On March 16, Patricia Frieson, a 61-year-old retired nurse from Auburn Gresham and described as the rock of her family, was the first person in Illinois to die from COVID-19. Her sister, 63-year-old Wanda Bailey, a medical coder living in south suburban Crete, was hospitalized with the virus at the time; she died nine days later.
Six and a half months later, Illinois has surpassed 10,000 deaths, according to the Illinois Department of Public Health. The sisters’ deaths prefigured who would be most vulnerable to the disease: They were Black Chicagoans, over 55, with significant underlying conditions like hypertension or diabetes.
A lot has changed since. Encouragingly, the response from the medical community, businesses, and regular citizens has reduced the mortality rate even as the state has been unable to check its spread. And, as cases and deaths show signs of the predicted seasonal resurgence, all those lessons can be used to help the sick recover and prevent transmission in the first place.
“We all want to be with our friends and family for the holidays. Perhaps on this holiday, as we have already done for most of 2020, we’re going to have to do it COVID-style,” Illinois Department of Public Health Director Dr. Ngozi Ezike said on the Thursday when the state passed its grim milestone. “And that means virtual. We’ll have to stay at home and forego the large gatherings so we can be with our friends and family.”
To see where patterns may emerge in the next six months, we looked for clues in data on the road to 10,000 deaths — starting with Cook County, which was hit hard first.
Black and Latino residents suffered early
Of the first thousand people to die of COVID-19 in Cook County — which took until April 18, almost exactly a month after the first death — 49.9% were Black and 31.2% were white, in a county that’s about one-quarter Black and about half white, according to data from the medical examiner. (Seventy of the first 100 victims were black, as WBEZ discovered on Apr. 5; ProPublica did a deeply reported look at the public-health implications of that figure in May.) Cook County reached 2,000 deaths by May 2, and the ratio of victims by race reversed but was still disproportionately Black: 35.1% Black and 41.5% white. Less than two weeks later, on May 15, Cook County hit 3,000 deaths; of this cohort, 27.6% were Black and 43.9% were white.
As of Nov. 1, there have been 5,539 deaths in the county, of whom 32% are Black and 40% are white. As the virus passed through the county, the demographics of its victims evolved closer to those of the county itself after hitting Black residents hardest at first, though the numbers are still disproportionately high for Blacks and low for whites.
A comparable pattern can be seen among Cook County Latinos. Of the first 1,000 deaths, 13.5% were Latino. That rose slowly, then quickly: 16.5% in the next cohort, then 21.3%, then 26.3%. Out of all 5,539 deaths, 1,177 are Latino, or 21%. The share of Latinos in Cook County is 29% overall, according to American Community Survey data.
Both Black and Latino residents suffered early from the virus. According to IDPH data, the test positivity rate among Blacks peaked at 48% on Mar. 30 and among Latinos at 55% on Apr. 7. Testing was much less common at the beginning of the pandemic and more likely to be sought by high-risk populations. But those are still very high numbers and much higher than among Cook County’s white population, where the positivity rate has not exceeded 24% to date.
“There’s very clear evidence that individuals in Black and brown communities, in poor communities, do worse with COVID than people who aren’t in that demographic…. And it’s incredibly multifactorial,” said Emily Landon, an associate professor and hospital epidemiologist at the University of Chicago School of Medicine, who’s served as an adviser to Gov. J.B. Pritzker and a regular source for news coverage of the pandemic. “And it’s a burden of everything from not having great access to get care for your asthma to the long-term physical effects of being discriminated against for many years and many generations.”
Concentration of Black and Latino residents in service-sector and front-line health-care jobs, which cannot be done from home, likely played a role in the virus’ spread. Interestingly, the death rate among Latino residents is disproportionately low — 21%, compared to 29% share of the population. This may be explained by the fact that their median age in Cook County is comparatively young: 31, versus 37 for Blacks and 43 for whites. In other words, despite high test positivity rates (evidence of more frequent exposure to the virus), Latinos had better chance for survival.
Chicago’s racial disparity played out across Illinois
Similar trends have played out statewide. According to data from the COVID Tracking Project (a site launched by The Atlantic to monitor COVID-19 data in the US; the author of this story is a contributor), Blacks make up 14% of the state, 16% of cases for which racial and ethnic data is available, and 24% of deaths. For Latinos, the breakdown is 17% of the state population, 31% of COVID-19 cases and 19% of deaths. For whites, it’s 62% of the population, 45% of cases and 52% of deaths.
Racial disparities in cases and deaths are common across states by the COVID Tracking Project’s definitions. But a 10-point difference between the share of the population and the share of deaths — as is the case with Blacks in Illinois — is high. Only Maryland (11 points), Missouri (11 points), Alabama (12 points), Michigan (12 points), South Carolina (12 points), Louisiana (13 points) and the District of Columbia (29 points) also cross that threshold.
By contrast, the share of deaths among long-term care residents in the state is more in line with national numbers. In Illinois, the death toll is astonishingly high — about 5,000 or almost half of all COVID deaths statewide. Nationally, such deaths account for 40% of those across the U.S. as of Oct. 29, according to the COVID Tracking Project. But 40% is almost certainly low due to inconsistency in ways these deaths are counted.
The state of New York, for instance, only counts deaths that occurred within long-term care (LTC) facilities, not deaths that are connected to such facilities. So, if a resident contracted COVID-19 in a long-term care facility then later died in a hospital, that person wouldn’t be counted as a long-term care facility death. Most states include those deaths in their LTC data; if that method of counting was consistent across the board, the share would be higher nationwide and closer to Illinois’ 50%.
One bright spot in the state’s LTC data is that the fatality rate has decreased. “This is a bloodbath,” one worker told WBEZ seven months ago in April. “I feel like my heart is breaking.” It took less than two months for deaths in long-term care facilities to double from 2,000 to 4,000, from late May to late July. It took three months — from late July to late October — to increase by half as many deaths, from 4,000 to 5,000. Illinois was one of the first states with a major outbreak, and the poorly understood virus devastated unprepared facilities which struggled with staffing and the effort to obtain personal protective equipment.
From chaos to control
As conditions have improved, death rates have dropped for a variety of reasons.
“There were a lot of challenges in the beginning in how to control the spread of disease in congregate living facilities,” Landon said. “And that came down to inadequate testing, inadequate PPE, and inadequate space and facilities to separate individuals that were in different risk groups. Now space obviously hasn’t changed, but the PPE and the testing has changed dramatically.”
These improvements in the medical response manifested in a slowdown of fatalities across the state and across demographic groups: For each set of 1,000 deaths, the number of days to reach each increment peaked early at 12 days and stayed below 30 until mid-August. Finally, the velocity slowed considerably: Getting from 8,000 to 9,000 deaths took 47 days from Aug. 17 to Oct. 3, according to the COVID Tracking Project’s count.
The reduction in the case-fatality rate has been aided by our growing understanding of a novel virus. “There is definitely an art to taking care of really ill patients,” Landon explained. “And once you get a feel for the clinical syndrome, and you get a feel for what works and what doesn’t work, and you can make much better granular, small decisions early on in the course of the care that can really influence the outcome.”
Recent studies also suggest that wearing masks not only reduces the spread of the disease, but also results in less severe cases in those who do acquire COVID-19. “This is true for many other infectious diseases. You know, the proverbial church picnic, where everybody who ate the potato salad ends up with diarrhea, and the people who ate more potato salad were worse off than the people who ate less,” Landon said. “This is the dose effect.”
On Thursday, Nov. 5, the state set a new record, with nearly 10,000 cases reported in a single day — then broke it the next day with 11,356 cases. Illinois also recorded the most new cases in nursing homes in one week since early May, with more than 2,000. Falguni Dave, a nurse and union representative at Stroger Hospital, told WBEZ that the hospital has expanded its ICU unit in preparation, but she’s concerned about a potential shortage of PPE supplies and insufficient staffing levels. Dr. Zaher Sahloul, a pulmonologist at Saint Anthony Hospital, said that he’s seeing mostly minority patients as part of this new wave, as it was at the beginning of the pandemic.
The message? To keep things from worsening further, the state and its residents will have to commit to lessons learned and carry them through the dark winter, like masking, social distancing and caution about gatherings during the cold months.
“I think that we need a mindset shift. People need to understand the kind of exposure that you have in a household where you don’t have adequate ventilation. People think, it’s fine, because you had a barbecue outside in the summer, ‘We’ll just do the same thing — we’ll just come inside, we’ll just say six feet apart.’ And indoor ventilation is not adequate for that,” Landon said. “The only way to safely be able to get together with your family for Thanksgiving is either to do it virtually or to have everybody quarantine — quarantine — before getting together, regardless of exposure.”
Whet Moser is a freelance writer in Chicago.