Structural Racism Continues to Beset Pandemic Response

On March 29, Eric, the most prominent lay leader at my church in Cambridge, Massachusetts, perished from COVID-19. He was one of 685 people across the United States and one of 15 in Massachusetts to die from the disease that day. On April 6, Eric's mother Elmo also died from the coronavirus, one of 907 in the US and one of 12 in Massachusetts.

Both were likely casualties of a nation and state that betrayed them more than once during the pandemic: First by failing to quell the virus last year; secondly by allowing people like them to fall behind in getting vaccines; and thirdly by relaxing coronavirus restrictions while the nation remains riddled with racial vaccine disparities.

All put together, Eric and Elmo are among those who have fallen to the collective selfishness of the prior White House and the nation's governors, regardless of political stripe--a selfishness significantly stained by systemic racism.

When Eric's family emigrated from Barbados to Cambridge in the mid 1960s, their first visit to the church ended with rejection because of segregation. The barrier came down a couple years later and Eric quickly became a fixture for the next 50 years. He read scripture, assisted with communion, lit our candles, and bore the processional cross. In later years, he led a Mother's Day coffee hour where he and other men served women in black tie. For decades, up until 2019, he was a working-class warehouse manager and a concierge. For years, he also cared full time for Elmo, who was declining from dementia.

In the comings and goings that are part of many multi-generational homes, including visits from home health aides, COVID-19 got to them both. Eric was 65. Elmo was 95. They were Black. A modern wall of segregation so evident in the nation's COVID-19 response may well have doomed them the same way it blew out the candles of life for so many of the 84,000 Black people who have been lost in this country to the pandemic.

Structural barriers to vaccination

Eric and Elmo were not yet vaccinated. In theory, both could have been vaccinated in mid-February had they been able to secure an online appointment at a mass vaccination site. Based on the liberal politics Eric wore on his Facebook sleeve, which included re-posting criticism of anti-maskers and denunciation of anti-Asian hate in the wake of former President Trump's scapegoating of China for COVID-19, it seems unlikely that Eric was opposed to vaccination.

While nearly one in three White workers can work from home in the United States, only one in five Black workers and one in six Latinx have the same privilege.

It is far more likely that, because of his caretaking and constant associated errands, he did not have the luxury to be laser-focused on a laptop for 10 straight hours as I was to secure my first shot in the early stages of Massachusetts' maddening vaccination rollout.

All across the nation, online signups for shots have been far easier for white-collar families with fast computers and high-speed Internet. They could work from home during the pandemic at desk jobs that could allow them to peek regularly back to vaccine websites and refresh their browsers to get in the queue.

By definition, that also meant the first wave of vaccine availability was skewed toward White families. While nearly one in three White workers can work from home in the United States, only one in five Black workers and one in six Latinx have the same privilege. Rev. Miniard Culpepper, a leader among Boston's Black clergy calling for an equitable response to COVID-19, said on a February Facebook Live panel, "I don't know too many folks in my church that can take six hours out of a day to try to get an appointment."

Nor did Culpepper know of too many folks who, even with an appointment, could take the time many White families could to travel to a vaccination site. Massachusetts is one of many states that has relied heavily on mass vaccination sites such as stadiums and suburban shopping malls. In mid-February, the Boston Globe featured the dilemma faced by seniors of all colors to get to these locations.

That dilemma is far worse for families attending to seniors of color, as people of color statewide are two and a half times more likely not to have a car than White people. In the city of Boston, forty percent of residents of color do not own a car, compared to 29 percent of White residents.

Eric was apparently among the number without wheels, usually seen arriving at church by taxi or public transportation. The latter mode highlights another barrier for people of color getting COVID-19 shots--bus service is so poor in Boston's communities of color that Black bus riders in the city spend 64 more hours per year commuting than White riders.

Such compounding disadvantages for Black households were plainly on display on the first day Massachusetts opened its first mass vaccination site in a community of color--in an athletic center in predominantly Black Roxbury. Most of the people in line for shots were White, having driven in from all over the metropolitan area. Black people I know around Boston joked that it was probably the first time in Roxbury for many of those people. The collective refrain was, "They used to say they wouldn't come to the 'hood even if it would kill them. COVID made them rethink that."

This kind of debacle was repeated in many cities. The head of one clinic in a predominately Black neighborhood in Washington, DC, told the New York Times that when vaccines became available, "Suddenly our clinic was full of white people." Similarly, the chief executive of Dallas County noted to the Times how a vaccine site in a mainly Black and Latinx neighborhood experienced a "huge stampede of people from the suburbs who had reliable cars."

Vaccine disparities: the numbers tell the story

It will remain an unanswered question whether Eric and Elmo were unable to get promptly vaccinated because of some aspect of this structural racism, but the data suggest high odds. Despite more recent, after-thought scrambling by states and cities to engage churches, neighborhood clinics, and community centers to get the vaccine deeper into communities of color, Eric and Elmo died with the nation remaining far away from closing the racial vaccine gap.

Fresh confirmation of the gap came April 12 when Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Black people, who make up 12 percent of the population, account for just 8.4 percent of those who have received at least one shot. Latinx residents, 18 percent of the population, account for only 10.7 percent of those who have received a shot.

Disparities like that led her to declare racism a "serious public health threat." That officially lent the CDC's voice to those of nearly 200 cities, counties, and states--beginning with Milwaukee County in 2019-- that have declared racism a public health crisis or emergency.

Even though the pandemic has long since reached every corner of the United States and killed more than 560,000 people, Black and Latinx populations, bedeviled by an array of risk factors, were the leading edge of death a year ago in the first surge of the pandemic and remain twice as likely to die from COVID-19, according to the CDC.

And yet, these populations are statistically last to get the vaccine, as White vaccination rates exceed their population share in the vast majority of states. As of April 12, according to data compiled by the Kaiser Family Foundation (KFF), White people were 70 percent more likely to have gotten a first shot as Latinx people and 60 percent more likely to get a shot than Black people.

Of states that are at least 10 percent Black, Pennsylvania's record is the most egregious. The state is 11 percent Black but only 4 percent of vaccinations have gone to Black people according to KFF. The pharmacy chain Rite Aid became symbolic of the state's incompetence, at one point giving nearly 87 percent of its vaccines in Philadelphia to White people from across the metro region while giving only 4 percent of them to Black people (a 21-to-1 ratio), despite the fact that Philadelphia is 44 percent Black and 45 percent White.

According to KFF, other states with major Black populations and disgraceful rates of Black vaccination as of April 12 include:

• Delaware (22 percent Black population, only 13 percent of the vaccinated)
• Florida (16 percent Black population, only 8 percent of the vaccinated)
• Illinois (14 percent Black population, only 9 percent of the vaccinated)
• Michigan (13 percent Black population, only 8 percent of the vaccinated)
• New Jersey (12 percent Black population, only 6 percent of the vaccinated)
• New York (16 percent Black population, only 10 percent of the vaccinated)
• Ohio (12 percent Black population, only 7 percent of the vaccinated)
• Texas (12 percent Black population, only 8 percent of the vaccinated)

The story is worse for Latinx, who in several states have vaccination rates less than half their share of the population, including:

• Arizona (32 percent Latinx, 13 percent of the vaccinated)
• California (40 percent Latinx, but only 24 percent of vaccine recipients)
• Colorado (22 percent of population, 9 percent of vaccinated)
• Nevada (29 percent of population, 18 percent of vaccinated)
• New Jersey (21 percent of population, 10 percent of vaccinated)
• New Mexico (49 percent of population, 40 percent of vaccinated)
• Texas (40 percent of population, 30 percent of vaccinated)

Reopening policies reinforce structural racism

Gaps as sizable as the ones listed above, compounded with the fact that people of color are disproportionately represented in so many categories of "essential workers" who make it possible for disproportionately-vaccinated White people to enjoy the "reopening" of economies, make it an act of White supremacy for states to relax coronavirus restrictions. An exclamation point on this is the fact that the number of states without mask mandates has mushroomed back to 24, even though less than half of the general population has received a first shot and only a quarter is fully vaccinated, according to April 16 New York Times tracking.

It is racially irresponsible given that, as of KFF's April 12 tracking, one in three White people have received a first shot, compared to only one in five of Black and Brown people.

Thus we are witnessing a vile parallel to last year's disastrous reopenings, which were also clearly done on the backs of essential workers. No matter how much individual governors cherry-pick data to relax restrictions, cases nationally have climbed from a 7-day average of 54,000 daily cases on March 22 to 70,000 on April 15. The latter number is seven times the 10,000 cases per day targeted by the nation's top infectious disease expert, Anthony Fauci, as being the level to consider for trying to return to some kind of normal.

Saying recently that cases were stuck at a "disturbingly high level," Fauci reminded the White House press corps of last year's tragic attempt to negotiate with the virus. The 7-day rolling average in mid-September before the fearsome fall and winter surge was 35,000--half of what we're seeing today.

"You might remember, a year ago or a little bit more than a year ago, when we were looking for the summer to rescue us from surges, it was in fact the opposite," Fauci said. "We saw some substantial surges in the summer. I don't think we should even think about relying on the weather to bail us out of anything we're in right now."

How much death do we tolerate?

CDC Director Walensky has pled in vain for weeks for states to restrain themselves until enough people are vaccinated. Scientists estimate that herd immunity, the point at which the coronavirus runs out of people to infect, would be achieved at a vaccination level of between 70 and 90 percent. "I understand that people are tired and that they are ready for this pandemic to be over, as am I," Walensky said. "Please continue to hang in there."

But governors are having nothing of "hanging in there," as fans return to the stands at outdoor baseball and indoor basketball games, as indoor capacities increase at restaurants, bars, churches, museums, concert halls, gyms, personal care establishments, and bowling alleys. Air travel is soaring from winter's levels. In announcing his state's wide-open reopening plans, California governor Gavin Newsom said, "the light at the end of this tunnel has never been brighter."

If last summer is any indication, that light at the end of a tunnel is the headlamp of a viral freight train coming to mow through the unprotected among us once again. Many experts are trying to find solace in the fact that, with many older people getting vaccinated and new infections happening more among younger people, that the death toll is not as severe as last year. But that seems more like wishful rationale as we continue to lose two jumbo jets worth of people a day in the 7-day rolling average of daily deaths. States are getting back to "normal," even though, as of April 16 tracking by the New York Times, cases are either staying high or going up in 31 states, Puerto Rico, and the Virgin Islands.

One of those states where cases are high and staying high is Massachusetts. Governor Charlie Baker, a moderate Republican, last month announced a major relaxing of coronavirus restrictions, despite the fact that White people in his state have been disproportionately vaccinated. Nearly 30 Boston and state public health, civil rights, and health equity groups wrote Baker to say, "Reopening should not be prioritized while the Commonwealth has yet to address the inequities with the vaccination distribution plans and implementation."

Ashish Jha, the dean of Brown University's School of Public Health, who has repeatedly criticized the speed with which Massachusetts and the nation are rushing back to normal, asked the question no governor dares answer. He recently wrote, "How many folks do we tolerate getting COVID, dying in the final weeks before vaccinations get us to a better place?"

Tragically, two answers to that question are named Eric and Elmo.