Rich and Healthy vs. Poor and Dead
The talk in New York is about when to return to normal. But that misses the point; normal never really left, it just changed clothes. We traded economic disparity expressed through poverty for economic disparity expressed through viral death. The real problem isn’t when we’ll return to normal, it is that we will.
All the energy that made this city more than livable, made it desirable, is gone. It’s just a big, empty place now, all the seams showing. The closed stores still have St Patrick’s Day decorations. Time stopped in March. I am a native New Yorker by birth, seven years now returned. I don’t know how many times we can all stand on the ledge and not jump. 9/11, the 2008 financial crisis, Super Storm Sandy, and now this. Today the city feels more like the gray of post-war East Germany than the white hot panic of late WWII Berlin.
New York state has more corona cases than any other country in the world. About half of all U.S. deaths are here in the broader New York area. Sure, there are other hot pockets but while NYC counts the bodies in the thousands there are some states still in single figures and most others in the hundreds. The stars may soon again hold benefit concerts for us, echoing post-9/11’s “ferocious tenderness of how desperately America loves New York.” When the city talks in its sleep what many remember most is the kindness people showed toward one another that blue September, little courtesies of holding doors and allowing someone to cut the line, half smiles from total strangers in a place where such vulnerability could have made you prey just days earlier.
Not with the virus. We snap at each other, enemies now, each a potential carrier. This is a not a city which lends itself to personal space without a flash of aggressive eye contact. Walk without a mask and someone will snap at you. Two guys hissing something in Spanish at an Asian woman. Lines to enter the food store with everyone watching like North Korean border guards for sneaks. SNL and late night never mocked Bush in the immediate 9/11 aftermath. If we ever were One we are not now. Because we are for certain not all in this together as Governor Andrew Cuomo said: “Everyone is subject to this virus. I don’t care how smart, how rich, how powerful you think you are.”
That is not true. The virus is highly concentrated in the poorest Hispanic and black neighborhoods of Queens and the Bronx. The viral death rate for Hispanics is 22 people per 100,000; for blacks 20 per 100,000 while the rate for whites is 10 per 100,000. For whites even that is deceptive, given the hot spots in the isolated Hasidic Jewish enclaves of Brooklyn versus the lack of white deaths in high-income areas. Poorer people are more likely to die at home than in a hospital, and so the surge in at-home deaths, most never tested, suggests the death rate for the virus is being under-counted. Overall the virus is twice as deadly for Hispanics and blacks than whites in NYC.
In New York we speak hundreds of languages but not to each other. A map of viral cases neighborhood-by-neighborhood tells the tale. America’s most diverse city, America’s most sanctimonious city about that, is also one of her most segregated on the ground.
New York City is also the most economically unequal city in the country. It is home to 70 billionaires, more than any other American city. Living among those billionaires (NYC is also home to nearly one million millionaires, more than any other city in the world) the city also has the largest homeless population of any American metropolis. The number of New Yorkers who live below the poverty line is larger than the population of Philadelphia or Phoenix, and would be the country’s 7th largest city. The billionaires fund the social services and the poor clean the homes and scavenge the trash of the billionaires.
The reasons are the same reasons. Poor neighborhoods are served by the city’s miserable public hospitals, not its world-class private ones. A virus patient in the ravaged Bronx is twice as likely to die as one in a “nice” neighborhood. The problem is the quality, not the quantity, of healthcare. “We are watching, in real time, racial disparities and the pandemic of poverty,” one assemblyman said.
Poor people suffer from comorbidities (86 percent of the dead have one), particularly the ones of bad diets like diabetes, hypertension, and obesity. Hypertension is three times more prevalent, and diabetes five times more, in the South Bronx than in well-to-do lower Manhattan. Influenza, which has already killed about twice as many people this season as COVID-19, follows a similar pattern.
The Elmhurst neighborhood in Queens is “the epicenter within the epicenter,” according to the mayor. Some 64 percent of its residents are Hispanic, and the median household income is three-quarters of that of the metro area. Nearly 11 percent of households there are multigenerational. The grouping of young (who carry the virus without symptoms) and elderly together helps drive the higher infection rates.
Park Slope, Brooklyn, has some of the city’s lowest rates of COVID-19, 56 percent below average. Two-thirds of its population is white and the median household income is one and a half times greater than average. Less than two percent of households are multigenerational. But when the Surgeon General specifically admonished people of color to stop drinking and using drugs during the pandemic to power up their immune systems he was called a racist.
This is the normal. The economic disparity driving the cases in NYC was here long before the virus; COVID-19 was superimposed on that sordid base. What is happening now, the deaths, was always happening, albeit more slowly. This mocks what pundits are calling the big question, how to balance the city’s health and the city’s economic needs, and when to re-open for business. Economic inequality has been killing people all along, and keeping poor people from working by decree only makes them poorer and eventually sicker. It is a slow death as opposed to the quick countable deaths from the virus. Tom Hanks will thank the food delivery guys for their service on SNL but we still won’t pay them a living wage.
One of the things blamed in NYC was the late decision to close the public schools. Many wealthy private schools closed on their own in early March. The mayor kept the massive public school system open until the middle of the month not for educational reasons, but because it doubles as a social service center for poor children, including 114,000 who are homeless.
More than half of all public students get their meals at school, and for the homeless kids it is the only place they can wash clothing and clean themselves. Birth control and STD testing for kids from strict Hispanic Catholic homes mostly happens surreptitiously through the schools. The schools provide daycare so poor people can work, and are the last hope to keep a few children out of gangs and offer them a break from abusive homes. “Given the alternatives, schools are a safer place for many kids,” one teacher said. Closing the schools was a “last resort,” judged a better option than hiding from the virus at one point. The uptick in child violence and domestic violence in general New York is experiencing now was understood to be coming, collateral damage.
The city made up its mind a long time ago. During the 1918 Spanish Flu pandemic which killed 30,000 New Yorkers, the Health Commissioner demanded public schools be kept open, believing the risks of gathering kids together were outweighed by the benefits of giving them a break from their crowded and unsanitary tenement apartments. The Commissioner also noted working immigrant parents had no time to care for their kids, better to have them looked after at schools. As he put it, sick people don’t go to the theater when they feel bad but they do go to work.
Same for the subway system, still running 24/7, a remarkably effective way to spread the virus. As in 1918, poor people can’t work remotely. NYC kept the public schools open, and keeps public transport running, then and now, knowing it would spread the virus, because the alternative hardships seem worse.
I’ve lived in the developing world and you get used to this. You have and they don’t, that’s the way it is, beyond one man’s blame and seemingly any man’s fix. The biggest barrier to some sort of “re-opening” in NYC is to figure out how to express that in palatable terms for 2020. Not that we weren’t already already doing it for the last hundred years, but now we need to make rules to govern our apartheid of dollars that sound OK in the Sunday Review section. The rest is just logistics.
Peter Van Buren, a 24-year State Department veteran, is the author of We Meant Well: How I Helped Lose the Battle for the Hearts and Minds of the Iraqi People, Hooper’s War: A Novel of WWII Japan, and Ghosts of Tom Joad: A Story of the #99 Percent.