This week, in an anxious nation where nearly any encounter with a screen has become triggering, Kim Kardashian West took a shot with all her firepower, announcing plans for her 40th birthday. To the undoing of Twitter, she noted that she had flown friends and family to a private island to pretend “things were normal just for a brief moment.” The pandemic at the heart of the current peculiarities was easily circumvented by quarantine and “2 weeks of multiple health screens.”
Covid cases are now rising around the country, with the prospect of the holidays heightening the fear of a another wave. In an effort to avert further disaster, mayors and governors have begun to preach a doctrine of mirthlessness to American families — this will be the year of pie eaten alone in front of an iPad. Many will have little choice but to comply.
Others, however, will find a way to create their own private islands, traveling to places where they will sit at long communal tables, conviviality unhindered. The difference, in many instances, will come down to testing, who does and does not get it, another mark of division amid all the gripping upheaval that is shaped by class.
In New York, the disparities are unmistakable. Recently, Wil Lieberman-Cribbin, a doctoral student in environmental health at Columbia, tabulated the prevalence of coronavirus testing in the city, during the months of September and October, according to ZIP code.
Overwhelmingly, the wealthiest neighborhoods — in fact, most of Manhattan below 110th Street — showed the highest rates of testing, while the poorest neighborhoods, in Central Brooklyn and the South Bronx, for example, largely correlated with the lowest. In some instances, the differences between the most affluent communities and the least advantaged were four times as great.
So many months into the pandemic, these inequities might have been corrected; instead they have simply been left to persist. In September, Mr. Lieberman-Cribbin, in conjunction with fellow researchers, published a paper in The American Journal of Preventive Medicine that looked at analogous testing data for March and April and found a similar imbalance. The authors concluded that widespread testing and public-health outreach was urgently needed in the city’s most vulnerable populations.
As it happened, the tide took things in a different direction. In effect, testing among the privileged was routinized. It became a function of neurosis; of a return to office work or private school; of an iron will to avoid certain constraints and sacrifices in lifestyle. In recent years, urgent-care centers have come to fill gentrified neighborhoods, making it no harder to get a Covid test in many places than it is to pick up a box of Raisin Bran; concierge medicine, delivering quick results, has filled other parts of the void.
As Emanuela Taioli, the director of the Institute for Translational Epidemiology at Mount Sinai, pointed out, testing in Manhattan has evolved as a mechanism for screening and contact tracing, while in low-income communities, it has been deployed more narrowly as a diagnostic tool for those already experiencing symptoms or otherwise at high risk.
This is not the way to contain a virus. What concerns public-health experts is that high rates of positivity have emerged in areas with low rates of testing, which suggests that infection could be much more widespread than it appears. In the early days of the pandemic, testing was virtually impossible for all but the visibly sick. Since then, the city has created 200 testing sites, where it is free. But disseminating information about theses sites — where they are, what sort of identification is needed when you get there, what risks the process might pose to immigration status and so on — has been fraught.
To address some of this confusion, the Health Department created “tailored webinars.” But, along with other online sources, they have turned out to be of little use to the many low-income people with no internet access. “We just don’t have the technology,” Shirlene Cooper, an AIDS activist living in Flatbush, Brooklyn, told me. “For me, a person living with H.I.V., no one told me what to do.”
In the view of Beverly Xaviera Watkins, a social epidemiologist at the University of California-Irvine, messaging in low-income communities of color hasn’t been inadequate; it has been “horrendous.” It has had little success overriding deeply held suspicions of a medical class that has a long history of exploiting Black Americans or disabling a broader mistrust of government. These strains of doubt are amplified in public housing, where decades of neglect and deceit have resulted in buildings tainted with lead paint and mold and a vanished faith among people who live there that their well-being is anyone’s priority.
Not long ago, Dr. Watkins began investigating the spread of the coronavirus in buildings of the New York City Housing Authority. With Karen Blondel, an environmental-justice advocate and longtime resident of the Red Hook Houses, she surveyed a representative sample of people living in three complexes in Brooklyn and found that a vast majority of respondents had not been tested even though more than a third knew someone who had died of Covid-19.
At one point, the city had workers knocking on doors to ask people if they wanted to be tested, but this, Ms. Blondel observed, served only to spread more fear. The people who showed up were strangers, and those on the other side of the door experienced a sense of invasion. They worried, too, about what might be done surreptitiously with their bodily submissions — what else would clinicians be looking for?
Dr. Watkins’s survey also included a question about a potential vaccine, another explosive subject. Nearly half in the group said they were not sure that they would take one if it were offered. A few people wondered if it might give you the disease. There was also an urban myth circulating that the vaccine would contain a tracker that allowed the government to check your movements.
“I thought it was insane at first, but then I kept hearing it,” Dr. Watkins told me. “The thing is, you could get control of the virus everywhere in the city, but if you can’t get it down in public housing, you’ve lost the war.”
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