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Health, Science, Environment

St. Louis Is No Exception. COVID-19 Reveals The Inequities In Health Care Here

Alderwoman Pam Boyd, D-27th Ward, recognized the need for coronavirus testing stations in north St. Louis at the beginning of March. 

In meetings with local officials and fellow aldermen, Boyd found the city was on alert but seemed unaware of the impact coronavirus would have on the region. Specifically, Boyd sensed predominantly black north St. Louis would be forgotten in the city’s COVID-19 preparations. 

“As usual, we're always left out. We’re the second thought,” Boyd said. 

Each chance Boyd had to reiterate the critical need for testing in north city, she did so. In every Board of Alderman meeting — in the chambers or over the phone — the first few words out of Boyd’s mouth were, “What are we going to do with north St. Louis?” 

In mid-March, the region’s first coronavirus testing site opened in Chesterfield. Days later, testing began in Washington, south St. Louis County and Hillsboro. And soon after, another site opened in the Cortex and in the Metro East. 

Early on in the pandemic, the Centers for Disease Control and Prevention warned that people 65 and older, persons who traveled abroad and those with underlying conditions were at high risk for COVID-19. The underlying conditions risk directly applies to African Americans, who form the majority of the north city population. 

The legacies of segregation and discrimination have contributed to north St. Louis residents facing extreme poverty, unsatisfactory education systems, poor air quality, limited or no access to a major hospital, homelessness and food deserts. These inequities pave the way for a pandemic to do its worst. 

According to the CDC, African Americans have the highest risk for heart disease and are disportionately affected by asthma, diabetes, hypertension and obesity — conditions that are linked to high COVID-19 mortality rates.

“A lot of the residents that live in north St. Louis have issues already medically,” Boyd said. 

Testing arrives

North city’s first walk-up and drive-thru testing site opened in the parking lot of Affinia Healthcare’s Biddle Street location on April 2, nearly two weeks after the region’s first site in Chesterfield. This was problematic for Boyd. Her constituents — in far north neighborhoods like Baden and North Point — would find it challenging to get to the Biddle Street site near downtown.

Affinia Healthcare's Biddle Street location began testing on April 2, and during the first hour of testing, the medical staff tested 10 patients for coronavirus.
Kendra Holmes

After much pleading, Boyd learned her community would have access to testing through CareSTL Health at its Martin Luther King Jr. Drive location. Both Federally Qualified Health Centers — Affinia Healthcare and CareSTL Health — have testing locations where anyone who meets CDC pre-screening requirements can be tested.

In early April, the city started releasing COVID-19 data outlining the total deaths, cases, pending cases and number of people quarantined due to exposure. An interactive map now provides the number of cases by ZIP code. Early on, communities in the predominantly black,  north city 63115 ZIP code recorded the highest number of cases.

As of April 12, the city had reported more than 70 cases in 63115 — nearly three times the number of cases in other ZIP codes in the city. 

Alderman John Collins-Muhammad, D-21st Ward, represents 63115, which residents of the Mark Twain, Penrose and Greater Ville neighborhoods call home. He said he was not surprised about the number of cases in his area, because his predominantly black community has been disenfranchised for so long. 

“North St. Louis has always been on the back burner of the minds of government officials, the back burner of the minds as it pertains to public access and public epidemics like we are experiencing now,” Collins-Muhammad said.

Not just St. Louis

On April 7, the Trump administration’s coronavirus task force acknowledged the disparities in COVID-19 deaths and health conditions for African Americans during a pandemic press briefing. President Trump and  Dr. Anthony Fauci’s response came days after other cities released COVID-19 data by race. 

For example, in Chicago, black Americans make up about 30% of the population but about 70% of the COVID-19 deaths in the city were African Americans. 

African Americans in St. Louis make up about 47% of the population of 300,000. Though the city of St. Louis has not yet released the racial data breakdown of COVID-19 cases, the city’s health director, Dr. Fred Echols, penned in an op-ed piece in the St. Louis American on April 8 revealing that the first 12 deaths in the city were all African Americans. 

Mistrust

Dr. Hari Nallapaneni, CareSTL Health’s chief medical officer, said the communities he serves in north St. Louis need additional testing sites because of the alarming rate of underlying conditions in the area. 

“Once you know that you have a certain disease, you would react differently than when you do know what the disease is and that you still have the same symptoms,” Nallapaneni said. “[I] don't want them to think it’s probably their allergies or asthma, whatever they typically are used to having before.”

CareSTL Health's chief medical officer Dr. Hari Nallapaneni guides one of his staff members as she tests for coronavirus at their Martin Luther King Jr. Drive location.
Deneen Busby

Nallapaneni said he knows that false information about the coronavirus is circling in the African American community and that many distrust the health care system.

“We have to take into consideration the history of health care delivery, especially for the minority population. And everybody knows the Tuskegee experiment and what had happened in that,” Nallapaneni said. “Unfortunately, [that’s partially] why there is also a little bit of a mistrust among the minority populations with the health care in general and the health care providers.”

Like Nallapaneni, the director for Harris-Stowe State University’s Institute of Social Justice, Candice Idlebird, believes that many African Americans do not trust the medical system because of the government-ordered syphilis studies performed on black men at the Tuskegee Institute in Alabama. But it’s also as simple as having access to physicians they can rely on, she said — doctors who can spend adequate time with patients when making a diagnosis. 

Now what?

Because of the high rate of pre-existing conditions among African Americans compared to people of other races, questions have been raised socially of whether African Americans should be tested without showing any symptoms. 

Echols said that is a logical question. He said he understands the compounded issues north St. Louis has already been faced with, but added that the city of St. Louis has to be strategic in how it uses its testing sites and supplies because of the nationwide shortage. 

Still, the city is collaborating with agencies and groups like PrepareSTL to help deliver timely information about the pandemic to north St. Louis and other African American communities — including testing locations and how to protect themselves during the outbreak.

Affinia Healthcare chief operating officer Kendra Holmes said her organization is implementing training for all staff on implicit biases and cultural competency. The goal is to better connect with patients during times like the pandemic, where the community is relying heavily on its local clinics to provide critical medical care and updates.  

Echols said he acknowledges that there are “challenges” in the relationship between black St. Louisans and the city, including the health department.

“But at this time, we really want them to adhere to the guidance,” Echols said. “I'm not asking them to do anything I wouldn't do myself on a daily basis, because I care not only about my life, but I care about the lives of individuals in this jurisdiction.”

Boyd and Collins-Muhammad both said they will continue to fight for equal rights, because they know that inequities will still exist when the virus is no longer around.

“This is what black aldermen and black elected officials fight against every day — fighting to make sure that we have a fair share of resources and when we don't have resources, things like this will transpire, things like this will get out of hand, and things like this will become gigantic to a point where it is beyond our control,” Collins-Muhammad said. 

Follow Andrea Henderson on Twitter: @drebjournalist

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