How U.S. cities lost precious time to protect black residents from the coronavirus
“Shreveport Mayor Adrian Perkins had a hunch. He had used data compiled for emergency responders in late March to create a computerized map showing cases of the novel coronavirus by address. A cluster of red pins curved around downtown and extended into black neighborhoods toward the city’s western edge.
At the time, policymakers and public health experts studying the still mysterious disease had been focusing on risk factors such as international travel, age and chronic health conditions including diabetes and heart disease — not race. Most states — including Louisiana — weren’t even publicly tracking race-related data about the virus’s impact.
But Perkins’s map was showing him that ignoring race could be a catastrophic mistake.
“People in these areas need to know their neighborhoods are being affected disproportionately,” he said.
It was a rare, early action aimed at halting the spread of the coronavirus among African Americans, who bore the brunt of the disease across the country as attention and resources flowed elsewhere.
Interviews with nearly 60 public health experts, lawmakers and community leaders show that many of the first coronavirus testing sites went up in areas that happened to be whiter and more affluent, despite the requests of black leaders. Local governments — sometimes ignoring the pleas of community activists — targeted few of their education campaigns about prevention and social distancing specifically to African Americans, even as conspiracy theories spread that black people were immune to the disease.
Poor reporting of data, which initially masked the fact that the disease was disproportionately affecting black communities, remains a problem even as states move to reopen their economies.
Today, Americans living in counties with above-average black populations are three times as likely to die of the coronavirus as those in above-average white counties, according to an analysis of census and other data by The Washington Post.
Black deaths per 100,000 people
White deaths per 100,000 people
1 New Orleans area
2 Baton Rouge area
5 Southwest Louisiana
6 Central Louisiana
7 Northwest Louisiana
8 Northeast Louisiana
Frustration over the lives lost during the pandemic, as well as the economic devastation it has caused, in black communities is helping to fuel unrest around the nation as protesters demonstrate against police brutality.
“People have been asking and asking for our leaders to pay attention to their struggles,” said Roland Walker, a pediatrician and health commissioner in Gary, Ind. “You can only tell people, 'It’s a process’ and, ‘It’s going to take time,’ so many times before people start thinking there needs to be a drastic change.”
State and federal officials say the lack of available testing and the unprecedented nature of the virus complicated their anti-coronavirus efforts. Garlin Gilchrist II, Michigan’s lieutenant governor, acknowledged a blind spot early on: “I cannot say we specifically had race in mind.”
By the time his state set up a task force aimed at expanding testing in black communities in late April, the Detroit native had personally known 16 people — most of them African American — who had died of covid-19, the disease caused by the coronavirus. He said leaders like him should have predicted its deadly path.
“There are wounds of structural racism, there are wounds of persistent poverty and … there are a lot of flavors of salt that can be poured on that wound,” said Gilchrist, who now leads a coronavirus racial task force that helped expand testing in black communities. “It looks like the coronavirus is one of those flavors of salt.”
Officials in Gary struggled for weeks to persuade the state health department to set up a testing site there. The city finally got a state mobile testing site April 13, days after Indiana health officials revealed African Americans accounted for 20 percent of coronavirus-related deaths even though they were 10 percent of the population.
But after two weeks of testing, the state’s mobile site left for another city.
The lack of consistent testing has left the city unable to determine the scope of the coronavirus’s deadly reach, according to Walker. While pools and summer camps are opening across the state, Gary has barely relaxed social distancing guidelines because the rate of infection remains too high.
“Everyone around us is doing victory laps,” Walker said. “I just can’t.”
A familiar pattern
The coronavirus crisis in black America follows a familiar pattern, from the AIDS epidemic to maternal mortality to breast cancer to even natural disasters such as Hurricane Katrina, where community concerns were overlooked until gross disparities were revealed.
In Shreveport, Perkins tried to break the trend. He had shared his computerized map, with its telling clusters of red pins, with black clergy on April 1, enlisting their help in sounding an alarm on what he deemed hot spots.
He appeared on hip-hop radio stations, naming hard-hit neighborhoods and urging young people to stop gathering in parking lots. He posted a one-minute video of himself on Facebook, saying he would be staying home from church to protect his family and community.
Yet in the midst of a global pandemic, other local leaders appeared nervous about Perkins publicizing his findings. It resurrected a familiar conversation in this country, in times of crisis or not, about whether drawing attention to race would do more harm than good.
Those concerns initially helped delay the release of data about the virus’s racial impact.
In Nashville, the chair of the local coronavirus task force said at a news conference that he saw “no specific reason” to release data about testing. In Jackson County, Mo., the county executive warned he was concerned that the release of such information would lead to African Americans “feeling inferior” and being rejected for services.
In Shreveport, Perkins said some local leaders, including a public health official, tried to discourage him from naming the hot spots because they feared black communities would be blamed for the disease.
Perkins, a Democrat elected mayor in 2018 at age 33 after serving as the first African American class president at the U.S. Military Academy and student body president at Harvard Law School, tried to assure the public that this was about bringing resources to the most affected communities, not pointing fingers. He had grown up in Cedar Grove, one of Shreveport’s poorest neighborhoods, which would soon join the ranks of the most infected.
“This isn’t a blame game at all,” Perkins assured them. “We aren’t trying to stigmatize neighborhoods whatsoever.”
On April 6, Gov. John Bel Edwards (D) announced that 70 percent of Louisianans who had died of covid-19 were African American, despite making up just a third of the state population.
At the end of April, nearly a month after Perkins first named the hot spots, a repurposed mammography van rolled into the Martin Luther King neighborhood. It was the state’s first mobile rapid testing site in medically underserved African American communities.
Of the 201 people in Perkins’s parish who had died of the coronavirus by early June, 71 percent were black — a ratio that had not changed in the two months since the virus first struck Shreveport. A Post analysis of coronavirus infections by census tract shows that as of May 24, the three most heavily African American neighborhoods in Shreveport — including two Perkins first identified as hot spots — had at least twice the rate of confirmed infections as its three whitest neighborhoods.
Cases per 1,000 people in Shreveport, La.
Non-black majority neighborhoods
Advocates and public health researchers in Louisiana have said the lesson from cities such as Shreveport is to release race-related data more immediately and in more detail so local leaders have less guesswork about where to place resources.
They argue more data on testing and hospitalization is needed to prevent black communities from becoming collateral damage in efforts to restart the state economy.
Earl “Nupsius” Benjamin-Robinson, who leads the Louisiana Department of Health’s equity office, said the state was working as fast as it could to make sure the releases of data are accurate. The pandemic was just moving faster than the process.
“We don’t want to create unnecessary alarm and additional stigma,” Benjamin-Robinson said. “We want to make sure that what we’re seeing is what we’re seeing.”
Before the first coronavirus death in St. Louis, activist Jamala Rogers warned public officials about what they would likely see.
She figured the coronavirus, like so many other diseases, would be able to exploit preexisting social and economic conditions. Federal data shows African Americans are more likely to suffer from chronic health conditions. Four out of every five African Americans work jobs in which they cannot stay at home, and come home to multigenerational households — factors that also contribute to the high infection and death rates now being seen Latino and Native American communities.
To make matters worse, there is no full-service hospital on the north side of St. Louis, which Rogers figured meant special, early efforts would need to be made to get testing and information to the community. But that didn’t happen.
Predominantly black north St. Louis got its first testing site April 2, three weeks after the first sites went up in the suburbs. An information campaign targeting black residents did not start until a week after that.
When the coronavirus hit St. Louis, the first 12 to die were black. Now, about 65 percent of the 1,959 confirmed cases of the coronavirus are among black patients, even though the city is about 47 percent black, city statistics show. Of the 122 people who have died of the virus, 81 were black.
Will Ross, the chairman of the St. Louis health advisory board, said the disparity showed the importance of early interventions and listening to local leaders.
“When we first heard of this virus, we should have said, ’We know what community is going to be affected. Let’s go in and get these resources to the community, let’s identify cases earlier, let’s use what we know to stem the tide,’” Ross said. “That would have resulted in fewer deaths, unequivocally.”
Fredrick Echols, the city’s health director, said local governments were facing structural challenges — particularly because of a lack of mobilization at the federal level. The city could not find tests on its own, leaving that work up to the hospital system.
“The delay was circumstantial,” Echols said. “We couldn’t access testing kits in a timely manner … We couldn’t set up a testing site with only 15 testing kits.”
The national shortage of medical supplies gave hospitals serving wealthier populations a competitive advantage in securing ventilators and stockpiling protective equipment, said Angela Brown, CEO of the St. Louis Regional Health Commission.
Today, St. Louis has a public website rich with information that tracks cases and deaths in the city by race, gender and even Zip code.
But Rogers believes lives were lost because of a predictable snag in bureaucracy, in which the needs of minority communities are not prioritized.
“They weren’t quick about getting a proactive plan in place and that’s why we have the tragedies that we have,” Rogers said.
“We’re still doing triage. And now we’re opening up so we can see another upsurge.”
The great unknown
In Gary, Walker, the health commissioner, was trying not to get overwhelmed by his city’s pain.
He knew Gary, which last year took out a $40 million loan to pay its bills, did not have enough money to handle the coronavirus on its own. Gary’s population is now half of what is was a half-century ago, before jobs at the steel mill were exported overseas and residents fled, leaving abandoned houses and boarded up factories in their wake. But the help came intermittently.
He sent emails to GM and Ford asking for additional ventilators and face shields for health-care workers. He successfully begged a Chicago multimillionaire to donate money so the city could hand out 50,000 surgical masks.
As early as March 11, Walker’s department had been asking for the state to provide testing kits, according to staff emails and notes obtained through a public records request. But the state said such purchases were against protocol.
At that point, Walker felt the city was doing all that it could with the resources it had. It restricted gatherings of more than 100 people in early March, and Mayor Jerome Prince (D) discussed the importance of social distancing on local television and radio.
Walker felt confident enough to bring his parents, retired guidance counselors living in Mississippi, to Indiana to ride out the pandemic.
But 12 days after coming to the city their son was supposed to protect, Tommy Walker started to have seizures. Juanita Walker had trouble moving her right side. He took them to the hospital, where they were able to get coronavirus tests because they were living with a medical worker. Both parents tested positive.
So did Walker, although he showed no symptoms.
“I’m a mess,” Walker said. “I’ve been blaming myself.
To see his parents suffering — unable to move or breathe on their own — added clarity to Walker’s purpose to find more testing for those without his advantage. He began searching the private market but could finagle only 50 tests for the health department.
Then, in early April, Walker saw what he thought was a good sign. Indiana’s health department changed its protocol; it was going to start dispatching mobile testing sites.
Despite Walker’s requests, it did not send a testing site to Gary. Instead, help went to Merrillville, a town at the southern end of the same county, in an area with a median income twice as high as Gary’s and a larger proportion of white residents.
The question peppered through the city: Why did the wealthier, whiter area get the test first?
The mayor insisted his staff avoid bringing up the topic of race with state officials.
“I’m not trying to get into a pissing match with the governor,” Prince told The Post. “We have more communication with them than we’ve ever had, so I’m not going to go into theories that the state government was intentionally leaving all the black people behind. That certainly may be the case, but to say so would create chaos.”
In a statement, state officials declined to explain their reasoning for sending the county’s first testing site to the wealthier, whiter area but said decisions were “often made initially based on the desire to quickly open testing sites, then constantly adjust and move sites based on new information and additional needs.”
As the state revealed racial disparities in infection rates, officials changed the criteria to prioritize getting testing to areas with “vulnerable populations.” The governor’s office convened a racial disparities task force. And when the mobile testing site appeared in Gary in mid-April, Walker felt confident all the attention had worked.
From there, Walker was hoping he could persuade the state to start taking random samples for covid-related antibodies in his city.
His mother’s health, though, was getting worse. While being treated for the coronavirus, she developed pneumonia and had to be placed on a ventilator. She remains in the hospital. Walker often set out a keyboard near her hospital bed to play her favorite hymns.
One recent Sunday, when Walker couldn’t find an adapter to plug in his keyboard, he drove to a Walmart at the southern end of the county.
Walking to the store, he saw a strange, enviable site: a group of health-care workers under a tent with medical equipment.
It turned out the state had sent staff to do the first phase of the random sampling for antibodies he had been dreaming about.
The program extended all across Indiana. Gary, again, had missed out. State officials declined to say why they did not put one in Gary, but said the program would be implemented in phases.
“This is what happens to us,” Walker said. “It happens too much. I know we can’t get everything, but …”
Days after Walker’s visit to Walmart, he sat in his office. The testing for active infections had revealed close to 400 in Gary, 100 more than the predominantly white county next door, which was twice its size.
He called the local coroner. The deaths continued to mount. A former city employee. A local clown. A couple who had been together for 62 years.
In other parts of the country, malls were opening, bars were filling up and boardwalks were catering to tourists as summer begins. But here, in this struggling black city so acquainted with abandonment, how to continue handling the pandemic was still a great unknown.Robert Samuels is a national political reporter who focuses on the intersection of politics, policy and people. He previously told stories about life in the District for The Post's social issues team.”