Why coronavirus looks different to black America

Why We Wrote This

The coronavirus has hit black communities disproportionately hard. Understanding why can help improve health care for minorities going forward.

Patrik Jonsson/The Christian Science Monitor
Pitmaster Bobby Lewis tends the ribs and butts at Randy's BBQ on Savannah's east side on April 14, 2020. Mr. Lewis supports the mayor's aggressive enforcement of shelter-in-place rules

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Mayor Van Johnson made a lot of unpopular decisions in aggressively shutting down Savannah, Georgia, to blunt the spread of coronavirus. And he’s not about to apologize.

Savannah is 54% black, and he’s seen too much evidence – recently and over the years – that black health outcomes in America are worse than for other groups. COVID-19 “exploited what we already knew: If you were poor, if you were darker, if you were less educated, if you did not have a home, you were going to be disproportionately affected by this,” he says.

Figures in Georgia and beyond show these trends playing out. Black leaders note, anecdotally, that some community members didn’t take the virus seriously early on. But the problems now center around a lack of access to health care and historic distrust of the system.

Now, Mr. Johnson’s approach is starting to win converts in Savannah. And more broadly, the need is for treatment that goes beyond medical care to building relationships, says Lisa Price Stevens, chief medical officer of a Virginia facility. “Those relationships do everything when you talk about health.”

Back in early March, shortly after Mardi Gras had raged in New Orleans and Florida welcomed spring breakers, Savannah Mayor Van Johnson made an unpopular decision. He canceled the second largest St. Patrick’s Day parade in the country.

It fit with the Democratic mayor’s early response to the COVID-19 pandemic, which was as aggressive as that of any civic leader in the South at the time.

He issued his city’s stay-at-home order on March 19 – more than two weeks before the statewide order in early April. He closed non-essential businesses, including barber shops and beauty salons, cracking down on 30 businesses that refused to close. He ordered police drones to disperse street parties. And he even broke up a fight at a local Walmart, which he said had become a version of “the club” – a replacement for the loss of evening revelries.

Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.

Residents bristled at the early shutdown, calling the mayor a tyrant and sending him about 2,000 mostly critical messages.

But Mr. Johnson had a different perspective. Back when he first issued his stay-at-home order, startling racial disparities in the country’s coronavirus cases were just gaining attention. Now, they are in stark relief. Black residents make up less than a third of Georgia’s population but account for more than half its COVID-19 fatalities – a trend seen nationwide.

Patrik Jonsson/The Christian Science Monitor
Mayor Van Johnson of Savannah, seen here on April 20 in his office at Savannah City Hall, has been a relentless enforcer of social distancing rules in Savannah, Georgia, after after three members of his own family in New York contracted the virus. "We keep the faith and follow the science," he says.

Some causes are seen as particular to this pandemic, with a number of black leaders noting, anecdotally, that members of the community weren’t taking the virus seriously early on. But the deeper problems are chronic, with the coronavirus merely amplifying long-standing inequities, from a lack of access to care to the related dearth of trust in the health system.

“What this [virus] did was it exploited every weakness we’ve had in our socioeconomic system, every single one,” says Mr. Johnson. “It exploited what we already knew: If you were poor, if you were darker, if you were less educated, if you did not have a home, you were going to be disproportionately affected by this. The national figures bear that out.” 

That was why he acted the way he did.

“A lot of people are just, like, ‘Why we got to talk about race?’” he adds. “We have to talk about race. The problem is that we haven’t been talking about race. All of those things become very, very real to us.”

Indeed, at least part of Mayor Johnson’s actions sprang from the experience of his own family. His father, sister, and brother-in-law, who live in New York City, had each contracted the virus. A deacon at his church had died.

The view from Savannah

Now, Mr. Johnson’s approach is coming into conflict with his governor’s. Georgia Gov. Brian Kemp, a Republican, announced the state – among the last to issue a stay-at-home order – would begin to restart its economy last week. Gyms, bowling alleys, tattoo parlors, as well as hair salons and barbershops, were allowed to reopen on April 24 with strict social-distancing rules ­– a move the Savannah mayor called “reckless, premature, and dangerous.”

Savannah, which is 54% black, has seen its cases stabilize. Its numbers have also been more evenly distributed across racial groups. That has helped change the attitudes of many of Savannah’s black residents. Early resistance has shifted to solid support – and kinder messages, the mayor says. 

“This virus ain’t racist,” says Bobby Lewis, pitmaster at Randy’s BBQ, a popular local haunt that has stayed open for delivery and pickup. “No one is immune. Everybody has to step up.”

As a community, “we’re trying to get from where we’ve been to where we need to be,” he adds. “Van Johnson’s attitude has been a big part of that. Not everybody likes it. But I do. I think it’s working.”

That blunt message was needed, some say.

“When COVID first came out, there really was a sense that this is not a black people’s disease because it started in China and went to Europe,” says Sandra Elizabeth Ford, head of the DeKalb and Fulton County health departments in Georgia. 

That perception has changed. Since March, a number of national polls have indicated that black and Hispanic Americans have been more concerned about the virus than white Americans. The Pew Research Center found that 43% of Hispanics and 31% of black adults said they were very concerned about contracting COVID-19, compared with 18% of white adults. 

“There are so many dimensions that matter for African Americans with this pandemic,” says Alford Young, a sociologist at the University of Michigan in Ann Arbor. “Every social and health-related and structural factor in their lives exacerbates their exposure to the virus.”

“African Americans live in smaller spaces and in more densely populated communities,” Dr. Young continues. What’s more, “the extended family for the black community is about as intimate as the immediate family for a lot of other Americans. When African Americans check in on their family, they’re thinking cousins, uncles, my aunts, grandparents – not just siblings and parents at home.”

The deeper challenges

The racial disparities seen in the COVID-19 pandemic are nothing new and stem from structural inequities woven into American society for decades, if not centuries, scholars say. 

For example, the deliberate “redlining” of black neighborhoods to exclude them from federal programs to purchase homes has chronically depressed black wealth. With education funding based on local property taxes, that has contributed to underresourced schools.

These economic stresses have made it hard for hospitals and health clinics to survive, too. Few residents have health insurance, and Medicare and Medicaid simply can’t pay the bills.

All these factors contribute to the greater vulnerability of minority populations in general, and during a pandemic in particular.   

“We have an economy where you’re going to see people of color disproportionately working low-paying service jobs where they are essential workers, but they may not be getting the right protective equipment,” says Andra Gillespie, a political scientist at Emory University in Atlanta. “But then there is, ‘OK, if you’re going to ignore congregation bans and go to a party – that’s not race-specific, but just individual dumb behavior.’”

“What can we empower people to do, to be their own best advocate and their own defense against contracting this disease against so many systemic odds?” she asks.

One answer is to help build trust in the health care system among black Americans.  

“There’s a level of distrust that’s rooted in history and in lived experiences that makes it more difficult for life-saving messages to get through to these communities,” says Jamila Michener, professor of government at Cornell University in Ithaca, New York.

Giving care, building relationships

That is a big reason why Lisa Price Stevens became a doctor in the first place. She’s wanted to be a doctor ever since, at age 7, she saw her mother save another family member with the Heimlich maneuver.

“As physicians, we are innately concerned about the health care disparities and racial disparities we’re seeing, and particularly as an African American physician, this is a passion of mine,” says Dr. Stevens, chief medical officer at JenCare Senior Medical Center in Norfolk, Virginia.

Her patients are among those most vulnerable: lower-income, Medicare-eligible seniors, over half of whom are people of color. So treatment includes more than just medical care.

“We work in care teams where we address the social determinants of our patient’s health, with social workers and case managers so that we not only address the holistic caring of the mind, body, and soul, we’re looking at, Where do you live? Housing is health. How do you obtain your nutrition? So I can manage your diabetes,” Dr. Stevens says.

“Those relationships do everything when you talk about health,” she adds. 

It’s one of the reasons Mayor Johnson has turned things around in Savannah. 

“I don’t live in a spirit of fear. I’m not going to be intimidated,” he continues. “The vast majority of people recognize that these are extraordinary times that require extraordinary measures, and we have extraordinary tools to keep our citizens safe.”

Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.

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