The City of Milwaukee Health Department released a public service announcement detailing the seriousness of COVID-19. Milwaukee Journal Sentinel
Death arrived in Milwaukee two weeks ago, carried by an invisible enemy.
In three days, the novel coronavirus known as COVID-19 claimed three lives: all African American men in their 50s and 60s with underlying health conditions.
Since then, the losses have continued to mount.
Of the 25 people confirmed to have died from complications of COVID-19 in Milwaukee County as of late Friday morning, 20 have been African American, two have been Latino and three have been white.
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Although testing data remains limited and incomplete, a tragic trend has emerged in a region already known for wide racial disparities and high rates of housing segregation.
African Americans appear to have worse outcomes from coronavirus than their white counterparts — and local officials and public health experts say that is not surprising given existing racial inequalities.
State Rep. David Bowen, a Milwaukee Democrat who has coronavirus, said there are a number of reasons African Americans living on the city’s north side are being hit particularly hard. Misinformation, economic factors and limited access to health care, he said, have helped fuel the spread.
“Because of the misinformation, people didn’t take the proper precautions to slow the spread, to distance themselves, to stop having large gatherings or going out,” Bowen said. “You also had the dynamic of people working in jobs where they can’t work from home.”
Leading public health experts from around the country are concerned.
“It’s exactly what I would predict would happen,” said David R. Williams, public health professor and chairman of the Department of Social and Behavioral Sciences at Harvard University.
The respiratory virus is still being studied, but so far, experts have found higher rates of complications in patients over 60, especially those with chronic medical conditions.
That makes the virus particularly dangerous for African Americans as a population, who have higher rates of chronic illness, greater co-occurrence of illnesses — meaning they are more likely to have diabetes and high blood pressure, for example — and tend to develop those illnesses earlier in life.
“Here is a virus attacking individuals, and they’re more vulnerable physically and they’re also vulnerable socioeconomically,” Williams said. “We have mountains of evidence that indicates people of color in this country have higher levels of underlying stressors.”
Those factors include economic challenges like working lower-wage jobs without benefits. African Americans are less likely to have health insurance and more likely to be underinsured if they do have it, with higher deductibles and co-pays.
“What we are looking at is a perfect storm,” he said.
‘It’s not the fault of that community’
State and local officials have stressed no one is immune to coronavirus — it has spread rapidly across all ages, races, genders and throughout Wisconsin. They also have regularly raised concerns about the racial disparities they are seeing.
Mayor Tom Barrett said in a Friday interview with the Journal Sentinel that Milwaukee seems to be one of the few places sharing information about racial demographics when it comes to coronavirus cases.
“We don’t like what we see, but we’re, we’re happy that we care enough that we’re doing it,” Barrett said. “As soon as I saw it, I started flagging it because I felt it was so important that we stop the spread of the disease.”
African Americans have accounted for nearly half of the more than 900 confirmed COVID-19 cases in Milwaukee County, while making up about 27% of the county’s population. Officials have not released the racial makeup of all those tested, nor have they said how many people in total have been tested.
Ben Weston, a physician who serves as the director of medical services for the Milwaukee County Office of Emergency Management, told reporters he believes the same factors behind other disparities in chronic illnesses are shaping who is being hurt most by the coronavirus pandemic.
“It’s the same answer as why we see more cardiac arrests in that community, why we see more strokes in that community, why we see more cancer in that community,” Weston said.
“It’s not the fault of that community, it’s not the fault of people gathering, or police not enforcing,” he said. “It’s a combination of institutional, historical and ongoing issues that cause our underserved communities to suffer the burden of disease.”
Local officials in recent days have raised the alarm about the continued spread and an apparent rise in cases in the city’s Hmong and Latino population.
“We’re also starting to see incidents in the near south side as well, which is the Hispanic community,” Barrett said. “So, the health care disparity there is being reflected as well.”
Some aldermen who represent those areas have called for stricter enforcement of the stay-at-home order.
Ald. Khalif Rainey, whose district on the city’s north side has seen many confirmed cases, argued for nonessential businesses that remain open in violation of state emergency orders to be forced to close.
“I would prefer to be overcautious with how we address this issue,” he said.
Rainey said the challenges already facing African Americans in Milwaukee have been compounded by the pandemic.
“When you thrust the pandemic upon a situation that’s already unstable, many people shouldn’t be surprised that the impact of COVID has been what it’s been on the black community here in Milwaukee,” Rainey said.
The state Department of Health Services now has nearly 100 workers helping to trace the spread of coronavirus in Milwaukee and two nearby communities due to concerns about how quickly it is spreading here.
The surge in state workers came after Gov. Tony Evers called the outbreak in Milwaukee’s African American community “a crisis within a crisis.”
Disproportionate impact on racially diverse, low-income communities
Milwaukee is not alone in this trend.
Although it is too early to determine the magnitude of racial inequities, many of the latest coronavirus outbreaks are in areas with large low-income and diverse communities, such as New York, New Orleans and Detroit, said Nadia Siddiqui, director of Health Equity Programs at the Texas Health Institute.
Previous research — including studies of the impact of H1N1 flu — has led Siddiqui and other experts to conclude minority communities will be more affected by coronavirus.
“Time and again we see that racially diverse low-income communities of color are disproportionally impacted,” she said.
When it comes to the coronavirus, statistics are elusive.
U.S. Sens. Elizabeth Warren and Kamala Harris, along with U.S. Rep. Ayanna Pressley and others, wrote to the U.S. Department of Health and Human Services late last month calling on federal officials “to monitor and address racial disparities in our nation’s response to the coronavirus disease.”
“The CDC is currently failing to collect and publicly report on the racial and ethnic demographic information of patients tested for and affected by COVID-19,” they wrote.
Without that demographic data, policymakers and researchers will not have information necessary to stop the escalating impact of coronavirus, the lawmakers said.
“Although COVID-19 does not discriminate along racial or ethnic lines, existing racial disparities and inequities in health outcomes and health care access may mean that the nation’s response to preventing and mitigating its harms will not be felt equally in every community,” they wrote.
Why public health messaging matters
Milwaukee leaders have launched a public awareness campaign with a focus on reaching the black community. The city’s Health Department produced a series of videos featuring prominent voices in the African American community, including WNOV program director Homer Blow and spoken word poet and author Muhibb Dyer.
Health Commissioner Jeanette Kowalik said that officials wanted to warn people as quickly as possible that the virus was spreading in the community as they worked to track the possible reasons behind the outbreak on the north side.
“I just want to continue to highlight the need for critical information,” Kowalik said.
The challenge is not just about providing the information, but making sure it is accessible and viewed as credible by the people health officials want to reach, said Tito Izard, a family physician and president and chief executive of Milwaukee Health Services Inc.
“Just because you give someone the correct information, if they’re in an unstable situation, they may not necessarily respond in the way you thought they would,” he said.
“And if you don’t understand what’s going on with that person and their situation — that’s where cultural competency is important — and don’t understand what’s going on in their life that is preventing them from being able to apply the information in an effective way, it just leads to frustration,” he added.
The messaging can be complicated when a community has a long-standing and justified historic mistrust of institutions, including the medical establishment and government.
There is a long history in the U.S. of African Americans being abused and misused by medical researchers, including those funded by the federal government, said Williams, the Harvard professor.
“We also have research, including research from Milwaukee, about the negative effects of discrimination on health in very highly segregated cities,” he said. “You’re looking at a population that has not been treated well by those in authority.”
Credible messengers: those who have recovered
In recent weeks, African American leaders who have contracted the virus have spoken out about their experiences.
Bowen said he initially thought he just had cold when he started to feel sick in mid-March.
“As it gets worse, in the back of your mind you’re like, ‘Maybe it’s that stuff,’ ” he said. “But then it’s like, ‘But isn’t that on the other side of the world. Like, that’s not here.’ ”
He added: “Yes, it is.”
A couple of days after starting to feel sick, he got a call from the North Shore Health Department that he had been exposed to COVID-19 and went to get tested. He developed a 103-degree fever, cough, tightness in his chest, body aches and chills.
Bowen noted that one of the first people to die in Milwaukee County after contracting the virus was law enforcement trailblazer Lenard “Lenny” Wells, whom he called a mentor.
Wells spent 27 years on the Milwaukee Police Department, where he worked tirelessly to bring racial equity to the ranks as president of the League of Martin, an association for African American officers.
Another legendary African American leader, Reuben Harpole, was diagnosed with coronavirus after being hospitalized last weekend, his daughter, Annette Harpole, said.
Harpole, who is sometimes called “Milwaukee’s Unofficial Mayor,” is a civil rights activist and longtime educator who along with his deceased wife, Mildred, formed a beloved Milwaukee power couple as they fought for racial equality.
“My dad’s a very social person,” Annette Harpole said. “This environment, this social distancing, is just foreign to him.”
Thankfully, Annette Harpole said her father is improving and is not on a ventilator. She said on Thursday afternoon he felt well enough to be on his feet, and even shaving.
“I’m just trying to be cautiously optimistic about my dad,” she said. “He’s a fighter and he is very optimistic. I was struggling on a call with him yesterday and he actually ended up making me feel better.”
Maria Perez of the Journal Sentinel staff contributed to this report.
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