Introduction
Public health crises have uneven impacts on different communities, and the COVID-19 pandemic is no exception. Neighborhoods inhabited by individuals of lower socioeconomic status and historically marginalized racial or ethnic minorities tend to face worse outcomes in epidemics than richer and Whiter areas. This discrepancy can be attributed to reduced access to critical health resources such as quality nutrition, housing, and healthcare, caused by poverty and structural discrimination. With its diverse, yet economically disadvantaged population, the East River Houses public housing complex in East (or Spanish) Harlem constitutes an area of heightened concern during the pandemic. Persistent neglect by authorities has led to cramped and unsanitary conditions in the complex, which can substantially increase the health risks for its inhabitants. To mitigate the pandemic in East River Houses, city and health authorities will need to provide information support that is tailored to the residents’ specific risks and needs. This must include guidelines for ameliorating indoor environmental health hazards through education on cleaning and sanitary best practices.
Coronavirus Mitigation Measures
Mitigation, a course of action aimed at reducing the impact of a disaster, is a crucial part of the public health response to epidemics. In that context, it means controlling the spread of disease through sanitary and hygiene measures. The novel nature of the coronavirus means that no medical countermeasures are currently available, and no timeline exists for the development of a vaccine. Full containment of the disease has proved impossible due to widespread asymptomatic cases. As a result, mitigation measures are particularly vital in the current pandemic. While mitigation cannot prevent the coronavirus’ spreading entirely, it can win time and save lives by reducing the strain on healthcare systems until a medical solution could be found.
Governments and health experts around the world have proposed and implemented several mitigation measures to check the spread of the pandemic. The cornerstone of mitigation, social distancing, requires self-isolating, avoiding mass gatherings, and maintaining a safe distance from people outside of one’s household. Other personal measures include observing scrupulous hand hygiene and respiratory etiquette, wearing protective face masks, and self-monitoring for the emergence of known coronavirus symptoms. Additionally, a high standard of environmental cleanliness and ventilation must be maintained to reduce the possibility of infection from contaminated surfaces. Those measures require widespread cooperation from the population to be effective, which in turn depends on the successful education of the population about the pandemic’s behavior. Even a few people disregarding the instructions can fatally undermine mitigation. For various reasons, the implementation of these measures is much more challenging in some communities than in others.
Public Health Conditions in East River Houses
The challenges facing attempts at mitigation in East River Houses are in large part a reflection of broader problems affecting public health throughout Spanish Harlem. While the average life expectancy in New York City (NYC) is 81.2 years, the average life expectancy in the district is 77.3 years, which reflects several endemic social issues. Many of those issues may be attributed to structural racism, as according to a 2018 report, the district’s population is 50% Latino of any race and 30% non-Hispanic Black. Long-term discrimination has contributed to the lower average socioeconomic status of those groups. Historical policies such as redlining, which prevent access to services from finance to healthcare by residents in poorer neighborhoods, have had a greater impact on minorities than on poor Whites. East Harlem also has one of the highest incarceration rates in NYC, more than three times the city average. Overpolicing disproportionately impacts Blacks and Latinos, compounding their economic inequality. In addition to its enduring economic impacts, a long history of real and perceived racial discrimination increases neighborhood distrust towards authorities, which can prove deadly during an epidemic.
Racial and economic inequality can translate into health inequity in several ways. Reduced access to quality nutrition, housing, education, and healthcare undermines overall health, increases the risk of disease, and lowers the likelihood of effective treatment. Past and current health problems can reduce resilience to new ones, as well as exacerbate them directly. Both lower socioeconomic status and belonging to racial or ethnic minority groups have been proven to have a direct relationship with greater vulnerability to the coronavirus pandemic and a higher rate of comorbidities. Minority individuals tend to encounter more health problems than non-Hispanic Whites of similar socioeconomic status. The historically fraught relationship between marginalized groups and healthcare providers exacerbates the situation through miscommunication and mistrust. Navigating those complexities is essential for a successful mitigation effort.
The inhabitants of Spanish Harlem face numerous present-day deficits of community resources. For example, there are seventeen bodegas for every supermarket in the district, making it more likely that residents would depend on less healthy food from convenience stores compared to districts with more supermarkets. This effect may be somewhat alleviated by the presence of eight farmers’ markets. While only 14% of adults lack health insurance, identical to the rest of NYC, the rate of avoidable hospitalization is more than double the citywide rate, suggesting a deficiency in primary care. Although East Harlem used to have more hospitals, it is presently served only by Mount Sinai Hospital and Metropolitan Hospital Center. The rates of obesity, diabetes, and hypertension, the most common comorbidities of COVID-19, are all somewhat higher than the NYC average. This situation puts all of the district’s inhabitants at higher risk during the pandemic.
Further problems emerge in connection to the poor conditions that prevail in much of NYC’s municipal housing. Public housing, which accounts for 33% of housing in East Harlem, is run by the NYC Housing Authority (NYCHA), whose resources are often insufficient to ensure an adequate standard of maintenance in the units. Constructed in 1941 as a pioneering low-income high-rise project, East River Houses started with a mostly white tenantry that gave way to an overwhelmingly Black and Puerto Rican majority by 1969. The complex did not escape the environmental deterioration faced by other public housing units, leading to the appearance of mold, insects, rodents, and other health hazards. A 2018 New York State Department of Health (NYSDOH) report drew particular attention to flaking paint and evidence of recent fires in the common areas of the complex. Such environmental conditions increase the risk of respiratory illness, including COVID-19 and some of its comorbidities. The NYSDOH inspectors also mentioned poor ventilation, inefficient heating, and damage to walls throughout NYCHA properties. Addressing environmental conditions is critical for mitigation efforts to succeed.
How to Improve East River Houses Mitigation
Successful community mitigation efforts for East River Houses require the cooperation of multiple stakeholders. NYCHA, NYSDOH, and the NYC Department of Health and Mental Hygiene (NYCDHMH) are the government agencies that need to be most directly involved in the efforts. NYCDHMH’s Neighborhood Health Action Centers (NHACs), one of which operates in East Harlem, have proven effective in reaching out to communities and local partners as part of their place-based approach. Local non-profit organizations such as the Union Settlement or the LSA Family Health Service also have extensive experience with community-building and health education. Mount Sinai Hospital and Metropolitan Hospital Center can significantly assist the mitigation effort and should be kept apprised of any developments that may impact their workload. It may be possible to identify other local stakeholders, such as businesses, educational institutions, faith leaders, activists, and area influencers that can assist in mitigation by spreading information, organizing the community, or providing more resources. Last but not least, the success of any mitigation strategy hinges on the active and informed participation of the residents of East River Houses.
The city and health authorities must develop a more effective approach to health education and public information about the pandemic. This approach must be science-based, community-oriented, culturally sensitive, and accessible for all inhabitants. City officials, medical professionals, and local healthcare providers must work together to develop mitigation guidelines that can be used by both community members and frontline healthcare workers. Those guidelines should be regularly updated based on the latest findings regarding the coronavirus, its comorbidities, and effective mitigation practices. As 19% of Spanish Harlem’s population has only a limited English proficiency, it seems advisable to prepare information in multiple languages. Members of minority communities in East River Houses and individuals who have worked with them should be consulted to help refine the guidelines, paying attention to local conditions and culturally sensitive delivery. Configuring information and recommendations to the specific risks, views, and resources of the communities is required to optimize mitigation efforts.
The guidelines, and all accompanying public information messages, need to make mitigation measures as simple as possible while making a compelling case for following them. Emphasis should be placed on increased vulnerability based on socioeconomic status, ethnicity or race, and pre-existing conditions. Explanations should be detailed and transparent, making it clear why each mitigation measure is required and how the community or its members should implement it. Given its proven effectiveness, up-to-date recommendations on social distancing that take into account local circumstances such as limited space are vital. Likewise, special care must be taken to instruct the inhabitants of East River Houses on superior hygienic, cleaning, and ventilation practices that could counter the hazardousness of their environment. Residents must have all the latest information necessary for self-monitoring, as well as for instructions on how to proceed if they suspect that any member of their household has the disease. Giving the community access to clear, detailed, actionable information should make it possible to minimize the risks and the damage from the pandemic.
Effective communication of the necessary information requires the use of multiple channels and platforms with the support of all interested stakeholders. The websites and social media pages of participating government agencies and healthcare provider organizations present one route. Other local stakeholders that can command the community’s attention, such as activist networks, should contribute to this effort as well. However, direct engagement with the community is indispensable, both to avoid any information gaps caused by a primarily online approach and to gather feedback to improve communications. Given their long-standing familiarity and trusting relationships with the community, the local non-profit organizations and the NHAC seem best equipped to carry out this engagement effort. Their websites and social media can also be used for virtual community organizing. Community members could use scientific resources on those sites to learn more about the pandemic and volunteer to support mitigation efforts. While more difficult situations such as actual coronavirus cases require experts, volunteers could assist other community members, reducing the burden on healthcare professionals.
In addition to spreading information about community mitigation measures, healthcare providers will need to stand ready to assist in their implementation. NHAC should draw on its prior experience to take the lead by coordinating local healthcare organizations to ensure reliable information support. Telemedicine seems to offer the most promising technical angle for this assistance, as it allows experts to support the community with vital information and guidance without needlessly compromising social distancing. The experts will be able to provide additional support for specific situations, such as indoor environmental hazards. They could also carry out remote testing and instruct residents on how to isolate sick household members before hospitalization safely. In this way, the coronavirus threat to residents and its strain on the local healthcare system can be controlled.
Conclusion
Community mitigation efforts are vital for reducing the coronavirus pandemic’s impact on the population and the healthcare system. For those efforts to succeed, communities need to be provided with timely, relevant, and actionable information that is tailored to their specific circumstances and needs. Mitigation in the East River Houses complex of Spanish Harlem requires the cooperation of numerous stakeholders, including government agencies, healthcare provider organizations, and community members. In addition to circulating guidelines through all available platforms and channels, direct engagement will be necessary to minimize information gaps, receive feedback, and provide remote assistance in specific scenarios. The NHAC and local community-oriented non-profit organizations seem especially well-positioned for engagement due to their previous work with the community and the trust they have built with its members. By maintaining constant engagement and comparing the pandemic’s impact with other public housing complexes, it should be possible to assess the effectiveness of the mitigation guidelines and outreach efforts.
Bibliography
- Bloom, Nicholas Dagen, and Matthew Gordon Lasner, eds. Affordable Housing in New York: The People, Places, and Policies That Transformed a City. Princeton: Princeton Univ. Press, 2019.
- Dannefer, Rachel, Barbara C. Wong, Padmore John, Jaime Gutierrez, Kim Freeman, Calpurnyia Roberts, Elana Martins, Ewel Napier, Philip Noyes, Hannah Seoh, Jane Bedell, Cassiopeia Toner, Torian Easterling, Javier Lopez, Noel Manyindo, and Karen Aletha Maybank. “The Neighborhood as a Unit of Change for Health: Early Findings from the East Harlem Neighborhood Health Action Center.” Journal of Community Health 45, no. 1 (2020): 161-169.
- Hinterland, Kinjia, Megan Naidoo, Liza King, Veronica Lewin, Gayle Myerson, Bianca Noumbissi, Miriam Woodward, L. Hannah Gould, R. Charon Gwynn, Oxiris Barbot, and Mary Travis Bassett. Community Health Profiles 2018, Manhattan Community District 11: East Harlem. [New York]: The New York City Department of Health and Mental Hygiene, 2018. Web.
- Lasry, Arielle, Daniel Kidder, Marisa Hast, Jason Poovey, Gregory Sunshine, Kathryn Winglee, Nicole Zviedrite, Faruque Ahmed, and Kathleen A. Ethier. “Timing of Community Mitigation and Changes in Reported COVID-19 and Community Mobility-Four US Metropolitan Areas, 2020.” MMWR. Morbidity and Mortality Weekly Report 69, no. 15 (2020): 451-457.
- López, Ray, Tongtan Chantarat, Anne Bozack, Amanda Lopez, and Linda Weiss. “Reducing Childhood Asthma Triggers in Public Housing: Implementation and Outcomes from an East Harlem Community Health Worker Program.” Environmental Justice 8, no. 5 (2015): 185-191. Web.
- Myers, Elise M. “Compounding Health Risks and Increased Vulnerability to SARS-CoV-2 for Racial and Ethnic Minorities and Low Socioeconomic Status Individuals in the United States.” Preprints (2020). Web.
- Assessment of New York City Housing Authority (NYCHA) Properties. [Albany]: New York State Department of Health, 2018. Web.
- Yang, Jing, Ya Zheng, Xi Gou, Ke Pu, Zhaofeng Chen, Qinghong Guo, Rui Ji, Haojia Wang, Yuping Wang, and Yongning Zhou. “Prevalence of Comorbidities and Its Effects in Patients Infected with SARS-CoV-2: A Systematic Review and Meta-Analysis.” International Journal of Infectious Diseases 94 (2020): 91-95. Web.