People of color hit harder by COVID-19 in Twin Cities, ZIP code data confirm

When Kirstin Johnson-Nixon tested positive for the coronavirus in May, all she could think was, "Oh, here we go."

The north Minneapolis mother of three and public school social worker had a feeling for weeks that she would get the virus. She's the lead caregiver for her two parents and is in constant contact with them. From what she knew from the news, it seemed like Black people would be most affected.

"I was thinking, 'I'm going to be positive and this could mean that we might die,' that's all I could think of at the time," Johnson-Nixon said. "I just didn't have anything else in my mind except 'Oh my God, what is this going to be like?' "

By the first week of May, Johnson-Nixon, her husband, three sons, mother and father tested positive for COVID.

Johnson-Nixon's worries were well-founded. Black and Hispanic Minnesotans are far more likely to be infected than white Minnesotans, state data show. Each group accounts for about 20% of the confirmed cases in Minnesota, but they only make up 5% and 6% of the population, respectively.

The share of cases in the Asian and Native American communities are both roughly equal to their share of the population.

State death records also show that people of color are dying from COVID at disproportionately high rates, a fact that hasn't gotten a lot of attention due to the high number of deaths among elderly, and mostly white, residents of long-term care facilities. People of color make up 63% of the deaths among adults under age 64, though they are just 16% of that population. But even among older residents, people of color account for 15% of the deaths, triple their share of the population.

Minnesota leaders of color have suffered their share of losses to COVID-19. St. Paul School Board Chairwoman Marny Xiong, the mother of Attorney General Keith Ellison and the father of U.S. Rep. Ilhan Omar have all died from the virus. Nationally, the toll of deaths and infections from the virus among communities of color has also been evident in cities such as Chicago, Detroit, Los Angeles and New York City.

On Thursday, Herman Cain, a leading Black conservative who ran for president in 2012, died after contracting COVID-19.

The chaos for the Johnson-Nixon family began when her father was diagnosed with COVID-19 on May 4. Johnson-Nixon said she, her husband and mother drove to Maple Grove two days later to get tested. Since it was around the time when clinics were giving tests only to those with symptoms, she had to lie and say they all had fevers and coughs.

Their results came back positive within days. Her mother was found days later at her home unresponsive and was taken to the hospital. Johnson-Nixon said her mother was incoherent. They thought it might be dementia but learned later that COVID can cause bouts of delirium.

Johnson-Nixon said she'd had the flu and pneumonia before, but they paled in comparison to COVID-19. She said she had a fever that felt as if it "started in my waist and went all of the way down to my feet," and she felt like she couldn't lie down in bed comfortably so she was constantly stretching and walking around her small bedroom.

She and her husband, Charles, drank cups of hot tea and looked up YouTube videos of breathing exercises to break up the mucus in their lungs.

Meanwhile, son Caleb, 17, lost his sense of smell and son Raphael, 13, had a headache and a slight fever. Her other son, Judah, 13, was tested, but the hospital could find no record of it.

COVID "made you feel at times like you're feeling better and I would try to wash my hair and then it would kind of knock me down again," Johnson-Nixon said. "I think it was a lot more severe to me than the flu was and for the psychological piece, I know people die from the flu, but I never thought I was going to die because I had the flu."

Federal, state and local public health officials warned early on in the pandemic that communities of color would be vulnerable to COVID-19 because of higher rates of chronic health issues like diabetes, heart disease, high blood pressure and obesity. COVID-19 can exacerbate some of these issues, making it harder for the body to adequately fight the viral infection, according to health experts. Also, people of color are more likely to be on the front lines as essential workers in jobs they cannot do remotely, such as in grocery stores and factories.

In the metro area, areas with a higher share of people of color are more likely to have higher COVID-19 rates, regardless of income, according to a Star Tribune analysis. For every 10 percentage point increase in the nonwhite population in a ZIP code, there are an average of 2 more COVID cases per 1,000 people.

The four ZIP codes in the metro area with the highest COVID-19 rates have populations that are at least 45% people of color. That includes two areas of Minneapolis and parts of Brooklyn Center, Brooklyn Park, New Hope and Crystal.

April Graves, a public health specialist with the Minneapolis Department of Health, said the department has been working with community groups to pull together resources to help people keep their housing and to obtain donations for food and hand sanitizer. When the unrest after George Floyd's death erupted in Minneapolis, the groups worked to pass out 50,000 masks.

Knowing that vulnerable populations aren't accustomed to visiting the city's website, Graves said the city has tried to find ways to reach them — particularly young people — and educate them on the virus, including making TikTok videos that focus on mental health, feelings of isolation and encouraging social distancing. Graves said it's important for people to understand that "there's a segment of society that are living in fear of losing their life everyday."

"You may not be taking COVID seriously when you think about the chance of being shot versus catching a virus in your mind," Graves said.

Stella Whitney-West, CEO of Northpoint Health and Wellness Center, a north Minneapolis area community health office, said she and her staff had long anticipated people of color being most affected by COVID-19. More than half of the clinic's patients are Black, another 30% are Latino and another 10% are Hmong. Many are low-income and are one emergency away from losing everything.

The clinic opened a walk-in testing site last week to try to accommodate more people. It has been doing drive-up testing as well.

"People are doing the best that they can, but there's a fear and anxiety that people have that if they get sick, what is this going to mean," Whitney-West said about how COVID-19 could change the lives of the community they serve. "I think the messages they see on TV is that people get sick enough and go to the hospital that they die, they have to be put on a ventilator, that they can't breathe."

Beyond the dangers of COVID-19 is the larger systemic and institutional discrimination that communities of color face, particularly when overcoming generations of difficulty with housing, health care, food, employment and other economic issues.

Lack of access to bare necessities and space to social distance has made stay-at-home orders challenging for households where one emergency could upend their finances or housing for months. The pandemic is forcing communities of color to confront longtime fears of doctors, hospitals and medical research; also, the lack of diversity among health professionals often makes them delay care.

Even potential progress on the vaccine has been overshadowed by concern over whether medical professionals will be able to convince patients of color that the vaccine is safe. The public health community still has to overcome the distrust created by the Tuskegee experiment, when between 1932 and 1972, hundreds of Black men living with syphilis in Alabama had treatment withheld from them.

Jaime Slaughter-Acey, an epidemiologist with the University of Minnesota's School of Public Health, said that the disproportionate number of people of color dying from COVID-19 hasn't surprised her, especially with how "the insidious nature of racism would be put on display" during the pandemic.

But she said it's been heartbreaking to see the backlash to public health solutions like wearing masks and practicing social distancing. She said she initially hoped the country would have come together to mitigate the spread of the virus.

"What makes it uncomfortable, and I don't mean any offense, but white people are not forced to think about racism on a day-in, day-out basis," Slaughter-Acey said. "I think the initial stories about the pandemic around race and racism were quite jarring to people and some people probably took it as a step back in part because we don't teach people about race consciousness."

"In order to move forward, Blacks, Indigenous people and people of color can't be the only ones who are conscious about what race means and how it impacts lived experiences."

For now, Johnson-Nixon's family is in recovery mode. Her mother has moved in with them and her father is in a rehabilitation center, gaining strength to walk and put his clothes on by himself and eating solid foods again. He's expected to get out Tuesday, but he'll need an oxygen tank to breathe.

Two weeks ago, he had no memory of his long hospital stay and cannot remember the home phone number they'd had for 40 years. Her children have recovered but Johnson-Nixon and her husband have been hesitant to send them outside to play lacrosse, lest they get COVID-19 again or bring it back to the house.

Meanwhile, Johnson-Nixon said she still has a cough and "feels like I'm always trying to clear my throat." Her doctor told her there's nothing they can do but find ways to keep the discomfort at bay. Johnson-Nixon has kept drinking hot tea and taking Nyquil. But she said she worries Black families are not being reached by public health messaging.

She said it's important to keep talking about COVID and how to stay safe, and she's even thought about standing outside of frequented grocery stores and shops telling anyone who will listen.

"When I see a Black family and the whole family, there might be four kids even or two kids, and no one has a mask on, I almost want to walk up to them and say, 'Do you guys know what this could mean for you if you get this virus?' " Johnson-Nixon said. "Because I see so many folks that don't have masks on, don't have gloves. ... I just feel like they're not taking it seriously."