By early May, the field of bioethics was debating the associated risks of shutdown versus re-opening, as various states began to get a better picture of the demographics associated with Covid-19 deaths. What was emerging was a familiar and alarming health disparities story in which Covid-19 was ravaging vulnerable populations such as nursing home residents, African Americans, immigrant worker populations – particularly those who worked in meat plants. – particularly bearing the brunt of outbreaks in meat-packing plants. The U.S. now had over 1 million cases of coronavirus and by May 8, 76,000 deaths. Of those who died, almost 60% were African American (see: https://www.washingtonpost.com/nation/2020/05/06/study-finds-that-disproportionately-black-counties-account-more-than-half-covid-19-cases-us-nearly-60-percent-deaths/). Meanwhile, one-third of all Covid-19 deaths were in nursing home residents (see: https://www.nytimes.com/interactive/2020/05/09/us/coronavirus-cases-nursing-homes-us.html). But even among nursing home residents, there were disproportionate racial disparities (https://www.nytimes.com/article/coronavirus-nursing-homes-racial-disparity.html).
Other vulnerable groups were mostly immigrant workers in meat-packing plants (https://www.washingtonpost.com/outlook/2020/05/22/immigrant-workers-have-born-brunt-covid-19-outbreaks-meatpacking-plants/), as well as prison populations. As the health disparities news emerged, it began to drive policy in the wrong direction. An article in The Atlantic analyzed that the Trump Administration was less concerned about the pandemic once it was clear that the deaths were targeting vulnerable Americans who were not part of his base of supporters. The article notes: “Once the disproportionate impact of the epidemic was revealed to the American political and financial elite, many began to regard the rising death toll less as a national emergency than as an inconvenience… The lives of workers at the front lines of the pandemic—such as meatpackers, transportation workers, and grocery clerks—have been deemed so worthless that legislators want to immunize their employers from liability even as they force them to work under unsafe conditions….” (See: https://www.theatlantic.com/ideas/archive/2020/05/americas-racial-contract-showing/611389/).
What was clear is that populations with more comorbidities such as hypertension and type 2 diabetes were at much higher risk of dying from Covid-19, while the social production of chronic health problems are more prevalent with economic disparities and poverty. It was also clear that our nursing home system was perilously unprepared and underfunded.
In the African American population, the health disparities story is a familiar pattern. It was becoming clear that Covid harkened back to inequities that came from centuries of institutionalized racism that led to the Tuskegee study, disproportionate HIV infections in African Americans by the 1990s, and the abandonment of less mobile African Americans in the wake of Hurricane Katrina. An African American New York Times journalist, Mara Gay, recovered from Covid, and wrote this:
“Why are more people dying of this disease in the United States than in anywhere else in the world? Because we live in a broken country, with a broken health care system. Because even though people of all races and backgrounds are suffering, the disease in the United States has hit black and brown and Indigenous people the hardest, and we are seen as expendable.” (See: https://www.nytimes.com/2020/05/14/opinion/coronavirus-young-people.html?action=click&module=Opinion&pgtype=Homepage).
All the while, conservative groups were fighting mitigation orders: several churches wanted to begin holding live services again, “anti-government” protestors marched outside of state legislatures, while mask-wearing became intensely political because American leadership was demonstrably against mask-wearing. For example, Vice President Pence would not wear a mask even when touring the Mayo clinic in April, and President Trump openly refused to wear a mask throughout May, even while touring a Ford plant in Michigan, which was retooling to make PPE and ventilators. See:https://www.washingtonpost.com/politics/2020/05/21/trumps-reason-not-wearing-mask-sticking-it-media and :https://www.forbes.com/sites/mattperez/2020/05/21/trump-refuses-to-wear-a-face-mask-during-tour-of-ford-facility-in-michigan/#5e92cfa658f7 .
Americans struggling with staying safe during the worst pandemic in over a century found themselves battling an unlikely culture war over masks. By May, mask-wearing becomes an exhausting education effort for healthcare providers. Consider this piece from a Reno physician May 18: https://www.rgj.com/story/news/2020/05/18/reno-er-doctor-wearing-mask-sacrifice-we-all-need-take/5215101002/.
Worse, not only do many Americans openly defy mask-wearing policies instituted by individual retailers, but they even begin to deny that Covid-19 is “real” as bizarre conspiracy theories about “inflated death tolls” begin to circulate on right wing social media sites (https://www.forbes.com/sites/mattperez/2020/05/10/death-toll-conspiracy-why-conservative-media-and-soon-possibly-trump-are-doubting-coronavirus-mortality-figures/#550f772a57d5).
This piece from the Washington Post encapsulates the “Covid denialism” and the divisiveness coursing through the country: https://www.nytimes.com/2020/05/15/opinion/coronavirus-democracy.html?action=click&module=Opinion&pgtype=Homepage&fbclid=IwAR15p5RtwV16JGneqBXZI-cRwGRfjpSf6zi2cq7nZgsI7hdWw9udPUcSJ5A
By May, the United States had signaled to the world that it was incapable of managing a pandemic and began to be pitied. See, for example: https://www.washingtonpost.com/opinions/the-united-states-is-a-country-to-be-pitied/2020/05/14/d2d98e9c-961e-11ea-91d7-cf4423d47683_story.html . In fact, the United States inability to handle the pandemic was turning into a national security problem as other countries watched in horror how easy it was to paralyze the United States by a virus: https://www.washingtonpost.com/national-security/plagued-by-disease-unemployment-and-outrage-at-the-police-america-plunges-into-crisis/2020/05/29/c8329bb2-a1b5-11ea-81bb-c2f70f01034b_story.html?fbclid=IwAR3diZl9dV7Es6XNpUpWNBcMc3kOnJUQeNRFiFvJpcpOfPeIMj4_yARdJck
By Memorial Day on May 25, we had reached the milestone of 100,000 deaths (see: https://www.washingtonpost.com/graphics/2020/national/100000-deaths-american-coronavirus/), and the New York Times listed the names of the first 10,000 victims of Covid-19 in a gripping front page: https://www.nytimes.com/interactive/2020/05/24/us/us-coronavirus-deaths-100000.html
That same day, George Floyd was killed by police in Minneapolis in a horrifying death caught on camera that lasted over 8 minutes in which he continuously states “I can’t breathe”. Although Floyd’s death was not Covid-related per se, at the same time, it had everything to do with the African American experiences with the respiratory symptoms of Covid-19, and the political moment of feeling unseen and ignored, and killed by the disease of racism. The beginning of a roughly 25-day protest and movement surrounding systemic racism would begin to unfold.