New York’s Inequalities Are Fueling COVID-19

Dr. Royal S. Copeland, the field marshal in New York City’s battle against the 1918 influenza epidemic, knew his enemy was more than just a virus. As health commissioner, he oversaw a medical crisis that would eventually kill some 30,000 New Yorkers over three waves of the disease. In Copeland’s estimation, the problem was not only influenza but also the city’s crowded tenements and endemic poverty.

To modern eyes, the measures he took to stymie the spread might seem strange. In an extensive interview with The New York Times after the first wave of influenza had passed, Copeland touted the decision not to close New York’s public schools. It was, he reasoned, best to keep them open to give the city’s children respite from crowded apartments and, if need be, a point of access to the medical system. “We have practically 1,000,000 children in the public schools, about 750,000 of them from tenement homes. These homes are frequently unsanitary and crowded,” he said. “The children’s parents are occupied with the manifold duties involved in keeping the wolf from the door. No matter how loving they may be — and, of course, they are just as loving as any parents anywhere — they simply have not the time to give the necessary attention to the initial symptoms of disease.”

Even under normal circumstances, living in New York City requires a certain surrender of personal space: Subways are packed, apartments are small and bodegas get cramped with after-work shoppers. But not all New Yorkers have to live in a stressful crowd all the time, a fact the COVID-19 pandemic has laid all too bare. The city’s wealth inequality has always been apparent: financial safety nets, Whole Foods delivery and routine access to health care. But the pandemic has added a new layer to what affluence can afford some New Yorkers, including routine access to personal space and the flexibility that white-collar work allows. While over 100 years have gone by since the 1918 pandemic, some of Copeland’s worries about the difficult nature of city life — and the inequities of who lives the most comfortably — remain chillingly relevant.

We know already that the COVID-19 pandemic is affecting people of color more than white Americans. While the virus stalks the rich and poor — leading some to call it “the great equalizer” — those with lesser means have fewer places to hide from it. Dr. Andrew Goodman, a professor of public health at New York University who used to work for the city’s Health Promotion and Disease Prevention unit, pointed to the pandemic as “a more dramatic example of the health-inequity side of income inequality and racial inequality in the U.S.” Deaths from diseases that disproportionately affect minority communities, like diabetes and hypertension, “usually get spread out over time, and it doesn’t seem as dramatic,” Goodman said. “This is a more accelerated version.”

While there is a lot of uncertainty about the actual numbers of those infected — only a fraction of people who show symptoms are tested, so the rate of infection is almost certainly higher than what’s being reported — life in two New York City ZIP codes, one working class and one wealthy, gives us a glimpse into different ways of city living that might mean life or death in today’s New York.

Densely populated and working-class, East Elmhurst, Queens, has one of the highest rates of COVID-19 in New York City.

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According to a running ProPublica tally of confirmed positive COVID-19 cases, the ZIP codes with the highest rate of infection are in a certain corner of Queens: East Elmhurst. One East Elmhurst ZIP code, 11370, is home to the notorious Rikers Island correctional facility, and has the highest recorded positive test rate in New York City — 127 percent worse than the city’s average. Jails like Rikers have become hotbeds for spreading the disease given their space constraints — well over 600 inmates and workers are infected with the virus at Rikers. East Elmhurst’s other, non-Rikers ZIP code, 11369, is a residential neighborhood and has the second worst positive test rate in the city, 121 percent greater than the average.

East Elmhurst has seen a high rate of individuals tested, and that might be in part because Elmhurst Hospital in neighboring Elmhurst, Queens — “the epicenter within the epicenter,” in the words of New York City Mayor Bill de Blasio — has set up a testing tent outside the hospital. According to 2018 data from the Census Bureau’s American Community Survey, 34,118 people live in the 1.1 square miles of East Elmhurst’s 11369 ZIP code. Sixty-four percent of its residents are Latino, and the median household income is $54,121, three-quarters of the median income in New York’s greater metro area. On the neighborhood’s northern border is LaGuardia Airport, and south of that are mosques and diners, a baseball field and blocks and blocks of houses cramped together. On those cramped blocks, the average household size is 3.2 people, 20 percent above the city average.

Nearly 11 percent of all households in ZIP code 11369 are also multigenerational, with three or more generations living under the same roof. It’s possible that the grouping of young and old together in one house could have something to do with higher infection rates. Researchers are still unclear about how many others a person infects when they have the virus, but early estimates were around 2 to 2.5 people. The elderly are more susceptible, and in Italy, doctors believe that the country’s culture of intergenerational living and familial closeness has had disastrous effects during the pandemic; Italy’s rate of death from COVID-19 is among the highest in the world.

Underlying conditions like asthma tend to be more prevalent in crowded environments, according to Dr. Y. Claire Wang, who specializes in public health and chronic disease prevention at the New York Academy of Medicine. The respiratory condition puts individuals at greater risk for COVID-19 complications, and households in city apartments with pests or mold, common problems in public housing units, often have higher rates of asthma, she said.

Things look different on the other side of the positive test rate list. ZIP code 11215 in Park Slope, Brooklyn, has among the city’s lowest rates of COVID-19, at 56 percent below average.1 Park Slope is a different New York from East Elmhurst in many ways. Two-thirds of its population is white, and at $123,583, the median household income is one and a half times greater than that of the average in New York’s greater metropolitan area. The neighborhood is named for its proximity to one of the city’s largest green spaces, Prospect Park, and it’s known for its gracious brownstones and tree-lined streets. The average household size in Park Slope is 2.4 people, and only 1.8 percent of households are multigenerational.

Residents of Park Slope, Brooklyn, tend to be affluent, with white-collar jobs easily adaptable to working from home.

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The racial and ethnic differences between Park Slope and East Elmhurst might prove particularly important as both neighborhoods weather the pandemic. Early statistical reports on the disease are already painting a picture of racial inequity. Earlier this week New York State released preliminary numbers that showed Latinos have the highest rate of COVID-19 fatality in New York City.

A Kaiser Family Foundation report on initial pandemic data reveals that minorities are bearing the brunt of infection and death from the virus in many places. Higher rates of chronic conditions in minorities put them at greater risk for serious complications from COVID-19. In Washington, D.C., where black residents make up 45 percent of the total population, they account for 29 percent of confirmed cases and 59 percent of deaths. In Michigan, black residents are 14 percent of the population, but represent 33 percent of confirmed cases and 41 percent of deaths.

“We say something as simple as ‘your ZIP code should not define your health’ — [but] in New York City, that’s often the story,” said Dr. Torian Easterling, the deputy commissioner of the Center for Health Equity and Community Wellness, a city agency that addresses racial and social inequities in health. He pointed to high rates of chronic diseases like diabetes and hypertension and a lack of access to healthy foods in minority communities as long-standing public health problems that have only been exacerbated by the onset of COVID-19.

During the 1918 pandemic, the white population had a higher rate of infection, according to a 2007 study of the outbreak by Thomas A. Garrett, then an economist at the St. Louis Federal Reserve. But that, Garrett surmised, had to do with the fact that the black population in the U.S. was still largely rural; the pandemic was a particular menace to cities. “[T]he nonwhite population in the United States has become much more urban. … A modern-day pandemic may result in greater nonwhite mortality rates because a greater percentage of the nonwhite population in the United States lives in urban areas,” he wrote. Census estimates from 2019 show that the majority of New York City residents are people of color.

Across New York, communities of color have long been more subject to chronic ailments like diabetes and hypertension. The COVID-19 pandemic has only exacerbated these trends.

JOHN NACION / NURPHOTO VIA GETTY IMAGES / ANGELA WEISS / AFP VIA GETTY IMAGES

Park Slope and the East Elmhurst ZIP code of 11369 are similarly dense, with roughly 32,000 and 31,000 people per square mile, respectively. But life in the neighborhoods is different in other ways that might contribute to their divergent rates of apparent COVID-19 infection. According to the latest Census Bureau count, the most prevalent jobs in East Elmhurst are clerical work, food service and construction. In Park Slope, management, entertainment, education and business are the most common professions. The typical East Elmhurst worker is required to leave home to perform their job, while the lines of work most common in Park Slope are adaptable to teleworking. And Latinos — East Elmhurst’s dominant ethnic group — are more likely than all other Americans to consider COVID-19 a threat to their financial stability, according to a recent Pew Research Center survey.

We’ve already seen how socioeconomic circumstances can correlate with Americans’ ability to stay at home. A recent New York Times analysis of anonymized cellphone data tracked the movements of Americans and found that those in the top 10 percent income bracket have limited their movements more than those in the bottom 10 percent. What Copeland said in 1918 could very likely still hold true: “I have no doubt that the most dangerous means of transmitting disease was the subway. … Many a man who was sick must have felt that he had to go to work.”

Copeland’s struggle against the currents of poverty and influenza would continue into 1920. Updating the public on the state of the epidemic, which had reemerged, Copeland told The New York Times that the health department was working to stop the eviction of tenants during the outbreak and described the struggle to attract nurses to the city’s hospitals, since wealthy individuals were offering them higher pay to work in private homes. He pleaded for better ventilation on subways and buses and criticized coffin-makers who were price-gouging the city’s residents. Even in death, New York was unrelenting.

And so it remains today. Early this week, the city announced that hospital morgues around New York were overflowing with the dead. An Associated Press report painted a grim picture of one Brooklyn hospital. Even with an infection rate much lower than those in Queens, “mounds of corpses” had become so difficult to navigate that hospital staff were stepping over them.

The great equalizer isn’t COVID-19 — it’s death. But in New York’s epidemic, death attends to the haves and have-nots differently: For the city’s poor, it hovers closely, and when it comes, it leaves them as crowded as ever.