In the epicenter of the COVID-19 pandemic, New York City residents face unequal levels of risk and accessibility to treatment along socioeconomic lines. For low-income neighborhoods like West Harlem, COVID-19 poses a risk for thousands of elderly and immunocompromised families.
A report from the New York City Department of Health and Mental Hygiene in 2017 revealed that compared to other New York City neighborhoods, child and adult asthma-related emergencies were over twice as frequent in Community District 9, which covers Morningside Heights, West Harlem, and surrounding areas.
A later report released in 2020 ranked CD9 as the third highest in the city for people who needed medical attention and couldn’t get it.
Coupled with the peak of COVID-19 cases in New York City, over 145,000 CD9 residents have one
Research suggests that the cost of COVID-19 treatment could top $20,000, making up a third of the residents’ median household income. Nearly 40 percent of the community is on income assistance, nearly 25 percent live below the poverty line, and approximately half are rent burdened, meaning that they spend over 30 percent of their income on rent.
As concerns rise around the novel coronavirus, community leaders say that the virus has exacerbated the long-time health concerns that have historically plagued low-income neighborhoods like the West Harlem community. With limited access to hospitals, a large immunocompromised population, and high cost of treatment, Community District 9 residents are both more vulnerable to COVID-19 and less likely to access treatment, research shows.
With over 102,504 confirmed cases and the number of deaths surpassing 5,700, New York City has become the epicenter of the coronavirus outbreak in the United States. As of Sunday, Manhattan has 13,280 verified cases and 664 deaths due to the virus. As the number of cases rises, the city’s healthcare system has grappled with a shortage of beds for patients and lack of accessible personal protective equipment for thousands of health workers and residents of the community.
Columbia responded to the outbreak by complying with recommendations both from the CDC and from New York State to limit person-to-person interaction. On March 12, President Lee Bollinger announced the implementation of online learning and mandated that all able students vacate their housing assignments before March 18.
In the following week, Columbia opened 170 University-owned apartment units to New York-Presbyterian Hospital staff in an effort to decrease frontline workers’ commutes and reduce their risk of infecting others.
Amid the growing uncertainty of the pandemic for health experts and community leaders alike, one consensus is clear: Low-income communities who often lack the resources necessary to access health care are the most affected by COVID-19.
Community District 9
Graphic by NYC Health on April 12, 2020. Additional design by Luke Dobrovic.
Graphic by NYC Health on April 12, 2020. Additional design by Luke Dobrovic.
Even before the outbreak, many openly recognized the disparity in quality of life between low-income and high-income Americans. A study done by Stanford researchers surveyed 1.4 billion U.S. tax records from the years 2001 to 2014 and found that New Yorkers in the top quartile live 4.8 years longer than those in the bottom quartile.
Additionally, low-income populations in the United States are also more likely to suffer from obesity, mental health issues, high blood pressure, and chronic illnesses than their wealthier counterparts.
District 9, composed of the Manhattanville, Morningside Heights, Hamilton Heights, and West Harlem neighborhoods, has one of the highest poverty rates in all of Manhattan, with 20 percent of residents falling below the poverty line. Experts say that this inequality is an indicator of the overall health care issues in the community.
Social distancing has widely been recommended as a necessary measure to ensure personal and communal safety against the spread of the coronavirus. However, according to Miriam Aristy-Farer, co-chair of the CB9 Health and Environment Committee, many of the low-income residents in the district hold service jobs at essential businesses or staff hospitals, requiring them to commute to work and place themselves in constant contact with customers. The businesses continuing to operate around Columbia University require essential workers to continue serving the Morningside Heights community, but high rent prices in the area means that these workers often commute from surrounding neighborhoods in West Harlem.
Location data collected from cellphones have illuminated the divide between safety measures that wealthier populations can afford versus the limited options available to the working class—a reality that is especially salient during the pandemic.
On average, CD9 is also home to a larger number of immunocompromised individuals compared to other districts in Manhattan, with more smokers, higher rates of diabetes, hypertension, obesity, and new HIV diagnoses, according to a community health report released in 2018. The district also has the third highest number of reported rates of child emergency room visits due to asthma across all of the Manhattan districts.
According to the CDC, those with underlying conditions such as asthma, obesity, diabetes, in addition to those who smoke, are at a higher risk of developing severe illness if they contract the new coronavirus.
A report by New York City Health stated that as of April 6, COVID-19 death rates for both the Hispanic/Latinx population and the Black population—a demographic that comprises 68 percent of the district’s population—were double that of white patients.
The disease is also reported to be disproportionately fatal for individuals aged 50 and over, a demographic that comprises nearly a third of the district.
For low-income communities like CD9, the effects of this pandemic will persist longer and present more severe damage, said Dr. Dustin Duncan, a social epidemiologist at Columbia.
“I think that social inequalities will further exacerbate because of COVID and health inequalities will exacerbate,” he said. “People who are poor and racial minorities will be more likely to potentially acquire [the coronavirus] and suffer from the negative consequences in terms of prognosis.”
Community members have stated that the district has historically lacked the financial stability needed to promote overall wellness, citing the limited access to health care for many community residents.
In response to these inequities, Mayor Bill de Blasio announced the opening of more testing centers for severely-affected communities such as West Harlem to address the health disparities that the pandemic threatens to exacerbate.
However, Aristy-Farer said that the problems facing the community have existed long before the outbreak of the virus, and the current governmental efforts to aid communities like District 9 only address one of the many problems faced by the health care system.
“This is a band-aid solution; it's not permanent,” she said. “The pandemic brought to light what a weak health care system that we have nationally.”
Since 2000, there have been 24 hospital closures in New York City, making Mount Sinai Morningside—a private hospital—the only hospital in CD9. The hospital houses ICU beds at a rate of 1.9 per 10,000 adults, which is lower than the citywide average of 3 per 10,000.
Meanwhile, 11 percent of adults in the district lack health insurance, potentially leaving those adults with the full expense if they require treatment for the infection, according to a city health report from 2018. Treatments for respiratory-related complications that require a ventilator can reach $20,000, according to a health care cost report. For a patient who suffers from even more severe symptoms, such as pneumonia, care can cost nearly $90,000.
Typically, the costs associated with private medical care make these locations inaccessible to low-income residents in the district. To combat these concerns, the federal government has promised to cover uninsured coronavirus patients and mandated that insurance companies’ waive copays.
But according to Dr. John Rowe, a professor at Columbia’s Mailman School of Public Health and previous CEO of Mount Sinai NYU Health, these efforts are not foolproof. He cited the likelihood that long-time uninsured members of the community are not informed about these updated policies, and as a result, will continue to avoid seeking care.
“One of the problems is that uninsured individuals have become accustomed to not seeking care because they’re afraid of the cost, and they may not be aware of the fact that the government is going to cover those payments,” Rowe said. “The primary consideration at this time really has to be the communication to the individuals that they will not have a financial obligation, not just for testing but for care.”
If they decide to seek care, patients have often found that hospitals are overwhelmed with high rates of infection of healthcare workers, leaving hospitals with a depleted staff, said Diana Torres, a nurse at Mount Sinai West.
“More and more people are sick on a daily basis,” Torres said. “Whenever I come back to work, there’s another person missing because they’re sick and they need to stay home, or they’ve already tested positive and they’re symptomatic.”
Torres reported seeing nurses wearing trash bags as a substitute for the isolation gowns that healthcare workers wear to protect themselves against the virus. She avoided contact with anyone other than her patients and her fellow staff, assuming that she has had enough exposure to be a carrier. These measures are not enough, Torres said, as healthcare workers are still falling ill and dying, as was the case with a fellow nurse who died after contracting the coronavirus at Mount Sinai West.
Residents of CD9 also bear the brunt of high risks of infection associated with healthcare work, as the district is home to a number of essential, non-medical personnel who work alongside doctors and nurses, often providing cleaning and janitorial services, according to Aristy-Farer. The workers who hold these jobs have reported no access to masks and no paid sick leave, as doctors and nurses have priority access to protective equipment, a reality that leaves healthcare workers in CD9 at risk and unprotected.
According to Torres, the virus exposed a healthcare system that was already broken, one that already failed to protect its workers. For public hospitals, experts say that overcrowding can make the effect that much worse.
A health research analysis in 2017 reported that hospitals that treated patients with private health insurance charged 2.4 times the cost than those with Medicare. This inflation generates revenue for the hospitals, giving hospitals incentive to fill their beds with privately-insured patients.
Because of the high cost of private healthcare at locations such as Mount Sinai, low-income residents in CD9 gravitate toward Harlem Hospital Center, whose proximity to the district also makes it an accessible option for those who contract the disease. A teaching hospital affiliated with Columbia University, Harlem Hospital Center is one of New York City’s 11 public hospitals. Last week, 30 health care workers rallied in front of the hospital protesting severe shortages in personal protective equipment.
“Right now, Harlem Hospital is out of stretchers,” Aristy-Farer said. “A lot of our people are going to Harlem Hospital because it's a public hospital, so the fact that [some residents] don't have insurance does affect our community. It overburdens certain hospitals while others are not as burdened.”
Other public medical centers have experienced similar conditions. Elmhurst Hospital in Queens, which serves a large number of undocumented immigrants and low-income families, was one of the earliest and most severely overwhelmed hospitals to be affected by large numbers of COVID-19 patients.
Aristy-Farer said that the coronavirus has shown just how much the health care system’s focus on profit over people can cause inequities for communities like Community District 9—inequities that leave people infected, hospitals overburdened, and communities broken.
“We completely have been caught off guard,” she said. “I hope and I pray that our [elected officials] and our entire country look at the health care system from a new lens—not from the lens of profitability but from the lens that it should, of saving lives.”
Staff writer Destiny Glover can be contacted at firstname.lastname@example.org.