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When COVID-19 Meets Health Inequality

In cities like Chicago and its surrounding Cook County, the coronavirus pandemic is turning longtime health inequalities among prisoners and poor neighborhoods into a nightmare.

Signs pleading for help hang in windows at the Cook County jail complex on April 09, 2020 in Chicago, Illinois. Scott Olson / Getty

COVID-19 has shone a bright spotlight on the deep cracks of inequality in Chicago. Unfortunately, some of the decisions being made by those in charge of Cook County, which includes Chicago and its surrounding suburbs, have been somewhere between oblivious and negligent.

I spent two recent Sundays working at Cook County Jail. Located in Chicago, it is one of the largest prisons in the entire country, and it was at one point the nation’s largest-known hotspot of COVID-19 infections. As of April 30, almost 800 detainees and staff have tested positive, and six inmates and one officer have died. I’ve been a nurse for thirteen years and spent eight of them in the busy emergency room at Cook County’s Stroger Hospital. This has been my first time working in a prison setting. It was worse than I anticipated.

Several of the inmates reported not getting adequate care. Another I worked with was incidentally diagnosed with diabetes after their incarceration. He was so frustrated because he had contracted COVID-19, he didn’t believe the diabetes diagnosis was true, was refusing treatment for the diabetes, and had been protesting by hunger striking for two days. Two other young men with diabetes had glucose levels higher than my device could measure. One said this was because he had not received his insulin the day before.

I asked another nurse how this could have happened. They responded that when there is not enough staff, people do not get their medication. Short staffing is a chronic problem that management is aware of, but nurses have not spoken out for fear of retaliation.

Nurses are now being hailed by many as heroes, people who are putting their lives on the line to help others. But there is a disconnection between that lionization and the actual conditions many nurses are operating in.

Almost all of the challenges we confront did not arise on the day coronavirus emerged — they have existed for decades. Thousands of people incarcerated at the jail have not been convicted of anything, but they are being held because they cannot afford bail. The court system was overburdened prior to the pandemic, and now prisoners face a potential death sentence for the crime of being poor, in a state that abolished this practice almost ten years ago.

African Americans make up about 30 percent of Chicago’s population, but 72 percent of deaths from COVID-19. This pandemic has exacerbated the underlying health inequities and medical apartheid that have existed in this country for centuries. Those who have already suffered so much have had the dial turned up.

The United States spends more than any other country when it comes to health care, and it has some of the worst outcomes — particularly when it comes to poor communities of color. Multiple peer-reviewed studies have linked health to adequate housing, access to healthy foods, availability of primary health care and medication, having a job that pays a living wage, and the level of stress one endures. I have met countless patients who take their blood pressure pill every other day instead of daily, who split insulin with a family member. It should come as no surprise that overall control of hypertension and diabetes in this country is dangerously low.

The reason I had been assigned to the jail was because the South Side emergency room I have had a part-time job at for the past two and a half years was closed for renovations on April 6, set to reopen on May 6. The first hospital ever opened and operated by African Americans, Provident is in the poor community of Washington Park. Adjacent to the much wealthier neighborhood of Hyde Park, home to the University of Chicago, average life expectancy drops fourteen years if one is born on the “wrong side” of Cottage Grove Avenue in Washington Park.

According to Cook County Board president Toni Preckwinkle, Provident Hospital’s ER was closed for renovations because “a member of our health care staff in the emergency department had [the coronavirus].” But there’s not a single comparable health care setting anywhere in the country in which at least one employee has not tested positive for COVID-19.

This same Cook County government, which is responsible for both the jail and the health system that includes Provident, has prepared a 66,000-square-foot makeshift morgue. This refrigerated warehouse will be able to contain more than two thousand corpses. Given the extent to which the disease has spread, the morgue is, unfortunately, probably needed. But the county’s inaction at jails and its shuttering of the Washington Park emergency room will help fill up that morgue. We need more health care in communities like Washington Park, not less.

My colleagues and I were not opposed to improving the ER, but we didn’t think it needed to be entirely closed. An emergency room is not like a Burger King. You can’t just turn the lights off and put up a closed sign when you find a mouse in the fryer. People come to the ER because they need emergency care. In my time there, I have worked with women who are victims of domestic violence, people who can’t breathe because of asthma, people having heart attacks, people who have traumatic wounds, and people who have stopped breathing because of a heroin overdose.

We also didn’t think an upgrade should take a month. A ten-minute drive north from Provident Hospital is McCormick Place, where $13 million was spent to have 400 construction workers laboring around the clock to convert the convention center into a hospital. Are the families of Washington Park less important?

Alongside our union, National Nurses United, nurses organized protests. We reached out to other unions like the Chicago Teachers Union and community organizations active in that area. We held a press conference on the afternoon of Monday, April 6, and we asked why they were closing a community emergency room in an African American neighborhood just when this pandemic was hitting the hardest. We started an online petition that eventually garnered almost three thousand signatures. We created a video that stated the case and started sharing it and the petition on social media. We asked the signers of the petition to call politicians and demand they reverse the decision.

We succeeded in getting the ER to be opened up sixteen days earlier than the county originally announced. Regular working people, united through their unions, community organizations, and local politicians, decreased the chances that something tragic could have occurred during a closure. It’s entirely possible that a very sick person could have been brought to those ER doors, where inadequate help would have been available.

What else can be done? We can reduce the population of Cook County Jail, expedite the cases of those who can be released, and increase the level of health care for the people who must remain. Resources exist to meet this catastrophe — Cook County should place resources in areas where they will have maximum impact. Downtown Chicago has hundreds of hotel rooms vacant due to the pandemic. If the concern is that those awaiting trial, simply there because they cannot afford bail, pose a health risk to their communities, house them in hotel rooms. Let them be quarantined for two weeks before returning to their own homes. Their legal proceedings can be taken up after this crisis.

Long-term solutions to the preexisting problems plaguing our health care system must be acted upon. It should already have been a three-alarm emergency that there is a life-expectancy gap of thirty years between the wealthy and predominantly white areas of Chicago and the underfunded neighborhoods predominantly populated by people of color. This was true before COVID-19. The gap will only widen under the pandemic unless governing bodies like Cook County act to maintain and expand health care rather than contract it, and unless we rapidly dismantle the carceral system that is making the pandemic infinitely worse.