It’s been quiet in Dr. Patricia McManus’ neighborhood lately. She doesn’t like it.
“You don’t see people going up and down the streets like you normally do. … Nobody walking down the street says hello,” she says. “You can certainly see fewer cars early in the morning. You don’t see the school buses. You don’t see people going to work. … That’s not supposed to be the case.”
McManus is the president and CEO of the Black Health Coalition of Wisconsin. She lives near the corner of 58th and Center streets, a predominantly African American neighborhood right at the epicenter of Milwaukee’s coronavirus outbreak. She’s been glad to see more people wearing masks in grocery stores. It’s been good to hear less people racing their cars or swerving recklessly through traffic. But with a “safer at home” order in place, social distancing directives being mostly followed, and an international pandemic hitting inner-city Milwaukee particularly hard, this isn’t a joyous time in the city.
A lot of families are struggling to put food on the table, with breadwinners risking their health and the health of their loved ones to get to essential jobs. Other families are mourning loved ones. Others are praying their loved ones don’t fall victim to COVID-19 too.
The numbers – as limited as testing has been – show how Milwaukee’s black community has faced the worst of Wisconsin’s coronavirus outbreak. Of the first 68 people to die from COVID-19 within the county, 45 have been African American. That means that 2 out of every 3 people in the county who have died from COVID-19 have been black, even though only 1 in 4 Milwaukeeans are black.
There’s a similar disparity in the number of confirmed cases. More than 44% of the county’s confirmed cases, as of April 9, have been black.
That means that not only are black people getting the virus more; they’re also more likely to die from it.
There are four primary reasons why Milwaukee’s black community has been suffering the most from COVID-19, according to the local health leaders that Milwaukee Magazine spoke with. And they all have to do with institutionalized, historical racism. Here they are:
- Population density
- Generational lack of access to health care
- Limited freedom in work environments
- National slow acceptance of the threat of COVID-19
“Whenever a crisis does occur, the people who have been most disenfranchised are always going to suffer the most,” says Dr. Jeanette Kowalik, the City of Milwaukee’s commissioner of health.
The county has tried to be public with as much of its health data as possible throughout this pandemic. And by looking at the data, the reasons behind the racial disparity become more obvious.
The Milwaukee County COVID-19 Dashboard allows the public to get a look at a heat map of which neighborhoods have had the most confirmed cases. And that heat map can be overlaid with other demographic data, including the CDC’s Social Vulnerability Index — which measures communities’ resilience “when confronted by external stresses on human health, stresses such as natural or human-caused disasters, or disease outbreaks.”
Considering the current pandemic, it shouldn’t be surprising that the areas that scored poorly on the CDC’s index also have high case counts of COVID-19. And those same areas also are predominantly black.
“The data look remarkably similar,” Ben Weston, medical director for the Milwaukee County Office of Emergency Management, says of the overlapping heat maps.
That overlapping of racial breakdowns and poor health outcomes is why the city and the county both declared racism to be a public health crisis in 2019.
“Where is your (epidemic’s) hotspot going to be? It’s going to be where this racism is, where the segregation is, where it’s been,” says McManus, who also taught nursing at Marquette University. “There has been benign neglect of what we go through this city, and it’s been ignored for decades.”
Kowalik grew up in Sherman Park. She says that historically racist policies and practices have forced black people into denser living situations, in part because it’s been tougher for black people here to become insured, to own a home and because of the other countless quiet atrocities that have earned Milwaukee a grim title of America’s most segregated city.
Those policies can end up manifesting in a lot of ailments for people, like how stress can lead to high blood pressure, or the lack of access to health care allowing diabetes to be more destructive. And it doesn’t help, Kowalik points out, that predatory advertising from alcohol and tobacco companies have disproportionately affected black communities too.
As such, even if COVID-19 were to be spread evenly across racial boundaries in Milwaukee, white and Asian people, for example, would be less likely to die or suffer complications than black people.
“When you talk about the underlying health problems and the things that have been generated over the years, due to pay inequity for instance or having to pay more for their mortgage or not being able to qualify for a mortgage and having housing instability or having to jam in with other family members because they can’t get their own place, there’s a lot of circumstances that people face that impact their ability to live their best lives,” Kowalik says.
“We’ve been flying blind.”
Dr. Jeanette Kowalik, City of Milwaukee’s commissioner of health
“There’s a number of people of color who are considered essential workers,” Kowalik says. Many of those workers, because of the nature of their employment, “don’t have the freedom of teleworking” like so many other more white-collar Milwaukeeans.
According to the U.S. Bureau of Labor Statistics, 29.9% of white people and 37% of Asian people can work from home because of the nature of their work. Compare that with black people, where only 19.7% of black people can work from home.
And because the access to education and good jobs has been limited, many of those who are lucky enough to have not been laid off are more often forced to rely on public transit to get to work.
“This is classic inequity playing out,” Kowalik says.
And remember: COVID-19 can survive on some hard surfaces for up to three days, according to research from the National Institutes of Health. Think about that next time you have to grab a bus’s handrail.
But then for those who are out of work, the problems of poverty are exacerbated.
“People in this community are living paycheck to paycheck,” McManus says. “When you have 10 kids in one house, what are you going to do to keep everyone fed?”
Churches and other charities are stepping up to fill the void left by lost jobs, but McManus worries how long that can last. Calls to southeastern Wisconsin’s 2-1-1 helpline have doubled during the crisis.
McManus fears that people will grow more restless the longer Safer at Home goes on. And the longer workers’ hours are trimmed, the longer families will have to rely on charity to keep food on the table.
“You’re dealing with people who are frustrated and living on a day-to-day basis already,” she says. “If this lasts a whole lot longer, there’s going to be a lot more stress.”
McManus thinks that Wisconsin’s and/or Milwaukee’s governments need to start being more present on the North Side. There needs to be evidence that citizens’ fears are being heard and that help is coming.
If Milwaukeeans feel ignored, like McManus says she is feeling right now while being stuck at home, “that could rile some people up. I’m starting to think: ‘Why aren’t they helping us … Why isn’t there more visible help here?”
But how did the breakout get so bad in the first place?
Well, on Feb. 24, President Donald Trump tweeted “The Coronavirus is very much under control in the USA.” That kind of thinking at the federal level not only caused most people to not believe COVID-19 was serious, but it also led to inadequate preparation for when the virus inevitably reached the U.S.
The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart. Stock Market starting to look very good to me!
— Donald J. Trump (@realDonaldTrump) February 24, 2020
The effects of that are now seen with the ongoing shortages of personal protective equipment and test supplies, and with some states instituting shelter-in-place orders too late. Some say Wisconsin waited too long, too.
And because we didn’t have tests from the start, it made it impossible for anyone — from public health professionals to your cousin who lives down the block — to understand the extent or seriousness of the problem. One week into March, the U.S. had only 5 tests completed for every million people. South Korea had 740 times as many people tested per capita. And the U.K. had tested 70 times as many people as the U.S. at the same time.
“We’ve been flying blind,” Kowalik says.
Kowalik told me about one of the people who inadvertently brought coronavirus to Milwaukee. That person had just returned to the U.S. from a country that was an early coronavirus hotspot. They landed on the East Coast, were tested, but then sent on their merry way before the results came back. That person found out they were positive for COVID-19 after they had already arrived in Milwaukee, potentially exposing others to the disease.
“That’s why widespread testing is important,” Kowalik says, noting that widespread testing is an impossibility because of federal and state choices that resulted from lacking prior planning, limiting American COVID-19 testing capacities. “The reason we’re in this predicament is because of the federal level … They didn’t see this as a credible threat because their planning was stalled.”
Not only that, but “early on, there was a lot of false information that black people couldn’t get the coronavirus,” Kowalik adds.
Some of that was because of fake news, like the baseless memes that said having melanin somehow stopped COVID-19 in its tracks.
There were also cultural misunderstandings. When coronavirus broke out in China in December, most Americans, regardless of color, figured they weren’t at risk because they weren’t going to China and didn’t know anyone who was going to be in China. That created a false sense of security that left the public unprepared for when COVID-19 did show up.
To combat that, the “Stay Home Save Lives” campaign was rolled out across greater Milwaukee.
But, Kowalik says, “you can’t have a cookie cutter response to an outbreak response.”
That’s why a second wave of that campaign is being rolled out with targeted messages for different slices of Milwaukee’s diverse population, with messages targeted for African-American, Latinx and Hmong populations. That messaging campaign is being rolled out now in April.
For the moment, McManus is still getting used to Milwaukee’s newly empty streets.
“It’s much quieter, but it’s not a good quiet … Everyone is hunkering down in their homes,” she says. “It’s the current normal. I don’t want it to be called the new normal. I hope it doesn’t last.”