The lived experience in one of the hardest hit communities in New York City (Harlem), and one of the least vaccinated for COVID-19. Some Lessons Learned.

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This essay will draw on my experience while working as a frontline health care provider during the COVID-19 Pandemic.

BACKGROUND

The COVID-19 pandemic proved to be a daunting task for many bureaucracies and its people the world over.

After the World Health Organization declared the impending COVID-19 pandemic a public health emergency, the United States soon followed suit on February 3, 2020 (see Declaring a National Emergency Concerning the Novel Coronavirus Outbreak. Executive Office of the President, 2020).

On March 13, 2020, the then President of the United States, Donald J. Trump, declared a national shutdown. This action resulted in the closure of the US borders to foreign visitors and the quarantine of Americans who arrived at our borders from countries deemed COVID-19 elevated risk. Further, the order resulted in the closure of schools and most businesses to curtail the spread of the deadly virus.

On March 30, 2020, federal government officials announced, “Operation Warp Speed (OWS).” This resulted in the funding of multiple governmental and commercial interests to the tune of billions of dollars to expedite the development of COVID-19 vaccines (Gregory, 2021).

By July and August of 2020, compressed COVID-19 vaccine clinical trials were begun for potential COVID-19 vaccines. By December 2020, we had our first emergency usage approval of one of those vaccines by federal authorities (Gregory, 2021) & (Lovelace, 2020). Only then, we, as a nation, began to see the proverbial “light at the end of the tunnel.”

Since then, the virus has been responsible for over 1.1 million COVID-19-related deaths in the United States, and over 6 million deaths worldwide. These death figures have been reported to represent an undercount of 2–3× of what has been officially reported in both instances (Wang et al., 2020).

Part 1

The New York City Event

Early in the pandemic, New York City (NYC) was designated as the epicenter of COVID-19 in terms of viral illnesses, and deaths in the United States. According to a report from the CDC, there were more than 200,000 confirmed tests in NYC, with Black and Hispanic citizens bearing the brunt of illnesses and deaths (Thompson et al., 2020). It was noted that most patients who succumbed to the virus had a positive or confirmed COVID-19 test and that mortality rates for hospitalized COVID-19 patients during the initial first 6-month surge of the virus was 32% in NYC area hospitals. And just as important in this group, most had two or more preexisting medical conditions, such as cardiac-related (70%) and diabetes-related (58%). This picture of illness and death was reflected in demographically similar communities across the nation (Finch & Finch, 2020).

Later, in the pandemic, during the Omicron variant surge of late December 2021 and January/February 2022, Black American hospitalization rates peaked at 4× the rate of whites. In fact, Blacks had the highest rates among all racial and ethnic groups at the time. Among other causes, poor vaccination rates resulted in heightened COVID-19 illnesses/hospitalizations particularly in those who were not vaccinated, or those who only received their initial primary doses, but no booster injections (see Racial Inequities in COVID-19 Hospitalizations During the Omicron Wave in Hospitalizations During the Omicron Wave in NYC, 2022)

My New York City Experience

For starters, I am a Black American who was born in the great state of Texas.

After a stint in the US Army, I completed studies at both San Francisco College of Mortuary Science and Prairie View A&M University. Following these studies, I was subsequently, accepted and completed my medical studies at the University of Iowa College of Medicine in 1984. I then completed a postgraduate residency training program at the University of Illinois Hospitals and Clinics in Chicago, Illinois, in 1988.

To add to my academic training, I applied to and was accepted in a clinical fellowship at New York Hospital/Cornell Medical College in 1989–1990. After completing the latter program, I practiced Therapeutic Radiology/Oncology in the Tri-state area until fall of 2020. At the latter time, COVID-19 viral pandemic was in its second wave. And because I worked through these initial surges as a high-risk senior citizen and medical provider, I was physically and emotionally impacted by the effects of working through this period. As such, it was very clear to me that I needed rest and healing.

During the initial phase of the pandemic, in Harlem, specifically, the national shutdown was clearly obvious to this observer. The area in central Harlem where I reside appeared as if it was a deserted island. Due to stay-at-home orders, the streets were empty, and devoid of any human activity as one would typically see, saved for the constant sirens of ambulances. This was one of the many deadly reminders of how serious the viral contagion was or would soon become.

For frontline (health care workers/public servants, myself included, these were the most memorable moments for me. The stillness, but for the noise of the constant sirens, and the daily~7:00 pm daily “musical” interludes, of sorts. These “musical” renderings were, as I recall, in the form folks banging kitchen utensils as instruments. This brought some measure of saneness or mental relief for many, myself included. Because of the large apartment buildings in the area where I live, the sound carried for blocks. And, because Morningside Park so close to us, this allowed little diminution of the sounds.

After recovering from working the first 7 months of the first deadly wave of the viral pandemic, I was eventually able to recover enough to reemerge and engage in other public activities risky as it was for me as a senior citizen, particularly. It was late October 2020 and my first public effort, at this emergence, was to become a New York City election (poll) worker. I served in two polling precincts here in Harlem, and later work as a vaccinator and medical greeter at one of the sites, as well.

Equally important, at the time, was a crucial national presidential election, among others, about to occur during this period. And from the high voter turnout I witnessed during the 12 days of early voting and the actual voting day periods, I knew that a political change was in the works.

The downside of this political adventure was that as a high-risk senior citizen working in this public capacity with no viable or approved COVID-19 vaccines by then, I placed myself in an untenable and risky position again. As the only protection we had then were masks, social distancing, and hand hygiene, for examples. For me, these measures worked, for I did not contract COVID-19 again, during this period.

MITIGATION EFFORT: 1. Direct community involvement combined with effective virus mitigation efforts. Very effective.

Once it was clear the election had changed the trajectory of our national politics, I then laser focused on the burgeoning vaccine mitigation efforts. Because of the evolving good news of how successful the new mRNA vaccines were proving to be in clinical trials, I started to imagine that we now had possible effective preventive medicines that would allow us to gain some measure of control of the COVID-19 virus, and its deadly grip on us.

As it was, I had already been activated by the New York City Medical Reserve Corps (NYC MRC) at the start of the COVID-19 pandemic in late February 2020. So, it was just a matter of time before we were given opportunities/assignments by NYC Health Department officials to work at various vaccine point-of-dispensing (POD) sites in our respective communities.

As I will discuss below, I later became part of the newly created public health worker infrastructure, despite having retired from actively practicing medicine in the August of 2020.

Part 2

Here Comes the Vaccine Mitigation Cavalry

To safely deliver millions of doses of COVID-19 vaccines would require a very complex management undertaking with well-coordinated efforts by many players. We are talking about administering vaccine doses to a citizenry of 8–9 million persons within the five boroughs of NYC and, potentially, more from surrounding communities.

By January 21, 2021, under the direction of Mayor DeBlasio and his leadership team, one notable accomplishment included the opening and operation vaccine delivery POD centers throughout the five boroughs.

MITIGATION EFFORT: There were at least 12 POD sites by March 2021 in NYC. These sites were initially staff by NYC Medical Reserve Corps (MRC) members, and NYC Department of Health and Mental Health staffers, among others. There were upwards to 125 vaccine delivery sites in NYC (Gallahue & Lanza, 2021).

This writer worked in the capacity, initially, as a volunteer vaccinator and medical greeter in two of the PODs here in Harlem. I administered vaccinations and served as a Medical Greeter at four NYCDOH POD sites during the initial vaccination phase. These sites included The Wadleigh School (PS 114) on 114^th street in south Harlem (10026), A. Phillip Randolph High located on the campus of City College of New York in north Harlem (10027), the South Bronx Educational Center (10455), and finally, the Bushwick Education Center in Bushwick (11237), Brooklyn. Further, large mass vaccination sites such as the Jacob Javits Center, to name one, were open by the state of New York under the direction of the then Governor Cuomo. Military members and other health professionals staffed this site as well.

Both local major league baseball team stadiums (Yankees and Mets) were used as mass vaccination sites too.

I have to say that the effort to defeat the virus not only required vaccines and vaccinators but also a reliable computer infrastructure, as well. Though I had heard of the business software giant Salesforce (San Francisco, California) in various news reports and all, it was when we embarked on our COVID-19 mitigation efforts in combating the deadly virus, did I truly appreciate what Salesforce role was as computer software experts. Their importance in terms of developing the software necessary to help carry out the logistics of delivering the shots; of giving an accounting to who delivered them and to whom, and where they were given and how, to name a few. These were all crucial because of the millions of folks soon to be involved in this massive effort as receivers of the vaccines, and equally important, those who logistically managed and administered them too. A safe and effective computer infrastructure was certainly a must in this complex endeavor. I am certain there were more players and complex operations required to carry out these enormous feats. But because I worked intimately with this software system during this acute period of the vaccination effort, I became truly appreciative of the coordination and guidance required to incorporate the many parts of this complex system, to help in healing our nation from this viral monster. And of course, the handy IPads were useful as well in assembling the data we created while delivering millions of vaccinations.

The downside to this worthwhile and prodigious effort required some of us to travel to various sites outside of our respective communities using public transportation resources. I was able to use my private vehicle on occasion but also had to resort to public transportation. The daily news of initial troubling issues occurring on, and, in our public transportation resources required constant vigilance and care. Per the New York Post of 04/20/2020, city officials were able to regain some measure of stability on the subways, for example, by getting COVID-19 positive unhoused, and others, to city provided hotel rooms for temporary safekeeping.

Part 3

Sickness, Death, and Economic Mayhem. How Do We Resolve These Social Dilemmas?

The socioeconomic deprivations caused by this deadly virus will require considerable time and effort to bring back some measure of social and economic stabilization. In this regard, this writer was strengthened by some of the measures enacted or instituted by our political, academic, and medical leadership, to name a few. These measures revolved around the socioeconomic and medical policies, which will briefly be discussed below. They had the potential of being game changers in rectifying entrenched deprivations that pre-dated the viral pandemic.

• First: Serious health comorbidities in the form of obesity, diabetes mellitus, heart disease, suppressed immunological conditions, mental health conditions, among others, all contributed to the disproportionate negative impact on those so affected in this medical demographic (Hill & Artiga, 2022). During the initial virus wave, Black and Hispanic New Yorkers were overrepresented in those hospitalized and who subsequently succumbed to the virus (West, 2020).MITIGATION EFFORT: The federal government enacted measures to lessen burdensome administrative measures so that ill citizens could access Medicare, Medicaid, and Children’s Health Insurance Programs (CHIP). This has had mixed results. Once the pandemic is declared over however portends a return to poor mismatch coverages depending on the state one resides (Wilensky, 2022). Of course, the newly developed COVID-19 vaccines were actual lifesavers or gamechangers to say the least.

• Second: Food insecurity, housing insecurity, job displacement, and the stress of all that was occurring at the time, potentially, made many more susceptible to the virus’s deadly effects. As mentioned before, besides direct federal government intervention, NYC officials enhanced those resources that would help its citizens access social service platforms that could help mitigate some, or all, the areas of deficient social determinants.MITIGATION EFFORT: The social services platform referred to as NOWPOW (Chicago, Illinois) has had a pivotal role in mitigating the many areas of poor social determinants in this writer’s experience as a member of New York City Public Health Corps (NYC PHC). This resource helped bring together under-resourced clients, and providers, with crucial referrals for access to job search assistance, food pantries, general education programs (GED), senior citizens housing search assistance, and personal counseling, to name but a few. DOH officials report well over 400,000 referrals were made to social service platforms since October 2021 to date. And, anecdotally, I bear witness to the many astonished faces of vaccine recipients once they realized the extent of services offered to them, if needed. Community members serving as newly minted CHWs formed the backbone of this aspect of care in the vaccine delivery effort, while serving in community organizations within their communities.

• Third: The lack of social resources to combat the virus in vulnerable under-resourced communities were later reinforced and expanded during this period in NYC. Many of these under-resourced communities had been previously identified by the New York City Health Department officials. City officials expanded the pool from 27 to 33 under-resourced communities identified by zip codes (Gallahue & Merlino, 2021).MITIGATION EFFORTS: The formation of the “Taskforce for Racial Inclusion and Equity (TRIE)” allowed for the development of the “Vaccine for ALL Corps.” The latter provided job opportunities for community members, and others, hired to provide various functions within the Point of (vaccine) Distribution (POD) centers. These centers were operated by the NYCDOH and included some private contractors, which extended vaccine coverage city-wide. The latter move allowed some of the civil servants to return to their prior DOH jobs as the city tried to return to normal operating capacities. From my experience working as a member of the Vaccine for All Corps reflected a strong camaraderie among the POD staff at any of the sites I worked at. As staffers of the PODs, we were divided into vaccinator, medical greeters, information technology (IT) personal, local vaccine outreach team members, onsite security, or administrators, to name a few. Many of the POD workers were non-health care–related workers pre-pandemic. But many of them show a heightened learning capacity to function safely and effectively with their assigned tasks/jobs per my experience.

There were nurses, doctors, mental health workers, retirees of various sorts, among others, who met the challenges we faced.

One of the downsides to this aspect of operation was the rollout of the financial incentive program instituted to get some community members who lagged in vaccination involved in the effort. On occasion, this presented some interesting public interactions, which required interventions of various sorts. But overall, the incentives, in my view, were very effective at drawing more vaccine takers.

• Fourth: A further expansion of the DOH’s “Vaccine for All” effort evolved into a specially created NYC PHC, which incorporated many of the workers from the “Vaccine for All” effort. NYC PHC participants attended city colleges on behalf of the NYCDOH and were awarded micro-degrees as Community Health Workers (CHW), if they successfully completed the 90 hours of courses offered.MITIGATION EFFORTS: The newly minted CHWs, as mentioned above, were then deployed to various community health clinics and social organizations in communities targeted by the Task Force for Vaccine Equity to facilitate vaccine outreach efforts, and social service referrals. The emphasis in this new endeavor was to create training measures and job opportunities to sustain this new aspect of public health workforce at the local level. In other words, these efforts were used to help communities developed a public heath local infrastructure by using those persons indigenous to it. The program was a component of the Expanded Access to Care (EAC) (14).In this new program, thousands of COVID-19 vaccines were administered, and similarly, social service referrals were made to clients needing such interventions. Client immediate social needs were determined through social screening tools. Hence, the term Community Health Worker (CHW) had taken a more critical meaning than it had before these recent tragic global events. This is evidenced by a recent meeting held at the White House awarding monetary grants to local groups across the nation to stand-up viable community health care workforces (Dillinger, 2022). For it is a sure bet that more infectious pathogens are bound to create more health and sociological havoc in the future. And it is purposed that this existing group of workers will be on the forefront of fighting any new infectious outbreak should it occur in their respective communities.

Another useful purpose for these newly minted CHWs would be as local outreach. That is, purveyors of vaccine/public health information in a manner that is trusted as neighbors or friends. And a message delivered in a language needed to reassured community members as opposed to what read on social media and other suspect information outlets.

In this regard, during the acute phase of the vaccine delivery effort, each POD site sent out teams daily to educate the communities in vaccine literacy and availability at a site where they served. Clearly, these persons working in the pods could not provide the content of true literacy due to language confinements and cultural differences. Again, this is where a local department of health supported existing “indigenous CHW workforce” would be ready and at hand to facilitate any education and/or training effort to others who seek to participate in health mitigation efforts in their respective communities. From my recent experience, our newly minted NYCPHC CHW group of 200 or so have migrated to employment opportunities at various community-based health clinics, local organizations, and large hospital systems in the city, such as New York Health and Hospitals corporation, to name a few. So, what was once a large NYCDOH endeavor has returned to its original core group of DOH workers, save for a dozen or so CHWs, remaining with the city agency from our initial group of ~200 or so CHW workers.

These actions have created a new, and hopefully, permanent CHW front line health care worker infrastructure within local communities particularly those that are under-resourced.

Most are well versed on the importance and use of socially determinants of health, which forms a large component of what some of us perform daily in our practices and organizations.

• Fifth: Vaccine hesitancy has been probably one of the most challenging efforts to mitigate against in the Black community in NYC, among other locales. An examination of vaccination rates in specific zip codes in Harlem and Brooklyn bares this reality out in stark details to this day. It did not help much when, initially, health care workers balked at receiving the vaccines during the initial vaccine rollout process. The look to the communities, like Harlem, only validated the anxieties and exacerbated the hesitancies of affected community members (Frenkel, 2021). Plus, the negative propaganda available on many social media sites only multiplied the madness. And the sad fact is being that social media misinformation/disinformation, was not just a problem in the Black community or even just America. The problem of vaccine distrust was a world-wide phenomenon as well. Folks in the pop culture sphere have certainly played integral roles in extending the influence of anti-vax sentiments (Wright, 2022). This anti-vax media campaign, joined with a barrage of negative social media influences, has had negative consequences as seen reflected in the low vaccination rates and high mortality figures seen in some communities. MITIGATION EFFORTS: Developing a network of “trusted” Community Health Workers (CHW) and dedicated public health mass communication networks should be in the forefront or frontline of vaccine literacy efforts as a matter of routine work in their respective communities. Further, public health–related topics with periodic public service announcements (PSAs) should be a matter of routine, henceforth. The dearth of sensible public health instructions and measures proved problematic in that allowed for the void to be filled by quacks and conspiracy mongers. At the time, some of the information delivered was confusing and often bordered on craziness, especially at the start of the pandemic. However, as time went on, expanded research efforts bolstered our thinking and help clarify the needed public health measures required to lessen the spread of the virus. However, notwithstanding, the valuable newly developed COVID-19 vaccines and their life saving effectiveness.

Closing Thoughts

The COVID-19 Pandemic and Beyond

Only until dependable COVID-19 vaccines were made available for emergency use in the late December 2020, and early January of 2021, did we get a handle on the very serious COVID-19 pandemic.

In the United States, and mirrored elsewhere, some communities were disproportionally affected by illness and death from the virus due to demographic circumstances such as risky labor participation categories or a vulnerability to illness from the virus due to existing comorbidities like obesity, diabetes mellitus, hypertension, and immune system conditions, to name a few.

Equally important was the association of illness and death from the COVID-19 was advanced age (West, 2020) & (Hill & Artiga, 2022).

Communities more resourced fared somewhat better than those under-resourced with few exceptions (Hill & Artiga, 2022). & (Garber, 2020).

As it is currently, there are few boundaries available to us that would prevent such infectious pandemics from occurring again. For example, consider the speed of jet travel the world over. As such, this single example of air travel could allow for the rapid dissemination of a particular infectious agent before any warning is given of such an event occurring in real time.

The coming climate challenge and its consequential effects including more that are infectious, in nature, predict a very interesting future that will require reparative cooperation across varying communities and worldwide national borders.

On the local level, based on our experience during the COVID-19 pandemic here in NYC, there is evidence that workable solutions are in our grasp as presented by the above examples. Included in this area would be the continued development of a public health worker infrastructure that is community-based and beholden to an official city agency to ensure its professional sustainability and continuing educational support programs. This would be similar efforts already in existence for sexually transmitted diseases, HIV and TB control teams, as examples.

I would like to think that expanding the CHW workforce into these areas of critical concern would serve the citizenry here and elsewhere well. And could, at a minimum, mitigate the impact of another catastrophic biological event such as that just occurred during the COVID-19 pandemic.

Hope springs eternal!

Disclosure statement

No potential conflict of interest was reported by the author.

Correction Statement

The views and opinions expressed in this article are solely those of the writer

This article has been republished with minor changes. These changes do not impact the academic content of the article.