SHEREEN MARISOL MERAJI, HOST:
Hey, CODE SWITCH family. Shereen here. By now, you've seen the statistics about COVID-19 deaths and how they break down by race. In the nearly four years of doing this podcast, we've brought you countless stories that point to the health and wealth inequities in this country, so if you're a regular CODE SWITCH listener, these statistics probably didn't surprise you. But if you're anything like me, they made you really upset and incredibly frustrated.
On this bonus episode, Mary Harris, host of Slate's daily news podcast "What's Next" (ph), talks with Akilah Johnson from ProPublica about race and COVID-19. And a warning - there's some foul language in this episode. All right, here's Mary.
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MARY HARRIS: For a reporter, uncovering the face of the coronavirus feels a little like watching film develop in a darkroom. First, we learned the elderly were at risk, but children seemed to be safer. Then it seemed like men were getting sicker than women.
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AKILAH JOHNSON: The question that I think is driving me as a reporter and I think that is largely driving a lot of us is how do we get closer to the ground? The stories from people in power tend to be easier to access.
HARRIS: They have a bigger megaphone.
JOHNSON: They have a bigger megaphone. They're on social media. They have access to more - you know, not just medical care, but then the ability to get the story out.
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HARRIS: Some cities began breaking down their infection rate by ZIP code to show who is more at risk. And then they began breaking down the coronavirus caseload by race.
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UNIDENTIFIED REPORTER: New statistics from the governor's office showed that the majority of COVID-19 deaths in Louisiana have involved African American patients, and high blood pressure is the No. 1 underlying...
BEN WAGNER: That's right. The health commissioner says that a large number of those cases are on Milwaukee's northwest side in predominantly African American neighborhoods.
LORI LIGHTFOOT: I mean, it's breathtaking. When I first saw these numbers, I had a hard time thinking about anything else because I knew that this was going to land like a bomb.
JOHNSON: One of the arguments that, you know, you hear and is made is that we're all being affected by this, right? That COVID-19 is - it doesn't discriminate. You know, you've got everybody from Boris Johnson in the U.K., who is severely affected by this, to bus drivers and transportation workers in the U.S. who are affected by it. However, the difference is not everybody is affected the same, right? The size of suffering varies depending upon who you are and your circumstances in life. And so as with so much, when it comes to race and poverty, particularly in the U.S., they're very uncomfortable conversations to have.
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HARRIS: But this uncomfortable conversation - we're about to have it, like it or not. So today on the show, Akilah is going to lay out what we know and what we don't about the coronavirus and race and why public health experts are saying we can't afford to take a race-neutral approach in this pandemic.
Let's talk about what we know because I feel like in the last few days, we just keep getting more information that's pointing in the same direction, like Louisiana - 70% of COVID-19 deaths are black patients - or Chicago - 61 of the 86 recorded deaths. Again, 70% were black residents. I know that you took a really close look at Milwaukee. Why did you want to go there?
JOHNSON: Milwaukee was interesting because they were so transparent with the data about who was dying and why they were dying. So it's not just the fact that they were releasing race and ethnic demographics, but then they were also listing various comorbidities. And so what does that mean? That means if people also had diabetes, hypertension, chronic heart disease, lung disease. They were listing those factors in addition to age and race and ethnicity.
So it was very much, like, a case study and a window into at least a municipality that was trying to be very clear-eyed about what was happening and the way that they were approaching it when there are so few who were doing at the time. So it was just a window into that.
HARRIS: What were the numbers they were finding in Milwaukee?
JOHNSON: So, you know, in Milwaukee, they were finding early on, at first, everybody who died in Milwaukee was black. All of the initial deaths up until - I want to say - they had 10. Like, all their first 10 deaths were all black. And then after that, it became disproportionate numbers, which is concerning when, I believe, the city of Milwaukee is 38% black and the county is 26% black and all of your deaths and a disproportionate number of your infection rates are of African Americans. And as the number of cases not just of infections but also deaths have grown, that disparity has also continued. Not everybody who has died in Milwaukee now is African American. However, the disproportionate number of deaths are.
HARRIS: Milwaukee's coronavirus outbreak followed the same pattern as other cities. At first, testing was really limited, mostly reserved for people who had traveled internationally or were showing symptoms. Akilah says that made the city's health commissioner, Jeanette Kowalik, really nervous.
JOHNSON: She's watching what's happening in New York. She's watching what's happening in California. And as a public health official, she's thinking to herself, it's only a matter of time before this happens in Milwaukee, but I am not in a position to test to see if people in my community have it, if it's already here because of these testing limitations and restrictions.
So why was she so concerned about the possibility of there already being community spread in Milwaukee or the possibility and potential of it? She said it's a very commuter-heavy city. You've got people who are coming in and out, some who are traveling down daily from Chicago, who are coming in from suburban areas to work in Milwaukee. And that's actually how the first case entered the city. The first case in the area from - was a neighboring affluent, predominantly white suburb, and someone had contact with that person in the suburbs - someone who lived in Milwaukee - and came home and then tested positive for COVID. By the fourth case, which this is all happening kind of in rapid succession, she determined it was community spread because the cases weren't entering Milwaukee from international travel. And then, to reiterate, within the span of a week, it went from one case to 40.
HARRIS: Having a lot of commuters was one factor, but there was something else that made black residents in Milwaukee and elsewhere especially vulnerable - persistent rumors they couldn't get sick.
JOHNSON: You know, in the beginning, there were a lot of kind of bogus conspiracy theories that were floating around that African Americans and black folks were somehow immune to COVID-19. You know, PolitiFact has debunked this. There have been several stories debunking this. But it was definitely something that was populating on social media. And that is a concern that I heard repeated from everybody from city counselors in rural communities in South Carolina to the public health commissioner in Milwaukee to infectious diseases doctors in Washington, D.C. You know, Idris Elba did a whole video debunking that claim because it was definitely out there at the beginning.
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IDRIS ELBA: My people, black people - black people, please, please, please understand the coronavirus is - you can get it, all right? There are so many stupid, ridiculous conspiracy theories about black people not being able to get it. That's dumb. It's stupid, all right? That is the quickest way to get more black people killed, and...
HARRIS: These kinds of conspiracy theories - they're dangerous and confusing, but they aren't the whole story. There are layers upon layers of history making it harder for black communities to defend themselves against this virus. Akilah says in Milwaukee, that looks like access to quality care, even housing.
You talked about how the health commissioner herself talked to you about how her parents had trouble finding a place to buy a home, and home ownership is quite low in black communities. But then what that means, as you said, is that black individuals might be living in a situation where they are running up against other people just by default.
JOHNSON: Well, absolutely. So Health Commissioner Kowalik did share a story with me. So she is biracial. Her mother is African American. Her father is Polish. And she shared a story that growing up in Milwaukee, when her parents went to go buy a home, her father had to go to the bank without her mother in order to secure the loan. So again...
HARRIS: Because he was white.
JOHNSON: Because he's white and her mother was black. So again, the not-too-distant past. You know, this is very much kind of recent history.
And so home ownership in Milwaukee in the black community - the numbers were vast. It was something like 7% of the black community owns a home, compared to over 80% of the white community owns their home. And so that speaks to generational wealth, but that also speaks to your autonomy to control your environment and have more control over your environment. So not only can you shelter in place, but you can determine how long you can be there, how many people are going to be there with you. But it also then speaks to your ability, in some ways, to not just control your environment, but it speaks to the - your income level and income status to be able to make sure there's food in that house and the water is running and there are cleaning supplies in it. You know, it is very layered and multidimensional.
And so I think sometimes it can be kind of confusing to what's the significance of owning a home, but home ownership has been very much the bedrock of the gateway to the American middle class and financial stability and generational wealth in this country. And here is a community that largely, through no fault of its own, that's not a possibility.
HARRIS: And I imagine you could go right down the line - like, look at car ownership rates and whether you're reliant on traveling with other people on a subway or a bus, and health insurance rates, like whether you feel comfortable walking into a medical facility in Milwaukee. I mean, there's even some evidence that pollution might make people more vulnerable to infection. And, of course, there's years and years of reporting showing that communities of color are more likely to live in places that are more polluted.
JOHNSON: Yes, you know, through historic redlining and residential segregation. And so you can go down the line. And you can go down the line in Milwaukee, and you can go down the line in a variety of - name an American city, almost, and you'll see very similar gaps in wealth and home ownership, access to insurers, access to medical care, access to clean air. I mean, it affects the air you breathe. And it being - you know, our country's history of discriminatory policies when it comes to economics, housing, health care, education, it creates the types of conditions and breeding ground that result in just very kind of unequal impact, you know, in managing pandemics.
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HARRIS: I want to spend a little bit of time talking about something else, which is who is considered an essential worker. I keep thinking back to that video that the bus driver made in Detroit. Did you see it?
JOHNSON: I know what you're talking about. I haven't been able to bring myself to watch the video.
HARRIS: Yeah. It's a bus driver - he's black, and he was driving the bus. And someone started coughing on his bus and wasn't covering her mouth. And he just kind of lets loose on a Facebook Live saying, you can't do this. I'm an essential worker. I have to be here. Please don't put me at risk.
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JASON HARGROVE: This is real. I'm out here. We out here. We moving the city around back and forth, trying to do our jobs and be professional about what we do. Again, I ain't blaming nobody - nobody - not the city, not the mayor, not the department, not the state of Michigan, not the government, nobody, not the president. I blame that woman who stood on this f****** bus and coughed. It's her fault. It's people like her who don't take s*** for real while this s*** is still existing and still spreading.
HARRIS: And then he passed away from COVID-19. Do we have any good information about the racial breakdown of essential workers?
JOHNSON: Not that I have seen. To be honest, I don't know if anybody's collecting statistics along those lines. But I can say if you look historically at who holds the positions that are now being deemed essential workers, and I think traditionally, we think of essential workers as law enforcement, firefighters, which they are, but this pandemic has widened the aperture of that lens to include folks in the food chain supply, say, your grocery store workers and MTA workers and transportation workers. It includes a lot - a variety of government workers, you know - the post office, the post office workers.
Traditionally, these roles and these jobs have been the pathway for African Americans into the middle class. If you look at specific industries, and there are large numbers of African Americans and brown and black folks who hold those positions, exposure risk is higher for a pandemic because these are people who can't work from home.
HARRIS: To understand how this virus is disproportionately affecting people around the country, there's got to be data about these essential workers, about everyone who's getting sick. As they collect information about coronavirus tests, the CDC is collecting information about race and ethnicity, too; they just haven't been releasing it. Some say this data is incomplete so it isn't reliable, but other public health officials, they disagree. They say even some information is better than nothing.
One of the more powerful arguments I saw for releasing this data, just right away, was a policy wonk person who basically said we learned this with Hurricane Katrina and with the financial crisis, that if we don't understand who's most impacted, we're not going to put in place the policies that help the people who need it. And I just thought, oh, of course. And I hadn't thought to compare this particular crisis in this way, like, with the racial breakdown, to the financial crisis or Katrina, but it made perfect sense when I heard someone else do it.
JOHNSON: Well, and that's the argument that you're hearing from public health officials. That's what they're saying in terms of - and they're looking very much through a public health lens, right? But what have we learned from history, and why are we not applying those lessons to our current crisis? Why make these things an afterthought, is the question that's being raised.
There is an increasing national push, and there is an increasing - you know, an alarm is being sounded from federal lawmakers, national civil rights organizations, physicians on the ground to release this data and not just to release it for the sake of releasing it but to release it so that resources can be deployed adequately and in places where they are most needed and various mitigation strategies can begin in earnest.
HARRIS: It's interesting. I just - I keep thinking about the delicacy of this data and how it needs to be handled with such care because in the wrong hands, it could be used in such a toxic way, where people could say, oh, this is a disease of certain people or certain people are sick. And it makes me feel really divided, I guess, because of the world that we live in right now.
JOHNSON: Well, that is not an unrealistic concern. So one of the things that - I can just speak that I was very conscious of and remain conscious of and I believe my colleagues at ProPublica are conscious of as we continue to report on this issue is making sure that we're not unnecessarily or unduly and unfairly racializing a disease, if that makes any sense, right? Because COVID-19 as an entity - there is no race. That is not, like, a - this is something that only black people get or more black people get, period.
There are a myriad of circumstances that are creating circumstances where African Americans, early data's showing, are disproportionately impacted, who are more likely to have, you know, more significant health outcomes because of a variety of - a disproportionate number of chronic health conditions. But I do share the concern of too easy or too quick of a causation and a link. But I think if you - and I think what we are beginning to see, as more and more people are beginning to tell the story and as different municipalities are beginning to share this information, that it is necessary information, and it is needed information and that these conversations are never easy, but they are necessary, and they are nuanced.
HARRIS: Yeah. It's just - I was just looking at an interview that a senator gave on the radio this morning, and he did exactly what I feared. This is Senator Bill Cassidy, a Republican, who looked at the same information we are and apparently said that there was some kind of physiological difference that was causing black patients to die with more frequency from COVID-19.
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BILL CASSIDY: Now, as a physician, I would say we need to address the obesity epidemic, which disproportionately affects African Americans, but all - and all Americans need to address it. That would lower the prevalence of diabetes, of hypertension, of the ACE receptors, etc., and that's what would bring benefit.
DAVID GREENE: Well, I mean, as we heard in that report, I mean, some underlying health conditions and disparities are part of the issue here. But I mean, we heard Congressman Cedric Richmond say as well that this is rooted in years of systemic racism. Aren't there other forces at work here?
CASSIDY: Well, you know, that's rhetoric, and it may be, but as a physician, I'm looking at science. And the science...
GREENE: You're saying that's just rhetoric? I mean, there are more...
JOHNSON: It's a very similar debate that you hear sometimes when you when you hear people talk about, oh, personal responsibility, personal choice. And, take, for instance, like, you know, the issue of African Americans being disproportionately affected by diabetes, and the conversation can quite often distill to these very general, well, just control your diet. Go exercise more. It's a matter of personal responsibility. If you stopped eating these things, if you stopped doing these things, your health would improve, and because - because folks are not doing that, then they clearly, like - they don't care.
There's a lack of personal responsibility without really getting to some of the systemic wears. Well, how am I going to buy healthy food if I can't afford it? Where am I going to buy fresh produce if I live in a food desert? How am I going to manage and, you know, maintain my chronic health condition if there are barriers to health care? I mean, just physically getting to a physician, you know, in terms of there may not be a hospital nearby. You may live in a health care desert.
There's always another question on the why, but that takes time, and that takes nuance, and it is not neatly wrapped up in quick soundbites and discussions. And so sometimes - oftentimes, conversations stop at the surface level. And that surface level and the quickest thing for people to wrap their minds around is this concept of, like, well, therefore, it is a personal choice.
HARRIS: Akilah Johnson, thank you so much for joining me.
JOHNSON: Thank you. It was my pleasure.
HARRIS: Akilah Johnson is a narrative health care reporter at ProPublica.
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HARRIS: And that's the show. We want to thank you for calling us and leaving messages about how you're getting through this really weird period. Here's a call that we really loved.
CHARLES: Hey, my name is Charles. I'm a paramedic on the East Coast. I'm not going to be more specific than that because of HIPAA, but I run 911 as well as take patients to hospital discharges.
Yesterday, we were discharging a 90-year-old female, taking her back to the nursing home, and miraculously, the patient's daughter was able to catch us in the 20 feet from the back of my ambulance to the front doors of the nursing home. The daughter hadn't been able to see her mom for weeks during the hospital. She wasn't going to be able to see her in the nursing home. The patient's on the fifth floor so she wasn't even going to be able to see her through a window in her room. But the daughter was able to catch us, and she was able to say hello to her mom, let her know that she's still thinking of her, hadn't been forgotten about.
And one of the hardest parts about this pandemic is the fact that, normally, I know what to do. Like, if you get shot, I can plug the hole, get you to the bright lights and cold steel. Like, I know what to do. But with this pandemic, it's like, we just kind of sit and wait. So to have this small victory where I was able to just hang out with a patient for a few minutes, let the daughter and the patient talk at a good social distance - this daughter, I mean, she kept about 12 feet away, really - but just how that small victory meant so much to me in this time of just - where we don't know what's going to happen next. All right. Thank you.
HARRIS: Our number is 202-888-2588. Your voicemail could inform our reporting or get played on the show so give us a ring. "What Next" is produced by Mary Wilson, Jason de Leon, Danielle Hewett and Mara Silvers. Thanks for listening. I'm Mary Harris.
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