A collage of pictures of COVID-19 victims
Courtesy of families

50 Lives In 4 ZIP Codes

WBEZ spoke with the relatives of 50 Chicago COVID-19 victims to understand the systemic conditions behind the pandemic’s disproportionate impact.

Courtesy of families
A collage of pictures of COVID-19 victims
Courtesy of families

50 Lives In 4 ZIP Codes

WBEZ spoke with the relatives of 50 Chicago COVID-19 victims to understand the systemic conditions behind the pandemic’s disproportionate impact.

Courtesy of families

After losing two restaurant jobs in March when the city shut down, Margarito Lucero took a temporary job in a factory. An undocumented immigrant and resident of Chicago’s Little Village community, Lucero told his wife most of his coworkers were temps covering for full-timers who had been infected with COVID-19.

Margarito Lucero
Margarito Lucero

But Lucero, 51, needed to work to support his family here and in Mexico. Within two weeks, he was ill. Two weeks later, the father of three, who had no preexisting conditions, was dead.

Not long after COVID-19 began to spread through the South Shore nursing home where Herbert Adams lived, the 64-year-old told his family he was experiencing headaches and chills. The nursing home assured his wife of 43 years, Diana Adams, that he didn’t have a fever and that he appeared OK.

A few days later, the nursing home told Diana that Herbert had tested positive. A housekeeper later found him in distress. Herbert Adams eventually died at Jackson Park Hospital.

Herbert Adams
Herbert Adams

Fernando Vera, 54, spent much time in and out of hospitals due to his many complications with diabetes. His hospital stays were often strained, so when he became sick with COVID-19, Vera avoided going to one. About a week later, he died in his Little Village apartment.

“I didn’t get to see him for three days because I was very ill,” said his daughter Julie Vera. “My dad, unfortunately, passed away alone.”

Jillian Woodbury, 32, lived at Rainbow Beach Care Center, a nursing home for people with mental disabilities. In late April, she was taken to the emergency room at nearby South Shore Hospital for a urinary tract infection. Days later, she died there of COVID-19. Her family is still pained by the lack of communication between the hospital and the nursing home regarding Woodbury’s condition and coronavirus test results.

Most of that hospital’s patients are Black, said Woodbury’s cousin Nichole Marshall. “In the minds of some, that means that you’re disposable.”

“Some of that is systemic, not individual,” Marshall said. “But she, ultimately, became a casualty of that system of disregard for poor brown people who just don’t have access to the resources and advocacy that others across the city do.”

The first person to die of COVID-19 in Illinois was a Black woman from Chicago named Patricia Frieson. She died March 16; nine days later, her sister Wanda Bailey died. WBEZ first reported a month later that 70% of Chicago’s COVID-19 deaths were Black residents. Since then, Chicago Latinos have suffered the highest infection rates.

These early indicators of stark racial disparities led a team of WBEZ reporters to spend more than two months trying to reach hundreds of relatives of Chicagoans who had died from COVID-19 from March 16 through May 9. Those extensive efforts focused on four ZIP codes that best illustrate the city’s inequalities during the pandemic and surface some of the reasons why they exist. Ultimately, the relatives of 50 victims talked with WBEZ about the lives, fears and final moments of the loved ones they lost to COVID-19.

The ZIP codes

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The 60649 ZIP code comprises the mostly Black South Shore community, a lakefront neighborhood on the South Side that struggles with crime and disinvestment. Unemployment there is more than 17%, the median household income is roughly half the citywide figure and only about one in five own their homes. As of Aug. 8, it also has the highest COVID-19 death rate in Chicago, with 123 people dying — roughly 27 for every 10,000 residents, according to city of Chicago figures.

About 67% of the respondents from 60649 told WBEZ their relatives had some form of government insurance. And 83% said their relatives did not trust the nearest nursing homes or community hospitals. Some avoided going to the closest community hospital, and one victim took an Uber to a suburban hospital.

The 60623 ZIP code has the highest rate of COVID-19 infections in Chicago and the highest number of deaths. As of Aug. 8, a total of 3,900 residents there have tested positive — more than 450 per 10,000 residents — and 154 have died. This area encompasses the mostly Latino immigrant neighborhood of Little Village and the mostly Black neighborhood of North Lawndale. Fewer than 10% of adults there have attained a bachelor’s degree or higher education level, unemployment is nearly 12% and a third of households live in poverty.

About 70% of the 60623 respondents believe their loved ones were either infected at work or became infected after working relatives brought the virus into their multigenerational households.

On the North Side, near downtown, the 60611 and 60610 ZIP codes had the lowest rates for COVID-19 deaths among the city’s most populous ZIP codes. As of Aug. 8, three people have died in 60611 — that’s fewer than one death per 10,000 residents. The area includes Streeterville, a wealthy, white enclave chock full of amenities and a life expectancy of 90 years, a potent reminder of how segregation in the city fosters gaps in life and death. It’s also home to Northwestern Memorial Hospital, a nationally ranked academic medical center.

60623 | Little Village and North Lawndale

Little Village scene
Manuel Martinez / WBEZ

60649 | South Shore

Scene from South Shore
Manuel Martinez / WBEZ

60611 | Streeterville

WBEZ
Manuel Martinez / WBEZ

60610 | Gold Coast

A scene from Streeterville
Manuel Martinez / WBEZ

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A total of 10 people have died in 60610, about 2.6 deaths per 10,000 residents. That ZIP code includes Near North Side neighborhoods like the affluent Gold Coast. In 60610 and 60611, more than three-quarters of residents have at least a bachelor’s degree, unemployment is less than 4% and just one in 10 households live in poverty.

For Chicago ZIP codes with the highest rates of COVID-19 infections and deaths, the interviews, survey results and data revealed higher rates of underlying conditions that typically lead to more severe COVID-19 outcomes; higher rates of essential workers and others unable to work remotely; and more crowded living quarters where social distancing is sometimes impossible. These factors all served as building blocks to the stark disparities of COVID-19 cases and deaths in Chicago’s Black and Latino communities. They also illustrate long-standing, systemic conditions that made the pandemic’s disproportionate impact rather predictable.

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These areas also relied more heavily on under-resourced and overwhelmed community hospitals, endured inadequate testing during the earliest days of the pandemic and experienced some of the largest outbreaks among nursing homes in Illinois. Such factors could have been remediated considering the known risks facing these vulnerable communities. It raises questions about how medical institutions and public officials prepared for the pandemic and the measures they took once the racial disparities became apparent.

To piece together the role hospitals played, WBEZ contacted several hospitals to provide their own data for patient counts, ICU beds and ventilators. In particular, WBEZ wanted to compare Northwestern Memorial in Streeterville with safety-net hospitals located near the two Chicago ZIP codes with the highest numbers of COVID-19 deaths: Saint Anthony Hospital, Mount Sinai Hospital, Jackson Park Hospital and South Shore Hospital. Saint Anthony was the only hospital that provided information.

The Chicago Department of Public Health (CDPH) also denied WBEZ records requests about where the city has steered its stockpile of supplies, like masks and gowns. This is just one way hospitals can get supplies, but many small, cash-strapped hospitals can’t afford sky-high prices on the private market and depend on the city’s stockpile. WBEZ also requested the number of COVID-19 patients, ventilators, deaths and ICU beds by hospital. Those requests were also denied. WBEZ has filed a lawsuit under the Illinois Freedom of Information Act and has filed appeals with the Illinois attorney general’s office for other records.

Besides citing various exemptions, the city argues that releasing hospital-specific information could jeopardize relationships with medical centers.

“CDPH depends upon the cooperation of hospitals and healthcare providers to effectuate the COVID-19 emergency plan,” Chicago public health officials responded in the lawsuit.

Chicago public health officials have emphasized that the city doesn’t regulate hospitals — the state does.

Even in the absence of cooperation from hospitals or the city, it’s clear that there are wide gaps in resources between the downtown-area academic medical center and the community hospitals. For instance, in its most recent cost report, Northwestern Memorial reported $7.6 billion in gross patient revenue — four times more than the combined total reported by the four community hospitals, according to the American Hospital Directory. And during the pandemic, Northwestern Memorial received about $14 million more in federal coronavirus stimulus money under the CARES Act than the four community hospitals combined.

In addition, according to data from the Illinois Department of Public Health (IDPH), 83% of Northwestern Memorial patients surveyed said they would definitely recommend the hospital — the highest mark of any hospital in Chicago. None of the four community hospitals topped 62%.

An emergency sign at Northwestern Memorial Hospital

A COVID-19 testing sign at Northwestern Memorial Hospital

Northwestern Memorial Hospital, in the Streeterville neighborhood, is a highly resourced hospital that could help ease pressure on safety-net hospitals by taking more transfer patients. (Manuel Martinez/WBEZ)

City and state officials said they were well aware of the heightened risks and that they took steps early to diminish the disproportionate impact of COVID-19 on Black and Latino communities throughout Chicago and Illinois.

Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, said the city started preparing for a possible pandemic last summer. By the time COVID-19 hit Chicago, the emergency management team was ready, she said.

“We thought a lot, with our partners, about in a pandemic who would be disproportionately impacted. What might we need to do?” said Arwady. “It turns out, we had really done on a much better job here in Chicago than virtually any other city.”

In April, the city announced the creation of its Racial Equity Rapid Response Team, a partnership with community organizations to emphasize education, prevention, testing, treatment and supportive services, particularly in Black and Latino communities hit hard by the pandemic. Among other things, that work included widespread community outreach, the distribution of personal protective equipment (PPE) and coordination between communities and the city to identify gaps in services.

In response to requests for comment, the office of Illinois Gov. JB Pritzker emailed WBEZ a statement indicating that the state had also created an equity team composed of state agencies and community organizations “to identify emerging issues and patterns impacting medically and socially vulnerable communities, identify the available assets, and propose swift recommendation.”

The state also said it expanded testing, delivered PPE, conferred with community and faith leaders, provided alternative housing and distributed hundreds of millions of dollars in grants and other assistance through an assortment of programs to aid community hospitals, as well as renters, homeowners and businesses impacted by COVID-19.

More than statistics

COVID-19 is a monster. Visitor restrictions at hospitals and nursing homes limit the ability of family members to advocate for their loved ones. It also means that many patients die alone — intensifying the grief and helplessness for relatives.

Through tears, family members shared with WBEZ reporters the health journeys and personal stories of people who died, adamant that their relatives be more than a COVID-19 death statistic. Their loved ones were tenderhearted and hardheaded, funny and flawed.

Phillip Thomas, 48, took the bus everyday from South Shore to the suburban Evergreen Park Walmart where he was a packer. When Thomas, a diabetic with an amputated toe, didn’t feel well, his doctor told him to self-quarantine. He didn’t heed the advice and went to Jackson Park Hospital where he tested positive for COVID-19. A few days later, Thomas’ heart stopped and he died.

Angela McMiller leans against a brick wall, wearing a tshirt depicting her brother with angel wings.
Angela McMiller is Phillip Thomas’ older sister. Thomas, a packer at Walmart, died in March of COVID-19 at the age of 48. “People put their lives at risk all the time as essential workers. These are the little people who don’t make a bunch of money, but they do a service for you. So don’t ever forget them.” Manuel Martinez / WBEZ

A weeping Sadariah Harrell feels like she failed her mother, Eboney, 41, because she didn’t know what was going on at Mercy Hospital and Medical Center where her mother died. The whole family, except her newborn baby, tested positive for COVID-19.

Hollis Winters, 74, lived in a nursing home and loved when his sister Karen drove him to church. He had even cut back on his drinking.

Lillie Merrill, 98, came from a proud line of independent Oklahoma women. She moved to Englewood in 1955, and she went back to school so that she could provide care in a hospital.

Lillie Merrill
Lillie Merrill

Robert Sherrell is still coming to grips with the death of his curmudgeon brother John, with whom he shares more memories than any other family member.

Within 11 days, LaFrieda Poe lost both her mother, Alice, 71, and her father, Booker, 81. She hopes to continue to live and find comfort through her mother’s beloved recipes, like the one for Thanksgiving dressing.

Estene Parham, 77, didn’t drink coffee, yet she brewed a cup every morning just for the smell of it.

Back in 1973, Larry Arnold, 70, was an extra in the classic book-turned-movie The Spook Who Sat by the Door.

Joseph Graham, 67, had many trophies from competing in steppin’ contests.

Understanding the racial disparities

Dr. Monica Peek sees patients at the University of Chicago Medical Center and teaches at the medical school. Her area of expertise is researching racial health disparities. Her response to the WBEZ findings? “No surprise.”

Living and working conditions among Black and Latino Chicagoans increased the threat of their exposure to the coronavirus. A lack of testing in their communities during the early weeks of the pandemic allowed the virus to spread undetected among many residents. And higher rates of underlying health conditions and other structural inequities exacerbated the toll of COVID-19 when they got sick. The end results were higher rates of infections and deaths.

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“There’s no better perfect storm for this pandemic sweeping through our very segregated city based on race and class,” said Peek, adding that there’s a COVID-19 risk based on the individual and where they live.

“Although all Black people don’t live in Black communities, [they] are still Black,” Peek said. “You’re still at risk for the effects of racism and increased risk of chronic diseases.”

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The 60649 ZIP code has been subject to historic housing and economic disinvestment — all of which impacts one’s health. The area also has one of the highest asthma rates in the city. Among the elderly, the rate of asthma-related emergency room visits in 60649 is more than 10 times higher than it is in 60611 and other downtown ZIP codes, according to the Chicago Health Atlas.

The 60623 ZIP code has battled environmental racism for decades. Even during the pandemic, on April 11, Little Village residents woke up to a massive dust cloud from a city-approved demolition. The dust was so thick that it made it difficult for residents to breathe. The Hilco company had demolished the old Crawford Coal smokestack. By then, the pandemic had already taken hold in 60623 with more than 300 infected and 15 dead from COVID-19, which attacks the respiratory system.

The rates of diabetes-related hospitalizations in both 60649 and 60623 — 34.7 and 32.7 per 10,000 residents, respectively — are six times higher than in 60611 and other downtown ZIP codes where the rate is 5.5 per 10,000 residents, according to the Chicago Health Atlas.

Black and Latino workers are also more likely to be deemed essential workers, and they’re less likely to work remotely. That puts them at higher risk of contracting and spreading the coronavirus.

In addition, crowded homes in Black and Latino communities can make it more difficult to social distance at home, which can contribute to the rapid spread of the virus. Nearly 38% of households in 60623 and about 14% in 60649 have four or more occupants — compared with just 2% in both 60610 and 60611, according to data from the U.S. Census Bureau. About 10% of households in 60623 and about 4% in 60649 have more than one occupant per room, compared with less than 2% in both 60610 and 60611.

Still, as COVID-19 began its ominous spread throughout Chicago, its presence went largely unnoticed in the city’s Black and Latino communities due to inadequate testing, despite the vulnerabilities of those areas. And during the first few weeks of the pandemic, testing rates in Latino communities severely lagged those in other areas.

Early in the pandemic, testing was considerably slower for all Chicagoans than it is currently, according to a WBEZ analysis of data from the city of Chicago. It was early April, a month into the pandemic, before a total of 30,000 Chicago residents had been tested for COVID-19, the analysis shows. Conversely, at least 30,000 Chicagoans have been tested each week since early July.

It would be three weeks into March before the overall rate of testing in majority-Black ZIP codes would match the rate for majority-white ZIP codes. And it was late April before the overall testing rate for majority-Latino ZIP codes would catch up.

By the time widespread testing reached many Black and Latino communities, the virus had already spread widely there as evidenced by positivity rates that dwarfed those in white communities where the risks weren’t as high. For instance, by early May, the weekly testing rates in 60623 and 60649 had surpassed those in 60610 and 60611. But the analysis shows that weekly positivity rates were still much higher in 60623 and 60649 — 51% and 22%, respectively, for the week ending May 2 — than they were in 60610 and 60611 — 11% and 5%, respectively.

Safety-net hospitals lack resources and community trust

Roberto Escobar, 37, died of COVID-19 after he became infected while working at El Milagro, a tortilla factory located on the city’s West Side. He had no preexisting conditions.

Before the Salvadoran immigrant became infected, he spent two weeks with his parents who were visiting. Escobar was an introvert and only went outside to run and work. He hadn’t seen his parents since he immigrated to the U.S. as a teenager. A few days after he returned to work, he fell ill.

“When he went back to work, I told him to protect himself,” said Gabriela Hernández, his wife. “He tried to wear a mask inside the factory but wasn’t allowed.”

Hernández said her husband became infected at work because no one else in the family tested positive for the virus. She said El Milagro did not provide proper PPE to workers, and that she knows the families of other El Milagro workers who died of COVID-19. She last spoke to managers at the company when she picked up her husband’s final paycheck while he was hospitalized.

El Milagro declined multiple requests for comment.

Hernández said her healthy young husband delayed seeking medical care out of fear.

“Now, I see the text messages between him and his coworkers,” she said in Spanish. “They would tell him, ‘Don’t go to the hospital because they won’t do anything to help you.’ And he believed it, because when he asked me to call the ambulance, he told me: ‘Sweetheart, I can’t breathe. But I think, if I go to the hospital, they’re going to kill me.’ ”

Roberto Escobar
Roberto Escobar

Escobar died at Saint Anthony, a Catholic community hospital serving Little Village and North Lawndale.

Community hospitals, like Saint Anthony, became focal points in 60623 and 60649 as the pandemic reached its peak. Communities there rely heavily upon these hospitals, which serve as primary health care options due to their proximity and their missions to provide care to all in need. For instance, half of the respondents in the 60623 ZIP code told WBEZ their relatives had Medicaid or Medicare, while a third had no health insurance at all — most of them undocumented immigrants.

It’s unclear whether the outcomes for COVID-19 patients were impacted by where they sought treatment. But these safety-net hospitals struggled mightily with limited resources and issues with capacity, staffing, equipment and quality of care, according to interviews with relatives of COVID-19 victims, hospital staff and other sources. Many residents were already wary of the hospitals even before the pandemic.

A third of the respondents in the 60623 ZIP code said their relatives died at Saint Anthony. And at least three respondents said they took their relatives to another hospital to avoid going to Saint Anthony.

The distrust stems from the inability of families to advocate or translate for their infected relatives, something they’ve had to do in the past in order to get adequate care. In some cases, family members say they were not notified for days that their loved ones had died. And, in at least two cases, immigrants died in their apartments as they tried to avoid going to the hospital — an outcome doctors feared.

“There’s a distrust, there’s no doubt about it,” said Dr. Howard Ehrman, founder of the Little Village People’s Response Network, a community-based effort to address the pandemic.

Ehrman, a former city assistant health commissioner and professor, said Saint Anthony has struggled with distrust in the community for decades. He said he’s told community members to avoid going to this hospital or Mount Sinai, if they’re sick with the coronavirus. He said Stroger Hospital, the region’s biggest medical safety net for poor and uninsured patients, is a better option.

Saint Anthony was in a dire financial situation before the pandemic. Then on April 27, the hospital sued the Illinois Department of Healthcare and Family Services, accusing the state’s Medicaid program of owing the hospital $22 million for services it had provided to patients since mid-February.

“Before the COVID-19 pandemic, these problems were serious. Now, they threaten the ability of Saint Anthony to respond to the pandemic,” according to the lawsuit.

A COVID-19 testing facility at Saint Anthony Hospital
Saint Anthony’s Hospital is a so-called “safety net” hospital, serving mostly low-income patients of color. In interviews with WBEZ, residents of nearby communities expressed distrust of community hospitals. Manuel Martinez / WBEZ

“The state’s broken Medicaid managed care system has been driving community hospitals like Saint Anthony, which turn away no one and depend on Medicaid to serve its disproportionately poor patient population, to the brink of being unable to carry out its mission,” the lawsuit said.

As the pandemic reached its peak, Saint Anthony became overwhelmed with testing struggles, staffing shortages and elevated patient counts.

Saint Anthony struggled to get access to testing and to get results back quickly. Typically, it took 10 days to get test results. On April 27, Francisco Flores died of COVID-19 at Saint Anthony; a few days after his death, his family received a letter telling him that he tested negative for the virus.

Between March and May, the peak of the pandemic, the hospital treated 348 COVID-19 patients, according to Dr. Alfredo Mena Lora, the hospital’s only infection prevention expert. Saint Anthony expanded capacity from 15 intensive-care units to 34 ICU beds. The hospital has 17 ventilators and two anesthesia machines that can be used as ventilators, though officials said the hospital did not go beyond having 15 people on ventilators at one time during the pandemic’s peak.

An ambulance is parked in front of Saint Anthony
During the peak of the pandemic, Saint Anthony treated 348 COVID-19 patients, while struggling with a lack of resources and staffing. Manuel Martinez / WBEZ

“Community hospitals like ours reflect the community in which we exist,” said Mena Lora. “I think our community was going through extremely difficult times, and as a hospital, we were there hand in hand.”

Hospital staffing took a hit during the pandemic when 15 ICU nurses abruptly resigned or canceled their shifts. The hospital relied on its network to try and find nurses, said Sherrie Spencer, chief nursing officer at Saint Anthony. “Although we lost those nurses, many people jumped in to work as a staff nurse, including myself, and other leaders.”

Spencer said there were challenging nights. On a Friday night, Spencer got a call from the hospital warning her that nearly 10 new patients had showed up to the emergency room with COVID-19 symptoms. She counted the available ICU beds and respirators and became worried that the hospital couldn’t accommodate everyone. Fortunately, she said, not all of those patients needed respirators.

“We’ve had nights like that, where it was like: ‘Oh my gosh, what’s going to happen?’ ” she said. “This community was really hit.”

A bigger problem is that no agency is coordinating how patients are moved from one hospital to another. A $65 million makeshift field hospital was constructed this spring at McCormick Place to help alleviate overburdened hospitals during the pandemic, but the facility treated just 38 patients. Saint Anthony was among the hospitals that had trouble transferring patients there because patients didn’t meet the strict criteria, a WBEZ investigation found.

Even when a medical center becomes overwhelmed, no government agency has the power to force hospitals to take any of its patients, the investigation found.

While the city can’t force hospitals to accept transfers, Arwady, the city’s public health commissioner, said hospitals have been very cooperative.

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“We work to build the system and work to really create the ability,” she said. “We did not want to see happen in Chicago what we had seen in New York and in some other places where you saw some hospitals become very overwhelmed with patients and others have capacity.”

Arwady said the city distributed ventilators and PPE to hospitals depending on need. The ventilators went to big hospitals like Rush University Medical Center on the Near West Side, which received 41 ventilators for their expanded 254 ICU beds, as well as small community hospitals like Jackson Park Hospital in 60649, which received 10 ventilators for its 12 ICU beds. Community First Medical Center, Loretto Hospital and Saint Anthony Hospital received the most PPE from the city, she said. Her department would not provide a more complete picture.

Community hospitals remain in need, and some residents literally fear them.

Over at Jackson Park Hospital, nurses went to hospital administrators to put their foot down about reusing hospital gowns, said Yulonda Clark, an emergency room nurse there who’s seen patients test positive for COVID-19, including individuals from nursing homes and others who were homeless or who suffered from drug or alcohol addictions.

“We do not have all that we need,” Clark said in late June. Shoe covers ran out, and N95 masks were either too big or too small. “Rarely, you would get one that would fit nicely,” she said.

“You don’t want to abandon your patient, but at the same time, you are putting yourself at risk to do it — to work without the right equipment,” Clark said.

When Jesus Segura’s mom became sick from COVID-19, he wanted to take her to Rush, but the ambulance took her to Saint Anthony, two miles away from their home. By the time his father had to be hospitalized at Saint Anthony a little more than a week later, the resources there were limited.

“The reason why he was not placed in ICU is because there were no ICU beds available. Every single ICU bed was taken, as well as all the ventilators,” Segura said.

He lost both parents a few weeks apart. His mother, Maria Luisa, 89, died on April 28 and his father, Martin Segura, 82, died on May 18.

Segura said he tried to find a way to transfer his father to another hospital but couldn’t. He wonders whether his parents would still be alive had they gone to Rush hospital.

However, officials at Saint Anthony said they never ran out of ICU beds.

“Although you weren’t physically in the ICU department, we created ICU beds,” said Spencer, the chief nursing officer.

Mena Lora acknowledged the challenges facing Saint Anthony. He said he’s been working nonstop to help the community stay healthy.

“I think a lot of our patients feel very comfortable coming to our facility, but those challenges remain,” said Mena Lora, who added that he often speaks with community groups. “It’s a very vulnerable population,” he added. “Even at my busiest weeks, as a native Spanish speaker, I tried to do outreach through the web and news outlets.”

Alfredo Mena Lora stands in a hospital hallway. He is wearing a white mask.
Dr. Alfredo Mena Lora is Saint Anthony’s only infectious disease expert. As the pandemic reached its peak, the hospital became overwhelmed with testing struggles, staffing shortages and elevated patient counts. Katherine Nagasawa / WBEZ

Nursing homes struggle to contain COVID-19

In addition to community hospitals, nursing homes were also focal points at the height of the pandemic in the Chicago ZIP code with the highest COVID-19 death rate.

As of July 27, based on a WBEZ analysis of records from the office of the Cook County medical examiner, more than half the deaths in the 60649 ZIP code were linked to the community’s four licensed nursing homes. The facility with the highest number was Villa at Windsor Park, 2649 E. 75th St. By early August, according to data from the Illinois Department of Public Health (IDPH), there were 48 COVID-19 deaths tied to Villa at Windsor Park, the highest among nursing homes in the city — and one of the highest tallies in Illinois.

In early April, Pat King went to the Villa at Windsor Park to see her 75-year-old mother, Rosie Stevens, whom she saw “pretty much every day” before the pandemic. King was concerned about her mother. She had already been wary of the facility after some incidents where her mother’s medication ran out.

“I cried in the lobby, and one of the nurses said, ‘I’ll bring her down so you can see her,’ ” King remembered. When Stevens was brought down, she told her daughter that she had a bad cold and had been coughing.

“And the nurse said, ‘Oh, don’t say that, don’t tell her you’ve been coughing a lot,’ and my mother said, ‘Well, I have,’ ” King said, adding that there were people “coming in and out without masks on” that day. “The signs were there that they weren’t taking care of these people the way they should have been.”

Stevens tested positive for COVID-19 at the nursing home and was moved out of the room she shared with two other residents. After being placed in isolation for five days, her health did not improve, and she was admitted to South Shore Hospital. Stevens died 13 days later.

A closer look at Villa — through interviews with numerous sources — revealed challenging work conditions, major leadership changes and a lack of communication with family members of residents who died from COVID-19.

But experts said the challenges at Villa are also indicative of broader issues throughout the nursing home industry, particularly among for-profit nursing homes, where facilities serving mostly low-income people of color struggle with staffing, equipment and quality of care. IDPH’s 2018 Long-Term Care Facility Questionnaire shows that more than 95% of Villa’s residents are Black, and nearly 60% of its revenue comes from Medicaid, government-issued insurance for low-income patients.

Early on in the pandemic, Villa fired its administrator, Levi Israel, after a local activist named Eric Russell claimed that Israel had tested positive for COVID-19 but continued to come to work.

Russell’s mother was a resident at Villa at the time, and one of the staff members texted him about a recent morning meeting led by Israel.

“He did a teary-eyed confession to the senior staff, explaining to everyone that he was aware that COVID-19 was running rampant through the building, … and he went on to say he had actually tested positive himself,” Russell told WBEZ, summarizing what the Villa staffer shared with him. Russell said the Villa staffer and several other workers walked out in response to Israel’s remarks.

Eric Russell's mother was a resident at Villa at Windsor Park, a nursing home in the 60649 ZIP code. Russell exposed that a Villa administrator had tested positive for COVID-19 but continued to come to work.
Eric Russell’s mother was a resident at Villa at Windsor Park, a nursing home in the 60649 ZIP code. Russell exposed that a Villa administrator had tested positive for COVID-19 but continued to come to work. Esther Yoon-Ji Kang / WBEZ

Villa Healthcare declined requests from WBEZ for interviews and, citing company policy, declined to comment on personnel matters involving Israel. Instead, the company issued a statement in response to a list of questions saying that Russell’s statements “are simply incorrect.”

“No staff member was ever at the facility once they had tested positive for COVID-19 until they were allowed to return” per guidelines from the Centers for Disease Control and Prevention (CDC), the statement read. Israel himself could not be reached for comment.

Francine Rico, a certified nursing assistant, has worked at Villa for 23 years and spoken out in the media about the working conditions there, including the lack of adequate PPE and infection control during the pandemic. She said understaffing has always been a problem at the facility, and it was exacerbated when COVID-19 began to spread through the building.

“These are situations that we had been crying about before COVID-19 hit,” Rico said. “We’re supposed to, on a day shift, have no more than eight to nine people. So, if I’m carrying 12, 13 … where does that leave our residents with providing quality care?”

According to data reported to the Centers for Medicare & Medicaid Services, which regulates nursing homes, Villa at Windsor Park falls in the bottom 20th percentile in Illinois for direct care staffing — such as nurses and CNAs, who interact directly with patients.

Francine Rico leans against a chain-link fence
Francine Rico, a certified nursing assistant, has worked at Villa for 23 years. She said understaffing has always been a problem at the facility, and it was exacerbated when COVID-19 began to spread through the building. Manuel Martinez / WBEZ

Rico said masks were in short supply during the early weeks of the pandemic and that the facility also doled out rain ponchos for workers to wear during their shifts.

“It’s yellow. It’s got the hood. It’s got the little string. It’s got the snaps that you snap … but that was what we started with,” Rico said. “It was a hot mess. Everybody was scared. We were scared for ourselves, and we were scared for our residents, as well.”

For-profit nursing home chains, like Villa, are associated with higher patient-to-staff ratios, lower pay for core staff, poorer training and knowledge of regulations and care protocols among staff and more citations and complaints, said Lee Friedman, an associate professor at the University of Illinois at Chicago’s School of Public Health who has studied nursing homes.

“I’m not surprised, honestly, knowing its history — its ownership, its problems, its citations,” Friedman said of Villa’s struggle to contain COVID-19.

“The level of medical neglect [in for-profit nursing homes] that I was seeing,” Friedman added, “I knew it was going to translate to either poor protections in the facility for the residents [and] pressure on staff to work even if they’re sick, which leaves the residents at risk.”

Greg Will, a research director at SEIU Healthcare Illinois, the labor union that represents some nursing home workers, said Villa and many other for-profit nursing homes use their revenue to pay for services and equipment from companies under the same ownership as the nursing home.

For example, Will said, a for-profit owner may own both the nursing home operation and the land or building where it’s located, but the owner then charges high rent to the nursing home to occupy the very building it owns.

Will said these payments, which are often inflated, siphon revenue from the nursing homes and leave less money for the direct care of patients.

“It is a model of extraction of revenue and profit from what is a site of care for very vulnerable folks who are there because they need the care,” Will said.

A view of the outside of the Villa at Windsor Park nursing home
The Villa nursing home lacked adequate PPE and infection control during the height of the pandemic — even resorting to rain ponchos, according to longtime employee Francine Rico. Manuel Martinez / WBEZ

Pat Comstock, executive director of the Health Care Council of Illinois, a nursing home lobbying group that represents mostly for-profit chains, declined to comment on the business model and patient outcomes at for-profit nursing home companies.

“Everybody that is associated with any long-term care facility … has done yeoman’s work caring for the frail and elderly” during the pandemic, she said.

“Nobody could have been prepared for what happened,” said Comstock, adding that the state didn’t prioritize nursing homes during the early stages of the pandemic.

During the early weeks of the pandemic, state officials said IDPH focused on providing guidance for facilities, particularly those with the highest number of cases and deaths, providing information on infection control practices and proper use of PPE. As the death toll in nursing homes continued to climb, IDPH ramped up testing at long-term care facilities and began posting data about nursing home outbreaks on its website. In July, WBEZ reported that Gov. Pritzker’s administration was replacing two top officials in charge of the state’s COVID-19 response in nursing homes.

“Early on, we knew that residents and staff in nursing homes would be one of the most impacted populations,” read the statement Pritzker’s office emailed WBEZ. “Long-term care facilities remain a priority and IDPH required each long-term care facility to develop a written COVID-19 testing plan and response strategy.”

Brittany Anderson said Villa “failed” her mother and that its response to the COVID-19 outbreak was insufficient.

“The people I trusted to care for [my mother] didn’t,” said Anderson, who has filed a lawsuit against Villa.

Brittany Anderson filed a lawsuit against Villa nursing home after her mother, Barbara Anderson, died of COVID-19 after contracting the virus in the facility in April. Brittany Anderson said the nursing home did not take the necessary precautions to protect her mother from the virus.
Brittany Anderson filed a lawsuit against Villa nursing home after her mother, Barbara Anderson, died of COVID-19 after contracting the virus in the facility in April. Brittany Anderson said the nursing home did not take the necessary precautions to protect her mother from the virus. Manuel Martinez / WBEZ

Anderson said she called and emailed Villa over several weeks to inquire about the facility’s plans for protecting its residents from COVID-19. Her 61-year-old mother, Barbara Anderson, had only been at Villa since November 2019. Her mother had previously been in an assisted-living facility and was moved to Villa to receive more direct care for her various medical conditions, including an autoimmune disorder, heart problems and mental health disorders.

“I wasn’t happy and had been looking around for other nursing homes, and it gets frustrating because she was on [Medicaid], so the options were slim,” said Anderson, choking back tears. “Her health did improve. … If COVID[-19] didn’t happen, she would have been home.”

Instead, Anderson’s mother stayed in lockdown with her fellow residents at Villa.

Barbara Anderson
Barbara Anderson

Anderson said her mother told her that workers were moving from “room to room, floor to floor without changing their PPE, they weren’t wearing gloves when they needed to.” She said her mother “was scared, and she kept asking me if she could leave.”

As the virus spread through the nursing home, Villa began testing its residents on-site. On April 25, Anderson received the call that her mother had tested positive.

She said she called numerous times but the nursing home never told her, specifically, how many patients had tested positive or shared details about the facility’s isolation plan.

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Anderson said, on May 2, the nursing home called and told her that her mother’s condition had worsened and that she had been taken to South Shore Hospital.

“I just kind of knew that things weren’t gonna go pretty well for her at this point because it didn’t seem right,” Anderson recalled.

Barbara Anderson died of COVID-19-related pneumonia five days after being admitted to the hospital.

Anderson said she wishes she had done more about six months earlier to find a different nursing home for her mother. But mostly, she misses her mother’s numerous calls throughout the day.

“I used to hate it, especially if I was at work, because it was never an emergency,” she said. “Either she wanted to say ‘hi’ or she wanted to ask me to buy her snacks.”

Now, Anderson said she looks at her phone and wishes “it would light up and it would say ‘Mom.’ ”

“I’d kill for those four or five calls daily again,” she said.

Lessons learned moving forward

Dr. Peek, of the University of Chicago, said lessons from the spring can be applied going forward.

“We know that things are going to get worse in the fall, if not sooner,” Peek said. We cannot expect to contain the pandemic if we’re going to be releasing people from the hospital back to communities and homes where there’s overcrowding. That will exacerbate the pandemic.”

The systems that need to be put in place are not field hospitals, Peek said. Housing and hotels are infrastructure needed for aftercare for those who are recovering from COVID-19. “This is the time to regroup for what we know is coming ahead,” she said.

Dr. Monica Peek stands in front of an Emergency sign
Dr. Monica Peek researches racial health disparities at the University of Chicago Medical Center. “There’s no better perfect storm for this pandemic sweeping through our very segregated city based on race and class,” she said. Manuel Martinez / WBEZ

Peek recently co-wrote a racial disparities paper for the American Journal of Public Health where she highlighted recommendations from Mayor Lightfoot’s COVID-19 racial equity response team. Peek is a member.

One big area of concern is the lack of regionalization for hospital transfers, which would allow safety-net hospitals, such as Saint Anthony, to send their sickest patients to higher-resourced hospitals like Northwestern Memorial, for example.

Nursing homes also need to incorporate changes.

Said Friedman, the UIC professor: “If you don’t have systems to identify cases early and then set up the proper safeguards to protect the residents, sadly, it’s going to result in a lot of deaths because the people in nursing homes are the highest risk group of people, and it’s just going to be a terrible story for the families, for them.”

As executive director of Johns Hopkins University Centers for Civic Impact, Beth Blauer manages COVID-19 data collection based on race. Blauer said just because Illinois enters new phases doesn’t mean people who live in the hardest-hit communities with chronic diseases should start going to the mall or start doing other limited activities because of quarantine fatigue.

“There’s a false sense of security when the policies are coming out not designed for populations most at risk,” Blauer said. “Policymakers are looking at data in the aggregate. They’re not making specific recommendations based on those most vulnerable.”

While the city and state have gradually reopened over the past few months as overall positivity rates and seven-day average case counts have declined, those metrics have remained elevated in mostly Black and mostly Latino areas in Chicago.

For instance, a positivity rate at or below 20% was one of the benchmark metrics used to determine whether regions of the state could move from Phase 3 to Phase 4 at the end of June, which included the partial reopening of restaurants, some outdoor activities and nonessential businesses. The 60610 and 60611 ZIP codes were comfortably under that threshold with cumulative positivity rates of 12.4% and 7.6%, respectively. However, for 60623 and 60649, those figures were 39.9% and 21.6%, respectively.

Right now may be an opportune time for corrective action. Though case counts and positivity rates are low in comparison to the pandemic’s peak in late April and early May, they have increased over the last several weeks, according to a WBEZ analysis of city data.

For the week ending Aug. 1, the city topped 2,000 cases; it was the first time in two months. The city’s weekly positivity rates increased for three straight weeks at the end of July and into August — rising from 4.8% for the week ending July 18 to 6.4% the week ending Aug. 8. Prior to August, it had been two months since the city’s weekly mark topped 6%.

Despite those rising figures, the greater risks facing Black and Latino communities and the disproportionate impact they’ve endured during the pandemic, testing has been more robust in white communities over the past two months.

For nine consecutive weeks, from mid-June into August, the overall weekly testing rate for majority-white ZIP codes surpassed the figures for majority-Black and majority-Latino ZIP codes. For the week ending Aug. 8, the rate for majority-white ZIP codes was about 126 per 10,000 residents, compared with 104 and 94 per 10,000 residents for majority-Latino and majority-Black ZIP codes, respectively. Throughout the pandemic, a higher share of residents in Black and Latino communities have tested positive than their counterparts in other areas.

Until there’s a vaccine or some other effective treatment, COVID-19 will remain a vexing issue not just for Chicago and Illinois, but for the entire country. It’s like living with a chronic condition that has to be continually managed. But for those living in vulnerable ZIP codes such as 60623 or 60649, the coronavirus is a constant threat that exposes the brutality of systemic racism and structural inequality.

Sarah Karp, Alden Loury and Kristen Schorsch contributed to this report.

Natalie Moore is a reporter on WBEZ’s Race, Class and Communities desk. You can follow her on Twitter at @natalieymoore.

Esther Yoon-Ji Kang is a reporter on WBEZ’s Race, Class and Communities desk. Follow her on Twitter @estheryjkang.

María Inés Zamudio is a reporter for WBEZ’s Race, Class and Communities desk. Follow her @mizamudio.

Methodology

WBEZ obtained data from the Cook County medical examiner’s office of residents who died of COVID-19 between March 16 and May 9, 2020. WBEZ interviewed and surveyed relatives of 50 COVID-19 victims during that span. The survey included questions about the victims’ preexisting conditions and health care experiences. WBEZ also obtained data from the city of Chicago for the number of COVID-19 tests, confirmed cases and deaths by ZIP code. WBEZ calculated per capita rates of testing, cases and deaths using five-year population data by ZIP code from the U.S. Census Bureau’s 2018 American Community Survey. Only ZIP codes with at least 30,000 residents were included in the analysis. There are 41 ZIP codes in Chicago that meet that criteria.

Based on the analysis, WBEZ decided to focus its reporting on four ZIP codes: 60649, the Chicago ZIP code with the highest deaths per capita and 60623, which had the highest cases per capita. The 60611 and 60610 ZIP codes, which had the lowest rates for deaths, served as comparisons.