It's in our salad dressing, bread and most everything else we eat -- and it's doing tremendous harm to our bodies. How can we kick the salt habit?
The coronavirus pandemic brought decades of race-based health disparities in the District to the surface. Although Black Washingtonians are only 46% of the population, Black residents account for 74% of the city’s coronavirus-related fatalities.
How did D.C.’s elected officials manage the spread of the coronavirus at the start of the public health crisis? How effective was the District’s response to the pandemic in communities of color compared to other cities around the country?
Produced by Kayla Hewitt
- Christopher Peak Reporter, APM Reports
- Wayne Turnage Deputy Mayor, District of Columbia Health and Human Services
KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show' on WAMU 88.5, welcome. Later in the broadcast we'll examine why Black restaurants are seeing an uptick in support during the pandemic. But first although Black Washingtonians are only 46 percent of the District's population, Black residents account for 74 percent of the city's coronavirus related death. Other jurisdictions have seen a disproportionate impact on people of color. So how has the District responded to the public health crisis? And how does that response compare to other cities around the country? And what drives the stark race based health disparities in D.C.? Joining me to discuss this is Christopher Peak, a Reporter with APM Reports. Christopher Peak, thank you for joining us.
CHRISTOPHER PEAKThank you for having me.
NNAMDIChristopher Peak, when did you start this investigation of D.C.'s response to the coronavirus pandemic? And why did you focus on the pandemic's impact on the Black community in the District?
PEAKI started looking at this in probably mid-April. That was about a week after we began seeing data from across the country saying that in places like Chicago, Milwaukee, St. Louis, almost all of the first deaths from coronavirus were among Black people. And we had heard a lot from mayors and from governors about how outrageous that was and how they needed to do something about it.
PEAKSo I began basically tracking their promises, their commitments to see if they're actually going to follow through on those things. And from there I basically collected the data to see if those numbers started to change, to see if they were actually able to reduce those disparities. And from there that led me to focus on Washington D.C., which by far had some of the most extreme racial disparities where Black people were being disproportionately dying from the coronavirus at such extreme rates.
NNAMDIWell, racial health disparities in D.C. are not a new phenomenon.
NNAMDISo what factors contributed to these disparities even before the pandemic began?
PEAKIf you talk to public health experts they call these the social determinants of health. They say that it is not so much what your doctor can do when you're already sick, but all of the things that affect your day to day health whether you're able to go for a run at night, whether you're able to walk around your neighborhood, whether you're able to get fresh produce at a grocery store including maybe being able to get those medical checkups to you if you're starting to feel like somethings off.
PEAKSo D.C. in many ways had these pretty extreme racial disparities where people were dying far earlier even before the pandemic. I feel like that all the counties in the country that have a pretty sizable population D.C. comes out the worst in the gap and life expectancy. If you're Black in D.C. you're supposed to die 15 years earlier than a white person in D.C. And that's the most extreme disparity for any county in the country.
NNAMDIWhat is the life expectancy of Black Washingtonians compared to their white counterparts and how does that number compare to other urban centers in the country?
PEAKI didn't look exactly at the comparison from years, but the gap is the largest. I believe it was about 73 if you're Black and let's say maybe 88 if you're white, but I would need to double check that, but somewhere around that.
NNAMDIThe District has experienced extreme gentrification. How has that factored into the health outcomes of Black Washingtonians?
PEAKRight. So I talked to quite a few people about this. When you have housing insecurity, you might have to double up. You don't have your own bedroom where you can quarantine if you're sick. You might have lost some of those community connections where you used to have someone who could babysit your kids or have your grandparents help you out. Now everyone might be in the same house and have lost kind of the communication about how to respond to this pandemic. Are you able to help me go to the grocery store?
PEAKSo just that kind of lack might have contributed to -- especially later on the city health department was even saying we see this huge household transmission where people are passing it among family members, and although they didn't explicitly tie to gentrification that probably had something to do with why household transmission became a big problem in D.C.
NNAMDIChristopher, how soon after the first cases of coronavirus in the District did Mayor Bowser announce a stay-at-home order?
PEAKSo the stay-at-home order didn't come until April 1st. That was when it took effect, which was far far later than almost anywhere else in the country based on my reporting it was behind about 30 different governors had already issued their stay at home orders. To be fair that had been kind of phased in shutdown of the city. Schools had already closed through an order saying, we need to close businesses. But if you listen back to those press conferences reporters are asking, why don't we just issue a stay-at-home order? We have other elected officials saying, let's just really communicate to people the urgency of staying at home, but for some reason the mayor resisted that and didn't close the city down officially enforce the stay-at-home order until April 1st.
NNAMDIUnited Medical Center, it's in Ward 8. It's the only public hospital in the District. It was the first coronavirus testing location open east of the river. What kind of relationship does that hospital have with the community it serves?
PEAKNot the best. I think it's one of those cases were I talked to people and they said maybe it's not even the quality of the hospital itself, but just the perception of the hospital and the perception of the kind of care you might get there has really tainted the relationship with the community. There has been long long cries for having a better trauma center there, having neonatal care for moms, who really are at serious risk of losing their children or even their own lives during pregnancy.
PEAKAnd those things haven't been addressed at the hospital, which is probably not the fault of themselves. There not in control of their own budget necessarily. They get money from the city, but the hospital to say the least has not been able to serve its community in the way that many of its neighbors have been asking.
NNAMDIHow are representatives from the hospital responding to criticisms from the community?
PEAKThey've said that they believe it's really unfair the kind of coverage they get in the media. They say that problems happen all the time at hospitals, but the focus has been on UMC. In the way that they say maybe even has some kind of racist element to it where it's a largely Black staff. It's a largely Black population of patients and that they feel like they get unfair coverage in the media.
NNAMDIHere is Shay in Washington D.C. Shay, you're on the air. Go ahead, please.
SHAYGood afternoon. And thank you for taking my call. I wanted to know from the reporter what is your source for the data that you've included in your report as well as if you have interviewed or talked any of the Black residents in D.C. about this phenomenon. How many of those people have you spoken with?
PEAKSo the data comes from a lot of different state and city public health departments. That's where I compared how cities did is based on their own numbers of how many deaths they'd seen. Those of course had some issues where there's been a lot of reports about people being listed as dying from pneumonia instead of coronavirus. But the consistent data I gathered from public health departments. And I believe I talked to about probably 40 or 50 people. I didn't count up exactly for this story. So there's people who worked at homeless shelters, who are lawyers, who were patients at places like St. Elizabeth's and their family. All together I talked to about 40, 50 people I would say for this story.
NNAMDIShay, what's the nature of your concern?
SHAYMy concern is that he really hasn't spoken to the people. I guess the disadvantaged people, people in the southeast -- northeast section of the city in which he says is being mostly affected. I would like to know, you know, if you've spoken to any of those people. It doesn't sound like you've spoken to many and if some of the issues that they have are actually their own personal health problems? Like if they are unwilling to do exercise, if they're unwilling to eat better. It is somewhat not self-inflicted, but personal choices that they make and not so much the healthcare system that is the problem.
NNAMDICare to respond to that, Christopher Peak?
PEAKYeah. I've heard from some people before that there was complaints that there were people who were still hanging out outside, which gets the question of, was there enough messaging? Was there more that needs to be done to really inform those people about, you know, you're putting yourself and others at risk by being outside at least during this pandemic, but I think going back to before these kind of preexisting health disparities I think it's a little bit unfair to criticize people for their behavioral choices when those choices might not be a reality.
PEAKIt's maybe easy to say, you need to cook healthier meals, but it's hard when you don't actually have the groceries available to do that. To be able to go to run when you don't feel like your neighborhood maybe is safe or like we recently saw with what happened in Georgia. That sometimes this systemic racism that we're all living with can make those things -- there's obstacles in front of them.
NNAMDIHow did a lack of testing affect early coronavirus data specifically in Ward 7 and 8, the two most economically disadvantaged wards in the city?
PEAKRight. So if you look at the early data it seemed like there were almost no coronavirus cases early on in the pandemic. They were with on the map and everywhere else in the west side of city was all red in the early cases, which we ended up finding out was probably deceptive for how far coronavirus had actually spread east of the river. The death toll is now highest in Ward 8 and it's third highest in Ward 7. They've been hardest hit by this.
PEAKAnd part of what I found out in my reporting is that that first public testing site at United Medical Center was not easy to get to. It was only open from 10:00 a.m. to 2:00 p.m. three days a week. And the perception of the hospital probably kept people away. This was also during a time when the buses were only running half an hour or sometimes even an hour. So it's not the easiest place to get to.
PEAKAfter about two weeks the city was saying, we're only filling about half the appointments. We have spaces for 200 people to come in. We're only getting 110, and that seems to have really kept the numbers down deceptively low. And perhaps to maybe the earlier caller's point seemed like it wasn't really an issue east of the river. I thought that this was something that was affecting the other parts of downtown.
NNAMDIHere now is Claire in Washington D.C. Claire, we only have about a minute left in this segment. But go ahead, please.
CLAIREOkay. Yes, I live in the Metro center and I have a question about enforcing -- a comment about enforcing testing. I'm at the Walgreens on 7th and F yesterday morning. I walked in, got my prescription, walked up to the cashier. The cashier was in pain, grabbed her stomach, tore off her mask, bent over and vomited in front of me. I backed away. Of course, I'm concerned. I want to be contacted if it turns out she's testing positive. They have -- no one tests them. I called this morning.
NNAMDIAnd no system for contact. We might have a guest later, who can give you some advice. Right now we've got to take a short break. Thank you so much for your call. I'm Kojo Nnamdi.
NNAMDIWelcome back. We're talking with Christopher Peak, who did an investigative report on the District of Columbia's response to the pandemic. We know, Christopher Peak, there were shortages of all kinds of -- across the country including lack of tests, protective gear early on. How well did the District do in addressing that challenge?
PEAKI think that was a national issue. And I don't want to fault the District too much for something that was really out of the control in terms of how personal protective equipment and testing was distributed. There were some specific cases where maybe they might have distributed it a little better at places like St. Elizabeth's hospital where the infections were out of control and where it didn't seem to get to staff until mid-April. But in general that was something that every city across the country was dealing with. And really speaks to the national failures that only made things worse for places like D.C.
NNAMDIAnd essential workers have been disproportionately affected by this pandemic. Where does that intersect with the heavier toll on people of color here in D.C.?
PEAKRight. So that is something that I heard from a lot of people that the way you're going to get coronavirus and the way you're going to possibly die from it is just through exposure. If you have to continue showing up for work then you're the ones, who are going to be most at risk. And in D.C. we see pretty clear racial patterns with that of who had to continue showing up for work.
NNAMDIJoining us now is Wayne Turnage. Wayne Turnage is Deputy Mayor for Health and Human Services of the District of Columbia. Wayne Turnage, thank you for joining us.
WAYNE TURNAGEIt's my pleasure. How are you doing?
NNAMDII am doing okay. Trying to stay safe. Racial health disparities in the District have a long history. What initiatives were in place, Wayne Turnage, to close the health gap before the start of the pandemic?
TURNAGEWell, you know, the District had the impressive credential of having roughly 97 percent of its residents insured. We have the most aggressive Medicaid eligibility standards in the country. If you look at the Medicaid program and the counterpart in Alliance program, the District provides health insurance for 40 percent of District residents. Four out of every 10 District residents have access to healthcare through a publically funded healthcare program. The issue that we had to address was the absence of a quality healthcare system in Wards 7 and 8. That challenge has haunted the District since D.C. General closed before I came to D.C.
TURNAGEBut has now culminated in the approval just yesterday by the Council of the mayor's proposal to build an entire healthcare system in Wards 7 and 8, a new hospital, an ambulatory care center, an urgent care center in 8 and an urgent care center in 7. A full range of services, trauma services, it will one of the best healthcare systems in an underserved area in the country when it's completed. So that work began some time ago. But it culminated in a 12 to nothing vote by the Council on yesterday. So the District has made an effort long term to make sure that everybody has health insurance. And now they are addressing what was almost completely inadequate system of care in Ward 8 and Ward 7.
NNAMDIA stay-at-home order in the District was not announced until April 1st, Almost a month after the first positive coronavirus cases were reported. What led to that delay?
TURNAGEWell, let me say this about the investigative report that I wrote. I have been a part of the team. The mayor put together an incident management team very early in this process. And reading that report, it has no resemblance to the process that I was a part of. I can tell you that the mayor established the incident management team, its structure and the executive leadership on February 28. She had the emergency operation center was activated two days later.
TURNAGEThen the mayor has always said we're going to treat this as we would a dial. In other words, as conditions dictate, the responses can be more intense. And if those conditions are alleviated or mitigated then our responses can be dialed back. And to point to the date of her stay-at-home order and count the number of days between the order was issued and when the first case was identified in D.C. is to ignore the myriad of activities and steps that she took between February 28th and the stay-at-home order.
TURNAGEAll things that were publically notified in press conferences every day, press conferences that were staffed with the mayor and the health commissioner, there was a repeated emphasis on whatever issue there was that the mayor -- whatever policy the mayor was unveiling on that particular day. By just focusing on that stay-at-home order versus the first day of the confirmed case, you are ignoring when the public health emergency was declared, when the mayor put up a one million dollar contingency cash reserve fund to deal with this crisis, when she issued advisory saying no gatherings first to more than 1,000, then it went to no more than 250. Then it went to no more than 50 or 10. You're ignoring all of that. You're ignoring the dates that the restaurants and bars -- the mayor's orders that say the restaurants and bars could no longer open.
NNAMDIOkay. Allow me to interrupt for a second and ask, Christopher Peak. Christopher Peak, were you aware of all of this and did you speak with anyone in Mayor Bowser's administration?
PEAKI tried to talk to Bowser's administration repeatedly. I reached out to them for almost two months trying to get someone to interview about all these different questions that I had. I think the Deputy Mayor is right about the stay-at-home order. That's only two paragraphs in the story that were mentioned. But that's kind of symbolic of in general the city's slow response that they were so far behind 30 other governors in issuing the stay-at-home order.
PEAKIn general my reporting really focuses on testing availability, how it dealt with the congregate care facilities and like he said that the Medicaid rules are so large. But that again we talk about delays. It took almost a month for them to follow through on the mayor's promise. They said they were going to reach out to every Medicaid recipient, who was at risk giving them information about how to stay safe. And the city didn't start doing that until -- I again was asking about what's going on with these programs. And basically the contract wasn't awarded until -- the process for finding a contractor wasn't until a week before the city started reopening.
PEAKI don't think the work even started until after phase one had begun.
NNAMDIDid you specifically ever attempt to reach out to the Deputy Mayor for Health and Human Services that I'm speaking with now?
PEAKI don't think I did. I reached out to the mayor's office directly, but I don't believe I reached out to the Deputy Mayor.
NNAMDIWayne Turnage, had you been reached out to would you have responded?
TURNAGEOh, absolutely. I mean, you know, I'm not a big fan of the press, but, you know, as a public servant, if we are asked to speak I will certainly speak. And there was a lot to talk about. You know, I read that report. I'm saying this thing is egregiously flawed. You know, the whole testing piece that he mentions that was a federal government problem that bled into not only D.C. but jurisdictions all over the country. Our hands were tied. There was very little we could do until they opened up testing to public health labs.
NNAMDIWhich brings me to this, how much of an impact did a lack of federal funding affect the District's ability to respond to this pandemic?
TURNAGEI won't say it was a lack of federal funding, because I will tell you, the city administrator at the mayor's behest set aside significant amounts of dollars for a variety of agencies to be able to respond to this pandemic. And those dollars were set aside on a promise that we would be reimbursed. And, you know, that promise has not been fulfilled yet. But we have to submit our expenses and hopefully we'll be reimbursed. I don't think it was a funding issue. The mayor set aside $35 million to prepare the hospitals for a surge. I think our response to a possible surge was the best in the country. We were able to get every hospital in this city to expand within their footprint to set aside beds specifically for COVID, while they were shutting down any other procedures that were not considered emergency procedures, not considered medically necessary to avoid significant health problems.
TURNAGEThat was done very early in the process. The number of things that were done -- you know, when you're dealing with a pandemic that jumps out on you, you know, it was on us, on every city. It was on every state so fast that we had to respond to that. I would put the District's response to this pandemic under the mayor's leadership against anything I've seen nationwide.
NNAMDIJust about out of time in this segment. Christopher Peak, can we expect a follow-up of this report of any kind?
PEAKI'm definitely continuing to follow especially with these kind of health disparities that we saw were so bad in the pandemic where just being Black in D.C. meant you were six times more likely to die from coronavirus. I think those reflect these bigger health disparities. And I've heard from people in response to this story that it shows up in the way that the city responded to, for example, heroin overdoses, a lot of different issues.
NNAMDIMake sure if you're doing your story that you make a call to the Deputy Mayor for Health and Human Services, Wayne Turnage. Wayne Turnage, thank you for joining us.
TURNAGEThank you for having me. And I assure that if the reporter had spoken to me --
NNAMDIYes, we're out of time. Christopher Peak, thank you for joining us. I'm Kojo Nnamdi.
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