Unmasking inequality: the power of community organization during COVID-19

In medical school, I was charged with caring for Ms. R, a 47-year-old woman with type 2 diabetes, hypertension, and rheumatoid arthritis. She had been flagged as a high priority patient through the student-run free clinic (SRFC) and assigned to me for long-term follow-up. This signified seeing her during monthly check-ups, scheduling her appointments with specialists, and checking in with her to ensure her needs were being met.

Although I had a sense of my responsibilities when I stepped into this role, I was wholly unprepared to tackle the socioeconomic barriers that Ms. R. faced daily. During our weekly calls, I would listen as she described her inability to afford basic necessities like groceries or medications. Tapping into existing resources in the community, I would direct her to food pantries and clinic-affiliated social workers that could assist with payment relief. However, in April 2020, when Ms. R. approached me, asking for face masks to protect herself and her family from COVID-19, I was at a loss. She described how masks were fully out of stock or being sold at inflated prices in her neighborhood. Moreover, as an at-risk individual, she feared for her life.

Touted by some as a “great equalizer,” the COVID-19 pandemic has brought to the forefront long-standing disparities in access to health for Black, Latinx, immigrant, and low-income communities. While we are all in this fight together, some are bearing the burden more than others. Studies have shown that Blacks in the United States are especially affected, with them being represented twice as often among COVID-19 deaths as they are in the population (13 percent of the population vs. 27 percent of COVID-19 deaths). In New York City (NYC), primarily Black and Latinx neighborhoods are being ravaged, while whiter and wealthier areas are seeing fewer cases and deaths. Furthermore, there has been a mass exodus from whiter and wealthier neighborhoods, while New York’s Blacks, Latinxs, immigrants, and those from socioeconomically disadvantaged backgrounds have been unable to escape financial, mental, and literal suffocation by the virus.

Ms. R. is an undocumented, Spanish-speaking, single mother living in East Harlem, one of the poorest and most diverse zip codes in the United States. It is also among the hardest-hit areas in Manhattan and NYC, experiencing about 1-in-40 cases per capita and between 1-in-300 and 1-in-400 deaths per capita. Ms. R. works twelve-hour shifts in a delicatessen, making a little over $10,000 a year. She frequently complains of unsafe working conditions under the watchful eye of a boss who rarely allows her to take breaks. Although living with her children and elderly mother in a public housing development in East Harlem, Ms. R.’s mind frequently returns to Ecuador as she sends a portion of her wages to pay for her sister’s mental health care.

At the beginning of the outbreak, the United States was in dire need of personal protective equipment as hospital and warehouse stores had been depleted nationwide. In April, the Centers for Disease Control (CDC) recommended the use of [cloth] masks by all individuals, especially at-risk populations, with the aim of partially blocking droplets expelled when speaking, coughing, and sneezing. While it was prudent that all individuals followed these guidelines, the lack of resources and government funding left many communities neglected and vulnerable to exposure. This included the undomiciled and those in low socioeconomic brackets, making up about 14 percent and 43.1 percent of the NYC population, respectively.

As stories like Ms. R.’s became more commonplace, a team of medical students at Mount Sinai came together to found Mask Transit, an organization that provides cloth masks and educational material to at-risk communities. We sourced masks through outreach to NYC hospitals, local seamstresses, and small businesses. Our educational material, drafted by students and reviewed by physicians, distilled recommendations from the CDC and the World Health Organization (WHO) on using and cleaning masks and other measures to avoid contracting COVID-19. They were written in a fifth or sixth-grade reading level and translated into multiple languages, including Spanish, Mandarin, Arabic, and French, to meet the needs of the diverse populations residing in NYC.

A pilot program was first established through Mount Sinai’s SRFC in April 2020, where mask kits were distributed to patient households through mailing and no-contact drop-offs. Integral to expansion thereafter were partnerships with the East Harlem Community Health Committee and East Harlem Community Organizations Active in Disaster, committees entrenched in the community that offered accurate need assessments. We met with organizational leaders to quantify needs, identify the most common languages spoken by the populations served, and discuss distribution strategies. This led to partnerships with over 30 community organizations and the distribution of 45,000 masks across East Harlem and NYC. By employing a community-based model, we have since expanded to nine other states, established connections with 11 other SRFCs, and provided an additional 45,000 mask kits.

There are many lessons to be learned from the steps and missteps taken to combat the COVID-19 pandemic. While the government at all levels – federal, state, and local – has struggled to formulate proactive and scalable responses, ordinary citizens and community-based organizations have banded together to showcase the American ingenuity and propensity to do good. Mask Transit, conceived and led by the future leaders of health care, is one of many community organizations that has risen to the occasion to help address the gaps exposed by the pandemic. We have leveraged pre-existing community organizations and medical schools – mask-sewing outfits, food pantries, shelters, student-run free clinics, and activist groups – to act as both a bridge and a contributor. We recommend that for situations requiring swift and judicious action, formalized institutions such as governments, hospitals, manufacturers, and distributors similarly leverage the power of community-based organizations to deliver sustainable results.

Aishwarya Raja is a medical student. Inginia Genao is an internal medicine physician.

Image credit: Shutterstock.com

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