An aunt, an uncle, and a cousin have tested positive for coronavirus, says Cassandra Spratling. A friend’s husband died. Her brother’s friend, like her aunt and uncle, is hospitalized.
“I’m almost afraid, I almost hate turning on my Facebook page, or even sometimes answering my phone,” says the 64-year-old Detroit native, once a journalist at the Detroit Free Press. As the number of deaths from Covid-19 rise in the city, she says, “it makes me a little nervous when I get a phone call because I’m always afraid that it’s going to be somebody I know.”
Spratling, in her northwest Detroit neighborhood, is like many African Americans nationwide, watching in fear as the coronavirus rapidly spreads in her hometown and in other black communities across the US.
As states have begun to release data on coronavirus deaths by race, what Spratling sees among her own community, and what she and others across the country have feared is confirmed: Black people have been particularly vulnerable to the ravages of the pandemic. Though African Americans make up nearly 14 percent of the population in Michigan, they account for around 40 percent of the state’s 1,076 coronavirus deaths as of April 9.
The disproportionate deaths from coronavirus among African Americans is a recurring pattern nationally. In Chicago, 67 percent of deaths have been black people. In Louisiana, that figure is 70 percent, with one-third of the state’s population being black. The death rates from Covid-19 by race are also disproportionate in places like Milwaukee, Wisconsin, and New York City. Even in states like Georgia, which has not released infection rates and deaths by race, the pattern re-appears: A large concentration of infections and deaths are in the southwestern part of the state, in a county that is nearly three-quarters black. A Pew Research Center report found in March that nearly half of black people see coronavirus as a major threat to their health, compared to a fifth of white people.
Detroit has one of the largest African American populations in the country — 79 percent of the city’s residents are black. And as residents like Spratling have noted, the city has seen a sudden, drastic rise of Covid-19 cases over the past week and a half. More than 80 percent of the state’s coronavirus cases are now in metro Detroit, making it Michigan’s epicenter. Even the country’s leading infectious disease expert, Dr. Anthony Fauci, told ABC last week that “Detroit is starting to show some signs that they’re gonna take off.”
Residents, as well as health and elected officials, point to the city’s underlying inequalities as a reason.
The health disparities are stark for the community: Black people, from infants to older individuals, already die in disproportionately higher numbers than white people in Detroit, according to the city’s health department. The risk of diabetes is 77 percent higher for African Americans than white or Latinx communities in the city, a 2016 National Medical Association report found. Meanwhile, the Centers for Disease Control and Prevention has said higher blood pressure is more common among black people than white, Asian, or Latinx populations.
These underlying medical conditions — which also include asthma, heart disease, and other chronic lung disorders — are all more prevalent in black people than other groups because, as Fabiola Cineas pointed out for Vox, “hundreds of years of slavery, racism, and discrimination” — redlining, policing, restricting access to public health resources — “have compounded to deliver poor health and economic outcomes for black people.”
And now these same health conditions also appear to lead to more severe bouts of Covid-19, according to the World Health Organization. Further compounding these vulnerabilities are the fact that black people also face a lack of adequate access to health care and experience high rates of poverty.
As Michigan has seen its highest death tolls in recent days, Gov. Gretchen Whitmer has acknowledged these disparities and announced the Michigan Coronavirus Task Force on Racial Disparities on Thursday, chaired by Lieutenant Gov. Garlin Gilchrist, and consisting of local community leaders and health care professionals.
”This virus is holding up a mirror to our society and reminding us of deep inequities in our country,” Whitmer said in a statement. “From basic lack of access to health care, transportation, and protections in the workplace, these inequities hit people of color and vulnerable communities the hardest. This task force will help us start addressing these disparities right now as we work to mitigate the spread of Covid-19 in Michigan.”
It’s a series of inequalities that point to why black people, not just in Detroit but across the nation, are experiencing higher numbers of Covid-19 cases — and why they are more likely to die from the virus.
Generations of poverty have made Detroit residents vulnerable to coronavirus
Experts have long argued that the city’s history of redlining and discriminatory policies locked Detroit’s growing black population into poverty over the past century. As black people moved north in the Great Migration in the early 20th century, the federal government began using race as criteria for who could get home loans, ensuring black people were left out of the housing market. But as desegregation movements ramped up in the ‘50s and ‘60s, the once-predominantly white city of Detroit saw a shift in demographics with suburbanization and “white flight.” However, that did not ease redlining practices (black people are still more likely than whites to be denied a loan today) and Detroit has remained one of the most segregated cities in the country.
Add to that the auto industry’s decline over the second half of the 20th century as companies decentralized operations out of Detroit, and the significant role it played in unemployment among black residents. Then, in 2013, the city declared bankruptcy. Before that happened, though, Detroit’s public health department was privatized, with its services turned over to a nonprofit in 2014 with a full-time staff of just five. Today, nearly 37 percent of the population lives in poverty, according to 2019 Census data.
Though the city’s economy had been slowly recovering post-bankruptcy, its legacy has left Detroit’s black residents especially vulnerable.
“Often pathogens emerge in a way that affects everybody equally, but very quickly, it’s those who are the disadvantaged, the ones without resources, that bear the brunt of the burden,” says Joseph Eisenberg, epidemiology chair and professor at the University of Michigan.
“When we talk about the social determinants of disease, it’s really the fact that people living in poverty, without access to high-quality work opportunities without access to good transportation, who are forced to live in homes that are in disrepair and communities that expose folks to trauma, where the air is poisoned, the water may not be clean or too expensive so it’s unaffordable, where there’s not access to high quality foods, those all come together, they’re a syndrome,” Abdul El-Sayed, an epidemiologist who ran for Michigan governor in 2018, said of Detroit last year.
Measures that prevent the virus — hand-washing, social distancing — aren’t easy for residents without resources
As coronavirus cases popped up quickly in coastal cities like San Francisco and New York City, Detroit was preparing with plans in place by mid-March, the mayor’s office tells Vox. The city was “procuring testing kits and PPE supplies and putting plans in place for the large regional testing facility,” John Roach, communications director for Mayor Mike Duggan, says.
But there are measures also vital to containing the virus’s spread — like frequent hand-washing with soap — and thousands of homes in Detroit still had no water before the pandemic hit Michigan. Since 2014, over 140,000 homes in Detroit have had their water service disconnected as part of a debt-payment program, according to records obtained by local news outlet the Bridge. In 2019, more than 23,000 accounts had their water shut off, and 37 percent still hadn’t had service restored as of mid-January. With the virus spreading, the city promised to restore water to residents, but as of March 31, had only done so for 1,050 of the 10,000 people who called with a water service problem (8,000 of those callers did not qualify for the Coronavirus Water Restart Plan, according to a city report).
“They put the onus on the customer to have to go in and take affirmative steps [to restore their water], so there are a lot of people who do not know, or secondly, don’t have the ability to go in and meet with someone,” says veteran civil rights lawyer Alice Jennings, who is working to restore water to the city’s most vulnerable. Her daughter, a Detroit teacher and a cancer survivor, is battling coronavirus.
Community groups, in the meantime, she said, are passing around five gallons of water to residents who don’t have water for drinking, cooking, or bathing, but Jennings doubts that residents are using the scarce water they have to wash their hands. “If the primary recommendation is ‘wash your hands, continuously, wash your hands,’ and there’s no water in the house to wash your hands,” the number of cases is certain to skyrocket, Jennings says.
Roach says shut-offs are not necessarily the equivalent to a family without water, clarifying that some of the homes where water has been shut off are vacant and others have transferred ownership. But when asked for the number of households without water, he referred Vox to the Detroit Water and Sanitation Department.
A spokesperson for the Sanitation Department told Vox it is untrue many of Detroit’s households remain without water. “Our service interruptions are temporary and we have programs to get households back on,” said Bryan Peckinpaugh, deputy director of public affairs for the department. “Of the 2,800 that remained off, most of those are vacant and the rest have been restored.”
But water is not the only issue for Detroit’s poor and black populations.
For the 34 percent of Detroit residents who do not have access to a car — many of whom are health care workers, grocery store workers, and other essential staff moving around the city by public transport — Duggan says the city will place 20,000 masks for public use on buses beginning this week. A drive-thru testing location has also been opened in Detroit.
Then there is the issue of hospital beds and staff. Two weeks ago, Whitmer warned that Detroit’s hospitals were nearing capacity. On Thursday, CNN reported that two coronavirus patients have died in Detroit emergency room hallways before help arrived, with hospital workers saying they are understaffed and short on supplies. (The Detroit Department of Health has not responded to multiple questions from Vox regarding hospital capacity or community engagement among black residents.)
Social distancing has also been slow to catch on among some residents, whether out of necessity — living in multigenerational homes, having to work, or focusing on finding dinner over keeping track of six feet of distance — or lack of understanding and regard for the implications. Jennings has seen boys playing basketball on city property. She has noticed people congregating on the street, rarely standing six feet apart from one another. Detroit Mayor Mike Duggan acknowledged the issue in one of his regular briefings with Chief Public Health Officer of the Detroit Health Department, Denise Fair, on Monday, saying city police are breaking up groups and tracking those who are not following social distancing rules.
As elected officials and civil rights advocates have pointed out, to understand how to help coronavirus hot spots like Detroit is to understand — and address — the layers of inequities that its residents face.
Before Whitmer announced the state’s racial disparities task force on Thursday, Sen. Elizabeth Warren (D-MA) and Rep. Ayanna Pressley (D-MA) called on the federal government to collect data about testing, infection, and death by race, listing out socioeconomic factors and inequalities that might lead to vulnerabilities among people of color. They have also urged for a release of that data, as have dozens of doctors with the Lawyers’ Committee for Civil Rights Under Law, from US Department of Health and Human Services Secretary Alex Azar, to examine any inequity around testing and treatment among communities of color.
Eisenberg, the epidemiologist, suggests that there has always been a tension between addressing social inequities and poverty and finding a vaccine. He uses the example of polio, pointing out that although the disease is not widespread in 2020, it is fundamentally easier for foundations and NGOs to direct billions of dollars toward polio eradication than deal with socio-economic issues. “Foundations want that success story tackling eradication, and this [social] issue is much more daunting,” he said.
Spratling is unsurprised African Americans are facing the most urgent battle against the coronavirus. She attributes the crisis in Detroit, in part, to an “inherent acceptance” of racism in America. “What’s happening now is a result of the continuing inequality in this country that dates back to slavery.”
But she believes her hometown will weather the growing crisis. “This is a city that has been knocked down repeatedly over the years, and somehow, the city always comes back,” she says. “I think it will be very, very tough times for people in this city but, you know, we’re going to make it.”