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Cases of the coronavirus are spreading in D.C., with 1,523 confirmed cases of COVID-19 in the city and at least 32 deaths for the disease as of Wednesday. And as the virus establishes itself, so does a pattern seen elsewhere around the country: The majority of the deaths, 20, were of Black residents—62.5 percent of the city’s death rate, according to the most recent data from D.C.’s government. White residents have accounted for only 5 of the deaths, or 15.6 percent.
D.C.’s population is 46.4 percent Black and 45.6 percent white.
City officials began releasing race-based coronavirus data earlier this week. The numbers are preliminary and incomplete, with race going unreported in 536 of the city’s total cases. But out of the cases where race is documented, 542 of those afflicted with COVID-19 are Black, while 253 are white.
The disparities present in D.C. align with data from across the nation showing that Black people are more likely to be afflicted with COVID-19 and more likely to die from it. Black people account for 70 percent of coronavirus deaths in Louisiana, despite being 32.7 percent of the state’s overall population. In Milwaukee, Black people account for 81 percent of deaths and only 26 percent of the city’s population. Around 68 percent of deaths in Chicago have been Black, while Black people make up 30 percent of the city’s population. And in Michigan, Black people make up 14 percent of the state population and 40 percent of the COVID-19 deaths.
Officials have warned that D.C. could be the next city to experience a surge in COVID-19 cases, and in many ways, the city demonstrates how a number of compounding factors can create an ideal environment for a deadly virus to ravage an already susceptible community.
In the District, Black people live shorter lives than their white peers and experience myriad health complications. They are six times as likely to die from diabetes-related issues, three times as likely to die from prostate cancer, and twice as likely to die from coronary heart disease or a stroke.
Social forces complicate the city’s health landscape. Rapid gentrification causes rent to spike, which can result in homelessness, faulty housing, or food insecurity, all of which exacerbate the persistent poor health from which many Black residents in the district suffer. Rising housing costs can also cause those in low-wage jobs to move out farther and thus have more complicated commutes that take substantially longer (and enclosed spaces like public transit are transmission zones for viruses like the one that causes COVID-19). These workers also happen to be the ones who cannot distance themselves from the rest of society. Working from home is an advantage afforded to few, and many of those folks aren’t Black.
“Who’s delivering the groceries? Who’s delivering food to people’s houses? Who are the people who have to go out and do things that make it possible for the rest of us to work from home? It’s disproportionately African Americans,” said Thomas LaVeist, the dean of Tulane’s public health school and the former chair of George Washington University’s department of health policy and management.
Black folks are also more likely to be in an extended family living situation, and to rely more on their communities, than their white peers. LaVeist recalled the Anacostia neighborhood, as he knew it before moving to New Orleans, as a place with a strong sense of community, where the elderly person down the street would be checked on by younger folks who lived on the block. This, LaVeist said, is what the term “social distancing” gets wrong, creating the impression of every individual separating themselves from the greater societal good.
“That’s the kind of social connection that we need,” he said of the Anacostia example. “So we don’t need to be socially distant. We need to be physically distant.”
When all of this is coupled with a nationwide testing shortage and preexisting comorbidities, the effect of COVID-19 has been exacerbated in Black communities.
“We know the consequences of those risk factors and diseases,” said Lucile Adams-Campbell, the associate director for minority health and health disparities research at Georgetown University. “When you add in the COVID virus … you’re going to keep increasing the likelihood of mortality unless we can get a treatment, unless we can really socially isolate, unless we can provide access to testing.”
Most of D.C.’s Black populace lives in Wards 7 and 8, where most of the disparate health outcomes exist and where residents have limited access to care. In those wards, there has been a combined total of 397 reported cases.
Residents of Ward 8 rely heavily on emergency medical services—even for health issues that don’t rise to the level of medically urgent. This makes sense considering that nearly 70 percent of health clinics and urgent care facilities are in Wards 2 and 3, the whitest areas in the district. Wards 7 and 8 have the lowest number of pharmacies and the slowest ambulance response times. Only one hospital, United Medical Center, serves those wards, and it is unlikely to be equipped to handle an influx of patients.
All the ordinary infrastructure people rely on for health care, including emergency services and other routine hospital functions, will likely be tied up handling COVID-19 cases. As a result, clinicians are moving to telehealth in order to manage other existing health issues. But LaVeist pointed out that some patients will have a harder time using the tech due to limited access to broadband, being older, or having a smartphone that isn’t easy to use. He suspects that these troubles will be exacerbated in Wards 7 and 8.
Though LaVeist is worried, he does think the district has a chance to fare better than other places—like the Deep South—due to the city’s resources. There are a number of community leaders and organizations who can mount a strong response and have a bit of time to think ahead about some of the problems, rather than figure out solutions when the crisis is at its peak.
Against those assets, though, there is the number of existing health inequities and the fact that the pandemic will play out across more than the city proper. This crisis has an opportunity to expand into the deeply interconnected suburbs of Prince George’s County, said LaVeist, where there are pockets of poverty, older populations, and high rates of diseases that increase the chances of death when someone contracts COVID-19.
“There’s every reason to believe that things will not be good in Washington,” he said.