The Poorest Borough. The Worst Health Crisis. The Heaviest Toll.

Working on the front lines of the coronavirus pandemic can be hazardous, but staying home isn’t safe either for the emergency responders, pharmacists, home health aides, grocery clerks and deliverymen who fill River Park Towers in the Bronx.

Even a ride down the elevator is risky. Residents often must wait up to an hour to squeeze into small, poorly ventilated cars that break down frequently, with people crowding the hallways like commuters trying to push into the subway at rush hour.

There is talk that as many as 100 residents have been sickened by the coronavirus at the two massive towers rising above the Morris Heights neighborhood along the Harlem River. But no one knows for sure, since the leader of the tenant association died from Covid-19 in April.

“It’s the death towers, you could say that,” said Maria Lopez, 42, a resident with a variety of health issues, including asthma, who has watched 10 of her neighbors being taken away by paramedics.

The worst health crisis in a century has exploded across New York City, and it has inflicted the worst toll on the Bronx, the city’s poorest borough.

It has spread building by building in neighborhoods like Morris Heights that have been unable to fight back, reflecting a legacy of institutionalized racism, poverty, cramped housing and chronic health problems that have put their residents at higher risk of getting sick and dying.

In just months, the coronavirus has threatened to wipe out more than a decade of efforts to rebuild the Bronx with new development and businesses and has made life even more precarious for those already struggling to survive, including low-paid essential workers without health insurance, paid sick time or unions to back them.

The economic fallout has shuttered stores, restaurants and businesses across the borough and left thousands out of work, struggling to pay rent and buy food. As in the other boroughs, unemployment claims have surged in the Bronx — by mid-May they had skyrocketed 2,000 percent from a year ago. One Bronx economic development official warned that up to half the borough’s restaurants may never reopen.

The crisis has stirred frustration and resentment among Bronx residents angered that, once again, they are the ones paying the highest price. The Bronx has long struggled to attract attention and resources. During the economic boom of the past decade, it lagged behind the rest of the city in many indicators, including poverty and unemployment.

“This will happen again. This is not the last pandemic,” said Ruben Diaz Jr., the Bronx borough president, who counts at least three deaths in his own apartment complex in the Soundview neighborhood. “How do we remedy institutionalized neglect in communities like the Bronx so in the future we have a fighting chance?”

The coronavirus has been particularly deadly in the Bronx because race and income are key factors in who survives and who does not. At least 4,400 confirmed and probable Covid-19 deaths in the Bronx have been reported as of May 26.

Across the city, neighborhoods with large numbers of black, Latino or poor residents have the highest death rates. In the Bronx, about 90 percent of the borough’s 1.4 million residents are people of color, the highest concentration in the city, according to census data.

Many public health experts and Bronx officials say more should have been done to protect vulnerable communities. City and state leaders, they say, should have aggressively conducted testing to slow the spread of the virus, deployed more services and resources and focused on overlooked front-line workers who have kept stores open and the city running.

“We as a state and as a city could have done better,” said State Assemblyman Victor M. Pichardo, whose parents were both sickened by the virus. “We’re sort of picking up the pieces now.”

Mr. Pichardo said it was not until May — two months after the pandemic shut down the city — that he received more than 4,000 masks from the mayor’s office, and 300 bottles of hand sanitizer from the governor’s office, for his district, which includes Morris Heights.

City and state officials acknowledged the challenges the Bronx faced, but said they were constrained early on in the outbreak by limited testing capacity and resources and focused on prioritizing health care and emergency workers. They have since expanded testing sites in the Bronx and opened up testing to anyone who has symptoms.

“The Covid-19 crisis has exacerbated disparities that have existed for far too long in our city,” said Avery Cohen, a spokeswoman for Mayor Bill de Blasio. “We have put equity at the forefront of our plan to treat the virus and safely reopen the city. From opening community testing sites across the city, to our grass-roots outreach with community providers in the Bronx, and supporting NYC Health + Hospitals, we remain focused on saving lives and ensuring that all New Yorkers receive the care they deserve.”

Adults in the Bronx have the highest rates in the city of asthma, diabetes and high blood pressure, all of which can lead to severe complications for people who are infected with the coronavirus. Roughly one in three Bronx adults is obese — another factor that can make the virus worse — and lack of ready access to healthy foods makes it difficult for people to change their diets.

Of those Bronx residents who died from Covid-19, 90 percent had at least one such underlying condition.

The Bronx ranked last among New York State’s 62 counties in an annual survey of health indicators. And life expectancy in the Bronx is about five years lower than in Manhattan.

“What Covid-19 really shines a very harsh light on are the historical inequities in socioeconomic status and structural racism that are really driving disparities in health outcomes,” said Nadia S. Islam, an associate professor of population health at New York University’s Grossman School of Medicine.

The city’s northern borough once drew well-to-do families to its stretches of parkland and Art Deco apartment buildings. But in the 1970s, arson fires, rampant crime and poverty drove out residents, and turned the borough into a national symbol of urban decay.

Today, the Bronx is home to the nation’s poorest congressional district. Median household income is $38,000, compared with $82,000 in Manhattan and about $61,000 citywide.

Still, in recent years there were signs of a revival: The Bronx has attracted retail stores, hotels, start-up companies and manufacturers as well as an influx of newcomers priced out of Manhattan. The unemployment rate dropped to 4.7 percent in February before rising again to 5.7 percent in March, the latest data available.

Marlene Cintron, the president of the Bronx Overall Economic Development Corporation, which provides loans and services to businesses, said she hears every day from stores, restaurants and businesses that may not be able to reopen. At Hunts Point, a regional food hub, some distributors are owed millions of dollars by restaurants and hotels that have been unable to pay their bills, she said.

Lines at food pantries have been growing, and elected officials and community groups have been giving out free bags of groceries.

“It’s very worrisome,’’ said Dr. Bola Omotosho, the chairman of the community board that includes Morris Heights. “People are not able to pay rent — whether it’s for their apartments or for their businesses.’’

Morris Heights is a hilly enclave in the West Bronx, where hip-hop is said to have been born in the 1970s. About 40 percent of the area’s residents are poor, and almost all are black or Latino.

River Park Towers, which encompasses two 44-floor buildings, was built in the 1970s for lower-income and working families. Rents for the 1,654 apartments go up to $1,978 for a four-bedroom. More than 70 percent of the 5,000 tenants receive rent subsidies, a spokesman for the complex said.

Life in the towers has always been hard, residents said, recalling drive-by shootings in the 1980s. While violence has decreased in recent years, gangs and illegal drugs remain a problem, and there was a stabbing recently in a building lobby, they said.

But the coronavirus has brought new worries. Large groups walk around without masks. One janitor complained that he did not have enough protective gear.

“The chances of getting Covid here are greater than at work,” said Sandra Williams, 37, a nursing aide who commutes to a Brooklyn nursing home.

For Margarita Brown, 48, a pharmacist technician, getting ready for work is “like preparing for war.” She puts on a mask and gloves before getting into elevators “packed like sardines.” She has to go around crowds in the lobby before riding a bus to a pharmacy on the Upper West Side of Manhattan.

“Then you get to your job, but you’re not being appreciated,” said Ms. Brown, who has no health insurance. “It’s so stressful.”

Ronn Torossian, a spokesman for Reliant Realty Services and Omni New York, which owns River Park Towers, said the complex had tried to protect residents, including conducting “commercial-grade cleaning” of the buildings multiple times a day. In addition, he said, adjustments had been made to staff and spaces “to accommodate proper social-distancing protocols.”

But, he said, landlords had received no guidance from the city about what to do to keep housing safe. “We had to learn all about it, just like you guys, by watching the news,” he said.

City officials said they have held or taken part in more than 40 meetings and events in the Bronx to keep residents informed about the virus, and worked with health care workers and community organizations.

In Morris Heights alone, they said, they have given out 75,000 face coverings, including 10,000 specifically for River Park Towers.

But many Bronx leaders and public health experts said the city and state should have realized sooner that the virus was especially dangerous to higher-risk communities and taken more steps to try to stem the spread, like expanding testing and making it more accessible.

“We could have anticipated that the Bronx and other communities of need would have a higher infection rate,” said Diana Hernandez, an assistant professor of sociomedical sciences at Columbia University’s Mailman School of Public Health and a resident of the South Bronx. “It was really a missed opportunity to do testing, contact tracing and outreach to high-risk populations in a more targeted fashion.”

The first state-operated testing site in the Bronx was a drive-through center that opened March 23 at Lehman College, which made it difficult for anyone who did not have a car — or money for a taxi or Uber.

Bronx hospitals were rapidly overwhelmed with people trying to get tested.

The Morris Heights Health Center set up its own temporary testing sites in April. Nearly a third of the more than 1,000 people tested were positive. “We made every attempt to get ahead of it as quickly as possible,” said Mari G. Millet, the center’s president and chief executive, adding the center also gave out masks and introduced telemedicine visits so older patients could stay home.

Of the center’s 58,000 regular patients, 80 have been hospitalized, and 12 have died from Covid-19 since March 1, she said.

State officials said the drive-through testing centers were a way to provide testing safely and quickly in hard-hit areas. By mid-April they had opened the state’s first walk-in testing center in the Bronx, followed by a second site a week later, they said.

More than 140,000 people have been tested in the Bronx, according to the governor’s office, and the Bronx has received more tests per capita than Manhattan, Brooklyn and Queens.

The state has also given out more than 2 million pieces of personal protective equipment in the Bronx, including masks, gloves, gowns and face shields. Nearly 100,000 bottles of hand sanitizer have been sent to the Bronx, starting with hospitals in mid-March.

“The Bronx has been a priority since the start of this pandemic,” said Robert Mujica, the state budget director, who is part of the governor’s virus task force.

City officials have also expanded testing and are working to provide people who test positive with hotel rooms so they can remain isolated, which is not always possible in crowded Bronx apartments.

But in Morris Heights, many residents said they felt they had been left to fend off the virus on their own.

By the time that masks and hand sanitizer were given out this month at Karen Adams’s public housing complex, it was too late. Ms. Adams, 65, had already gotten the virus.

“They should make things available to us, but they didn’t,” she said. “The white community, they had everything that they needed. They had access to things.’’

At River Park Towers, the manager of a deli on the grounds said he has to tell young people to put on masks because the security guards and management do not.

“The effort was not there,” said the manager, Nelson Pier, 34, as he admonished a teenager from behind the counter. “Yo, put a mask on!”

Up on the 43rd floor, Ms. Lopez, who has asthma, regularly sprays the strip of floor between the front door of her apartment and the elevator with disinfectant.

“I’m scared but I can’t afford to get sick,” said Ms. Lopez, showing rashes on her hands from the disinfectant.

“We’re the black sheep put in the corner,” she said. “The city, the government, they have forgotten us.”

Gabriela Bhaskar contributed reporting.

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