Virus World

SOMERVILLE, Tenn. — Skill Wilson had amassed more than three decades of knowledge as a paramedic, first in Memphis and then in Fayette County. Two places that felt like night and day. With only five ambulances in the county and the nearest hospital as much as 45 minutes away, Skill relished the clinical know-how necessary to work in a rural setting. Doing things like sedating patients to insert tubes into their airways. But when it came to covid-19, despite more than 1 million deaths nationwide, Skill and his family felt their small town on the central-eastern side of Fayette County, with its fields of grazing cattle and rows of cotton and fewer than 200 covid deaths since the start of the pandemic, was a cocoon against the raging health emergency. “It was a lot easier to stay away from others,” his widow, Hollie Wilson, said of the largely White and predominantly conservative county of about 42,000 residents. “Less people. Less chance of exposure.” Covid seemed like other people’s problem — until it wasn’t. The imbalance in death rates among the nation’s racial and ethnic groups has been a defining part of the pandemic since the start. To see the pattern, The Washington Post analyzed every death during more than two years of the pandemic. Early in the crisis, the differing covid threat was evident in places such as Memphis and Fayette County. Deaths were concentrated in dense urban areas, where Black people died at several times the rate of White people. “I don’t want to say that we weren’t worried about it, but we weren’t,” said Hollie, who described her 59-year-old husband as someone who “never took a pill.” After a while, “you kind of slack off on some things,” she said.

Capt. Julian Greaves Wilson Jr., known to everybody as Skill, died of covid Jan. 23, a month after becoming infected with the coronavirus. He fell ill not long after transporting a covid patient to the hospital. At the time he died, infection rates in Fayette County had soared to 40.5 percent among people taking coronavirus tests. When the coronavirus appeared in the United States, it did what airborne viruses do — latched onto cells in people’s respiratory tract, evaded innate immune responses and multiplied. The pathogen, free of politics or ideology, had a diverse reservoir of hosts and found fertile pathways for growth in the inequalities born from centuries of racial animus and class resentments. Unequal exposure, unequal spread, unequal vulnerability and unequal treatment concentrated harm in communities that needed protection themost yet had the least. Cumulatively, Black, Latino and Native American people are 60 percent more likely to die of covid. But as the pandemic progressed, the damage done by the virus broadened, and the toxicity of modern-day politics came to the fore. The Post analysis revealed the changing pattern in covid deaths. At the start of the pandemic, Black people were more than three times as likely to die of covid as their White peers. But as 2020 progressed, the death rates narrowed — but not because fewer Black people were dying. White people began dying at increasingly unimaginable numbers, too, the Post analysis found. In summer 2021, the nation saw some of the pandemic’s lowest death rates, as vaccines, shoring up the body’s immune response, became widely available. Then came the delta variant. The virus mutated, able to spread among the vaccinated. As it did, an erosion of trust in government and in medicine — in any institution, really — slowed vaccination rates, stymieing the protection afforded by vaccines against severe illness and death. After delta’s peak in September 2021, the racial differences in covid deaths started eroding. The Post analysis found that Black deaths declined, while White deaths never eased, increasing slowly but steadily, until the mortality gap flipped. From the end of October through the end of December, White people died at a higher rate than Black people did, The Post found.

That remained true except for a stretch in winter 2021-2022, when the omicron variant rampaged. The Black death rate jumped above White people’s when the spike in cases and deaths overwhelmed providers in the Northeast, resulting in a bottleneck of testing and treatment. When the surge subsided, the Black death rate once again dropped below the White rate. “Usually, when we say a health disparity is disappearing, what we mean is that … the worse-off group is getting better,” said Tasleem Padamsee, an assistant professor at Ohio State University who researched vaccine use and was a member of the Ohio Department of Health’s work group on health equity. “We don’t usually mean that the group that had a systematic advantage got worse.” That’s exactly what happened as the White death rate surpassed that for Black people, even though Black Americans routinely confront stress so corrosive it causes them to age quicker, become sicker and die younger.  The shift in covid death rates “has vastly different implications for public health interventions,” said Nancy Krieger, professor of social epidemiology at Harvard University’s T.H. Chan School of Public Health. Officials must figure out how to connect with “communities who are ideologically opposed to the vaccine” while contending with “the cumulative impact of injustice” on communities of color. “Think about the fact that everyone who is age 57 and older in this country was born when Jim Crow was legal,” she said. “What that did was intersect with covid-19, meaning that embodied history is part of this pandemic, too.”