Name: The Other COVID Risks: How Race, Income, ZIP Code Influence Who Lives Or Dies
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The Other COVID Risks: How Race, Income, ZIP Code Influence Who Lives Or Dies

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April 22, 2020It started with a headache in late March. Then came the body aches.At first, Shalondra Rollins’ doctor thought it was the flu. By April 7, three days after she was finally diagnosed with COVID-19, the 38-year-old teaching assistant told her mom she was feeling winded. Within an hour, she was in an ambulance, conscious but struggling to breathe, bound for a hospital in Jackson, Mississippi.An hour later, she was dead.“I never in a million years thought I would get a call saying she was gone,” said her mother, 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 mother of two, had a number of factors that put her at higher risk of dying from COVID-19. Like her mother, she had diabetes. She was black, with a low-salary job.And she lived in Mississippi, whose population is in the country.She was one of 193 Mississippi residents who have died of COVID-19, and one of more than 4,800 with .Doctors know that people with ― such as who live with diabetes, hypertension, asthma and other chronic diseases ― are more vulnerable to COVID-19. So are patients without access to intensive care or mechanical ventilators.Yet some public health experts contend that social and economic conditions ― long overlooked by government leaders, policymakers and the public ― are even more powerful indicators of who will survive the pandemic. A toxic mix of racial, financial and geographic disadvantage can prove deadly.“Most epidemics are guided missiles attacking those who are poor, disenfranchised and have underlying health problems,” said Dr. Thomas Frieden, a former director of the Centers for Disease Control and Prevention.Federal health officials have known for nearly a decade which communities are most likely to suffer devastating losses ― both in lives and jobs ― during a disease outbreak or other major disaster. In 2011, the CDC created the to rate all the nation’s counties on factors such as poverty, housing and access to vehicles that predict their ability toYet the country has neglected to respond to warning signs that these communities ― where people already than those in more affluent areas ― could be devastated by a pandemic, said 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 said. Although counties are scattered throughout the country, they are concentrated across the South, in a belt of deprivation stretching from coastal North Carolina to the Mexican border and deserts of the Southwest.Some of the most vulnerable communities are in Mississippi, which has the ; Indian reservations in New Mexico, the second-poorest state, where thousands of households lack running water; and cities such as Memphis, Tennessee, a hot spot for asthma that recently among the bottom 15 metro areas in offering safe, livable housing to its residents.The first U.S. COVID-19 cases were detected in metropolitan areas, with Hispanics and blacks making up a disproportionate number of deaths in New York City. Outbreaks are now flaring in rural communities, the South and Upper Midwest. Both the New Orleans and Albany, Georgia, areas have infection rates above 1% of their populations. have been diagnosed with COVID-19 in the Sioux Falls, South Dakota, home to a meat-packing plant that employs immigrants and refugees from around the world.Whether COVID-19 patients live or die probably depends more on their baseline health than whether they have access to an intensive care bed, Brawley said. Some hospitals report that only about on ventilators survive.Many public health experts fear that COVID-19 will follow the same trajectory as HIV and AIDS, which began as a disease of big coastal cities ― New York, Los Angeles and San Francisco ― but quickly entrenched in and , which is considered the epicenter of the nation’s HIV/AIDS outbreak today.Like HIV and AIDS, the first COVID-19 cases in the United States were diagnosed in “jet-setters and people who traveled to Europe and other places,” said Dr. Carlos del Rio, professor of infectious diseases at 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 SegregationOne in 5 Mississippi residents live inIt is also in the heart of the a band of 11 Southern states where obesity, hypertension and smoking contribute to an elevated rate of strokes. Blacks make up 38% of the state population ― but more than half of COVID-19 infections in which race is known. They also account for nearly two-thirds of deaths from the virus, according to the state health department.Medical and socioeconomic conditions put Mississippians at higher risk of COVID-19 in several ways, said Frieden, now CEO of Resolve to Save Lives, a global public health initiative.People in low-income or minority communities are more likely to work in jobs that expose them to the virus ― in factories or grocery stores and public transit, for example. They’re less likely to have paid sick leave and more likely to live in crowded housing. They have . They also have less access to health care, especially routine preventive services. Mississippi is one of 14 states that have .“If they do have chronic conditions such as hypertension or diabetes,” Frieden said, “the health system doesn’t work as well for them, and they are less likely to have it under control.”Minority communities suffer the legacy of segregation, which has trapped generations in a downward economic spiral, said 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 said. “COVID-19 is a very fresh, vivid example of an old problem.”Research shows that “stress, economic disadvantage, economic deprivation not only affect the people experiencing it, but it’s passed on from one generation to another,” Woolf said.Tonja Sesley-Baymon, president and CEO of the Memphis Urban League, noted that social distancing is a . Just getting to work can put people at risk if they ride the bus. “If you take public transportation, social distancing is not an option for you,” she said.Cassandra Rollins with daughter ShalondraDr. LouAnn Woodward, the University of Mississippi Medical Center’s top executive, has treated many people in the emergency room whose life-threatening crises could have been prevented with routine care. She’s seen diabetes patients with blood sugar levels high enough to put them in a coma.Health insurance is only part of the problem, she said. When Woodward asked one woman why she waited so long to seek treatment for her breast tumor, the woman said, “I just got a ride.”Cassandra Rollins, the youngest of 11 siblings, knows hardship. Two of her sisters were murdered. She helped raise their children, who are now grown.She raised four of her own children as a single mother. Shalondra, the eldest, often acted as a second mom to her brother 18 years younger. Shalondra even attended her brother’s parent-teacher conferences when her mother couldn’t leave work.In September, her brother died by suicide at age 20.When her daughter was diagnosed with COVID-19, Cassandra Rollins said, “we had just gotten to a point where we didn’t cry every day.”The Navajo: Health Suffers In Food DesertsThe coronavirus is battering impoverished communities. More than have been diagnosed in the Navajo Nation, the country’s largest Indian reservation, located on 27,000 square miles at the junction of Arizona, New Mexico and Utah.There are few hospitals in the region, an area the size of West Virginia, and most lack intensive care units.The communities that make up the Navajo Nation have among the worst scores on the CDC’s Social Vulnerability Index. Thirty-nine percent of residents live in poverty.With a shortage of adequate housing, many live in modest homes with up to 10 people under one roof, said Jonathan Nez, Navajo Nation president. That can make it harder to contain the virus.“We’re social people,” Nez said. “We take care of our elders at home.”The first residents in mid-March, and cases skyrocketed within weeks. In the eight counties comprising the Navajo, Hopi and Zuni nations, 1,930 residents have tested positive and 79 have died. That’s more cases per 100,000 residents than the Washington, D.C., area.The Navajo Nation has taken aggressive steps to control the outbreak, including enforced by checkpoints and patrols.But more than lack a toilet or running water, according to the Navajo Water Project, a nonprofit that installs plumbing in homes. Residents often drive long distances to fill containers with water, Nez said.Having no running water makes it difficult to properly wash hands to prevent coronavirus infections.Navajo patients with diabetes have long struggled to clean skin infections, said Dr. Valory Wangler, chief medical officer at Rehoboth McKinley Christian Health Care Services in Gallup, New Mexico.Maintaining a healthy weight on the reservation is challenging, Nez said. Residents commonly spend hours daily traveling by car to and from work, leaving little time to exercise or cook. While the region has fast-food restaurants, far fewer stores sell fresh fruits and vegetables, he said, adding, “we’re in a food desert.”Memphis: Childhood Diseases Take Their TollMost children with COVID-19 are at of death. But many adults felled by the disease suffer the long-term effects of health damage they suffered as children, such as lead exposure or said Brawley of Johns Hopkins.in Memphis, Tennessee, pose potential lead hazards. Lead ― toxic at any level ― can cause brain damage and lead to , conditions that in COVID-19 patients.Shelby County, which includes Memphis, is home to 937,000 residents, 14% of the state’s population. Its COVID-19 burden is outsized, representing one-quarter of the cases and deaths in Tennessee. Where race is known, most patients have been black.ranked Memphis the worst metropolitan area for housing in 2013, although slightly.Memphis, with older housing stock and one of the poorest big U.S. cities, is a , which afflicts up to . The CDC has said that people with asthma may be at higher risk from COVID-19, although some hospitalsBlacks are almost three times as likely to die of asthma as whites, according to the Many children develop asthma after being exposed to substandard housing with dust mites, cockroaches, rodents and molds. Some .Many poor people can’t afford asthma medications and have no regular source of medical care to monitor their disease, said Dr. Robin Womeodu, chief medical officer at Methodist University Hospital.Asthma patients often go through “a revolving door in and out of the emergency department,” with an increased risk of death, she said.Health experts say these health risks could remain long after the pandemic passes.“The question is, ‘Do we value all life equally?’” said Dr. James Hildreth, president and CEO of Meharry Medical College in Nashville, a historically black college. “If we do, we will find a way to address these things.”KHN data editor Elizabeth Lucas contributed to this report.METHODOLOGYKaiser Health News analyzed COVID-19 case rates across the country and compared them to a number of demographic factors. KHN obtained COVID-19 data by county from and populations from 2019 U.S. Census Bureau Population Estimates to calculate cases per 100,000 residents. The national map displays COVID-19 case rates per 100,000 by commuting zone, defined as a group of counties that approximate local economies and can cross state boundaries.The charts comparing COVID-19 cases in Mississippi and Shelby County, Tennessee, by population and race are irrespective of Hispanic ethnicity because ethnicity is coded separately in the data.DATA SOURCESCOVID-19 cases and deaths by county:Commuting zone definitions: , with adjustments for recent county boundary changesHospitals and ICU beds: , Centers for Medicare &amp; Medicaid ServicesPopulation: U.S. Census Bureau , 2019Race, ethnicity and age: U.S. Census Bureau , 2018Health insurance: U.S. Census Bureau , 2018Poverty: U.S. Census Bureau , 2018Social Vulnerability: Centers for Disease Control and Prevention , 2018Copy HTMLWe encourage organizations to republish our content, free of charge. Here’s what we ask:You must credit us as the original publisher, with a hyperlink to our khn.org site. If possible, please include the original author(s) and “Kaiser Health News” in the byline. Please preserve the hyperlinks in the story.It’s important to note, not everything on khn.org is available for republishing. If a story is labeled “All Rights Reserved,” we cannot grant permission to republish that item.Have questions? Let us know atThank you for your interest in supporting Kaiser Health News (KHN), the nation’s leading nonprofit newsroom focused on health and health policy. We distribute our journalism for free and without advertising through media partners of all sizes and in communities large and small. We appreciate all forms of engagement from our readers and listeners, and welcome your support.KHN is an editorially independent program of KFF (Kaiser Family Foundation). 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April 22, 2020It started with a headache in late March. Then came the body aches.At first, Shalondra Rollins’ doctor thought it was the flu. By April 7, three days after she was finally diagnosed with COVID-19, the 38-year-old teaching assistant told her mom she was feeling winded. Within an hour, she was in an ambulance, conscious but struggling to breathe, bound for a hospital in Jackson, Mississippi.An hour later, she was dead.“I never in a million years thought I would get a call saying she was gone,” said her mother, Cassandra Rollins, 55. “I want the world to know she wasn’t just a...

The Other COVID Risks: How Race, Income, ZIP Code Influence Who Lives Or Dies

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