Three weeks ago, Olga Gutierrez called a taxi so she could take her 11-year old son Julio to the hospital. His sore throat was unbearable and she was worried he had COVID-19.
But Julio’s symptoms weren’t enough to warrant a test, Gutierrez was told, so she brought her son back to the cramped Bridgeport house they share with 14 other relatives, including Julio’s sister and father. Two weeks later, an uncle living with them tested positive for the coronavirus – although he, too, was initially told he didn’t meet the criteria for a test at Bridgeport Hospital.
Everyone else in the family was denied testing at the local community health center except for one aunt, who had a fever. She tested positive and has quarantined herself in one room of the small home.
Members of Julio’s family – all undocumented, uninsured immigrants from Honduras – have been out of work since the pandemic hit and don’t know how they will pay the $2,000 bill for his emergency room visit last month – or any other medical bills associated with the virus.
“We’re just hoping no one else has it,” said Gutierrez.
While accounts of people being denied testing due to scarcity of supplies were not uncommon at the beginning of the public health crisis, frustration is growing that Connecticut residents living in low income, predominantly minority neighborhoods continue to face larger barriers to testing and other services.
Nine weeks into the pandemic, there are only a handful of walk-up testing sites in the state, prohibiting those without cars from getting tested. Until last Friday, two-thirds of the state’s testing sites required a doctor’s note, and many of the residents living in these communities have no insurance or primary care doctor to refer them. Most of the community health centers located in these struggling neighborhoods have not been able to expand the number of COVID tests they can complete.
Government moves slower where the money is small.”
Kevin Hall, a resident of New Haven’s Whalley Avenue neighborhood who lost his job because of the pandemic, said he knows there are testing sites in the city, but they aren’t anywhere near his high-poverty neighborhood.
“I haven’t actually seen any,” said Hall. “Government moves slower where the money is small. When the money is small, things always take longer.”
People living in inner-city neighborhoods also warn that communication about the disease and how to get assistance has been confusing, that financial support for those who have lost their jobs has been sluggish, and that hunger is now a real threat for many blacks and Latinos living in poverty-stricken areas.
There is also a growing sense that, as Connecticut’s focus turns to reopening the economy, pandemic-related dangers and hardships experienced by poor people of color are being overlooked or disregarded. Minority lawmakers and community activists are now pushing for a dramatic change in the state’s coronavirus response in their inner-city neighborhoods.
“We’ve heard state government talk about helping communities of color,” said Jean Jordan, a retired teacher who heads the New London NAACP. “But what are they doing about it? I don’t see anything being done yet.”
Members of the legislature’s Black and Puerto Rican Caucus are growing increasingly frustrated with the state’s slow progress to address gaps in services and testing.
We’ve heard state government talk about helping communities of color. But what are they doing about it? I don’t see anything being done yet.”
“Long story short, our communities are suffering. There is a real need for the government to make this thing right,” said state Rep. Brandon McGee, a Democrat from Hartford and the leader of the caucus. “One major, major, major, major, major piece, is making sure we have access to testing in some of these areas.”
Health equity experts and members of the caucus are calling on the administration of Gov. Ned Lamont to better research the inequalities in communities of color that have been exacerbated by the pandemic and come up with a plan to tackle the problems.
“When we don’t have a clear strategy that keeps equity at the center when distributing testing resources, we’re likely to see this kind of disproportionate access,” Wizdom Powell, director of the Health Disparities Institute at UConn Health, told members of the caucus during a recent Zoom meeting, speaking of her suspicion that those who live in underserved communities are being tested less. “We need to know more.”
How hard is COVID-19 hitting communities of color?
Repeated calls for the state to begin tracking the racial and ethnic breakdown of the virus, both in terms of who is being tested and hospitalized and better tracking who is contracting the illness, have not led to any changes.
Members of the Black and Puerto Rican Caucus, the state chapter of the NAACP, minority residents and health equity experts are increasingly frustrated that their requests for better data collection have not materialized, stymying efforts to better understand how black and Hispanic communities are being impacted by the illness.
I think it took longer than it should have for state government to recognize the necessity of engaging minority communities.”
“We have repeatedly requested that the CT Department of Public Health provide the race and ethnicity demographic data of patients tested for and affected by COVID-19,” Scot Esdaile, president of the NAACP, wrote Lamont on April 15. “It is critical that this information be collected in a sceintific and organized manner and reported in a transparent fashion for the purpose of addressing ongoing health inequities.”
Weeks later, Department of Public Health Commissioner Renée Coleman-Mitchell told lawmakers during a town hall Zoom meeting that she agrees data is needed to better understand how COVID-19 is impacting black and Hispanic residents.
“I will tell you there has been many conversations with [sic] myself and my deputy and a couple of others at the department about the importance of having this racial and ethnic data breakdown. Anecdotally, we know what the story is, right? Do we really need the data to know it? But it helps support the story,” she said.
But nine weeks into the public health emergency, the Lamont administration has provided no plan to better understand who is getting access to testing or being hospitalized. The data released each day by the administration shows that black and Hispanic residents are more than twice as likely to test positive for COVID-19 – but one out of every three positive test results have no race or ethnicity information filled out. Connecticut has the fifth highest share of cases coming back with unknown race or ethnicity among the 39 states that report the breakdown, a review by Solutions Journalism Network shows.
In Connecticut, a large share of the unknown results are people who live in cities where the majority of residents are minorities.
Town-level data shows communities with high percentages of minorities are being hit the hardest. For example, in New Haven, where 70% of the population is minority, 129 residents out of every 10,000 has tested positive for COVID-19, compared to 42 residents in suburban Orange, where just 13% of the residents are minorities. These figures are accurate through last Wednesday and exclude nursing home residents, who have also been impacted harshly by COVID.
In New London, where 55% of the population is minority, 33 out of every 10,000 residents outside of nursing homes have COVID-19, compared to 14 out of every 10,000 residents in Waterford, where fewer that 18% of the residents are minorities.
Gov. Ned Lamont has frequently acknowledged during his daily briefings the disparate impact the virus is having on underserved communities and highlighted the efforts his administration has made to help those living in these communities. Last Thursday, for example, Lamont announced the state will no longer require a doctor’s order to get tested and will begin allowing pharmacists to administer tests if they can get them. He also pointed to two mobile vans, capable of testing 60 people a day, that the state Department of Public Health recently began sending to underserved communities.
“The issue of the supplies really does dictate how much we can do on a daily basis. But we’re so committed to this initiative,” said Coleman-Mitchell, during a recent interview.
But some urban activists are irate about the multiple weeks it’s taken state and city governments to start providing such services to low-income communities and insist the pace still isn’t fast enough.
“I hear promises [testing sites] are coming,” said Tamara Lanier, a Norwich resident and head of the southeast Connecticut chapter of the NAACP. “But there’s nothing I know of right now where I can go to get tested.”
“We have been asking from the beginning, where are the tests?” John Lugo, director of New Haven-based Unidad Latina en Accion, said. “Right now, it’s getting better.”
With testing levels still not showing a surge, state and local officials have said in recent days that some of the testing centers are underutilized.
“Right now we have a little bit of extra capacity,” Lamont said Monday. “Look, you got a cough, you got something that makes you think twice about it, I would go get tested.”
State officials were unable to provide a rundown last week of which locations have unused capacity, other than a CVS testing site in New Haven. The state is building a data portal to record testing capacity and results from hospitals, pharmacies and other test sites to ensure vulnerable populations have access to testing, officials said.
The state ranks 13th in the nation for the number of tests it has conducted on a per-capita basis, despite having the fifth-highest per-capita rate of residents testing positive for the virus, an analysis of testing data from the Covid Tracking Project and state population data from the Census show.
Meanwhile, residents and activists in many of Connecticut’s minority communities say COVID-19 testing in their neighborhoods continues to be absent or inadequate. They insist they need action now rather than more promises from the Lamont administration about “ramping up” testing in communities of color. People in inner-city neighborhoods also warn that communication about the disease and how to get assistance has been confusing.
Rev. Carl McCluster, pastor of Bridgeport’s Shiloh Baptist Church, said there are no residents from poor communities of color on the governor’s reopening advisory committee – proof that these communities are being excluded from the decision-making process.
“Look at the list and tell me who is really in touch with their community,” McCluster said, pointing out that Lamont’s advisory panel is dominated by current or former corporate leaders, academics and scientists – none of whom actually live in poor minority neighborhoods.
“I think it took longer than it should have for state government to recognize the necessity of engaging minority communities,” McCluster said. Clergy from Connecticut’s cities are asking the Lamont administration to include faith-based organizations more in the state’s COVID-19 response in communities of color.
Turned down for testing at the hospitals…
In the weeks after the novel coronavirus swept into Frog Hollow – one of the state’s most impoverished and segregated neighborhoods – hundreds of sick residents trying to get tested showed up at the local health center.
Some had been turned away from Hartford Hospital because they either weren’t sick enough to be hospitalized or they didn’t have a referral from a doctor in the group’s network. Others came straight to the community health center because they didn’t have a car to go through the hospital’s testing drive-through or lacked health insurance and didn’t trust they could leave the hospital without a huge bill.
Too many people showed up.
The health center – located in a neighborhood where 10% of the residents have no health insurance and are significantly more likely to have asthma, diabetes and other chronic health problems that make them particularly vulnerable to the coronavirus – had only five COVID-19 tests to administer each day. That meant one out of every three people who needed a test were turned away or given a doctor’s note and told to go to the drive-up testing site at the other hospital in the city. That hospital, St. Francis Hospital and Medical Center, at least didn’t require a referral from one of its providers.
“Right now, most of our patients haven’t been able to get tested at the hospital. They’ve been turned away. So they’re been coming here,” Nichelle Mullins, president of Charter Oak Health Center, said last week during an interview. “Access to testing has been very difficult.”
Some decided they couldn’t wait in the long drive-up line, and so staff at Charter Oak added their names and contact information to the list of people to call when they had an extra test. The mobile van that the governor regularly touts stopped by here twice to help clear that list and has tested 59 people, of which 15 were positive.
This sluggish testing pace continued for weeks as the virus ravaged city neighborhoods. In Hartford, 107 residents have died after contracting the virus, 65 of whom were living outside of nursing homes. Just over 1,100 city residents outside of nursing homes have tested positive for COVID-19.
The stakes are high to identify who has COVID-19 in communities of color so health officials and residents can stop the spread of the virus. Minorities are less likely to have health insurance, and more likely to have respiratory illness, like asthma or other serious health conditions, that make COVID-19 more dangerous.
On Monday – seven weeks after the first Hartford resident tested positive for the coronavirus – the community health center increased its testing capacity from 5 to 60 people each day. It will still take days for people to get their results.
“I think the political community took it too lightly at first,” McCluster said of the need for swift action in communities of color when the pandemic hit hard. “Two weeks is huge in something like this.”
Coleman-Mitchell said increased testing capacity at the community health centers is a top priority, adding that the state intends to use some of the federal funds it has received to pay for expanded testing in the coming weeks.
“We are committed to testing mass numbers of the underserved and those at greatest risk for COVID-19,” she said.
The commissioner does not support the state establishing standards for centers to determine who gets tested.
Some advocates say such a step is necessary to remove any implicit biases that might lead to black and Hispanic residents being turned away.
“If everybody’s playing by the same rules, then people have a better chance,” said Pat Baker, president of the Connecticut Health Foundation. “Everyone would have a fair shot at it. So it does take away barriers to securing access that may be there for some populations.”
But those decisions are best left to medical providers, Coleman-Mitchell explained.
“They’re more than qualified to make a clinical call as to who should get tested based on what the CDC guidance provides in terms of symptoms, and the likelihood,” she said. “So they are able to make that assessment and we trust that they do.”
With one-third of the state’s low-income families having access to a vehicle, providing walk-up testing options is critical, legislators and advocates say. The state also needs a centralized repository for all its testing information, including locations, hours and rules.
“I would urge the state to think about not only testing sites where people can drive, but how is it you could get to a test site on foot? Where are they? What are their hours?” Baker said. “I think we need a statewide messaging campaign to reach and target at-risk populations.”