Reginald Fulwood Jr. stood in the cold rain, his surgical mask and blue sweatshirt soaked, as he waited with his family to get tested for coronavirus outside a church in Philadelphia’s West Oak Lane neighborhood.
Fulwood, 40, said he wanted two things: a job to pay the bills and the solace of knowing that he, his 7-year-old twins, and his 69-year-old mother don’t have COVID-19.
“We want to make sure we don’t have this virus because we don’t want to die," Fulwood said. “No one wants to leave this earth right now. Black people, white people, Chinese people — no matter what the race is, we still want to live, so I thank God for giving us the opportunity and others who don’t have health insurance to come get tested to find out where we stand.”
Fulwood was among hundreds of residents lining up for tests last Friday at Mount Airy Church of God in Christ on Ogontz Avenue, in an area where African Americans are especially hard hit by the coronavirus.
In Philadelphia, black patients are dying of coronavirus at a rate of 4.1 for every 10,000 people — more than 30% higher than the death rate among white patients, according to city data.
More than half the city’s coronavirus deaths have been among African Americans, though they account for about 40% of Philadelphia’s population. Meanwhile white individuals, who make up 35% of the city’s population, account for less than a third of coronavirus deaths here.
These disparities have drawn an outcry from public officials, who have pledged resources and propped up task forces to improve access to testing and treatment for minorities, who are at greater risk of virus complications. The differences have been explained in part by higher rates of conditions such as diabetes and heart disease among African Americans.
But researchers and doctors who have dedicated their careers to working in communities of color know these inequities are not new — or isolated — to coronavirus. Ala Stanford, a Philadelphia physician, organized the church testing site with a team of volunteers after hearing government health officials repeatedly lament minority communities’ outsized suffering.
“I got tired of watching it," Stanford said, "so I called local officials, I called the state and said, ‘What are we doing in our hard-hit communities? I want to help.’ I got crickets. Because there was nothing happening.”
In the United States, people of color experience higher rates of almost every type of disease, have worse access to health care, and live shorter lives.
“COVID-19 has not created these inequities in health — it has simply become a magnifying glass that helps us see some long-standing shortfalls that have existed for minorities,” said David Williams, an internationally renowned Harvard University social scientist who studies social influences on health.
Black and Hispanic workers are more likely to have low-wage, essential-worker jobs, such as grocery clerks and delivery people. Without paid time off or health insurance, they are in a bind — working out of necessity and unprotected if they get sick. Families living in densely populated neighborhoods or multigenerational households aren’t able to practice social distancing.
But income and education don’t entirely explain why minorities experience higher rates of chronic health problems and develop them earlier in life, Williams said. Researchers have found that wealthy black families are still at greater risk for health problems and report more difficulty accessing care than white families with similar income.
Decades of racial bias have put minorities at a disadvantage in education, where they are less likely to be pushed toward elite colleges. The pattern continues in jobs, where they are routinely passed over for similarly qualified white candidates; in housing, where they frequently are steered to less desirable neighborhoods; and in health care, where their medical concerns often are not taken as seriously. The stress of racism alone has been linked to physiological changes that contribute to higher rates of asthma, diabetes, and kidney disease, Williams said.
“America’s preexisting condition is racism, and we are seeing the fault lines of racism in real time,” said Marshall Mitchell, pastor of Salem Baptist Church of Roslyn in Abington. He helped Stanford, a church member, expand her testing operations by gathering donations and rallying local pastors.
Just how deep the coronavirus inequities go in Pennsylvania is not fully clear — because the state has collected race data on only one-third of patients hospitalized with coronavirus. State officials have vowed to do better, creating a disparities task force to “serve as the basis for reform” and “really address the underlying crisis that has helped make this even more pronounced in the African American community,” said Lt. Gov. John Fetterman, who is leading the effort.
Stanford and her team are glad officials are finally paying attention, but aren’t waiting for them to act.
As of Friday, Stanford’s band of volunteer nurses and doctors had administered more than 2,000 tests at seven local churches and mobile sites in the city’s poorest neighborhoods.
Donna Greenwood, 62, of Germantown, was grateful to get tested. She sang during a small funeral at her church a day earlier and later learned someone there had been exposed to the virus.
“This virus, you can’t see it, you don’t know where it is ... it’s a beast. It’s horrible. So there are people out here who are probably exposed and don’t know it,” Greenwood said.
Stanford’s test sites also are a way to connect people with better health care.
“We’re not just saying, OK, you’re positive — good luck with life,” Stanford said. “It’s not just a Band-Aid. ... We’re trying to really move the needle on the poor health-care outcomes that are seen in our communities.”
When calling to relay test results, Stanford and her colleagues make sure people know where to go for care, and how to sign up for health insurance, “so that then they’ll have someone to help them not just with this acute care situation but with their preventative management,” she said.
While most Americans under age 65 get health insurance through an employer, low-wage and part-time positions often do not include those benefits. Workers who earn too much to qualify for Medicaid, the state-federal program, are on their own.
Mark Ruffin, 53, works 70 hours a week as a home health aide and spends $300 a month — a sizable chunk of his monthly pay — on a medical and dental plan because he has a family history of heart disease.
Ruffin took a bus from North Philadelphia to get tested by Stanford’s team because he takes care of elderly clients, helping them cook, clean, bathe, and dress. He can’t risk getting them sick, but he can’t afford to stay home unless he absolutely has to.
“Coronavirus compounds the issues people were already facing,” said Nicole Kligerman, director of the Pennsylvania chapter of the National Domestic Workers Alliance. “Domestic workers now and always are forced to choose between buying food and paying rent by going to work, or going without.”
The challenges are even more extreme for undocumented workers, like Jenny Vidal, because they are not eligible for unemployment benefits or food stamps, work jobs that don’t offer paid sick days, and are excluded from the federal COVID-19 stimulus funds.
Vidal, 40, immigrated from Venezuela to Philadelphia a year ago after it became impossible to support her family on her meager salary of about $6 a month selling used vehicles.
Vidal now earns between $300 and $350 a week cleaning houses, and sends as much as possible back to Venezuela, where her mother and two sons, 20 and 5, still live, but she has been out of work for several weeks.
She is always worried about getting sick because she has no access to health coverage and knows how expensive it is to pay for care out of pocket in the United States.
“I just stay in my room because I hear someone cough and it makes me scared,” said Vidal, who rents a room in a home shared with seven or eight other people, some of whom go out to work every day.
Vidal has been active with the National Domestic Workers Alliance, which helped move forward a domestic workers’ bill of rights adopted last year by the Philadelphia City Council. Considered some of the strongest protections of their kind in the country, the law strengthens antidiscrimination policies and requires meal and rest breaks. The law also created a paid-time off system for domestic workers — but it isn’t expected to take full effect until later this year.
Pastor Mitchell says improving health-care access cannot wait. On his church’s Facebook page, Mitchell announces new test locations and times with the sentence “Your Black Doctors will test our community again.”
“This is about doing for one another when government is slow to act or is not acting,” Mitchell said, “and so we are not making any apologies for trying to take care of our people.”