Liz Szabo, Kaiser Health News and Hannah Recht
It began with a headache in late March. Then got here the physique aches.
At first, Shalondra Rollins’ physician thought it was the flu. By April 7, three days after she was lastly recognized with COVID-19, the 38-year-old educating assistant informed her mother she was feeling winded. Within an hour, she was in an ambulance, acutely aware however struggling to breathe, sure for a hospital in Jackson, Mississippi.
An hour later, she was useless.
“I never in a million years thought I would get a call saying she was gone,” mentioned her mom, Cassandra Rollins, 55. “I want the world to know she wasn’t just a statistic. She was a wonderful person. She was loved.”
Shalondra Rollins, a mom of two, had various components that put her at larger danger of dying from COVID-19. Like her mom, she had diabetes. She was black, with a low-salary job.
And she lived in Mississippi, whose inhabitants is among the unhealthiest within the nation.
She was considered one of 193 Mississippi residents who’ve died of COVID-19, and considered one of greater than four,800 with confirmed illnesses.
Doctors know that folks with underlying health conditions ― resembling the 40% of Americans who dwell with diabetes, hypertension, bronchial asthma and different power ailments ― are extra weak to COVID-19. So are sufferers with out entry to intensive care or mechanical ventilators.
Yet some public well being specialists contend that social and financial circumstances ― lengthy ignored by authorities leaders, policymakers and the general public ― are much more highly effective indicators of who will survive the pandemic. A poisonous mixture of racial, monetary and geographic drawback can show lethal.
“Most epidemics are guided missiles attacking those who are poor, disenfranchised and have underlying health problems,” mentioned Dr. Thomas Frieden, a former director of the Centers for Disease Control and Prevention.
Federal well being officers have recognized for practically a decade which communities are more than likely to endure devastating losses ― each in lives and jobs ― throughout a illness outbreak or different main catastrophe. In 2011, the CDC created the Social Vulnerability Index to price all of the nation’s counties on components resembling poverty, housing and entry to automobiles that predict their skill to prepare, cope and recover from disasters.
Yet the nation has uncared for to reply to warning indicators that these communities ― the place individuals already live sicker and die younger than these in additional prosperous areas ― might be devastated by a pandemic, mentioned Dr. Otis Brawley, a professor at Johns Hopkins University.
“This is a failure of American society to take care of the Americans who need help the most,” Brawley mentioned. Although vulnerable counties are scattered all through the nation, they’re concentrated throughout the South, in a belt of deprivation stretching from coastal North Carolina to the Mexican border and deserts of the Southwest.
Some of essentially the most weak communities are in Mississippi, which has the highest poverty rate of any state; Indian reservations in New Mexico, the second-poorest state, the place 1000’s of households lack operating water; and cities resembling Memphis, Tennessee, a sizzling spot for bronchial asthma that not too long ago ranked among the many backside 15 metro areas in providing protected, livable housing to its residents.
The first U.S. COVID-19 instances had been detected in metropolitan areas, with Hispanics and blacks making up a disproportionate variety of deaths in New York City. Outbreaks at the moment are flaring in rural communities, the South and Upper Midwest. Both the New Orleans and Albany, Georgia, areas have an infection charges above 1% of their populations. More than 1,600 people have been recognized with COVID-19 within the Sioux Falls, South Dakota, residence to a meat-packing plant that employs immigrants and refugees from all over the world.
Whether COVID-19 sufferers dwell or die in all probability relies upon extra on their baseline well being than whether or not they have entry to an intensive care mattress, Brawley mentioned. Some hospitals report that solely about 20% of COVID-19 patients on ventilators survive.
Many public well being specialists concern that COVID-19 will comply with the identical trajectory as HIV and AIDS, which started as a illness of massive coastal cities ― New York, Los Angeles and San Francisco ― however shortly entrenched in the black community and in the South, which is taken into account the epicenter of the nation’s HIV/AIDS outbreak right now.
Like HIV and AIDS, the primary COVID-19 instances within the United States had been recognized in “jet-setters and people who traveled to Europe and other places,” mentioned Dr. Carlos del Rio, professor of infectious ailments on the Emory University Rollins School of Public Health. “As it settles in America, [COVID-19] is now disproportionately impacting minority populations, just like HIV.”
Mississippi: The Legacy Of Segregation
One in 5 Mississippi residents dwell in poverty.
It can be within the coronary heart of the “Stroke Belt,” a band of 11 Southern states the place weight problems, hypertension and smoking contribute to an elevated price of strokes. Blacks make up 38% of the state inhabitants ― however greater than half of COVID-19 infections during which race is understood. They additionally account for practically two-thirds of deaths from the virus, in response to the state well being division.
Medical and socioeconomic circumstances put Mississippians at larger danger of COVID-19 in a number of methods, mentioned Frieden, now CEO of Resolve to Save Lives, a worldwide public well being initiative.
People in low-income or minority communities usually tend to work in jobs that expose them to the virus ― in factories or grocery shops and public transit, for instance. They’re much less prone to have paid sick go away and extra prone to dwell in crowded housing. They have high rates of chronic illness. They even have much less entry to well being care, particularly routine preventive companies. Mississippi is considered one of 14 states which have not expanded Medicaid.
“If they do have chronic conditions such as hypertension or diabetes,” Frieden mentioned, “the health system doesn’t work as well for them, and they are less likely to have it under control.”
Minority communities endure the legacy of segregation, which has trapped generations in a downward financial spiral, mentioned Dr. Steven Woolf, a professor at Virginia Commonwealth University in Richmond.
“The fact that African Americans are more likely to die of heart disease is not an accident,” Woolf mentioned. “COVID-19 is a very fresh, vivid example of an old problem.”
Research reveals that “stress, economic disadvantage, economic deprivation not only affect the people experiencing it, but it’s passed on from one generation to another,” Woolf mentioned.
Tonja Sesley-Baymon, president and CEO of the Memphis Urban League, famous that social distancing is a privilege of the affluent. Just attending to work can put individuals in danger in the event that they trip the bus. “If you take public transportation, social distancing is not an option for you,” she mentioned.
Dr. LouAnn Woodward, the University of Mississippi Medical Center’s prime government, has handled many individuals within the emergency room whose life-threatening crises may have been prevented with routine care. She’s seen diabetes sufferers with blood sugar ranges excessive sufficient to place them in a coma.
Health insurance coverage is just a part of the issue, she mentioned. When Woodward requested one lady why she waited so lengthy to hunt remedy for her breast tumor, the girl mentioned, “I just got a ride.”
Cassandra Rollins, the youngest of 11 siblings, is aware of hardship. Two of her sisters had been murdered. She helped increase their kids, who at the moment are grown.
She raised 4 of her personal kids as a single mom. Shalondra, the eldest, typically acted as a second mother to her brother 18 years youthful. Shalondra even attended her brother’s parent-teacher conferences when her mom couldn’t go away work.
In September, her brother died by suicide at age 20.
When her daughter was recognized with COVID-19, Cassandra Rollins mentioned, “we had just gotten to a point where we didn’t cry every day.”
The Navajo: Health Suffers In Food Deserts
The coronavirus is battering impoverished communities. More than 1,200 COVID-19 cases and 48 deaths have been recognized within the Navajo Nation, the nation’s largest Indian reservation, positioned on 27,000 sq. miles on the junction of Arizona, New Mexico and Utah.
There are few hospitals within the area, an space the scale of West Virginia, and most lack intensive care models.
The communities that make up the Navajo Nation have among the many worst scores on the CDC’s Social Vulnerability Index. Thirty-nine p.c of residents dwell in poverty.
With a scarcity of satisfactory housing, many dwell in modest properties with as much as 10 individuals beneath one roof, mentioned Jonathan Nez, Navajo Nation president. That could make it tougher to include the virus.
“We’re social people,” Nez mentioned. “We take care of our elders at home.”
The first residents tested positive in mid-March, and instances skyrocketed inside weeks. In the eight counties comprising the Navajo, Hopi and Zuni nations, 1,930 residents have examined constructive and 79 have died. That’s extra instances per 100,000 residents than the Washington, D.C., space.
The Navajo Nation has taken aggressive steps to regulate the outbreak, together with weekend curfews enforced by checkpoints and patrols.
But greater than 30% of its households lack a rest room or operating water, in response to the Navajo Water Project, a nonprofit that installs plumbing in properties. Residents typically drive lengthy distances to fill containers with water, Nez mentioned.
Having no operating water makes it tough to correctly wash arms to stop coronavirus infections.
Navajo sufferers with diabetes have lengthy struggled to scrub pores and skin infections, mentioned Dr. Valory Wangler, chief medical officer at Rehoboth McKinley Christian Health Care Services in Gallup, New Mexico.
Maintaining a wholesome weight on the reservation is difficult, Nez mentioned. Residents generally spend hours each day touring by automobile to and from work, leaving little time to train or prepare dinner. While the area has fast-food eating places, far fewer shops promote contemporary vegetables and fruit, he mentioned, including, “we’re in a food desert.”
Memphis: Childhood Diseases Take Their Toll
Most kids with COVID-19 are at low risk of loss of life. But many adults felled by the illness endure the long-term results of well being harm they suffered as kids, resembling lead publicity or asthma, mentioned Brawley of Johns Hopkins.
More than 208,000 homes in Memphis, Tennessee, pose potential lead hazards. Lead ― poisonous at any stage ― could cause mind harm and result in hypertension and kidney disease, circumstances that increase the risk of complications in COVID-19 sufferers.
Shelby County, which incorporates Memphis, is residence to 937,000 residents, 14% of the state’s inhabitants. Its COVID-19 burden is outsized, representing one-quarter of the instances and deaths in Tennessee. Where race is understood, most sufferers have been black.
The National Center for Healthy Housing ranked Memphis the worst metropolitan space for housing in 2013, though its rating has since improved barely.
Memphis, with older housing inventory and one of many poorest massive U.S. cities, is a hot spot for asthma, which afflicts as much as 13.5% of its children. The CDC has mentioned that folks with bronchial asthma could also be at larger danger from COVID-19, though some hospitals haven’t seen higher death rates in this population.
Blacks are virtually 3 times as prone to die of bronchial asthma as whites, in response to the Health and Human Services’ Office of Minority Health. Many kids develop bronchial asthma after being uncovered to tobacco smoke or substandard housing with mud mites, cockroaches, rodents and molds. Some suffer for a lifetime.
Many poor individuals can’t afford bronchial asthma medicines and haven’t any common supply of medical care to watch their illness, mentioned Dr. Robin Womeodu, chief medical officer at Methodist University Hospital.
Asthma sufferers typically undergo “a revolving door in and out of the emergency department,” with an elevated danger of loss of life, she mentioned.
Health specialists say these well being dangers may stay lengthy after the pandemic passes.
“The question is, ‘Do we value all life equally?’” mentioned Dr. James Hildreth, president and CEO of Meharry Medical College in Nashville, a traditionally black school. “If we do, we will find a way to address these things.”
KHN knowledge editor Elizabeth Lucas contributed to this report.
METHODOLOGY
Kaiser Health News analyzed COVID-19 case charges throughout the nation and in contrast them to various demographic components. KHN obtained COVID-19 knowledge by county from The New York Times and populations from 2019 U.S. Census Bureau Population Estimates to calculate instances per 100,000 residents. The nationwide map shows COVID-19 case charges per 100,000 by commuting zone, outlined as a bunch of counties that approximate native economies and may cross state boundaries.
The charts evaluating COVID-19 instances in Mississippi and Shelby County, Tennessee, by inhabitants and race are no matter Hispanic ethnicity as a result of ethnicity is coded individually within the knowledge.
DATA SOURCES
COVID-19 instances and deaths by county: The New York Times
Commuting zone definitions: Urban Institute, with changes for latest county boundary modifications
Hospitals and ICU beds: Kaiser Health News analysis, Centers for Medicare & Medicaid Services
Population: U.S. Census Bureau Population Estimates, 2019
Race, ethnicity and age: U.S. Census Bureau American Community Survey, 2018
Health insurance coverage: U.S. Census Bureau Small Area Health Insurance Estimates, 2018
Poverty: U.S. Census Bureau Small Area Income and Poverty Estimates, 2018
Social Vulnerability: Centers for Disease Control and Prevention Social Vulnerability Index, 2018
Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially unbiased program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.