COVID-19 has exposed all Americans to an increased risk, even while doing the most mundane things: shopping at the grocery store, going to work, and taking walks. But it’s also exposed how communities of color are largely defenseless in the fight against an enemy that does not discriminate, but rather reveals to us our own discrimination.
“People didn't just get up one morning and decide, ‘I'm going to eat poorly. I'm not going to exercise. I'm going to do everything I can to get diabetes,’ and then predispose themselves at an individual level for these diseases,”said Dayna Bowen Matthew, a professor at the University of Virginia School of Law who has spent years studying race and inequality in healthcare.
Predisposition happens because of a broken system that begins long before someone visits the doctor.
The New York Times recently crunched all the numbers from the Centers for Disease Control and Prevention up to the most recent surge and found that Latinos and African Americans were three times more likely than white people to become infected with COVID-19 and nearly twice as likely to die from it.
The CDC said that pre-existing conditions, and comorbidities, are linked to poor health care. People who can’t afford to see a doctor skip the preventative care that’s critical to stave off diseases later in life. That group is particularly vulnerable in today’s pandemic.
Some clinics are trying to bridge the gaps between local communities and our healthcare systems.
Excluded from Care in Hidalgo County
In Hidalgo County, 31% of residents have no health insurance — the highest rate of uninsured persons in the state. That 31% represents a huge gap in the healthcare system that is not easily bridged.
“McAllen was the first place I had lived, where anybody could be what they wanted to be. It didn't matter whether you were born, Black, yellow, white, Hispanic. This is a place where anyone who works hard can succeed,” said Dee Treviño, the administrator and a nurse of the McAllen Family Urgent Care clinic.
The clinic is open to everyone. They have a payment plan system where anyone who needs care can pay in cash, no insurance needed. Since healthcare can be expensive, she tries to keep folks out of the hospital. With the current pandemic, she’s working even harder to do that.
“We are actually trying to work more closely with our elderly population to teach them that if it is not a heart attack or a stroke, almost everything else can be treated outpatient,” Treviño said.
That means they work to treat anything non-life threatening from broken bones to prescriptions.
The doctors focus on preventative healthcare like checkups, that can lower the risk of comorbidities, such as diabetes, high-blood pressure, and respiratory issues — all things that contribute to the severity of COVID-19. But, now the clinic is also fighting a pandemic, testing hundreds of people and providing care for those not sick enough to go to the hospital.
Treviño said at least through April, May, and early June, they were picking up about 10% of the county's positive cases.
The hard part about all this though, is getting people to come into the clinic. Latinos have the lowest rates of health insurance coverage in the country. They also make up more than 90% of Hidalgo County residents, according toCensus data. Among them are more than 100,000 undocumented people who live within and on the margins of the community. The vast majority have no health care and try to avoid the hospital at all costs.
“I would say that most of our people that come in and pay are part of a very widespread cash economy we have in the (Rio Grande) Valley,” Treviño said.
Most undocumented immigrants are paid in cash under the table. But with no health insurance, expenses are paid cash out of pocket. In an underresourced and undocumented population, health care is often a last resort.
“Usually, you can't find the communities if you're just driving down a highway. You would say, ‘Where on earth are all these hundreds of thousands of people in Hidalgo County?’” Treviño said. “Well, they are living back from the main highways because they don't really want to be seen.”
Across the gap between the healthcare system and the local community, Nelda Garza is the connecting bridge.
She works with the urgent care clinic to find patients who need care. Rather than people coming into the clinic, Garza goes out into the community to hear what they need. Doesn’t matter what it is, she’ll figure it out.
Recently, there was an outbreak at the local pulga, or flea market. One of her sources, Norma, said she’d had some symptoms, but never found out if it was COVID-19.
Centered around the flea market is a hyper-localized economy where everyone makes something for someone else in the community. But mirroring the larger American economy, the pandemic has more or less shut it down. And there are no stimulus checks or unemployment benefits sent to this community, so they’re left without income.
But, despite that, Norma has a hearing coming up soon on an immigration case. She has her papers, but said she needs a lawyer. Garza is trying to help her.
“They’re very tight,” Garza said of the community. “And that’s what you have to be when you’re excluded from the health care system, forced into an underground economic system, and pursued by an immigration system, all while in the middle of a pandemic of course.”
This pandemic has hit everyone in this community, either directly or indirectly. No one is immune. And that’s exactly why so many people are working to bridge this gap.
COVID-19 Ravages The Navajo Nation
Straddling the borders of New Mexico, Arizona and Utah is Navajo country. It’s more than 27,000 square miles of land occupied by more than 170,000 indiginous people.
Currently, there are more than 8,000 cases of COVID-19 with more than 400 lives lost. The number of cases — per capita — is higher than anywhere else in the country.
McKinley County in rural New Mexico at one point led the nation in the highest per capita COVID-19 cases over places like New York City. The majority of people who live here are Native American.
The high rate of cases is shocking considering how rural and spread out communities in the Navajo Nation are.
The nation is roughly the same size as West Virginia. But there are only 13 grocery stores and 12 health care facilities. One in three homes don’t have running water, meaning people have to haul water, buy bottled water and go to the laundromat to wash their clothes.
Each store, laundromat, water well, and gas station becomes a place where the disease can spread as people search for basic necessities like disinfectants, food, and water.
Janene Yazzie is the New Mexico lead coordinator for a $5.4 million dollar mutual aid fund called the Navajo and Hopi Families COVID-19 Relief.
Former Navajo Nation Attorney General Ethel Branch started it as a GoFundMe, but it’s since grown into an organization. The fund provides basic necessities to the Navajo community.
“Throughout every step of the pandemic, especially those of us who've been organizing and working in our communities prior to this pandemic, we were already hyper aware that due to our ethnicity and the history and legacy of colonization, that there is going to be certain vulnerabilities that our communities we're going to be grappling,” Yazzie said.
This is not the first project Yazzie has worked on in the community, so she suspected the community would be vulnerable to this virus.
“A lot of our initial concerns were about just due to generations of poor investment and all of the challenges that come with the use of federal dollars — which are really the only significant resources that are given to tribal communities,” she said.
Federal money runs the health care system, justice system and less than half the tribal government. They also receive added funding from the Bureau of Indian Affairs and Indian Health Services through the state.
The community historically distrusts these resources though. Generations of environmental contamination have made people fearful of piped water resources. Even if they had access, they’d be hesitant to use and depend on those water resources.
There are more than 500 abandoned uranium mines on the Navajo Nation that continue to contaminate water resources. Uranium companies left them after declaring bankruptcy in the early 2000s, leaving the federal government to take over multi-million dollar land reclamation projects.
Additionally, many communities don’t have reliable access to broadband. Since the pandemic, the internet — and social media specifically — has been the main platform for updated information from the Navajo Nation government to the people.
Many people didn’t know how deadly this virus is and how they can protect themselves by social distancing, wearing a mask and washing their hands or using hand sanitizer. The Navajo Nation president closed local governance offices called chapter houses which give out public information.
National media has reported that the lack of running water in Navajo Nation is the biggest contributing factor to the spread of the virus. However, people on the ground are skeptical.
“I'm not 100% sold on the idea that the lack of sanitation facilities or running water are the reason for the spread on Navajo. And there hasn't been any data presented to say, you know, this number of households come from places with no running water,” said Navajo Nation Council Delegate Carl Slater, who is part of the legislative body of the Navajo Nation..
“The nation's housing stock is having a bigger impact because that's where there is the sort of anecdotal evidence that's confirmed by every single reporting agency or, contact tracers or people who are intimately involved with it. They're saying in their experiences, it's people who come in and they infect their entire household because of the asymptomatic spread.”
Shondiin Yazzie (no relation to Janene Yazzie) is a member of the K’e Infoshop, a self- described communist, anarchist, feminist collective non-profit.
Yazzie and the K’e Infoshop are a team of six to eight young people who are helping to deliver produce, meat, essential pantry items, disinfectant, masks, and gloves to families who live in remote areas near the capital of the Navajo Nation in Window Rock, Arizona as well as up into the New Mexico part of the Navajo Nation.
“It was really heartbreaking to go to the community of Sawmill... It was kind of like going through a canyon, and we got there and we delivered them food,” they said. “They don't have running water. They don't have electricity and then they also have more than eight people within the house. And we are being told by the CDC there's only supposed to be five people at max.”
Not only are water resources contaminated, but they’re also drying up. The Navajo Nation has been going through a megadrought since 1996 that has deeply impacted families who rely on local water resources.
“They're telling me that the wells, the natural wells and aquifers are all drying out. And so even to get livestock food and water is really difficult,” Yazzie said. “And because of this pandemic and the lack of resources we have, I'm assuming that that's what has been contributing to the high rates of death and exposure.”
The COVID-19 case numbers on the Navajo Nation hit a record 240 in May before plateauing and creeping back down. But there was a spike of 121 new cases in a single day just a few weeks ago after the Navajo Nation lifted weekend lockdowns for two weeks. In an effort to bring the number of cases back down, an executive order was issued to re-establish weekend lockdowns for the next three weekends.
Navajo Times reporter Pauly Denetclaw said the pandemic has affected her deeply in ways she has yet to comprehend.
“When my community is in mourning we cut our hair. I think this is why one evening in May I cut almost a foot of my hair off. I felt I needed to,” Denetclaw said. “Later I realized, I’m in mourning for the people my community has lost. I report on the loss. I hear stories of loss. I document loss. To the outside these numbers are just numbers.
The toll infectious diseases have taken on Indigenous people goes back to the 1400s. Estimates vary, but before Europeans showed up, up to 18 million indiginous people lived, loved, and raised families in North America.
After Europeans — like Christopher Columbus — arrived, Europeans’ infectious diseases like smallpox, typhoid, bubonic plague, mumps, measles, whooping cough and influenza would burn through native populations with no immunity to such disease, killing millions.
“The Healthcare System is Infected With Racial Bias”
Columbus and men like him have been celebrated as brave discoverers of a new land. That idea is enshrined in our monuments. But people have long questioned who these statues honor, the version of history they celebrate, and the version of history they ignore.
One such statue stood for more than a century in New York. Gynecologist Dr. James Marion Sims was enshrined in bronze for his work improving women’s health. He was known as the Father of Modern Gynecology for developing the speculum, a tool healthcare professionals use to examine the vagina and cervix, and for developing a treatment for vesicovaginal fistula, a term for an opening between the bladder and vagina sometimes caused by long labors.
But that’s not the whole story. The whole story is sinister, and has a lot to teach us about the inadequate and sometimes inhumane medical treatment Black people too often receive in America today. Sims developed his treatment by experimenting on enslaved Black women. Without anesthesia.
New York officials took his statue down from Central Park in 2018. Now all that remains is a boarded up pedestal and a sign from the Parks Department. But that doesn't mean Dr. Sims’s legacy doesn’t loom large over medicine...particularly when it comes to treating people of color.
“I lived in Germany for a while as a child. And I go back every year to visit friends. And when I go to Germany, you never see statues, the Goebbels or Hitler or the architects of national socialism,” said Harriet A. Washington, who teaches bioethics at Columbia University. She’s also the author of the book, Medical Aparthied: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. “They have chosen to honor the victims of the Holocaust and national socialism. For whatever reason we choose to honor the perpetrators.”
Dr. Sims has been honored in academia throughout history and the statues around the country portray him as an American hero.
“One says in South Carolina, I think one says, he treated emperors and slave alike. Well, he treated an Empress and treated slaves, but he did not treat them alike,” Washington said.
Dr. Sims knew that curing vesicovaginal fistulas would provide fame and fortune. To develop a treatment, he would buy or borrow enslaved Black women to experiment on.
“So this was the way things were done. This was the norm, not an example, not an outlier, not an exception. This was the norm,” Washington said. “I think what's important here is that it is terrible that the women were treated without anesthesia. But to me, the most egregious violation is the fact that these were women who did not consent to what was being done to them.”
Anesthesia wasn’t widely used until 1846, but Sims did use ether vapors when he treated white women. This would knock them out. Sims didn’t use ether for Black women because he operated on the belief that Black people didn’t feel pain the same as white people.
“And it wasn't only Dr. Sims—all the prominent physicians in the United States—they frankly said that African Americans were essentially immune to pain,” Washington said. “They don't feel pain the way whites do. All of these beliefs actually supported enslavement because if you had creatures who didn't get certain diseases and didn't feel pain, then it was perfectly ethical to drive them unmercifully and to beat them on any pretext.”
This idea, according to Washington, still lives on today.
“The reason why they don't treat African-American pain as well as they treat white pain, is that they also believe that Black people don't feel pain as much as whites do,” Washington said. “This has been a very stubborn belief in American medicine and the surveys and studies have shown that it's something that doctors still believe, unfortunately.”
One study she references comes from the University of Virginia in 2016. It showed that out of 222 white medical students, more than half endorsed at least one false belief about the biological differences between Blacks and whites...such as Blacks’ skin is thicker than whites’. Those students who endorsed these statements were more likely to report lower pain rates for Blacks vs. whites when they were asked to look at mock medical cases.
“So at the individual level, we know that the healthcare system in the United States is infected with and permeated with racial bias, which is a polite way of saying racism,” said Dayna Bowen Matthew from the University of Virginia School of Law.
When doctors take the Hippocratic Oath and vow to do no harm, they also vow to “use treatment to help the sick according to [their] ability and judgment.” But our judgement can be influenced by our subconscious.
“We have seen studies that record conversations between patient and provider show us that a white patient is less likely to have a conversation where the doctor is verbally dominant where the doctor doesn't solicit information,” Matthew said. “And a Black or Latinx patient is more likely to have a conversation where they get to say very little and what they say is less likely to be credited and believed.”
“Why Can’t I Breathe?”
Home health nurse Mia Mungin had COVID-19 in March. This was before the United States declared a national emergency and even before the World Health Organization declared COVID-19 a pandemic. Mia wasn’t the only person in her family who got the virus. Her younger sister Rana “Zoe” Mungin also got sick. When Zoe went to the emergency room at Brookdale Hospital in East New York, they diagnosed her with a viral infection and they told her they weren’t doing COVID-19 testing at the time. Mia remembers the first time she saw Zoe after she felt better herself.
“And I made it up the stairs to see her,” Mia said.” I was still winded but not as bad. And I went into the room and my mother said it didn’t look like she was getting better. So I called 9-1-1 and when 9-1-1 came she was standing outside and she was leaning against the porch and she said to me, ‘I’m having problems breathing.”
Mia said she reported her sister as having an asthma attack but the 9-1-1 attendant told her Zoe was not having an asthma attack and that she was not in distress. Eventually Zoe was taken by ambulance to a local hospital.
In the ambulance, Zoe’s EKG was normal. Her pulse oximeter suggested she had 100% oxygen intake. Her blood pressure was fine. But Zoe kept struggling to breathe. At the emergency room Mia was not allowed inside, as the hospital was locked down. Zoe didn’t want to stay.
“I called her on the phone and said, ‘Zoe why don't you want to stay?’ She said, Mia, they don't test for COVID here.’”
Things took a turn for the worse from there.
“So she came out and the doctor asked me if I can watch her at night. I just watched her all night until about 6:30-7. As I was leaving, my mother called me and she says, Mia, can you get some Depends. She says she's having accidents. She said I can't get out the bed. I said, Oh my God.”
Mia called 911 and the race to save Zoe was on.
“We went into Brookdale and I waited there for about three or four hours. Nobody would give you updates. And at that point they had a lockdown, no visitors. I spoke to a doctor eventually and he said, she is intubated and she's on life support. And I just started to cry.
“Later on that day, I got a phone call that said that she tested positive for COVID,I said, where did you get the test from? You just told me that no one was testing in this hospital. You tested her on Friday when she came in. She was here Thursday. Where did you get the test from? [They said] Oh, we had tests, but we only had a limited amount.
Zoe would be transferred to two other hospitals. After weeks of battling COVID-19, she passed away on April 27th. Although Zoe didn’t die at Brookdale Hospital, Mia thinks they could have tested her the first two times she went to the ER before her symptoms became more severe. Mia said she doesn’t fault them and thinks they did the best they could. Brookdale Hospital did not respond to our request for comment. Mia has since recovered from the virus but still carries the burden.
“You ever heard of something called survivor's guilt? Why did she didn't make it? And I made it, when I'm the one that came and got sick and brought this in here,” she said.
As the 100,000th death from COVID-19 in the U.S. came and went in May, African-Americans comprised more than 20% of the fatalities, despite making up about 13 percent of the population. Mia’s sister is part of that statistic.
“I just really felt like the government failed her,” she said.
This story was a production of the Petrie Dish podcast.
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