Nine months into the pandemic, Black and brown communities throughout the Philadelphia region continue to be among the hardest hit as the virus’ grip on the nation tightens.

An Inquirer analysis of COVID-19 data from the spring to now shows that in both Philadelphia and its suburbs, rates of infection generally are highest in communities where the majority of residents are people of color.

Medical knowledge of the virus has leapfrogged in the last nine months, yet the situation for many Black Americans remains dire.

“It’s very hard to understand,” said William Collins an hour and a half into his wait Monday for a free COVID-19 test at the 69th Street Transportation Center in Upper Darby. “But then the Black community is really conditioned to accept s— we don’t understand.”

People interviewed in the line at the transportation center this week were furious with the federal government’s response to the pandemic, which they said has failed to help people who need it most. In Pennsylvania and New Jersey, Black residents are dying of COVID-19 at higher rates than the states’ white populations. In Philadelphia, both Black and Latino populations are being hospitalized at higher rates than the city’s white residents.

“There should have been 24-hour access to information on how this could affect you,” said Collins, of the city’s Andorra neighborhood. “The PPE masks should have been readily available to everyone who needed it.”

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Lee Horton, 32, noted that the long, indoor line — full of people who could get tests no other way but through the Black Doctors COVID-19 Consortium event — itself created risks.

“Older people ain’t going to want to stand in a line like this,” the Germantown man said. Those waiting were masked but not always socially distanced. “You’ve got senior citizens who might have an underlying disease.”

The burden in neighborhoods of color

In Philadelphia, seven of the 10 zip codes with the highest rates of coronavirus cases by population are majority Black and Latino. The zip code including the Ludlow neighborhood in North Philadelphia is more than 72% Black and brown, and one out of every 19 people has tested positive for the coronavirus. Old City and Society Hill’s zip code, by comparison, is more than 82% white and just one out of every 33 people has tested positive.

Of the three hardest-hit city zip codes with majority-white populations, two have multiple long-term care facilities and the third, Holmesburg, is home to detention centers. (The Inquirer limited its analysis to communities with at least 10,000 residents to avoid statistical outliers.)

The same pattern holds outside the city. Among municipalities with 10,000 residents in the Philadelphia region, seven of the 10 with the highest rates of COVID-19 infections in the region have populations that are majority Black and Latino. Of the rest, two have long-term care facilities and one, Glassboro, is home to Rowan University, which had offered students in-person classes and has had a significant number of cases.

Camden has the second-highest infection rate by population among the region’s municipalities, with one out of every 17 residents having tested positive. About 94% of the city’s approximately 73,600 people are non-white or Latino, according to the U.S. Census.

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On Wednesday, a similar line to the one at 69th Street Station trailed down the sidewalk in Camden outside CAMCare, a federally funded health-care provider offering free tests. Marian Wilson, 48, was there to be tested with her two sons and her older son’s girlfriend because her mother, a Camden resident who helps with child care while Wilson works, was hospitalized with COVID-19. Wilson lives in Pennsauken, which is about 66% Latino or nonwhite and also has a high rate of infection, one case for every 20 residents. She blames too many people ignoring COVID-19 safety guidelines, not a failure of government.

“I don’t think nothing else could have been done,” Wilson said. “It’s just the individual person.”

The zip code with the highest rate of infection does also include long-term care facilities. Some of the municipalities with high case counts and populations that are majority Black or brown also have long-term care facilities, but across the region, those with at least a 75% minority population have more than twice the rate of COVID-19 infections compared with those with populations that are at least 75% white.

Systemic causes

Indifference to pandemic safety recommendations plays a role in the virus’ spread in communities of every color. But experts said there are systemic factors fueling the high rates of infection in Black and Latino neighborhoods.

“We’re seeing pretty high intergenerational poverty, lower insurance status, less education, all of these things that kind of contribute to higher rates of chronic illness,” said Michael Poulson, a Boston University researcher who co-led a study into the relationship between race as a social construct and the pandemic. “We’re seeing the effect of racism on outcomes.”

A study of outcomes for people with the coronavirus he co-led at Boston University found Black coronavirus patients were 1.4 times more likely to be hospitalized than white patients and were twice as likely to need treatment in an intensive-care unit or to require a ventilator.

» READ MORE: ‘This is not the time to go outside your bubble,’ Black Doctors COVID-19 Consortium leader says

A major factor is the reality that in lower-income neighborhoods, many people can’t work from the safety of home.

About 87% of the people using the free testing sites that Black Doctors COVID-19 Consortium hosts, like the one at the 69th Street station, are Black, said Ala Stanford, a Philadelphia physician and founder of the consortium. The largest age group testing positive is people in their prime working years, aged 45 to 54.

“The people who are most productive and are taking care of their families are the ones that are contracting COVID,” she said.

One man getting tested at the transit center Monday, a 53-year-old worker at Philadelphia International Airport, said he had COVID-19 symptoms for the previous three days, and believed he caught the virus at his job, which requires him to interact with travelers.

“To me, my fear is always the essential workers meant the expendable workers,” said the man, who didn’t want his name published for fear of repercussions at work. “We’re out there and nobody’s saying, ‘Hey, we need to protect them.’”

Densely populated apartment buildings and multigenerational homes also are factors, experts said.

“A lot of it is group living,” said Jim Cucinotta, CAMCare’s chief of staff. “It’s families taking care of each other.”

The home that Lee Horton shares with his two sisters is no longer a haven from the pandemic. He and his sister Mariah McIntosh, 26, were in line for a COVID-19 test Monday because their sister had tested positive. The siblings learned later in the week they tested negative, and he said his sister is safely quarantining.

He lost his job at GoPuff shortly after the pandemic began and has struggled to support his two young sons with work as an actor, photographer, model, and comedian. Already prone to depression, he said, he has struggled for much of the year to be productive.

“A man is supposed to carry his household,” he said. “My depression kicks in if I’m sitting around and not doing anything.”

Well-founded skepticism

Even when vaccines are available, these disparities may persist. A report from the National Academies of Sciences, Engineering and Medicine on vaccine distribution acknowledged that many Black Americans have a well-founded distrust in established medicine that may leave them suspicious of the rapidly developed vaccines.

That report cited the unethical and deadly Tuskegee syphilis study; the Edmonston-Zagreb vaccine trial, in which Black and Latino infants were given an experimental vaccine without their parents’ consent; and forced sterilization of Latino, Native American, and Alaskan Native women.

The researchers recommended giving people of color priority access to limited vaccine supplies, which Philadelphia health officials are trying to ensure by working with pharmacies in specific neighborhoods.

Public education programs promoting vaccines in collaboration with churches and community organizations also are planned in Pennsylvania and New Jersey.

“We’re focusing our activities in geographic areas where communities of color live, where they seek health care, by improving those types of access,” said Caroline Johnson, Philadelphia’s deputy health commissioner.

Cucinotta, of CAMCare, said he is perpetually dealing with misinformation among people being tested. Some fear flu shots are related to the coronavirus. Others don’t realize that if they test positive they are entitled by law to two weeks of sick time.

“There’s no source that can give you the truth,” he said, lamenting the false information surrounding the pandemic. “Everyone’s giving you the spin.”

Physicians including Anthony Fauci, the nation’s leading expert on the pandemic, have said repeatedly they will take the vaccine as soon as it’s available. But the message isn’t getting out.

A survey conducted with people getting tested or receiving flu shots at Black Doctors COVID-19 Consortium sites found almost 73% said they worried the vaccine would be distributed before adequate testing had been done, and almost 58% said they would not take the vaccine when it first becomes available.

Horton’s sister McIntosh was among them. It’s hard for her to trust a vaccine promoted by the same federal government that she thinks hasn’t done nearly enough to combat the pandemic.

“I wouldn’t take it,” she said. “If I didn’t have a choice and it was my last option ... but other than that, no.”