By Emily Hopkins and Shari Rudavsky | Indianapolis Star
July 2, 2020
It takes only minutes to drive from northeast Marion County, with its winding suburban streets and lush greenery, to the neighborhoods of Martindale-Brightwood, crossed by railroad tracks and interrupted by industrial sites.
But when it comes to the coronavirus, the neighborhoods are worlds apart.
An IndyStar analysis of ZIP code level data reveals that COVID-19 infection rates in predominantly nonwhite ZIP codes such as Martindale-Brightwood’s are nearly three times as high as in the state’s whitest ZIP codes. Experts say such data could be used to identify hot spots and deploy resources to areas hardest hit, but state officials delayed release of the data until recently.
Among the causes of the disproportionate impact on Black and Hispanic populations, experts told IndyStar, are higher rates of people working low-income essential jobs, greater instance of underlying health issues and lower rates of health insurance.
“When we don’t address those things as a city and a town, the outcome, at its worse, is death,” said Matthew Nowlin, an analyst at The Polis Center who has analyzed coronavirus and demographic data. “The actual cost of inequality that we see is people’s lives sometimes. That’s the long-term takeaway.”
Comparing the mostly Black 46218 ZIP code that includes Martindale-Brightwood and the mostly white northeast Indianapolis suburban 46236 ZIP code offers one case in point. There have been about 6.6 cases for every 1,000 residents in the mostly white ZIP code vs 13.9 cases per 1,000 residents in the minority district.
As the state contemplates the next stage of reopening, IndyStar’s analysis sheds light for the first time on the degree of the coronavirus disparity across different populations in Indiana:
- Predominantly nonwhite areas had infection rates three times as high as areas where residents were mostly white.
- Infection rates in the state’s poorest neighborhoods are 77% higher than in the wealthiest.
- Higher proportions of white residents were related to lower infection rates, while higher proportions of Black and Latino residents were related to higher infection rates.
Accept that this is real
Indiana officials have been releasing race information about coronavirus cases since early April. The data show that, while Black Hoosiers make up only 9.8% of the state’s population, they’ve contracted at least 12.5% of COVID-19 cases. Hispanic/Latino Hoosiers make up 7.1% of the state’s population and 11.5% of the cases. The actual impact on those communities could be much higher due to the large percentage of race and ethnicity data listed as “unknown” on the state’s website.
Indiana first released ZIP code-level COVID-19 data on June 12, offering the first localized view of COVID-19 outbreaks below the county level.
Ideally, the state could use the ZIP code data to decide where to establish permanent testing sites with triage clinics to help advise those who are sick on whether they need to head to the hospital, state Rep. Robin Shackleford told IndyStar. She and others have been asking the governor to make the information public for a while, she said.
“The ZIP code data is needed and very important because it helps target where the state should be putting testing sites,” she said. Two of the ZIP codes in her district, 46218 and 46235, both have more than 417 cases. “I don’t think they have been following this data,” she said.
Like many others, Shackleford was not surprised by what the data revealed. Shackleford said she would like to see additional information released, such as deaths per ZIP code and information on pre-existing conditions. Emergency room visits by ZIP code and trend data over time could also prove useful in making key policy decisions.
On the community level, the struggle is less about knowing who’s most severely impacted and more about persuading people to respond to the reality of the virus.
“The information doesn’t tell us anything we didn’t already know, that we weren’t already experiencing,” said Imhotep Adisa, co-founder of the Kheprw Institute in Indianapolis. “I don’t know how we get people to accept that this is real. Everybody that we talk to, we talk about this stuff.”
Adisa, whose father-in-law tested positive for COVID-19 a month ago (he has since tested negative), said he talks regularly with his team to implement the latest best practices for preventing the spread of the coronavirus.
The organization, which operates several programs aimed at empowering self-sustaining communities, has among other precautions created a quarantine “bubble” — a group of individuals who have quarantined and are now safe to be around each other. Anyone who ventures out of the bubble must quarantine for 14 days before coming back in.
In South Bend, Father Paul Ybarra consulted with local public health officials before the state started reopening and learned that the two churches he serves sat in the ZIP code in St. Joseph County with the highest number of cases.
That information helped shape how those two churches, St. Adalbert and St. Casimir opened, Ybarra said. Both churches operated at half capacity at first with ample supplies of hand sanitizer and the people who attended Mass did so in masks.
Other areas in the city with fewer cases did not take the same measures, he said.
“They weren’t taking it as seriously as were,” he said. “Amongst my parishioners there was greater conscientiousness about it.”
Although he felt that contributed to some stigma when the South Bend Tribune wrote a story about the ZIP codes with the highest number of coronavirus cases, Ybarra said that it made perfect sense when you consider that many of the people in his neighborhood did not have the luxury of working from home and had to continue to work.
In Indianapolis, Adisa has noticed more and more folks stopping by their campus located in the 46208 ZIP code, where there are about eight cases for every 1,000 residents. He said that as restrictions are relaxed even further, Black communities will continue to be disproportionately impacted by the coronavirus.
“It is my view leadership in general and Black leadership in particular must double down on being diligent in protecting our community from the virus by encouraging and when possible demanding best practices both from the grassroots level and institutional level,” Adisa wrote in an email to IndyStar.
More testing needed in hot spots
Race and income alone do not explain the disparities among neighborhoods. Institutional settings such as jails or nursing homes could play a role. For example, the 46204 ZIP code in Indianapolis, which has the second highest infection rate in the state, is also home to Marion County Jail, where more than 122 inmates have tested positive.
But another outbreak shows just how those inequities can play a role in who falls ill with COVID-19, the disease coronavirus causes.
The area in the state with the highest rate of infection is a ZIP code in Logansport, where a Tyson meat processing plant closed temporarily after 146 employees tested positive for the virus. Throughout the pandemic, jobs like those in the Tyson plant were considered essential and could not be performed at home. Those who held those jobs might be making the choice between exposure and providing their families with basic needs.
“[When] they can’t afford to lose their income, they have to make that choice,” said Karen Frederickson Comer, director of Collaborative Research and Community Health Informatics at The Polis Center.
Outside of those institutional settings, however, ZIP code data could be used to allocate resources as part of the state’s coronavirus response.
For example, Marion County health officials identified the 46218 ZIP code as a “hot spot.” The Marion County Public Health Department partnered with Eastern Star Church to offer testing there in May.
That arrangement was temporary, however. Now it’s become difficult again for many who live in the neighborhood, said Melaine Moore, a board member of Faith in Indiana, which has been advocating for equity in coronavirus response.
In order to be tested for free, many residents of the neighborhood would have to take a bus and potentially wait in a long line, something they’re less likely to do if they’re already feeling under the weather, she said.
Making matters worse, Moore said, many of the people who live there work in places where they may be more likely to be exposed to infected people, such as hospitals or other public-facing jobs.
“There definitely needs to be more testing in those hot spots,” she said. “It’s almost like a snowball effect. Even if I’m front and center, if there isn’t enough areas to go and get tested, I may say I’m not going to get tested.”
Data was long unavailable
It’s unclear how long Indiana officials have been using ZIP code data as part of their response or how they are using it. The state repeatedly denied IndyStar’s May 13 request for the data, saying it had not analyzed the data in that way.
The state announced the release of the data on June 12, one day after IndyStar pressed the Regenstrief Institute, the state’s data partner, for the information.
Other public health experts believe that the nature and scope of the coronavirus pandemic shifted the calculus to the side of releasing ZIP code data earlier in the pandemic. In some areas, state health departments did not release such data but large cities did.
The city of Boston, for instance, first released a ZIP code map in mid-April. Currently the city provides weekly updates that include number tested, cumulative positive rate, current week positive rate and testing per 10,000 residents.
Such information can be important for people to know, said Dr. Andrew Chan, a professor of medicine at Harvard Medical School. Chan and colleagues have developed an app that allows people to keep track of their health and symptoms that could be coronavirus. The COVID symptom study asks its volunteer users to enter their ZIP code and collates data on the prevalence of the virus around the country.
“I think people are very interested in getting ZIP code data because ZIP code information provides us a fairly specific way of understanding geographically where the outbreak is happening,” he said. “It helps us to identify where are the particular hot spots for COVID…. I think we do want people to know what’s happening in their community.”
Emily Hopkins is a data reporter for IndyStar’s investigative team. Reach her at 317-444-6409, firstname.lastname@example.org or on Twitter: @indyemapolis.
Contact IndyStar reporter Shari Rudavsky at email@example.com. Follow her on Facebook and on Twitter: @srudavsky.
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