick leave, and only 24 percent of them have personal leave.

Everyone Deserves a Fighting Chance

There are racial and ethnic disparities related to the pandemic as well as socioeconomic injustices. That is partly due to the inequities of our health care system and living conditions.

According to the Washington Post, “More than 5 million people who identify as American Indian and Alaskan Native are especially vulnerable” to the virus because of the health care disparities they face. Native Americans experience higher rates of diabetes, cancer, heart disease, and asthma, and all of those conditions put them at a greater risk for COVID-19.

In addition, the New York Times points out that “black and Hispanic people [in the U.S.] suffer disproportionately from poverty, poor health care and chronic diseases like diabetes, hypertension and asthma,” and that they have disproportionately high rates of becoming ill and dying from COVID-19 in New York City, Chicago, Boston, and other cities.

These minority members are less likely to have primary care physicians and access to hospitals with life-saving equipment. They may have been inadequately informed about how they can protect themselves from infection, especially if English is not their primary language. They may live with multiple generations in crowded quarters, making it more difficult to maintain social distancing and self-quarantine protocols, and increasing the likelihood of spreading the virus to parents and grandparents.

It may not be possible for everyone to be treated with equanimity, but the magnitude of the disparity we observe now will only exacerbate the inequality we see after the pandemic. The haves will continue to prosper, while the have-nots will find themselves in a deeper hole. As this occurs, the seeds for further social unrest are being sown.

This pandemic exposes many challenges for our society. But there is probably no greater need than to ensure everyone has access to a lifeboat. Hopefully, decision-makers will agree.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

You can find him on Twitter: @LynnRWebsterMD.