Contributors: Dr. Sacoby Wilson, Sakereh Carter, and Aliyah Adegun
In an ideal world with a cohesive and competent COVID-19 response plan, the COVID-19 pandemic would have gone like this: Non-negotiable weekly testing across the nation, mandated proper personal protective equipment in public spaces, targeted interventions in low-wealth communities of color, stricter Environmental Protection Agency (EPA) industrial emission standards, livable monthly stipends for all citizens and non-citizens, eviction protection and rent forgiveness, and the proper allocation of resources to health care facilities. Instead, health care facilities are ill-equipped to handle the high volume of COVID-19 patients, people like Calvin Munerlyn are getting shot for asking a customer to put a piece of cloth around their cheeks [1], Blacks are more than twice as likely to die from COVID-19 [2] (See Table 1), the EPA ROLLED BACK pollution standards during the crisis [3], we’ve received ONE government-issued stipend check [4], 30–40 million people are at risk for eviction [5], and insufficient hospital infrastructure impedes high quality care across the nation [6].
This LACKADAISICAL, IRRESPONSIBLE, NON-SCIENTIFIC, AND IMMORAL way of handling the COVID-19 pandemic has cost 186,000 American lives which for the most part COULD have been avoided by addressing systemic inequities PRIOR to the global crisis and FASTER intervention at the beginning of the COVID-19 pandemic. We’ve robbed TOO MANY people of the opportunity to watch their grandchildren graduate from high school, to wake up next to their child, to get married, or to say goodbye to their deceased loved ones IT’S TIME to (1) address structured inequalities that allowed COVID-19 to ravage the nation, (2) handle the current COVID-19 crisis properly, and (3) prepare for future pandemics so that this NEVER HAPPENS AGAIN.
The nation has observed a striking disparity in COVID-19 morbidity and mortality rates between Whites and Black, Indigenous and People of Color since the beginning of the pandemic. In fact, Blacks, Latinx, and Native Americans are 2.2x, 1.1x, and 1.4x more likely to die from COVID-19 (See Table 1). As of April 15, 2020 Blacks comprise 30% of COVID-19 cases, even though they make up 13% of the total US population [7]. WHY? Pre-existing, social and environmental inequalities have EXACERBATED COVID-19 related ailments in low-wealth Black, Indigenous, and People of color (BIPOC) communities due to ineffective interventions, racist and opportunistic zoning and planning practices, devaluation of BIPOC communities, disinterested leadership, and inequitable distribution of power and resources.
As of May 19th, 2020, the state of Maryland ranked among the top 10 states with the highest COVID-19 cases and inadequate testing infrastructure [8]. As of September 3rd, 2020, Maryland state has reported 109,319 COVID cases and 3,623 deaths [9] (See Figure 1, 2). Within the state of Maryland, which counties are disproportionately impacted by COVID-19? On July 7th, 2020 Prince George’s County reported it’s 19,000th COVID-19 case surpassing the COVID-19 case number for 20 U.S. states combined [10]. Why? Prince George’s County is touted as “the country’s wealthiest majority-Black county”, but communities within the county experience chronic health conditions, food inequity, environmental hazards, and recently COVID-19 related ailments. Prince George’s County is 86% people of color and 9.8% of residents are designated low-wealth [11].
Characteristics of Prince George’s County that make its residents more susceptible to the global pandemic:
(1) HEALTH DISPARITIES: Prince George’s County ranks 14th among Maryland’s 24 counties for quality of community health [11]. Prince George’s County residents are disproportionately afflicted with chronic health conditions including heart disease, cancer, stroke, and diabetes. IN FACT, the rate of death from chronic related illness in the county is higher than all Maryland counties, the state, AND THE NATION [11]. One study found that people with chronic health conditions are TWELVE TIMES MORE LIKELY to die from COVID-19 [12]. What are the root causes of health inequity? According to Negussie et al., 2017, health inequities are attributed to racism, discrimination, residential segregation, food insecurity, lack of education, poor income and wealth, improper health systems and services, inadequate housing, insufficient parks and green space, climate change, poor transportation, the criminal justice system, police brutality, and overall public safety [13] (See Quote 1). As you can see, the entire lifestyle of BIPOC communities is TOXIC and multifactorial and must be treated as such.
““You still have no grocery stores in some areas. The parks are dilapidated,” he said. “You have a deficit of clinics. There are few walkable assetsl; you have to drive everywhere. It’s another barrier we have to overcome.””
(2) HEALTH CARE INFRASTRUCTURE: The ratio of primary care physicians to patients is 1,860:1 in Prince George’s County [11]. Thus, a county whose COVID-19 cases have skyrocketed has insufficient hospital infrastructure. The volume of COVID-19 patients in Prince George’s County is so high that many patients are transferred outside the county. Patients that arrive at Fort Washington Medical Center are often severely ill and doctors treat patients in surgical tents to keep up with the volume of patients [14]. How do you expect to receive high-quality health care with such a high ratio of patients to physicians? Healthcare infrastructure also entails providing residents with the proper personal protective equipment (PPE) to protect themselves from COVID-19 infection. Zenobia Shepherd, a Prince George’s County resident was unable to purchase respiratory masks at her local pharmacy, but easily identified face masks in Alexandria, VA [14].
(3) FOOD INSECURITY: Approximately, 71% of Prince George’s County residents are food insecure, meaning that most residents lack access to affordable, healthy food [11]. Food insecurity increases the risk of developing chronic health conditions including high blood pressure, coronary heart disease (CHD), hepatitis, stroke, cancer, arthritis, chronic obstructive pulmonary disease, and kidney disease [15]. Therefore, Prince George’s County residents are eating food devoid of any nutritional content and over time they’re developing chronic health conditions. When the COVID-19 pandemic struck Prince George’s County, these residents were designated high-risk populations because they harbor a chronic health condition that was created by racism and external forces that are OUTSIDE OF THEIR CONTROL.
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(4) LEAD: Deterioration of lead paint from dilapidated housing units is the primary source of lead exposure in Prince George’s County [16]. Lead exposure has been shown to affect educational attainment and intellectual capability [17]. Prolonged exposure to lead is associated with an increased risk of chronic health conditions including high blood pressure, heart disease, and infertility [18]. Stay-at-home orders are not always the safest option for low-wealth communities of color, as they are forced to reside in toxic homes that are often inundated with lead, mold, and pests [19] (See Quote 2).
(5) OVERCROWDING: According to Prince George’s County City Council, 6,712 households in Prince George’s County are overcrowded [20]. Moreover, 85% of rented and 47% of owned homes are overcrowded [20]. A study conducted by Melamed et al., 2020 found that low socio-economic households and overcrowded residential housing units have a greater COVID-19 infection risk [21]. Not only are BIPOC households packed like sardines because they can’t afford to live COMFORTABLY, but they’re living conditions may cost them their lives.