Race, Income, Nursing Homes: Why Does Hampden County Have State's Highest Rate Of COVID-19 Deaths?
Hampden County has the sixth highest rate in Massachusetts for confirmed COVID-19 cases. But it has the highest rate of deaths.
That indicates people who contract the virus in Hampden County are, on average, more likely to die from it than elsewhere in the state.
'Micro-pandemics every day'
When community organizers at Arise for Social Justice read early news reports of the coronavirus, they didn’t know how to prepare.
“There wasn't enough anticipation of what the impact was going to be,” said Tanisha Arena, executive director of the Springfield anti-poverty group. “I don't know if that's because we were somehow blindly hoping that the safety net of government was going to stop it from becoming what it now is.”
But Arena knew the population they serve was likely to be affected more than others, because that’s always what happens.
Springfield is the biggest city in Hampden County. The county is one of the state’s poorest. It has the second highest percentage of people of color in Massachusetts – just over a third of its population.
And within the county, black people earn, on average, about half the income of white people. Hispanics earn even less.
“In some ways, our community experiences … micro-pandemics every day,” Arena said.
Health data from the Public Health Institute of Western Massachusetts show people of color in Hampden County have higher rates of asthma from mold and air pollution, less access to health care or even good nutrition, and are more likely to have heart disease, COPD – a chronic lung disease – and diabetes.
Given that underlying health conditions make COVID-19 more dangerous, Arena is not surprised Hampden County has the state’s highest death rate from the virus. As of May 7, the county had 4,441 confirmed cases and 434 deaths.
“So the health disparities that were already there, I think, are amplified,” Arena said. “What health care looks like in our country ... for folks who are poor and lower income – it was already bad and now it's really bad.”
This type of inequity is playing out in other places. A recent study by researchers at Beth Israel found that in New York City, COVID-19 death rates were "starkly" different for low income and communities of color. The Bronx – with a high density of people of color – had twice as many deaths per capita then the more affluent and more white Manhattan.
Exposed 'to a greater level of risk'
At this point, we don’t know how many black and Hispanic people are dying of COVID-19 in Hampden county. Statewide, the racial data is missing for about half the deaths. The state declined to comment on disparities among regions of the state, instead referring back to the local health departments.
At a recent briefing, Springfield’s health commissioner, Helen Caulton-Harris, pointed to a map showing the COVID-19 hot spots tend to be in zip codes with mostly low-income people of color. But she said the city does not yet know the specifics on who died.
“We really don't have a true ethnic picture of race and ethnicity for those deaths based on the large number that is unknown or missing,” Caulton-Harris said.
Still, there is anecdotal information.
“I can tell you, the black people that I know in Springfield all have a friend or a family member who has died, whereas the white people that I know, it's much sparser,” said Catherine Ratté, who does population research at the Pioneer Valley Planning Commission.
PVPC ranks health outcomes for all 14 Massachusetts counties every year. Ratté said Hampden always comes in last — which she attributes largely to systemic racism.
“We've been understanding that for years, and now, just like Hurricane Katrina really exposed a lot of inequity with respect to race in response to that, that’s what we're we were anticipating to see with COVID,” said Ratté. “And sadly, now that's what we're seeing.”
Douglas Hall of PVPC pointed out that many low-income people of color also have a harder time avoiding the virus to begin with.
“They're still the ones that are on those front lines, driving those buses, working those cash registers in our grocery stores,” Hall said. “And so that … exposes them to a greater level of risk."
Mark Melnik has been collecting data on COVID-19 for the UMass Donahue Institute. He noted that Hampden County is home to four so-called “gateway cities” – Holyoke, Chicopee, Westfield and Springfield.
Gateway cities are defined as mid-sized former manufacturing hubs that now fall below the state average for income and education. Melnik said they tend to have more people who work in retail or service jobs — and live close together.
“And as we are seeing in these data, close proximity to people, density of people living in large households, these are the issues that are leading to a [higher] infection rate,” he said.
Counties as a whole also have different densities. Hampshire County, which has a relatively low infection and death rate, is more spread out then Hampden county, so people can social distance more easily.
Melnik said Hampshire County is also whiter, and it has a more highly educated population that can more easily work from home.
'A terrible vulnerability'
But on top of economic and health disparities, analysts said what likely pushed Hampden County to the highest rank in the state's COVID deaths is nursing home spread.
The county has 15 nursing homes where at least 30 people (including patients and staff) contracted the virus, according to state data. The Soldiers' Home in Holyoke has had 72 deaths alone.
“So obviously, we have to be working very hard on our nursing homes and senior facilities,” said Sarah Fortune with the Harvard School of Public Health. “It's just a terrible vulnerability.”
By comparison, Hampshire County only had three nursing homes with 30 or more cases.
“I think that it's very important to understand who is really bearing the burden and the risk of this infection,” Fortune said, “and be focusing our resources in those communities.”
Tanisha Arena of Arise for Social Justice goes one further. She’d like resources to keep going to vulnerable communities well after the pandemic. For instance, she’d like keep retail wages at the higher rate offered during the crisis and address the factors that keep people of color in substandard housing or polluted environments.
“We all know that this isn't OK. But who's listening? Who's really making those changes?” Arena said. “Because this has shown us, at least from my vantage point, that there are systemic and institutional things that really don't work and need to change.”
Arena said she doesn’t know if any of Arise's regulars have died of COVID-19, because the organization is not considered essential and had to close.