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For Urban Poor, the Coronavirus Complicates Existing Health Risks For Urban Poor, the Coronavirus Complicates Existing Health Risks
(about 16 hours later)
OAKLAND, Calif. — Several days had passed since the congestion in her chest left her feeling suffocated and racing to the emergency room. Now, Lisa McClendon, 64, was trying to level with her respiratory therapist about why her asthma had flared up again.OAKLAND, Calif. — Several days had passed since the congestion in her chest left her feeling suffocated and racing to the emergency room. Now, Lisa McClendon, 64, was trying to level with her respiratory therapist about why her asthma had flared up again.
In recent months, she explained from her cramped studio apartment in downtown Oakland, Calif., the money from Uber driving had not been enough to buy the nutritional supplements that help to keep her asthma under control. The therapist, Rochelle Allen, heard things like this often. She mostly treats African-Americans like Ms. McClendon who struggle to make ends meet, and whose health problems can be exacerbated by social factors like a lack of insurance, healthy food options and recreational opportunities.In recent months, she explained from her cramped studio apartment in downtown Oakland, Calif., the money from Uber driving had not been enough to buy the nutritional supplements that help to keep her asthma under control. The therapist, Rochelle Allen, heard things like this often. She mostly treats African-Americans like Ms. McClendon who struggle to make ends meet, and whose health problems can be exacerbated by social factors like a lack of insurance, healthy food options and recreational opportunities.
But Ms. Allen also saw another culprit in the asthma attack.But Ms. Allen also saw another culprit in the asthma attack.
“You have to use your controller,” she said, waving an orange inhaler that Ms. McClendon was not using twice a day as instructed.“You have to use your controller,” she said, waving an orange inhaler that Ms. McClendon was not using twice a day as instructed.
“I’m working to get off of these drugs,” Ms. McClendon said, adding that she preferred natural remedies. “I don’t trust the medical establishment.”“I’m working to get off of these drugs,” Ms. McClendon said, adding that she preferred natural remedies. “I don’t trust the medical establishment.”
Even in the best of times, low-income minorities can face daunting health and medical issues. Many public health experts now fear a potentially dire situation: If the novel coronavirus becomes an epidemic in the United States, it could exacerbate the vulnerabilities of resource-strapped minorities and cause devastating consequences.Even in the best of times, low-income minorities can face daunting health and medical issues. Many public health experts now fear a potentially dire situation: If the novel coronavirus becomes an epidemic in the United States, it could exacerbate the vulnerabilities of resource-strapped minorities and cause devastating consequences.
Not only would the disproportionately high rates of disease and illness among those populations make them particularly vulnerable if infected by the virus, but living in dense apartment buildings and using public transportation can also increase the risk of transmission. There is also the issue of distrust, especially among African-Americans, of a medical system with a history of mistreating and exploiting them.Not only would the disproportionately high rates of disease and illness among those populations make them particularly vulnerable if infected by the virus, but living in dense apartment buildings and using public transportation can also increase the risk of transmission. There is also the issue of distrust, especially among African-Americans, of a medical system with a history of mistreating and exploiting them.
“This definitely can be really bad for our community,” said Dominica Zone, the manager of the LifeLong East Oakland Health Center, a medical clinic and wellness facility with a patient population that is mostly black and low income.“This definitely can be really bad for our community,” said Dominica Zone, the manager of the LifeLong East Oakland Health Center, a medical clinic and wellness facility with a patient population that is mostly black and low income.
The challenges of treating low-income minorities were evident on a recent afternoon when Ms. Allen set out into the community to meet with patients. As a respiratory therapist for LifeLong and Sutter Health, she works out of a tiny windowless office in the East Oakland Health Center, which is tucked in a gray building in the back of a strip mall, next to a busy bingo hall.The challenges of treating low-income minorities were evident on a recent afternoon when Ms. Allen set out into the community to meet with patients. As a respiratory therapist for LifeLong and Sutter Health, she works out of a tiny windowless office in the East Oakland Health Center, which is tucked in a gray building in the back of a strip mall, next to a busy bingo hall.
Just reaching her patients can sometimes be the hardest thing. She gets referrals from hospitals of low-income black patients with asthma problems, and attempts to follow up with people for checkups after they are discharged.Just reaching her patients can sometimes be the hardest thing. She gets referrals from hospitals of low-income black patients with asthma problems, and attempts to follow up with people for checkups after they are discharged.
Messages can go unreturned for months. Some people do not have steady cellphone plans. Others are always on the move without a place to live. And still others lack transportation.Messages can go unreturned for months. Some people do not have steady cellphone plans. Others are always on the move without a place to live. And still others lack transportation.
So Ms. Allen, with 22 years of experience, often sets out to meet patients where they are.So Ms. Allen, with 22 years of experience, often sets out to meet patients where they are.
As she headed on Wednesday to see Ms. McClendon, an issue came up with another patient. Sandra Blackshear, 52 and homeless, called to say she needed a ride to a pharmacy on the other end of town to pick up her medication. Ms. Allen told her she would try to arrange for a social worker to help her, and they could discuss it when she came to see Ms. Blackshear later that afternoon for a scheduled treatment.As she headed on Wednesday to see Ms. McClendon, an issue came up with another patient. Sandra Blackshear, 52 and homeless, called to say she needed a ride to a pharmacy on the other end of town to pick up her medication. Ms. Allen told her she would try to arrange for a social worker to help her, and they could discuss it when she came to see Ms. Blackshear later that afternoon for a scheduled treatment.
Ms. Allen arrived at the Claridge Hotel, a pale yellow, six-story, single-room-occupancy building where Ms. McClendon lived, and took new precautions because of the coronavirus. She draped a yellow gown over her black blazer and moss green bunted skirt. She tucked her hair beneath a blue head cover and slid on a pair of goggles.Ms. Allen arrived at the Claridge Hotel, a pale yellow, six-story, single-room-occupancy building where Ms. McClendon lived, and took new precautions because of the coronavirus. She draped a yellow gown over her black blazer and moss green bunted skirt. She tucked her hair beneath a blue head cover and slid on a pair of goggles.
Dangers, she believed, lurked everywhere: the elevator buttons that get pressed by finger after unwashed finger; the communal toilets and showers. Ms. McClendon’s unit, about the size of a dorm room, was steamy with little airflow even with the lone window open on a sunny afternoon.Dangers, she believed, lurked everywhere: the elevator buttons that get pressed by finger after unwashed finger; the communal toilets and showers. Ms. McClendon’s unit, about the size of a dorm room, was steamy with little airflow even with the lone window open on a sunny afternoon.
“Since she’s so sensitive, I would be concerned if she got it,” Ms. Allen said. “I don’t think she would do well.”“Since she’s so sensitive, I would be concerned if she got it,” Ms. Allen said. “I don’t think she would do well.”
Ms. Allen’s main goal was to get Ms. McClendon to take her medication regularly to avoid hospitalization.Ms. Allen’s main goal was to get Ms. McClendon to take her medication regularly to avoid hospitalization.
“The hospital is the dirtiest place there is,” she said. “All the germs are there.”“The hospital is the dirtiest place there is,” she said. “All the germs are there.”
In California, black adults ages 18 to 39 are hospitalized for preventable asthma problems more than four times as often as white asthma sufferers.In California, black adults ages 18 to 39 are hospitalized for preventable asthma problems more than four times as often as white asthma sufferers.
Ms. McClendon, who goes to the emergency room about once a month because of her asthma, conceded that she was “being a bad girl” and not taking her orange inhaler, Flovent, daily. The medication is meant to help keep her airways clear and reduce hospitalizations. She was in the process of getting Medicare but did not go to the doctor for regular checkups.Ms. McClendon, who goes to the emergency room about once a month because of her asthma, conceded that she was “being a bad girl” and not taking her orange inhaler, Flovent, daily. The medication is meant to help keep her airways clear and reduce hospitalizations. She was in the process of getting Medicare but did not go to the doctor for regular checkups.
She promised Ms. Allen to be better about taking the inhaler — for now. A vegan who believes in herbal medicine, Ms. McClendon insisted that once she got her nutrition right, that would be enough to keep her asthma from flaring up. Still, she does worry about the coronavirus, she said. She is using hand sanitizer more and regularly disinfects her car, which she uses to drive for Uber 10 to 12 hours a day, six days a week.She promised Ms. Allen to be better about taking the inhaler — for now. A vegan who believes in herbal medicine, Ms. McClendon insisted that once she got her nutrition right, that would be enough to keep her asthma from flaring up. Still, she does worry about the coronavirus, she said. She is using hand sanitizer more and regularly disinfects her car, which she uses to drive for Uber 10 to 12 hours a day, six days a week.
“I know that if I’m not eating right, I’m going to get congested and then I will be a perfect breeding ground for the virus,” she said.“I know that if I’m not eating right, I’m going to get congested and then I will be a perfect breeding ground for the virus,” she said.
Ms. Blackshear, whom Ms. Allen met later on a sidewalk to administer a nebulizer to help with her coughing and wheezing, had only just started hearing about the coronavirus. While living on the streets, she said, she had little access to news media.Ms. Blackshear, whom Ms. Allen met later on a sidewalk to administer a nebulizer to help with her coughing and wheezing, had only just started hearing about the coronavirus. While living on the streets, she said, she had little access to news media.
Updated June 16, 2020Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
She has heard enough to know to use hand sanitizer a lot. But she does not have the luxury of staying away from people — she needs public transit to get around and sometimes sleeps in homeless encampments. Homeless for the past five years since reporting her former partner for domestic violence, Ms. Blackshear said she had not been able to work because of her asthma and mental health and substance abuse problems.She has heard enough to know to use hand sanitizer a lot. But she does not have the luxury of staying away from people — she needs public transit to get around and sometimes sleeps in homeless encampments. Homeless for the past five years since reporting her former partner for domestic violence, Ms. Blackshear said she had not been able to work because of her asthma and mental health and substance abuse problems.
Although she comes into regular contact with the medical system, she does not necessarily trust it. She questioned whether doctors prescribed drugs to help pharmaceutical companies make money rather than to keep their patients healthy. She would be hesitant to take a coronavirus vaccine, at least initially.Although she comes into regular contact with the medical system, she does not necessarily trust it. She questioned whether doctors prescribed drugs to help pharmaceutical companies make money rather than to keep their patients healthy. She would be hesitant to take a coronavirus vaccine, at least initially.
“Let the guinea pigs go first,” she said. “You don’t know what it’s going to do to you.”“Let the guinea pigs go first,” she said. “You don’t know what it’s going to do to you.”
That is a common barrier for African-Americans in disease outbreaks, said Dr. Michael A. LeNoir, a pediatrician and allergist who runs a public health clinic in Oakland under the LifeLong umbrella.That is a common barrier for African-Americans in disease outbreaks, said Dr. Michael A. LeNoir, a pediatrician and allergist who runs a public health clinic in Oakland under the LifeLong umbrella.
“The biggest problem we face is the attitude of people in our community about infectious diseases, especially about how they’re managed,” said Dr. LeNoir, the former president of the National Medical Association, a trade organization for African-American physicians.“The biggest problem we face is the attitude of people in our community about infectious diseases, especially about how they’re managed,” said Dr. LeNoir, the former president of the National Medical Association, a trade organization for African-American physicians.
Another issue is that many people do not have the bandwidth to pay attention to a disease outbreak.Another issue is that many people do not have the bandwidth to pay attention to a disease outbreak.
“There’s so much stress, if it ain’t hit you yet, you ain’t worried about it,” Ms. Allen said.“There’s so much stress, if it ain’t hit you yet, you ain’t worried about it,” Ms. Allen said.
The same, in some ways, could be said for East Oakland Health Center. While staff members are bracing for a virus outbreak — figuring out things like where it would isolate sick patients and who would get masks — there are more immediate concerns.The same, in some ways, could be said for East Oakland Health Center. While staff members are bracing for a virus outbreak — figuring out things like where it would isolate sick patients and who would get masks — there are more immediate concerns.
Most of the nearly 4,000 patients it served over the last year came from East Oakland ZIP codes where 8 percent of the population is unemployed, double the statewide figure, and 18 percent of families live in poverty, compared with 10.4 percent statewide. The median household income is $53,000, a quarter lower than the state’s median.Most of the nearly 4,000 patients it served over the last year came from East Oakland ZIP codes where 8 percent of the population is unemployed, double the statewide figure, and 18 percent of families live in poverty, compared with 10.4 percent statewide. The median household income is $53,000, a quarter lower than the state’s median.
Those social ills mean the staff is often asked to provide more than just medical care. With a patient population that is more than half black, the clinic tries to project an uplifting message. Framed black-and-white photos of black community members grace the walls. Black faces are emblazoned on a chart that patients use to describe their moods. And Ms. Zone, who wears earrings that say “Black Lives Matter,” will step in to help solve life problems. She spent much of one recent day helping a homeless patient with psychiatric problems find a place to sleep that night.Those social ills mean the staff is often asked to provide more than just medical care. With a patient population that is more than half black, the clinic tries to project an uplifting message. Framed black-and-white photos of black community members grace the walls. Black faces are emblazoned on a chart that patients use to describe their moods. And Ms. Zone, who wears earrings that say “Black Lives Matter,” will step in to help solve life problems. She spent much of one recent day helping a homeless patient with psychiatric problems find a place to sleep that night.
“My focus can’t be on the one thing,” she said of coronavirus. “There are so many other things going on with our patients.”“My focus can’t be on the one thing,” she said of coronavirus. “There are so many other things going on with our patients.”