By Alec Pruchnicki
There are numerous accounts of COVID infecting and killing more people of color (African-Americans and Hispanics) than whites in New York and other cities. This has come from health statistics, government agencies, and investigative reports on TV and in newspapers. There is one more strong source of evidence that I have noticed: the subways.
I usually get on the 2 or 3 Seventh Avenue express at 14th Street and take it up to my office near 110 Street and Lenox Avenue during the morning rush hour. At night, I make the reverse trip. Before this pandemic started, most of the riders from 96th Street to 14th were a mix of all different races. Although I wasn’t keeping a close count, retroactively I would estimate that there might have been a roughly 50-50 ratio of white to black with a smaller percentage of Asians. At 96th many school kids and elderly of all races would get on. At 42nd Street, what looked like office workers, of all races, got on.
After the quarantine was started, and the city went into widespread lockdown, all that changed. The total number of riders decreased dramatically during both rush hours. Sometimes I would get on a train with just a few other riders and there was almost always enough space to keep distance between us, if not exactly six feet. But the overwhelming majority of riders were black and Hispanic, with almost all white and Asian riders gone. This has been consistent throughout the quarantine.
The most logical explanation for this is that many of these riders where there because they had to be. Many of the essential jobs that require staff to come in are low paying positions that can’t be done remotely. Along with the doctors, nurses, and hospital staff members (which also are heavily minority), there are delivery people, food service workers, home health aides, and many others who are essential for the working of the city. They are often paid poorly and can’t afford to miss work, or risk being fired for not coming in. I can only imagine that they ride the subways because they have to.
Not only does this put them at continued risk of contracting COVID on the subways, like the over 50 MTA workers who have died from it, and on their jobs where protective equipment might be in short supply, but they then go back to their communities where their potential infections can be spread even further.
There are many reasons why poorer people who constitute a disproportionate number of minority individuals can suffer from COVID. Poverty itself, poor housing, poor nutrition, higher rates of other diseases, inadequate health care service, and other reasons can all contribute to this. Going to work in the middle of a pandemic only adds to this.
Then, of course, there is the question of race. Poorer treatment of minority populations by the healthcare system itself has been documented over the years. How much of these poor outcomes (as we in medicine euphemistically refer to death and disease), are racial and how much economic? Healthcare statistics on income are sometimes harder to get than those broken down by race. I hope when this epidemic is studied, social scientists will look at morbidity and mortality broken down by income. What is the difference between disease rates of poor vs middle class vs upper class people within the same racial group?
Meanwhile, for those of you who ride the subways or buses, let me know if you agree with these qualitative observations. I could be wrong in my perceptions, or explanations for them. I also hope that when this crisis has mostly past someone will study these questions so that we might be a little more ready for the next epidemic that will surely come down the road in the future.