Last week two prominent African American voices in Dallas spoke to the particular threat that COVID-19 poses to the city’s minority poor community. What they said raises an unavoidable and ugly question:
What if the two best ways to defend against the pandemic turn out to be being white and being rich? What long-term social and political aftereffects would be wrought on our world by a truth like that?
Nobody knows the whole story yet. The pandemic clearly is harvesting old lives more than young, people with certain preconditions more than those without. But the ethnic/economic component is suddenly pushing to the fore.
Dallas County began reporting the disease by ethnicity only in the last few days. The county says its numbers are incomplete, based on spotty recording of ethnicity. But even as a preliminary glimpse, the numbers already don’t look good.
According to the most recent report, white people in Dallas County have made up 26% of total cases, non-hospitalized and hospitalized. According to the most recent census estimates, people of the “white alone” census category make up 66.7% of the county’s population.
This won’t be only about race. If we were to fly up to 10,000 feet and look down with an expanded view of the impact, we would see waves of repercussion crashing out far beyond the physical illness itself into far reaches of the economy and society. Every gig worker, part-timer and person barely eking out an economic survival before COVID-19, regardless of color, is about to experience the bite of inequity as never before.
But in this country, even if race is not where inequity ends, it’s always where it begins. In an op-ed essay in The Dallas Morning News last week, Frederick Douglass Haynes III, senior pastor of Friendship-West Baptist Church in far southwest Dallas, spoke about a medical protocol adopted by Dallas hospitals. Called SOFA scoring or sequential organ failure assessment, the protocol is aimed in part at eliminating bias in life-and-death triage decisions if and when Dallas runs out of ventilators.
Haynes praised the intent and goal of the measure. But he pointed out that awarding a life-saving priority to the lives of people already in superior health only exposes and inflames a gaping racial disparity in health and life expectancy. That irony is unmistakable and brutal. An honest effort to strip the pandemic of racism only exposes the effects of racism all the more.
Last week Dallas County Commissioner John Wiley Price was the only member of the commissioners court to vote against an extension of the county judge’s emergency declaration. “We’re going to just kill off an entire community in the next 60 days,” he said.
Price was lambasted on social media for not recognizing the urgency of the medical emergency and for putting the interests of small businesses ahead of the greater good. But his community is mired in poverty, full of people scrambling day to day to survive hand to mouth. If they can’t scramble, they’re screwed.
Many of Price’s constituents and their children were close to hunger and next door to homelessness before this happened. This may push them out that door. If you had to make their choice, would you decide to quietly starve and watch your children starve or get out there and take your chances on infection? Was Price not supposed to mention any of that?
In politics and the media, we see all kinds of easy assumptions and snap judgments about where and why the disease hits the way it does. For some reason, the factors of race and poverty seem to have taken us much longer to get to and consider.
An assumption I heard a lot in recent weeks was that the disease hit New York City the way it did because of the sheer human density of the city — so many people living on top of each other. New York Gov. Andrew Cuomo has given some credence to that idea, so who am I to question?
But to satisfy my own curiosity this week, I put together my own weird little density and disease spreadsheet for the five boroughs of New York City. The population density per square mile of Manhattan is two to nine times that of the other boroughs — twice the density of the Bronx, three and a half times the density of Queens.
But the COVID-19 infection rate per 100,000 residents in the Bronx and Queens has been 175% the rate — one and three-quarters times higher — than the rate per 100,000 in Manhattan.
Twice the density in Manhattan. Almost half the infection rate. What could be the answer?
I’m in no position to say the answer is race and poverty, but I can’t just ignore the obvious contrast. According to the 2019 census estimates, Manhattan is 64.5% white while the other two boroughs with double the infection rates are less than half white. Household income in Manhattan is more than twice what it is in the Bronx, one and a third times what it is in Queens.
This isn’t just my own two-bit theory. All of a sudden this week, the racial and economic component of the impact seems to be dawning everywhere, maybe because the numbers weren’t available until now. In a hard-hitting piece in The Atlantic this week, Ibram X. Kendi lines up numbers from around the country depicting the phenomenon I found in New York City, only more dramatically. In case after case, place after place, COVID-19 is a seriously racist disease.
The instance that especially caught my own eye was Washtenaw County, Michigan, where I spent my childhood. Washtenaw County is home to Ann Arbor and the University of Michigan Medical Center, a global capital of medical excellence with a long history of public health outreach.
There, Kendi reports, 48% of residents hospitalized with COVID-19 have been black, while the black population of the county is only 11%. I checked and found almost identical numbers.
When I talked to the Rev. Haynes of Friendship-West Baptist this week, he spoke with great feeling and alarm about what may lie ahead. He told me he fears the disease will have a cruelly disparate impact on people “who are already suffering the most because of what I call medical apartheid as well as living in sadly unhealthy communities that lack options that can lead to a healthier lifestyle.
“We call them food deserts, but there are healthcare deserts, not to mention recreation deserts,” he said. “All of those create an environment of ill health in black and brown communities.”
Haynes talked about a history of racism in modern American medical practice, referencing a study of pain management and racial prejudice in medicine published in 2016 in the journal of the National Academy of Sciences. That study found: “A substantial number of white lay people and medical students and residents hold false beliefs about biological differences between blacks and whites.” The study said racially prejudiced beliefs “predict racial bias in pain perception and treatment recommendation accuracy.”
With that much bias in medicine so recently documented, Haynes is deeply pessimistic about what lies immediately ahead: “What I am afraid of is that we are going to see fewer tests on my side of town but more deaths on my side of town.
“The deaths will come as the result of the virus, but the testing that shows us who has been diagnosed and who has not been diagnosed with it, we won’t see that. It’s a recipe for the kind of genocide that’s about to take place.”
The test case and example for how to do this right seems to be Germany, where the death rate is hovering around 1% of cases, compared to 11% for Italy. A story on CNBC this week tied the low German death rate directly to widespread testing and a highly developed infrastructure of laboratories. I have seen other coverage that credits the high level of trust Germans have for their national government. And there is another factor that goes to the fears expressed by Haynes.
The Germans have been going to every home of a suspected case they could get to, in order to test, retest and monitor, so that infected persons who need hospitalization can be sent to the hospital early in the disease process, rather than late. I don’t know about you, but I sense something more than our stereotypes about typical German efficiency.
Getting to every home in every neighborhood, spending whatever it takes to test and retest: All of that sounds to me like the expression of a very high value being placed on the life of each and every citizen. That’s exactly what I hear Haynes and Price fearing will not happen here.
What is the history that would refute them? Maybe somebody wants to argue that the outcome of the pandemic will not expose or inflame underlying racial and economic injustice. OK. On what evidence would that argument rely? Show me the American experience that would take us toward that optimism.
And if it goes the other way, the way Haynes and Price warn and fear it may, what will that mean for the aftermath of the pandemic? Maybe racial inequity is only the canary in the coal mine for even larger inequity. Well, I’d call it the hawk in the coal mine, at the very least.
But if the pandemic reveals and stresses an entire underlying pattern of general social, economic and generational inequity — white people getting screwed, too — what then? Happily ever after? Again?