Long Island’s predominantly minority communities have driven down COVID-19 infection rates that were the Island’s highest at the peak of the pandemic in a public health success described by experts as one of the most successful turnarounds in the United States.
Since the end of August, the coronavirus has appeared in communities where Black and Hispanic residents make up more than half the population at lower rates than in other areas of Long Island, according to a Newsday analysis of reported case numbers.
The data marks the culmination of a five-month turnaround.
In April, confirmed cases of the coronavirus surfaced in communities that are home largely to minority residents at more than twice the rate that cases appeared in places populated mostly by others.
But starting in early July, the presence of the virus equalized across both Nassau and Suffolk counties, flattening a once sizable racial and ethnic disparity in per capita infection rates, Newsday’s analysis shows.
The infection-rate decline among Long Island's minority communities contrasts sharply with racial and ethnic disparities that persist in areas of the country where the virus is more prevalent.
"I think it’s unique and it’s important," said Dr. Eliseo J. Pérez-Stable, Director of the National Institute on Minority Health and Health Disparities, part of the National Institutes of Health, when informed of Newsday’s analysis. "I want to know what Long Island did right so that we can try and replicate that in other areas that are diverse."
Adherence to social distancing and individual precautions of the kind taken by Huntington Station grandmother Shirley Bradford, 73, and her 21-year-old granddaughter, Kiara, may hold keys to the answer.
“I came here for the test today because my grandmother, whom I live with, is a senior citizen so she’s at risk ... I want to be sure.”
- Kiara Bradford, 21
With surgical masks on, both underwent testing for the virus in July at an open-air clinic, housed in a tent outside the community’s St. Hugh of Lincoln Catholic Church — not because either was feeling symptoms of the virus but just for prevention.
"I came here for the test today because my grandmother, whom I live with, is a senior citizen so she’s at risk," explained Kiara, who said she is biracial. "I sometimes go and spend time with my friends and I’m not sure if they’re carriers, and I could be asymptomatic. So, I want to be sure."
Many had similar concerns in communities where high percentages of workers stayed on the job because they were deemed essential or because they could not afford to stay home.
"Everybody was scared," said Suffolk County Deputy County Executive Vanessa Baird-Streeter, remembering the deep health concerns in minority neighborhoods at the height of the virus. "Particularly in communities of color, a lot of those individuals were your frontline workers — they had to go out, regardless of the stay-at-home orders. They had to go out."
“Particularly in communities of color, a lot of those individuals were your frontline workers — they had to go out.”
- Vanessa Baird-Streeter, Suffolk County deputy county executive
At the same time, Long Island leaders point to public health efforts that range from providing free infection tests and masks to setting up neighborhood "pop-up" clinics with van service for those who needed transportation.
"We watched the data as it emerged and we started to see that some of our minority communities were among the hardest hit," said Dr. Lawrence Eisenstein, Nassau County Health Commissioner, who found that many sick patients lived in close quarters where the virus spread easily. "We started to realize that population density was one of the risks. Making sure that areas with the highest population density had access to testing would be very important."
Back in early April, Long Island and New York City were the epicenter of the pandemic. COVID-19 cases spiked, patients surged into hospitals and deaths rose. Infections spread most rapidly in predominantly minority communities that already suffered elevated rates of diabetes and heart disease.
To gauge the prevalence of the virus then and today, Newsday tabulated how many confirmed cases have appeared in every Long Island community and then matched those numbers against the population of each community. The process equalized how often COVID-19 cases had appeared per 1,000 residents, creating the ability to compare the coronavirus’s presence among communities of varying sizes and different racial and ethnic compositions.
Newsday relied on data kept by Nassau and Suffolk counties to determine the average number of cases confirmed daily over rolling seven-day periods. The U.S. Census Bureau’s most recent estimates of population sizes and make-ups identified communities where Black and Hispanic residents represented more than half the population.
At the peak, during the second week of April, predominantly Black and Hispanic communities experienced an average of 1.5 confirmed infections per 1,000 residents daily. That was more than twice the rate recorded in other Long Island communities — an average of 0.63 cases per 1,000 residents daily.
Here’s how those seemingly small numbers produced COVID-19’s onslaught as well as wide gaps between even adjoining communities.
- Garden City’s population of 22,500 is 7% Black and Hispanic. It recorded an average of eight cases per day for the week ending April 10. That’s a per capita rate of 0.35 cases per day per 1,000 residents.
- Neighboring Hempstead Village's population of 55,400 is 91% Black and Hispanic. It experienced an average of 66 cases daily for a per capita rate of 1.18 cases per day per 1,000 residents — more than three times higher than Garden City’s rate.
- Similarly, the per capita rate in Roosevelt, which is 97% Black and Hispanic, was more than double the rate in adjoining Merrick — 1.19 cases per 1,000 residents in Roosevelt compared with 0.49 cases per 1,000 in Merrick.
- The disparity was even larger between Commack, which is 8% Black and Hispanic, and Brentwood, which is 79% Black and Hispanic. Brentwood’s per capita rate was nearly seven times higher than Commack’s — 2.88 cases per day per 1,000 residents compared with 0.43 cases per day in Commack.
Health experts say COVID-19 cases began to recede after Gov. Andrew Cuomo’s March 22 stay-at-home order and public adoption of social distancing, masks, sanitizers and hand-washing.
Within two weeks of April’s pandemic peak, the infection rate in predominantly minority communities had been cut nearly in half. Within four weeks, it had declined 77%. Within six weeks, the decline had reached 91%.
Slide the circle to the right to see community infection rates of COVID-19 on April 7, and to the left to compare the rates on July 11. Darker colors indicate higher rates.
Sources: U.S. Census Bureau, Suffolk County GIS and Nassau County.
As a result, since July 11, the per-capita infection rates of the two groups of communities — those that are predominantly minority and those that are not — rarely differed by more than 0.01 cases per 1,000 residents on any single day until Aug. 28. That's when the infection rate in minority communities as a whole became less than the one for other communities by as much as 0.03 cases per 1,000 residents. Hempstead Village and Garden City, Roosevelt and Merrick, and Brentwood and Commack have all recorded comparable rates.
"I think it’s a great achievement," said Merlin Chowkwanyun, a Columbia University public health expert and co-author of a July 16 New England Journal of Medicine article examining racial health disparities with COVID-19.
In reducing infection rates among minorities, Chowkwanyun and other experts said, Long Island and the rest of New York State overcame obstacles that hastened the spread of the virus, including housing density in poor neighborhoods and concentrations of front-line workers who stayed on the job, sometimes without adequate safety protections.
"We didn’t have masks…we weren’t provided gloves, nothing."
-Luisa Araya, 63, who worked as a supermarket cashier
Luisa Araya, a 63-year-old Hispanic woman, worked as a cashier at a Mineola supermarket, where she believes she was infected.
"We didn’t have masks … we weren't supplied gloves, nothing," she recalled about herself and fellow workers, speaking through a translator. "I believe I was one of the first ones infected with the virus." Soon she felt sick, with nausea and vomiting.
Araya tested positive. On the advice of health providers, she quarantined at her Freeport home, where she lives with her daughter. Because she suffered from diabetes and other health problems, she decided not to return to her job at the grocery store.
Later, an antibody test performed at the South Ocean Care clinic in Freeport confirmed that Araya had experienced COVID-19.
"I mean, it wasn’t an easy time," she said about her ordeal, shedding tears. "I am alive because of my family."
For several weeks, South Ocean Care operated a "pop-up" tent on its grounds to offer testing and treatment to overflow COVID patients. Many were employed in grocery stores, as waitresses or in other jobs serving the public, which left them vulnerable to infection, said Jacqueline Gianzon, practice manager at South Ocean Care.
"They were considered essential workers," Gianzon explained. "They were not educated into, like, protecting themselves and wearing a mask. And a lot of the employers were not too keen on providing them the right PPE [personal protective equipment]."
On a neighborhood tour in the van, Gianzon said Hispanic community members — severely impacted by hospitalizations and deaths early in the crisis — have generally followed social distancing measures.
"A lot of times when they come in and the drivers are picking them up, they are already wearing the mask and they know they have to be protected," she said.
Clinics like South Ocean Care offered services regardless of patients’ ability to pay or their insurance. They also didn’t ask about immigration status, easing the minds of Hispanic immigrants who otherwise might have avoided testing, clinic officials said.
As the virus spread in the spring, a cry for more help came from minority communities throughout Long Island, including some who feared they might be forgotten.
"We’re not a big community like other places where testing was everywhere," said Regina Hunt, civic engagement chairwoman of the NAACP’s Brookhaven branch, about the group’s effort in North Bellport, which is 58% Black and Hispanic.
"There was really no testing in this area. You had to go a distance in order to be tested," she said, usually a long drive to Stony Brook University Hospital.
“The numbers were going higher and higher each day ... I knew we had to do something.”
-Regina Hunt, civic engagement chair of the NAACP’s Brookhaven branch
In the early days of the pandemic, Hunt said the virus infected about 350 people living in a 12-block area of North Bellport.
"The numbers were going higher and higher each day," she recalled. "I didn’t know if people were being tested, being hospitalized, if people were scared. I really didn’t know what it was. But I knew we had to do something."
At Hunt’s urging, Northwell Health and government officials helped set up a clinic at the New Bethel First Pentecostal Church in North Bellport that offered free antibody testing. The same testing took place at St. Agnes Roman Catholic Church in Greenport.
Not everything in the antivirus fight went perfectly. In Huntington Station, a testing site placed at the local high school failed to draw patients. Community advocates like Pilar Moya-Manchera urged that the clinic, housed in a tent, be moved to St. Hugh of Lincoln, a Catholic parish offering Mass in Spanish.
"The Latino community, the immigrant community, are a very religious community and they trust the church," says Moya-Manchera, executive director of Housing Help Inc. "Everybody knows that when they are in a church premises, they are safe. So that really made the change for us."
While diagnostic testing for patients with insurance often took place at hospitals and private clinics, efforts among poor and working-class minorities often centered on similar "hot spot" tents set up at key places in both Nassau and Suffolk to primarily serve Hispanic and Black patients.
"As we stemmed the tide and saw the numbers leveling off, within communities of color we still saw a high infection rate, so we knew our work was not over," said Suffolk’s Baird-Streeter.
Eventually, these government-funded "hot spot" facilities in Suffolk have tested nearly 10,000 patients since March, she added.
Local officials also said part of the reason for the reduction success is that many Black and Hispanic patients knew others infected by the virus and were inclined to follow public health advisories.
Doctors also relied more frequently on remote visits with minority patients to avoid the spread of the virus.
"The telehealth visits helped an enormous amount ... we were able to educate [patients] and enforce all of the public health initiatives."
- Dr. William Gehrhardt, medical director of the Dolan Family Health Center
"The telehealth visits helped an enormous amount," said Dr. William Gehrhardt, medical director of the Dolan Family Health Center, associated with Huntington Hospital and Northwell Health, which upped the remote visits at his local clinic from zero to 40 a day during the early days of the crisis.
"We were able to educate [patients] and enforce all of the public health initiatives that have to be done to eliminate the spread of this disease," Gehrhardt said.
When patients tested positive for COVID-19 at local clinics, contact tracers alerted the circle of people who had come in contact with patients, urging them to self-quarantine to avoid further spread of the virus. Health officials at clinics also called and texted to follow patients' recoveries.
Local officials say a decline in deaths and hospitalizations for minorities has corresponded with the lowered infection rates, though state health officials say precise racial and ethnic breakdowns in these categories are not available.
Unlike Long Island, a sharp racial disparity still exists nationally with COVID cases, according to Centers for Disease Control data and academic studies, including some analyzing racial differences in the public’s response to the virus’ threat.
While at least one study found that Blacks in the United States socially distanced more than whites during the first months of the crisis, the NIH’s Pérez-Stable cautioned about coming to conclusions at this point in the pandemic. However, he said researchers have learned that so-called co-morbidity factors like hypertension and diabetes demand more attention.
"By the end of March, it was clear [the virus] attacked mostly around racial groups," Pérez-Stable said. "African-Americans were dying more frequently and the analysis showed that these co-morbidity factors may be a reason. Later it became clear Latino/Hispanics were in the same boat."
Pérez-Stable says he’s impressed by statistics showing Long Island has reduced the racial and ethnic disparities in infection rates as much as any large region in the nation.
"Any success at decreasing transmission in our communities at this point is something to be applauded," he said. "If Long Island has been able to accomplish eliminating the disparity in infection rates among minorities, that’s an example that can be implemented in some form across the country."