Lessons (Not) Learned: Chicago Death Inequities during the 1918 Influenza and COVID-19 Pandemics.

During historical and contemporary crises in the U.S., Blacks and other marginalized groups experience an increased risk for adverse health, social, and economic outcomes. These outcomes are driven by structural factors, such as poverty, racial residential segregation, and racial discrimination. These factors affect communities' exposure to risk and ability to recover from disasters, such as pandemics. This study examines whether areas where descendants of enslaved Africans and other Blacks lived in Chicago were vulnerable to excess death during the 1918 influenza pandemic and whether these disparities persisted in the same areas during the COVID-19 pandemic. To examine disparities, demographic data and influenza and pneumonia deaths were digitized from historic weekly paper maps from the week ending on 5 October 1918 to the week ending on 16 November 1918. Census tracts were labeled predominantly Black or white if the population threshold for the group in a census tract was 40% or higher for only one group. Historic neighborhood boundaries were used to aggregate census tract data. The 1918 spatial distribution of influenza and pneumonia mortality rates and cases in Chicago was then compared to the spatial distribution of COVID-19 mortality rates and cases using publicly available datasets. The results show that during the 1918 pandemic, mortality rates in white, immigrant and Black neighborhoods near industrial areas were highest. Pneumonia mortality rates in both Black and immigrant white neighborhoods near industrial areas were approximately double the rates of neighborhoods with predominantly US-born whites. Pneumonia mortality in Black and immigrant white neighborhoods, far away from industrial areas, was also higher (40% more) than in US-born white neighborhoods. Around 100 years later, COVID-19 mortality was high in areas with high concentrations of Blacks based on zip code analysis, even though the proportion of the Black population with COVID was similar or lower than other racial and immigrant groups. These findings highlight the continued cost of racial disparities in American society in the form of avoidable high rates of Black death during pandemics.

COVID-19, green space exposure, and mask mandates.

INTRODUCTION: Mask-wearing and social distancing are critical prevention measures that have been implemented to stem the spread of COVID-19. The degree to which these measures are adhered to in the US, however, may be influenced by access to outdoor resources such as green space, as well as mask mandates that may vary by state. PURPOSE: To examine the association between the presence or absence of statewide mask mandates and green space exposure with COVID-19 cumulative incidence in the US. METHODS: In October 2020, COVID-19 case data for each US county was downloaded from USA Facts, in addition to statewide mask mandates from a database maintained by the American Association of Retired Persons. The Normalized Difference Vegetation Index from the US Geological Survey (USGS), was used as a measure of greenspace, while the 2016 National Land Cover Database was used to assess tree canopy exposure as an alternative measure of greenspace. We performed generalized linear regression to evaluate associations with COVID-19 incidence, adjusting for potential confounders such as other environmental factors (i.e., air pollution and climate) and socio-economic factors derived from the CDC social vulnerability index. In addition, we also performed spatial regression analyses to account for spatial autocorrelation across counties. RESULTS: Counties with mandatory mask-wearing policies had a lower cumulative incidence of COVID-19 (B = -0.299, SE = 0.038). Among environmental factors, precipitation (B = 0.005, SE = 0.001) and PM 2.5 (B = 0.072, SE = 0.012) were associated with a higher incidence of COVID-19, while tree canopy (B = -0.501, SE = 0.129) was associated with a lower risk of COVID-19. COVID-19 incidence was higher in counties with socially vulnerable populations regarding socioeconomic status, minority status, and housing and transportation. CONCLUSION: Mandatory mask regulation, exposure to green space, and reduced exposure to air pollution may reduce COVID-19 incidence in the US. Additional public health policies should consider ways to mitigate environmental conditions that may contribute to the risk of COVID-19, especially for vulnerable populations.

Disparities in the distribution of COVID-19 testing sites in black and Latino areas in new York City.

In New York City (NYC), there are disproportionately more cases and deaths from COVID-19 for Blacks and Latinos compared to Whites. Using data from the NYC coronavirus data repository and the 2018 American Community Survey 5-year census estimates, we examined the distribution of testing sites across NYC areas (zip code tabulation areas) by race in May 2020. ArcGIS was used to create majority race zip code-level maps showing the distribution of testing sites on May 1, 2020 and May 17, 2020 in NYC. t-tests were used to determine whether significant differences existed in the number of testing sites by the majority race of zip codes. Between May 1, 2020 and May 17, 2020, testing sites in majority Black areas increased by more than 240% from nine to 31, and more than 90% from 16 to 31 in majority Latino areas. Black (M = 1257.7) and Latino (M = 1662.3) areas had significantly more COVID-19 cases (p < 0.05) compared to White areas. Nonetheless, White (n = 70; 38.9%) areas had most of the 180 testing sites on May 17, 2020, compared to Black (n = 31;17.2%) and Latino (n = 31;17.2%) areas. Due to the socio-economic and underlying health conditions that may place Blacks and Latinos at high risk for COVID-19, it is imperative that access to testing is improved for vulnerable groups.