We Can’t Wait Until Coronavirus Is Over to Address Racial Disparities

Recent data from the Centers for Disease Control and Prevention on Covid-19 exposed stark inequalities: Rates of mortality and severe illness are far higher among Americans of color. Politicians, journalists and scholars have been attempting to explain these racial differences by pulling from a wide range of past studies and assumptions. Many of these early suggestions emphasize how Covid-19 is illuminating pre-existing inequality.

Yet, early reporting and existing studies suggest Covid-19 is not simply exposing past inequality. It is also creating it. Like previous crises, such as natural disasters, war, and economic recessions, our response to Covid-19 is exacerbating racial disparities. However, this is not inevitable. Addressing unequal distributions of Covid-19 testing, racial biases in health care, and policy responses to racial segregation now could mitigate how unjust this crisis turns out to be.

Comparing across regions in the U.S. and between countries, it has become abundantly clear that early detection and effective contact tracing are critical for both containing Covid-19 and curtailing its most severe symptoms. This requires widespread, accessible testing — something the United States has yet to implement anywhere. Yet, testing has been even more scarce in communities of color.

Early reporting by NPR has shown that Black Americans have been less likely to receive a Covid-19 test than White Americans even when showing the same symptoms. This has contributed to misdiagnosis and in some cases inaccurate medical advice. These patterns mirror previous research that has repeatedly shown doctors mis- and under-diagnosed Black people’s health conditions leading to further health complications and shorter life expectancy — an occurrence particularly pronounced for Black women whose knowledge about their own bodies is often dismissed, disregarded and misunderstood.

For Covid-19, the lack of testing and misdiagnoses has likely resulted in the virus spreading more rapidly across Black communities, and in individual cases escalating without the proper precautions and treatment. To fully empirically estimate the effect this lack of testing is having on the observed racial inequality, we need more data across all racial groups on who is getting access to proper testing and whether hospitalized Covid-19 patients are receiving improper advice or health care because of initial misdiagnoses. Not to mention, we also need more data from the tests themselves to see who is testing positive and how the virus is affecting various populations.

Beyond testing, initial studies on Covid-19 suggest severe symptoms and mortality are more likely when patients have underlying conditions such as hypertension, obesity, diabetes, asthma or cardiovascular disease. Black and Native Americans are more likely than their White counterparts to have these underlying and chronic conditions because of racial biases in health care, housing markets, employment sectors, educational institutions and the criminal justice system. Government officials and journalists have insinuated that Covid-19 hospitalizations and mortality inequities are a product of the racial gaps in these pre-existing conditions.

Although this is certainly part of the story, it is likely not all of it. The aforementioned lack of Covid-19 testing, lack of access to health care and the quality of health care received could be intensifying the effect underlying conditions have on patients of color with Covid-19. In other words, a White resident with underlying health conditions, who has access to early testing and whose doctors trust their account of their symptoms is more likely to avoid the most severe Covid-19 symptoms compared to a Black or Native American with identical underlying conditions and Covid-19 symptoms.

To fully unpack these various factors we need more data broken down by race about cases, treatments and outcomes. Yet, even without this data, it is clear it is not just pre-existing conditions driving the racial inequality. It is also access to and experiences within the health-care system that are creating the racial inequality.

In addition to underlying conditions, initial analyses by some scholars have explained this inequality as a product of existing occupational and residential segregation: Historical and contemporary labor policies and practices have concentrated workers of color into often below-living-wage employment sectors — many of the same sectors that are disproportionately experiencing heightened exposure to Covid-19 and offer inconsistent or limited sick leave policies. Yet, it goes beyond just class, as middle-class Black workers are disproportionately concentrated in government jobs like mail carriers or bus drivers compared to their White counterparts who are disproportionately employed by private companies.

Likewise, contemporary and historical (im)migration and housing policies have concentrated residents into certain neighborhoods, cities, counties and even regions of the country. This means, even in this time of social distancing, Americans are more likely to interact with people of their same race as they make essential trips to the local grocery store or receive packages on their front porch. Since Covid-19 is highly contagious, living in a community with more cases (for all the aforementioned reasons) means this contagion is likely to spread more quickly within racial groups, as we are witnessing in New York City’s Jackson Heights neighborhood and Louisiana’s Black communities. Just as so-called “Black-on-Black violence” is more a function of racial segregation and proximity than something cultural or biological as is often alleged, so might be Black-on-Black Covid-19 contraction.

Fully illuminating the role occupational and residential segregation are playing in the observed Covid-19 inequities will require significantly more data. Yet, even without this full picture, it is likely occupational and residential segregation combined with racialized practices within workplaces and across regions that are exacerbating the inequities.

Clearly, we need much more information before we can definitively say which mechanisms are contributing to the racial inequality in Covid-19 infections, hospitalizations and deaths. However, using history as a guide and what we know from early reporting, it is clear racial inequities are being created in how we are choosing to respond to this crisis.

To curtail this inequity, we need transparency about who has access to testing, test results, hospitalizations and mortality rates. We also need more data on how employees, residents and patients are interpreting their possible risk and access to healthcare. And we need to use this data to better understand who is getting sick, and why.

Beyond data, we need action steps that explicitly centralize the need for equity in our multifaceted response to this crisis. The federal government must make tests more widely available in communities of color. Health-care workers need to challenge their own racialized biases and ensure patients’ own assessments of their health are being heard. Corporate employers need to think critically about how their policies might directly and indirectly contribute to racial inequality. Federal and local governments need to consider how they can creatively decrease racial inequality through new ways of implementing immediate and long-term responses.

We cannot wait until the crisis is over to examine or address the structural inequalities Covid-19 is exposing. If we do, then these inequalities will only worsen. Prioritizing equity in our responses now is the only way we can begin to create a more equitable tomorrow.

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The Coronavirus Pandemic Makes a Case for Megaregions

As U.S. states move into the next phase of the coronavirus crisis, they may not be getting all the help they want from the federal government, but they won’t be alone. In at least three parts of the country, states have banded together to coordinate changing public health measures and recovery efforts as they consider timelines for lifting lockdowns, knowing that neither the outbreak nor modern-day regional economies adhere to jurisdictional boundaries set long ago.

The foundation of these three multistate compacts — seven Northeast states, from Delaware to Massachusetts; the West Coast including California, Oregon, and Washington; and seven Midwestern states radiating around Chicago — is a once little-known planning framework, known as megaregions, that shows just how much big chunks of the country are interlinked.

The pandemic, it turns out, is exactly the kind of massive but geographically clotted crisis that reveals what Europeans have called “territorial cohesion.” Some parts of the country are taking it slow, while others — such as Georgia, Tennessee, and South Carolina — are moving faster to reopen.

Most may think of three basic levels of government — federal, state, and local — but planners have long recognized that much activity actually occurs at the regional scale, across geographically proximate clusters of settlement. People live in one state and commute to a city in another, or live in the city and travel to a second home many miles away if they can.

The megaregion framework has been useful for all kinds of initiatives, whether protecting wilderness and watersheds that similarly cross political jurisdictions, designing transportation policy including inter-city high-speed rail networks, agreeing on carbon emissions reductions, or building more affordable housing across a larger catchment of labor markets (though that last one is very much a work in progress).

States have been working together in some modest ways for years, forming some 200 cross-border compacts or alliances covering everything from infrastructure to regulatory regimes, says Jonathan Barnett, author of Designing the Megaregion: Meeting Urban Challenges at a New Scale. The better-together arrangements can be found at the National Center for Interstate Compacts, part of the Council of State Governments, which provides technical assistance to keep them working. New reasons to collaborate have been steadily emerging, such as the Missouri-Kansas pact limiting tax subsidies as incentives for business relocation.

And now, others who have studied megaregions say, the approach will be well-suited to coordinating reopenings, or continuing closures, as states manage the next phases of the Covid-19 pandemic. If that’s successful, states may use megaregions to make future improvements in housing, transportation, and the environment.

“It’s clear that actions to manage and recover from the pandemic will require regional action, since the virus doesn’t respect arbitrary political boundaries,” says Robert Yaro, former head of the Regional Plan Association and now a professor at the University of Pennsylvania, who is co-authoring a new book on megaregions to be published by the Lincoln Institute of Land Policy (where I am a senior fellow).

“We can only hope this kind of collaboration will extend to the longer-term steps needed to rebuild the economy — and build the mobility systems and settlement patterns needed to mitigate against future events of this kind,” Yaro says.

The first clue that megaregions might be a useful way of confronting the pandemic emerged as early maps chronicling outbreak patterns mirrored the 11 U.S. megaregions outlined in 2008 by the Regional Plan Association initiative America 2050.

Just as the patterns of contagion mapped mostly along the megaregion categorization, fighting the disease intuitively seemed to require action and coordination across a broader geography than individual cities or states. New York Governor Andrew Cuomo was among the first to propose working together with other states in the Northeast. In the early days of the crisis, there was inter-state tension, as when Rhode Island stopped New Yorkers traveling to summer communities, near the Connecticut border.

In any gradual reopening, it makes all kinds of sense for neighboring states to acknowledge their interconnectedness, says Frederick “Fritz” Steiner, dean of the UPenn Stuart Weitzman School of Design. The closing and reopening of beaches, for example, would benefit from coordination, so there isn’t a patchwork of policies on either side of any state’s borders. Megaregions, which inherently recognize the interconnections in the movement of people emerging from lockdowns, “provide an ideal scale for cooperation in this crisis,” he says.

States in the newly formed alliances have also been sharing protective equipment and other vital supplies. California plans to distribute protective equipment from a ramped-up manufacturing effort throughout the U.S. West, wherever the need is greatest; Montana got more masks from North Dakota than from the national stockpile. Cuomo has proposed a purchasing consortium to avoid a repeat of the “chaos” of 50 states competing for supplies.

It’s important to note that regional interdependency and cooperation does not mean that cities and states don’t need help from the federal government; they clearly do, on such fronts as massive testing and contact-tracing, procuring medical equipment, providing financial relief to people and businesses, keeping beleaguered transit systems financially solvent, and many more pressing needs.

For many it has been gratifying to see how a planning construct could become so useful in this desperate time of need. Planners have been trying to illustrate the advantages of a regional approach for many years, though it has been an uphill battle. Historically, states have often resisted working together — Yaro quips that coordinating efforts of any kind haven’t really been seen since the days of Alexander Hamilton, and even then it was halting. In the 20th century, landscape architect Ian McHarg demonstrated how energy and ecological systems better function across boundaries. For a while, multistate climate pacts, such as the Northeast Regional Greenhouse Gas Initiative, were de rigeur.

Researchers at America 2050 showed that rather than thinking about a national high-speed rail network, it made more sense to focus on more self-contained chunks of the country — Florida, the Pacific Northwest (or Cascadia), Northern and Southern California, the Texas Triangle, and the Boston-to-Washington corridor. The Federal Railroad Administration has also proposed similar networks for the Midwest, Southeast, and Southwest states, roughly corresponding to the America 2050 map.

In the near-term response to the Covid-19 crisis, any megaregion-scale coordination will initially have a focus on nuts-and-bolts logistics. But the real challenge is what comes after that. Can multiple states continue to think regionally while socioeconomic structures, with all of the built-in inequities that the pandemic has revealed, are refashioned into something more resilient?

Looking ahead, megaregions could become the policy vessel for new realities, including more people working remotely, allowing them to spread out across agglomerated labor and housing markets. “It might actually help mitigate the overconcentration of jobs and population in our largest urban regions — and alleviate the extreme congestion and run-up in housing prices that has undercut the livability and functionality of America’s densest urban places,” Yaro says.

The key to that transformation, he says, will be regional transportation networks that shorten travel times across larger landscapes. That means going back to the notion of better multistate commuter and high-speed rail, at the megaregional scale, like the Regional Plan Association’s T-REX proposal for the tri-state region around New York, the Transit Matters vision for expanded transit all around metro Boston, and an envisioned North Atlantic rail network, including a rerouted Acela through Hartford, for the six New England states and downstate New York. The U.K. is advancing similar strategies with its decision to build HS2 and Northern Powerhouse Rail, underpinning a broader economic development initiative for the north of England.

In a post-pandemic world, better rail networks could speed the economic recovery by providing access to major urban centers by residents of even distant, midsize and legacy cities, bringing in areas across a larger landscape that have been left to decline economically in recent decades.

The deadly coronavirus has laid waste to so much and taken tens of thousands of American lives so far. The rebuilding process, which stands to be a national project not seen since the Great Depression or the aftermath of World War II, might well be more effective if it is structured on a more regional basis. A more megaregional future awaits.

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Did the Subway ‘Seed’ Coronavirus in New York?

On April 13, Jeffrey Harris, an economist at the Massachusetts Institute of Technology released a non-peer-reviewed study with a provocative title: “The Subways Seeded the Massive Coronavirus Epidemic in New York City.”

In the working paper now available at the National Bureau of Economic Research, Harris maps subway turnstile data against infection rate by zip code, and claims that the recent flattening of New York City’s epidemic curve is linked to the 65 percent decline in ridership that occurred in the first half of March. In an op-ed in the New York Daily News detailing the paper’s contents, he also points to the heavy death toll among MTA workers, which hit 79 on April 20, as another piece of evidence.

The study has been widely panned. Over the past week, mathematicians, infectious disease researchers, and transit policy experts have criticized Harris’ methods, warning that he fails to provide statistical evidence and ignores significant confounding factors. That hasn’t stopped its conclusions from now providing fodder for a political debate on social media, conservative talk radio, and among city policymakers about the appropriate public health response to coronavirus. On Sunday, a Queens politician cited the paper in a plea to New York Governor Andrew Cuomo to shut down all subway  service.

In this moment of profound uncertainty for public transit agencies, the dialogue around the paper shows how easily subways and buses can be scapegoated, even as they provide millions of essential trips during the pandemic.

To arrive at his deduction, Harris presents a series of thematic maps purporting to match busy train lines to infection rates, claiming that subway lines are the “correct unit of analysis” for studying the system’s role. The map that has been most widely shared online shows some of the stops along the 7 train — the Flushing Local Line — layered on top of a map of infection rates by zip code as it courses from Manhattan through the heart of Queens. He also charts ridership declines against the citywide epidemic curve.

Yet disease modeling experts say that the data visualizations that Harris includes do not appear to clearly support the correlation that he is trying to draw: For example, only 13 of the 22 stops shown on his map of the Flushing Local Line are located in zip codes with infection rates greater than 100 per 10,000 people.

Stops along the Flushing Local Line in the New York City subway system, superimposed on a section of infection rates by zip codes, with case data from April 8, 2020. The palest shade of green denotes areas with less than 70 cases per 10,000 people. The next darkest shade denotes areas with case numbers greater than 70 but less than 100 per 10,000 people. The darkest green denotes areas with more than 100 cases per 10,000 people. Harris writes, “the outer area of each point corresponds to the volume of turnstile entries during the first week in March 2020, while the inner area corresponds to the volume during the third week of that month.” (Jeffrey Harris/National Bureau of Economic Research)

The paper also does not attempt to disentangle the many confounding factors that could easily make the subway not the primary vector. With no statistical analysis to contextualize the significance of the numbers he presents, it’s impossible to say that ridership is more than a reflection of the other types of activity that declined in mid-March, after public schools and restaurants were closed and stay-at-home orders were issued.

“School closure, workplace closure and reduced community contacts have resulted in a reduction of transmissions,” said Philip Cooley, an emeritus fellow at the nonprofit research organization RTI International, who spent his career studying viral disease transmission through computational biology. “In other words, reduced subway ridership is a proxy for the increase in social distancing practices, and it is the culmination of all of those social distancing practices that have flattened the infection curve.”

Abbey Collins, the New York City MTA’s chief communications officer, called the paper “flawed — period.”

Transit researchers also warn that no such dramatic links between transit use and viral spread have been found elsewhere in the world. As one case in point, the city with the world’s longest subway system, Seoul, may also the among the very best at controlling Covid-19. The fact that the most recent rises in infections are happening in rural parts of the U.S. might also give credulous readers pause. Salim Furth, a senior research fellow in urban economics at George Mason University, dissected the paper on the blog Market Urbanism and determined that more attention ought to be paid to the infectious threat of car-based travel, considering (among other factors) that Staten Island, the least transit-reliant borough in New York City, now has the highest infection rate in the city.

In a withering blog post critiquing the paper, mathematician, transit analyst and CityLab contributor Alon Levy detailed several reasons that subway and track workers might have been affected worse than riders — “contamination at work is not the same as contamination during travel,” Levy wrote.

Harris maintains that the core premise of the argument is sound. “From the perspective of the highest standard of proof, this is a correlational study — there’s no way around that,” he said. “On the other hand, I can’t see how any serious practitioner of public health, having looked at facts, would recommended other than to focus sharply on the subway system as the fuse that lit the epidemic in New York City.”

But where the facts point, many infectious disease experts say, are to a few critical days in early March that daily life went on after the virus was established in the city of eight million, but before public health directives took effect. That lag is the leading explanation for why New York City wound up leading the world in coronavirus cases: well before subway ridership dropped off, “the damage was already done,” said Robyn Gershon, a clinical professor of epidemiology at New York University with a focus on occupational and environmental health and safety. “The virus was already spreading.”

That isn’t to say that germs did not spread in the subway. As one of many places in New York City where people crowd together, subway cars almost undoubtedly amplified the coronavirus pandemic, Gershon said. But to confidently measure the role that it played compared to taxis, schools, restaurants, workplaces and other shared spaces would take “a big, expensive study with a lot of grad students.” A researcher would likely need to swab a lot of subway poles, conduct a detailed survey about the commuting routes and habits of a representative sample of thousands of riders, and take antibody tests for all of them, similar to what Gershon did in a 2009 analysis of how subway noise impacts hearing loss among New Yorkers published in the American Journal of Public Health.

Gershon is gearing up for further survey-based research now: She says she hopes to partner with the Transit Workers Union to study how workplace conditions and labor practices could have led to the high infection rates and death toll from Covid-19 among MTA workers.

Alternatively, a scientist could build a simulation of virus transmission and run it on top of a synthetic population that reflects real commuter demographics over several weeks. That’s what Cooley did to study the subway’s role in the transmission of H1N1 in New York City in 2009, concluding that 4.4% of citywide infections were transmitted via the subway. If subway service had been suspended at at that time, he found, it could have reduced the total number of infections in NYC by 12.5%. Since coronavirus is far more contagious than H1N1, Cooley guesses that the subway infection rate for Covid-19 would be even greater.

However, the mysteries of coronavirus would present a major challenge to replicating that type of study, Cooley said. Crucially, with H1N1, Cooley knew the rates of virus immunity and reinfection among New Yorkers. Because coronavirus is so new, with no prior human immunity, an uncertain incubation period, and an unknown reinfection rate, a confident simulation of transmission on the scale of New York City might not be possible yet.

The Harris paper does prove at least one thing very clearly: how easily the subway can be blamed for a disaster of invisible origin, especially in a hotly partisan environment that pits cities against pretty much everywhere else. Public transit has long carried a social stigma in the auto-dominant United States, with low-income people of color and other marginalized groups making up an outsized share of riders. New York City was already a national outlier in many respects, including in terms of transit use. Now, with the help of the MIT paper, its famed subway has become ammunition in the mounting coronavirus culture war. “It is rather odd to see NY journos losing their shit about FL beaches when the NYC subway is still running,” Kyle Smith, a critic-at-large at the National Review, tweeted on Saturday. “Seems obvious that the subway was a leading means of spreading the disease, possibly the single most important means in the entire country.”

There are also now voices citing the paper in calls for a transit shutdown, including four New York City council members from outer-borough districts. They signed a letter to Governor Andrew Cuomo calling for a temporary closure of the MTA’s trains and buses, with riders diverted into for-hire vehicles instead, which Harris has also proposed. That seems unlikely to happen: Under normal conditions, nearly 60% of New York City’s 4.2 million workers rely on buses and trains, and although ridership has plunged 90% from normal levels, the subway system still supplied some 2.5 million rides in the first week of April.

In response to the council members, the MTA defended its operations as essential transportation for “doctors, nurses, first responders, grocery and pharmacy workers, and other essential personnel to get to work and save lives.”

New York City leaders will soon face a reckoning for the belated response to the coronavirus, and for the transit workers who are dying in such alarming numbers. Before the pandemic, the MTA already had its work cut out to improve service delays and overcrowded trains, and it’s not clear how the agency will now move forward, facing an $8.5 billion shortfall and a prolonged need for heightened sanitation and health protocols. But in a city as large and densely packed as New York, transit makes the economy function; while some commuters with means may choose to buy cars when lockdowns lift, many workers and students will inevitably return to the rails. Said Gershon: “We can never re-open without the subway.”

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The Race to Save Homeless Shelters from Coronavirus

On Good Friday, Tyree Leslie traded a bunk bed in Multi-Service Center South, San Francisco’s largest homeless shelter, for a bed in a room lined with pale yellow wallpaper in the city’s historic Hotel Whitcomb. He gets three meals a day, his own bathroom, and the chance to truly shelter in place — away from the coronavirus that tore through the shelter he’s been staying in since the winter. “It makes a difference,” he says. “I’m just glad to be indoors.”

So far, more than 750 people experiencing homelessness in San Francisco have been transferred into private hotel rooms in an effort to slow the spread of disease. That’s a small fraction of the homeless population in the city, which is estimated at around 9,000. Homelessness activists, health advocates, and city supervisors have been calling on the city to dramatically reduce density in crowded homeless shelters, navigation centers, and SROs by tapping San Francisco’s 30,000-plus empty hotel rooms as isolation housing since the city’s shelter-in-place was ordered on March 17. But what was first pitched as a preventive measure became more urgent on April 10, when more than 70 residents and staff in MSC South tested positive for the disease. By Tuesday, the number had climbed to over 100.

“It’s impossible for people to isolate when they’re living in a large group sharing a bathroom and sharing eating spaces with large groups of people,” says Jenny Friedenbach, the director of the Coalition on Homelessness, a San Francisco advocacy group. She’s calling for the city to dedicate 9,000 hotel rooms for the city’s entire homeless population, and expand testing to everyone in the shelters and the streets. “The have-nots are basically put into large congregate settings and locked down there until they’re able to pull out the dead bodies.”

She shared a fear echoed in cities nationwide, and around the world: If the populations crowding homeless shelters aren’t quickly and substantially thinned, there will be more coronavirus outbreaks, and more fatalities. On Tuesday, San Francisco’s Board of Supervisors took steps to meet the Coalition on Homelessness’ demands, unanimously passing an emergency ordinance to lease 7,000 hotel rooms for people experiencing homelessness, regardless of whether they had been exposed to the disease. Another 750 rooms will be made available to front-line health care workers, and 500 more for medical quarantine.

California has been a leader in the effort to tap unused hotel and motel space to ease crowding in shelters. On April 4, Governor Gavin Newsom announced an initiative dubbed Project Roomkey, a first-of-its-kind effort to relocate shelter residents to the more than 6,000 rooms under state possession.

Similar efforts are getting underway elsewhere. On April 11, New York City Mayor Bill de Blasio announced that in addition to the 3,500 homeless individuals already in private hotel rooms, he’d transfer about 2,500 more — a fraction of the 60,000 in shelters, and the other 3,000 on the streets. Los Angeles Mayor Eric Garcetti has secured 1,700 hotel rooms so far for the 36,000 homeless people in the city; In Washington, King County opened 400 for its 12,500-strong homeless population. In Connecticut, Governor Ned Lamont ordered shelters to move residents to the more than 1,000 hotel rooms available, if social distancing wasn’t possible on-site.

The movement to reduce shelter populations comes as alarm grows about how coronavirus is spreading undetected in large congregate facilities for people experiencing homelessness. In Boston, for example, researchers from Massachusetts General Hospital and the Boston Health Care for the Homeless Program conducted coronavirus tests at one large shelter for the homeless. Of the 408 individuals tested, 147 people tested positive for Covid-19 (or 38% of the shelter population). But only a handful of individuals showed any symptoms of illness. “Our findings illustrate the rapidity with which Covid-19 can be widely transmitted in a homeless shelter setting,” the researchers’ April 15 pre-publication paper reads. In MSC South, as the San Francisco Chronicle reports, none of the 93 residents who tested positive showed severe symptoms of the disease.  

Many cities, including San Francisco, have started by providing rooms only to homeless people who have been exposed to the virus, tested positive, or are in a high-risk category for Covid-19. Advocates want to go further, pushing for preemptive isolation and expanded testing, because these undetected cases pose just as large a risk. “We are very concerned that the lack of screening and the lack of testing at this point is allowing the virus to hide out,” said Chris Herring, a Ph.D. candidate in sociology at the University of California, Berkeley who has done research on Bay Area homelessness. “While we don’t know exactly how widespread the virus is within shelters, we are concerned that once it shows up, viral spread will be rapid.”

Charles Pitts, an unhoused man who attended a drive-through rally to advocate for opening hotel rooms in San Francisco on April 13, says he feels safer on the streets than in a shelter. “In the navigation centers, you have strangers six inches from each other,” he said. “I just understand for the most part whatever platform San Francisco is going to put or force me in is probably going to be more toxic than me staying outside.”

Nationally, , and news broke that 19 people in the emergency shelter had come into contact with someone who had the virus, was this plan scrapped.

She then promised to dedicate 3,500 vacant hotel rooms to homeless people in shelters and on the streets, starting with those like Leslie who may have been exposed to the virus, are over 60, or have underlying conditions.

Tyree Leslie’s hotel room, where he moved after residents of MSC South started testing positive for coronavirus. (Courtesy Tyree Leslie)

On Wednesday, Breed’s office told CityLab that the mayor was still reviewing the supervisors’ emergency ordinance to expand these targets, and cited the “incredible logistical challenge” of opening thousands of rooms by the end of the month. The city will “need to maintain flexibility in how we respond to this crisis as it continues to evolve,” her deputy communications director, Andy Lynch, wrote. When asked by the San Francisco Chronicle’s Trisha Thadani if the supervisors’ plan was realistic, Breed said no. “The mayor can choose to veto the legislation,” the newspaper reported. “But with a two-thirds vote — which likely will be easy to gather — the board can override her veto.”

In other cities where officials have made similar edicts, attempts to move homeless residents into hotels have been met with resistance from nearby businesses and residents, as well as hotel owners. (Preston says that Breed has the power as mayor to commandeer hotels that don’t voluntarily cooperate.) It’s also a notably expensive solution: San Francisco’s measure could cost an estimated $58.6 million per month, the San Francisco Examiner reported, with $10 million to $40 million eligible to be covered by state or federal funding.

Other cities have set up different kinds of emergency shelters. In San Diego, for example, dozens of homeless men and women began moving into the city’s convention center, where preemptive coronavirus testing is also beginning. But the alternatives can be grim, as illustrated recently by a now-notorious scheme from Las Vegas. Though the collapse of tourism has left the city with about 150,000 unused hotel rooms, city officials have yet to explore using them to shelter its estimated 5,500 homeless residents. Instead, the city painted small 10-by-10 boxes on a empty parking lot for homeless people to huddle within, on the pavement. After a public outcry, the city erected tents on the same parking lot for people experiencing symptoms who had nowhere else to go.

Those sheltering in motel and hotels may be far better off, but being safer from infection can also mean having their mobility severely restricted. Oakland’s hotel for people who have coronavirus or are presumed to, dubbed Operation Comfort, has a long list of rules for its residents, according to a picture posted on Twitter by Oakland-based independent journalist Jaime Omar Yassin. They get three scheduled 20-minute outside breaks a day, and do not have a key to their room, but can lock it from the inside. (The Alameda County office that runs the hotel did not respond to a request for comment.)

Leslie doesn’t have his own room key, either, but he says he feels free to move in and out whenever he needs — he just signs in and out, and takes an elevator ride downstairs (only one person is allowed in the lift at a time).

Security fears have fueled some of the resistance to hotel shelters. Mayor Breed and Grant Colfax, the director of the San Francisco department of public health, have warned that homeless individuals with severe mental health or substance abuse problems will find it hard to transition to private rooms. That’s a concern some shelter operators echo. “You can’t just throw somebody in a hotel and think it will all be good,” says Ivan Klassen, director of community partnerships for L.A. Mission. “That person may have mental health issues, or may be diabetic. There are also wraparound services that need to be taken into consideration. That is incredibly important, I think, as the city navigates this.”

Supervisor Preston says that though some people will need more round-the-clock care, the range of experiences of San Francisco’s unhoused is vast. “It’s been very disturbing to see the least-functional among the homeless population held up as the reason that there can’t be action for the thousands of more-functional people who can easily be placed in hotels and staffed by the same organizations that are staffing [the shelters],” he said.

After this phase of the crisis passes, what next?

When the first U.S. coronavirus cases emerged in suburban Seattle, the region’s homeless shelter officials knew how vulnerable they were. “It felt like we were sitting ducks,” said Daniel Malone, the executive director of Seattle’s Downtown Emergency Service Center, which supports 3,000 to 3,500 people across six homeless shelters, a few supportive housing locations, and a behavioral health program. “If illness gets into one of these places it has the potential to spread very quickly.”

Public health officials in King County are now cautiously optimistic that the region as a whole may have passed its peak of new infections and deaths. But Malone isn’t sure the worst is over for the people he works with. “I do not believe that anybody thinks that that describes the course of this spread within the homeless population,” said Malone of the state’s flattening curve. The first case detected among DESC’s residents was on April 2. Since then, Malone says the organization has averaged more than one case a day — as of April 13, 13 had tested positive, and one person living in supportive housing had died.

One theory for why the trajectory of infection among homeless populations has looked different than that of the general population may be because they have smaller and less diverse social networks. “It could be that folks experiencing homelessness are naturally isolated from a lot of mainstream society,” Malone said.

John Brooks, the chief development officer of Columbus House, a network of shelters in Connecticut, says that he was more worried that staff would infect clients than the other way around for that same reason. Columbus House discontinued all outside volunteer services, and asked that all clients stay in the shelter instead of leaving each day. They started screening people for signs of sickness and fever at the door, installing hand-washing stations, and feeding people dinner in multiple shifts. Finally, with the city of New Haven and the state’s support, Columbus House has moved everyone into hotels, starting with the most vulnerable. Along with three meals a day, the services they would have enjoyed at the shelter are brought to them. While three staff have tested positive, Brooks says no clients have.

Malone, too, has been able to get people more personal space. Of the 400 rooms King County offered, one 100-room hotel — a Red Lion in Renton, Washington — was given to DESC, whose shelter staff now runs the building. About 50 residents are living at a different motel, in rooms leased by DESC itself. The shelters that continue operating are running at a reduced density.

Another Red Lion was given to Sophia’s Way, a women-only shelter on the east side of King County. The shelter moved 20 women who had experience living alone into hotel rooms, and opened up the hotel’s ballroom for the approximately 40 women a night staying in the emergency shelter. Every day, 40 to 60 more women come in looking for a safe place to nap or eat.

The transition hasn’t been seamless. “There’s a hundred different issues that we have to deal with moving into the hotels,” said Alisa Chatinsky, the executive director of Sophia Way. Still, the current conditions are much safer: The women are farther apart when they sleep, and during the day. At their old location, “it was not a matter of if, it was a matter of when someone gets Covid,” Chatinsky said. “I’m not saying it’s perfect, but it’s better.”

The need is far greater than the capacity, she says: When word got out that Sophia Way had a hotel, an influx of women came seeking respite. Domestic violence organizations fear that pandemic lockdowns will trigger a surge in abuse in the coming weeks. “Everybody deserves a safe place,” she said. “I just don’t know how to go about giving them all that.”

Like Malone, she also worries that infection rates among unhoused people may be on a different timeline than the general population’s. “While this affects everyone, of course the poor and the underserved and people of color are being hardest hit because they lack the resources,” said Chatinsky. ”That’s why I think it’s going to come around again, and it’s going to come around harder.”

The future holds many other unknown threats. As unemployment rates reach historic proportions, and rent and mortgage payments loom, the ranks of the homeless in America could swell enormously. But just as the disease has ruthlessly exposed the vulnerabilities and inequities of the U.S. economy, it’s also shown what’s possible with extraordinary mobilization.

This mobilization requires buy-in from the shelters themselves. At the end of March, L.A.’s Skid Row reported its first case of Covid-19, when an employee at Union Rescue Mission tested positive for coronavirus. The mission — an affiliate in the Citygate Network, the faith-based system that has sought relief from local orders to evacuate — took its own steps to triage, isolating certain areas in the five-story building where it provides shelter for some 770 people. Since then, the employee has died and infections have spread, leading mission staff to scramble to relocate residents. (CityLab reached out to Union Rescue, Citygate, and federal authorities with questions about their shelter operations, but hasn’t received a response.)

Last month, Columbus House staff were able to get more than 40 residents into permanent housing, Malone said — an unprecedented number in such a short period. San Francisco, whose mix of tech-boom affluence and desperate poverty made it a national symbol of urban inequality in the pre-pandemic era, has suddenly managed to drum up support for an emergency housing-first policy.

“For years they told us there’s nothing that can be done about the homeless situation, that it costs too much money,” says Harry Louis Williams, a minister at San Francisco’s Glide Church, which serves homeless residents in the Tenderloin. “One of the questions is, once coronavirus peaks, will these rooms still be available to the people who need them, or will they come and say everything’s back the way it was and you’ll have to go to the streets again?”

Coalition on Homelessness’ Friedenbach hopes that won’t happen. “I’m hoping this will shift the way the general population thinks about homelessness — that they don’t see them as so other but that they’ll see how very intimately linked we all are to our fates,” she said. “This pandemic shows that.”

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Readers: Help Shape Our Coronavirus Coverage

In the past few weeks, CityLab has aggressively covered how coronavirus is impacting cities around the world, now and in the future. You can look back at our stories here. We invite you, our readers, to share ideas and tips for our future coverage by filling out the survey below.

CityLab’s reporters and editors are working hard to provide you with the news, context, and analysis about how the pandemic is affecting our lives and changing our cities. What topics should we cover more — or less? What type of new reporting would be the most helpful you in your life? And do you want us to cover more stories that have nothing at all to do with Covid-19? Your feedback is important to us.

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As Coronavirus Quiets Streets, Some Cities Speed Road and Transit Fixes

Eerie drone footage, dispersed block parties, unobstructed wildlife wanderings: The empty streets of the coronavirus era have given rise to all manner of creative applications. They’re also being put to practical use, with several U.S. cities seizing the opportunity to accelerate improvements to their transportation systems.

Los Angeles, where traffic levels have dropped 60% under shelter-in-place orders, may be the most prominent example. On March 31, the Beverly Hills City Council voted to approve a full temporary closure of a segment of Wilshire Boulevard, allowing the L.A. County Metropolitan Transportation Authority to expedite pile installation and the construction of a new concrete street deck on phase two of the extension of the L.A. Metro’s Purple Line into the heart of Beverly Hills.

For years, the $2.4 billion subway plan, which is slated for completion in 2025, has faced fierce opposition from residents in the tony community. While multiple lawsuits against L.A. Metro are still ongoing, Beverly Hills leaders appear to have for the moment set aside their differences out of interest in the local economy. The decision “will help us minimize future construction impacts to local businesses as they struggle to overcome the impacts of the Covid-19 health crisis,” Dave Sotero, the communications manager for L.A. Metro, said in a statement.

Reno is also taking advantage of the zeroed-out traffic to hasten work on the Virginia Street Bus RAPID Transit Extension Project, an $87 million plan to improve pedestrian access in the city’s core and extend an express bus line to the local University of Nevada campus. That involves shutting down and completely overhauling a half-mile stretch of of Virginia Street, which doubles as U.S. Highway 395, through the heart of the city. The closure extends through Nevada Governor Steve Sisolak’s shelter-in-place order, which currently lasts through the end of April.

Shutting down the street all at once, rather than in segments over time, should mean construction on the midtown segment will wrap up about six weeks earlier than planned, says Jeff Wilbrecht, a project manager at the Regional Transportation Commission of Washoe County. His back-of-the-envelope estimate is that the time savings could reduce 25% to 30% of the cost of this phase of the project. Right now, sidewalks and rerouted bus lines are still accessible, but Virginia Street “feels like the Wild West, with how barren and vacant and torn to dirt it is,” Wilbrecht said.

Road, highway, and bridge construction is likewise pressing forward in Indiana, Florida, New Jersey, and across the Washington, D.C., region.

Idled transit lines around the U.S. are getting a boost, too. In San Francisco, a labor shortage and massive ridership drop has forced the San Francisco Municipal Transportation Agency to suspend transit service to all but just 17 “core” bus lines. The upside: Track maintenance on Muni rail lines can now happen virtually unimpeded. Bay Area Rapid Transit, which moved closing time from midnight to 9 p.m. after losing 92% of its passengers, is spending the extra time and staff replacing rails and cables, shoring up leaky tunnels, and sprucing up stations. “That’s all work that had been on a certain timeline, and now we can put labor into it quicker,” said Alicia Trost, the chief communications officer for BART, on a recent podcast.  

What about the risks to all the workers performing this construction and repair work? Communications staff for all agencies said that these jobs are considered “essential” under their respective shelter-in-place orders, and workers are maintaining social distancing protocols to the greatest extent possible. Still, as a recent SFMTA video shows, track maintenance can be cozy work. In Oregon, where Governor Kate Brown’s shelter-in-place orders allow for all construction to continue, workers have expressed concern for their health as their duties continue apace. One New York-based contractor recently took to the industry publication Construction Dive to call for all non-essential construction to halt.  “Forget the schedule, forget liquidated damages, forget profits,” wrote James Lang, a superintendent for a central New York State contracting firm. “These are people’s lives.”

The question also remains as to whether the infrastructure that is being built will draw as many travelers as previously expected. For example, some transportation experts speculate that lingering fears of crowding and infection will discourage the use of public transit after the pandemic ends, accelerating the pre-coronavirus downward trend in ridership. Some agencies investing in their systems now say they hope that providing better service will help entice riders back to trains and buses after the lockdowns lift and the economy reawakens.

“Hopefully we’ll see a return in ridership,” said Michael Moreno, the public affairs manager at RTC of Washoe County. “Even more importantly, we’re hoping for an increase, because we’ll be serving a new segment of the population, with university faculty and staff.”

But funding for public infrastructure projects may soon dry up, especially for transit agencies reeling from the loss of farebox and sales tax revenue. In March, Congress allocated $25 billion to public transit agencies as part of its coronavirus aid package. Without further federal support, and with a possible long-term diminishment in transit’s appeal, agencies may not be able to continue to chase riders with the financial means to choose other modes, said Kari Watkins, a professor of civil & environmental engineering who specializes in public transit at Georgia Institute of Technology. “I’m not sure what the stomach will be for this type of stuff going forward.”

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Coronavirus Reveals Transit’s True Mission

As health authorities tell us to stay at home and to maintain a six-foot distance from one another, public transit ridership has understandably collapsed. A TransitApp analysis suggests that this collapse has now stabilized around 70% below pre-crisis levels, but many major agencies report bigger declines, especially on longer-distance and commute-oriented services. San Francisco’s BART system, for example, has lost 93% of its riders.

The financial disaster transit agencies face is hard to overstate. Most U.S. transit agency revenue comes from fares and payroll and sales taxes, all of which will have collapsed or can be expected to as the effects of the pandemic ripple down through the economy.

There is no silver lining here. The recent federal CARES Act includes $25 billion in emergency funds for transit agencies. This will keep the lights on for a while, but not if the crisis drags on.

In response to this emergency, major agencies are doing their best not to cut service much. Typically, agencies have deleted rush-hour express service (whose wealthier riders are almost all working from home) and have shut down tourism and recreation services. After that, their next step has usually been running Saturday or Sunday schedules every day, which implies reduced frequencies, although San Francisco is turning off some routes to protect frequency and prevent crowding on most-used routes nearby. Based on my informal discussions with many agencies, the service cuts seem to be in the range of 10% to 40% at this point, far less than the roughly 70% drop in ridership.

Even these service cuts aren’t all motivated by the need to save money. The first impetus has been a staff shortage. Bus and train drivers are ill, or afraid of becoming ill, or are stuck at home caring for children who would usually be in school. Even where budget is a consideration, agencies are desperate to avoid major layoffs and furloughs, both because they care about their employees and because they need a highly trained workforce to still be there when demand comes back.

At least agencies can save money by running smaller vehicles, right? Labor is most of bus operating cost, but agencies could save power, fuel, and wear-and-tear. But no: Agencies are trying to run big buses and long trains, so that their few passengers can stay six feet apart, and they’re being criticized when loads are too high. In short, they are intentionally creating the “empty buses” look that so many people misread as evidence of transit’s failure or irrelevance. (Good luck getting that much distance when using Uber.)

Why are agencies behaving this way? Because they are not businesses. And if there’s one thing we must learn from this moment, it’s that we have to stop talking about transit as though ridership is its only purpose, and its primary measure of success.

Right now, essential services have to keep going. It’s not just the hospital, the grocery store, and basic utilities.  It’s the entire supply chain that keeps those places stocked, running, and secure. Almost all of these jobs are low-wage. The people using transit now are working in hospitals that are saving lives. They are creating, shipping and selling urgently needed supplies. They are keeping grocery stores functioning, so we can eat.

In transit conversations we often talk about meeting the needs of people who depend on transit. This makes transit sound like something we’re doing for them. But in fact, those people are providing services that we all depend on, so by serving those lower income riders, we’re all serving ourselves.

The goal of transit, right now, is neither competing for riders nor providing a social service for those in need. It is helping prevent the collapse of civilization.

What’s more, transit has always been doing that. Those “essential service” workers, who are overwhelmingly low-income, have always been there, moving around quietly in our transit systems, keeping our cities functioning. Too often, we have patronized them by calling them needy or dependent when in fact everything would collapse if they couldn’t get to work.

Transit agencies rarely get credit for this work, and journalists rarely stop to consider it. For the last decade or more, the default news story about transit has been about ridership. When it’s down, we get alarmist stories. What are transit agencies doing wrong? How are they going to fix it? The near-universal assumption is that transit should be judged as though it were a business, and that transit ridership is the primary measure of transit’s usefulness or relevance. This assumption has always been wrong, but now it’s obviously wrong. If it were true, agencies wouldn’t still be running so much service right now.

Right now, in interviews, I’m being asked what transit agencies must do after the crisis to get ridership back. The false implication is not just that the return of ridership should be their only goal, but also that there’s something that they could do to bring ridership back to what it was. In normal times, transit agencies can improve ridership by making service more useful — that’s what I do as a consultant — but ridership has always gone up or down for reasons outside their control. That’s never been more obvious than right now.

In fact, there’s good reason to suspect that the return of previous riders could take a year or more. This crisis won’t end overnight. At some point we’ll emerge from our holes and start moving around again, but the virus will still be there and we’ll all be cautious about it. If you had an easy option to drive your own car — a car that you cleaned yourself and whose inner surfaces nobody outside your family has touched — would you choose instead to get into a transit vehicle, full of strangers and the surfaces they’ve been touching?

It’s quite possible, then, that ridership will rise only gradually, and that for some time, most of the people riding will be those who we too-often call the “transit dependent.” This term, like its opposite “choice rider,” has always been misleading, because most urban people are not totally dependent or totally “choice.” Instead, we each have a range of travel options with their own incentives and disincentives, and may make different choices for different trips. Some people also “choose transit dependence” by not owning cars even though they could afford one, thus revealing the absurdity of describing all riders as either “dependent” or “choice.”

But even for those with the fewest options, the term dependent has allowed us to imagine helpless people in need of our rescue, rather than people that we depend on to keep things running. Everyone who lives in a city, or invests in one, or lives by selling to urban populations is transit dependent in this sense.

Meanwhile, if we all drive cars out of a feeling of personal safety, we’ll quickly restore the congestion that strangles our cities, the emissions that poison us and our planet, and the appalling rates of traffic carnage that we are expected to tolerate. Once again, we’ll need incentives, such as market-based road pricing, to make transit attractive enough so that there’s room for everyone to move around the city. That will mean more ridership, but again, ridership isn’t exactly the point. The point is the functioning of the city, which again, all of us depend on.

So let’s take this moment to reframe our journalism and commentary around transit issues. Let’s learn from the remarkable work that transit agencies are doing now, and recognize that this is something they’ve always done and that we’ll always need them to do. Let’s look beyond ridership or “transit dependence” and instead measure all the ways that transit makes urban civilization possible. In big cities, transit is an essential service, like police and water, without which nothing else is possible. Maybe that’s how we should measure its results.

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The Coronavirus Class Divide in Cities

The coronavirus is exposing a longstanding class divide in the way Americans work — between the low-paid front-line workers and the stay-at-home professionals with more job security and benefits. The first group — the grocery clerks, delivery workers, transit workers, food service workers, emergency responders, physicians’ assistants, and nurses’ aides — are exposed to Covid-19 in their day-to-day jobs and often on long public transit commutes. The second group is dependent on of the very services provided by these workers.

This divide also expresses itself in geography. Just as this virus hits harder in some places than others and hits hardest in clusters of the aged, the infirmed and the truly disadvantaged, the workforces of some cities and metro areas are more exposed and more vulnerable, too.

To get a handle on this, I worked with University of Maine economist Todd Gabe, an expert in America’s job structures and skills, to identify the cities and metro areas whose workforces are most exposed and at risk from Covid-19. Gabe used detailed data from the Bureau of Labor Statistics O*NET survey to zero in on two key at-risk characteristics of jobs: the degree to which workers interact directly with the public and jobs that require high levels of very close physical proximity to others. We created index values for each metro, based on the share of workers in these occupations per metro divided by the percentage of workers who do these jobs nationally.

The Department of Homeland Security estimates that roughly 50 million to 60 million Americans – potentially more than 40% of the U.S. workforce – perform “essential infrastructure” jobs. We found that between 35 million and 40 million U.S. workers, roughly 3 in 10, do high-risk jobs that involve high physical proximity to their co-workers and close interaction with the people they serve. Three-quarters of the jobs that involve working directly with the public are low-paying service jobs; 70% of the people who work in close physical proximity to one another are low-wage service workers or blue-collar workers. From there, our analysis zeroed in on metropolitan areas to determine which workforces have the highest percentages of these high-risk occupations.

Analysis by Todd Gabe based on data from the Bureau of Labor Statistics, O*NET Survey.

The chart above shows the large metro areas (those with over 1 million people) whose workforces are most vulnerable. In the right-hand corner are metros whose workforces face a high degree of risk, with larger shares of workers doing jobs that require interaction with the public and physical proximity to one another.

Greater New York City, which is being hardest-hit area by the pandemic in the U.S., lands in this quadrant. It ranks fifth out of 53 large metros (more than 1 million people) for occupations that require high levels of physical proximity, and 17th in occupations that require direct interaction with the public. In addition, it has the largest percentage of workers, more than 30%, that use public transportation to get to work.

Many of the metros most at risk — like Las Vegas, Miami, Tampa and Orlando — rely on tourism and entertainment for revenue. They face a double whammy because they have a bigger percentage of their workforce potentially exposed to the virus and economies that may not be able to reopen for some time.

But they’re not the only vulnerable cities. Metros like Tucson, Providence, Pittsburgh, Jacksonville, Phoenix and hard-hit New Orleans are, too. And so are smaller metros like Myrtle Beach and Hilton Head in South Carolina; Asheville, North Carolina; and more remote places like Sioux Falls and Rapid City in South Dakota. These areas, where many urbanites are also fleeing, have even greater shares of workers whose jobs require a high degree of interaction with the public.

Large Metro

(More than 1 million people)

Share of Workers in Jobs with

High Levels of Public Interaction

Miami-Fort Lauderdale-West Palm Beach, FL

28.0%

Tucson, AZ

27.4%

Tampa-St. Petersburg-Clearwater, FL

27.2%

Las Vegas-Henderson-Paradise, NV

27.1%

Orlando-Kissimmee-Sanford, FL

26.3%

Providence-Warwick, RI-MA

26.3%

Birmingham-Hoover, AL

26.0%

Jacksonville, FL

25.8%

Phoenix-Mesa-Scottsdale, AZ

25.8%

New Orleans-Metairie, LA

25.3%

Next, let’s look at metros where a larger share of people are working in close physical proximity to other workers. Some of the same cities appear on this list, but there are new additions, including Rust Belt metros with bigger blue-collar workforces like Pittsburgh, Pennsylvania, and Rochester, New York. Certain smaller metros shouldn’t be overlooked either. Among these are The Villages, Florida – a bustling center for senior living and already a hotspot for the virus, as well as resource-driven economies like McAllen and Brownsville, Texas.

Large Metro

(More than 1 million people)

Share of Workers in Jobs with

High Levels of Physical Proximity

Las Vegas-Henderson-Paradise, NV

32.2%

Tucson, AZ

32.1%

Providence-Warwick, RI-MA

30.3%

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD

29.9%

New York-Newark-Jersey City, NY-NJ-PA

29.5%

San Antonio-New Braunfels, TX

29.5%

Tampa-St. Petersburg-Clearwater, FL

29.4%

Pittsburgh, PA

29.4%

Orlando-Kissimmee-Sanford, FL

29.2%

Rochester, NY

29.2%

On the flip side, tech hubs like the San Francisco Bay Area, Seattle, Austin, and Washington, D.C., have much smaller shares of workers in occupations that are in close contact with the general public or require physical proximity. Note their clustering in the bottom left corner of the chart above. Despite what is often said about high-tech work requiring high degrees of face-to-face interaction, the San Jose metro — the veritable heart of Silicon Valley — has the lowest share of occupations that require direct physical proximity of workers (less than 20%) and the lowest share of occupations that require direct interaction with the public  (16%). Look at how far off it is to the left of the chart.

Others have sliced the data in different ways to come to similar conclusions. A New York Times analysis looked at occupations where people work in close proximity to others and how exposed they are to disease and infection in their jobs. Those at greatest risk are medical professionals like doctors, nurses, and paramedics and front-line service workers like personal care aides, home health care aides, and cashiers, the Times found.

Outside of medical professionals who are most vulnerable, many of the workers who face high risks toil in low-paying service jobs like food preparation, where the median wage is $11.41 per hour, or stock clerks, who make $12.36 an hour, according to a recent Brookings Institution analysis. Many don’t have health coverage.

But, however you look at the data, the bottom line is clear: Front-line workers bear disproportionate risk from this pandemic, and some metro areas have a disproportionately high share of these workers.

It is imperative that we protect them as they help us fight our way through this crisis. That means getting them the protective gear they need to do their jobs safely and securely. A study of the spread of the related SARs virus showed that the combination of masks, gloves, protective gear, and washing reduced the propagation of that deadly virus by as much as 90%. States and cities need to work alongside employers and the federal government to mobilize to provide the required personal protective equipment — or PPE.  This is imperative now, but will continue to be the case as our cities and businesses reopen in the next month or two, and perhaps for the next six to 12 or 18 months until testing is in place, better therapies are developed, a vaccine is discovered, or the virus becomes less virulent.

There is no reason why most front-line service workers need to be in DIY garb or the equivalent of hazmat suits forever. PPE can be designed in ways that are far less visually obtrusive and do not strike fear in customers and residents. Airlines and luxury hotels often work with fashion designers to create stylish uniforms. While large chains and employers can develop PPE themselves, states and localities can work with local designers to turn out masks, shields, gloves, and protective garments that look as much as possible like regular workwear and develop technical assistance programs for small businesses to learn how to deploy it and use it.

Like the industrial workers of a century ago, the harsh conditions confronted by front-line workers are causing them to begin to organize to demand better protection and better pay: Workers at a number of large delivery companies and grocery chains have threatened strikes and job actions to draw attention to their working conditions.

Failure to protect our front-line workers not only imperils them, it imperils all of us, by potentially accelerating the spread of the deadly virus. We should spare no cost protect the people who are the true heroes of our effort to staunch this pandemic.

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In the Fight Against Coronavirus, the Makers Have Mobilized

In her studio in downtown Portland, Oregon, fashion designer Sloane White has been sewing cotton masks nonstop since her commissions dried up and she was laid off by the suit shop where she works.

In Brooklyn, Naomi Mishkin, the designer behind a made-to-order garment line, is hoping for a breakthrough in her quest to source materials to convert her Manhattan production operation into a factory for medical hoods.

And in Baltimore, a maker space called Open Works is coordinating a collaborative community effort to generate the components for face shields by deploying 3D printers across the city.

Two weeks into the campaign to flatten the curve of the coronavirus pandemic, people across the country are ramping up their efforts to manufacture the personal protective equipment that hospital workers desperately need, as well as the precautionary gear that the rest of us ought to be using.

Makers know they can’t turn the tide. They aren’t able to match the level of mobilization envisioned by the Defense Production Act, the Korean War-era law that the Trump administration has used (however falteringly) to order American factories to start churning out ventilators and respirators at scale.

“As one of my coworkers asked: Are we trying to save the farm with the BB gun here?” says Ryan Hoover, faculty in interdisciplinary sculpture and digital fabrication at Maryland Institute College of Art. “We’re trying to fill the gap, but we need manufacturers to step up. We need that. These are great rapid response technologies, but they are not equipped to deal with the scale that we need.”

Yet the demand for medical supplies has so wildly, dramatically outpaced production that the need is everywhere. The global coronavirus pandemic has ruthlessly revealed the vulnerabilities of the modern supply chain, which relies on offshore manufacturing and “just-in-time” delivery, leaving little room for error when demand suddenly surges worldwide. And that demand tracks at all levels of conceivable necessity, from the ventilators that keep desperately ill Covid-19 sufferers alive to the masks that offer some peace of mind and a modicum of protection to grocery-store workers and shoppers.

In this environment, local producers are mobilizing to  answer need where they can find it, doing what they can to turn hyperlocal capacity into distribution networks that serve neighborhoods. For adherents of the maker movement, who have promoted the idea of collaborative DIY manufacturing as a means of community empowerment, the coronavirus crisis represents an opportunity to demonstrate exactly why making stuff can be so powerful. It might not be Dunkirk, exactly, but makers are rising up to play a life-saving role in this global struggle.

***

In February, White brought her couture line to the runway at London Fashion Week. In fact, the Portland fashion designer’s custom gowns and dresses, made from 100% reusable materials, closed out the show — a high point in her career.

By mid-March, though, all her own couture commissions were either put on hold or canceled. And the made-to-measure suit shop where she works, Indochino, closed its doors. Like so many other Americans, White found herself out of a job. But she had a ton of quilters cotton on hand — material she had been saving for her ready-to-wear line of summer dresses. And her sewing machine, a Pfaff Creative 7550, is a real workhorse. As long as she was going to be holed up in her home studio in Portland’s Goose Hollow neighborhood, she decided to put herself to work.

She’s now putting 10 to 14 hours a day in to make sewing masks for anyone who asks. She’s made more than 800 so far. “If I can do something that can help in any way at all, I’ll do it. It feels better than being helpless.”

The cotton masks that White produces — two layers of 100% cotton in four very au courant panels — aren’t the medical-grade N-95 respirators that hospitals need so badly, but now that the Centers for Disease Control and Prevention is recommending cloth face coverings for all, orders are pouring in, through Facebook and word of mouth. White sent one batch of 200 masks to Legacy Meridian Park Hospital, at the request of cafeteria staff who aren’t being outfitted with the proper medical-grade PPE. Another shipment of masks went to a nursing home.

“I just looked online at some photos of the pattern, and then I just figured it out from there,” White says. “As long as I can keep getting fabric there’s no reason to stop.”

Other makers who have joined the campaign to produce medical equipment have access to proper factories. Naomi Mishkin, the designer and founder behind Naomi Nomi — a made-to-order workwear line for women in New York City — is one of a small number of designers that still produce all of their garments in America. In any normal spring, she would spend the last week of March head down in full production mode. Plans to put out work-appropriate bike shorts, a tank top, and a dress with seven pockets were next up for her company. Everything the line produces happens between her Brooklyn studio in Prospect Lefferts Gardens and two facilities on 35th Street in Manhattan’s Garment District. But now Mishkin is pivoting to produce PPE that doctors can use.

“I was watching [New York Governor Andrew] Cuomo’s press conference and texting with the head of one of our factories,” Mishkin says. “I’d been in contact with him hour to hour over the last 10 days. I texted him: ‘We’re making masks, aren’t we now?”

Production on the many-pocketed dress came to a grinding halt, and Mishkin and her fabrication partners began to plot out how to retool their operation. The factories in the Garment Center aren’t capable of producing N95 masks, but they have the capacity for something more industrial than cotton masks. After talking with an anesthesiologist, Mishkin and her partners came up with a plan to manufacture fabric hoods with plastic face shields that can be used by clinics and hospitals.

If Naomi Nomi can figure out the plastic and the fabric (a nonwoven, nonporous material), then her line alone could churn out thousands of medical hoods in short order. Today, Mishkin, like almost every other small business in America, is figuring out how the Paycheck Protection Program works, but she thinks that Naomi Nomi is close to a breakthrough — there’s a textile manufacturer in Long Island that might be able to provide the right fabric.

“Our biggest concern is getting the material. The patterns for gowns, that’s very easy,” Mishkin says. “We’re talking about factories that can turn out three-piece suits. Making a medical gown that’s technically supposed to be disposable is extremely easy from an engineering standpoint.”

***

For fabricators who can produce medical supplies at some level of scale, figuring out the supply chain can be a serious impediment. There’s need for manufacturers who can answer the government’s call for making ventilators, but manufacturers also need a way to suss out the new pandemic wartime logistics.

“It’s one of the things that people haven’t grasped: You need to consider the entire supply chain,” says Mike Galiazzo, president of the Regional Manufacturing Institute of Maryland. “Somebody could be making a mask or even making a ventilator, but if they don’t have the capacity coming through their supply chain, they’re really not useful in fighting coronavirus.”

In Maryland, the Regional Manufacturing Institute is trying to thread this needle with a database called Maryland Made to Save Lives. It allows local companies to declare what kind of manufacturing they can do — injection molding, for example, which is necessary to produce some personal protective equipment — and lets other companies source the supplies they need.

For example, a Baltimore-based company called Marlin Steel Wire signed up on RMI’s directory. The company makes wire baskets and other steel-form products. A medical group contacted Marlin Steel Wire with an urgent request for wire racks to hold test tubes; lab techs need something to hold all those coronavirus tests. The company is now manufacturing autoclave baskets, wash racks, sterilizing baskets, and other products for clinics and hospitals. “A steel company can be an important part of the battle,” Galiazzo says.

The Maryland Made to Save Lives database caught the attention of Hoover, who works in the digital fabrication studio as a faculty member at the Maryland Institute College of Art. He’s one of hundreds of people working in tandem with a Baltimore maker space, Open Works, to manufacture face shields via 3D printers. These makers are building their own networked chain in order to help out local health care workers, an initiative that he hopes to link up with the broader manufacturing mission.

Hoover joined the 3D-printing campaign after Open Works put out a call for face shields on behalf of LifeBridge Health, a health care nonprofit based in Baltimore. “There was an overwhelming response to the call,” Hoover says. “I think it’s one of few cases where we’ve had a similarly exponential response to the virus. One person wrote multiple people, and they wrote multiple people.”

Ryan McKibben, the digital fabrication studios manager at MICA, putting several machines to work printing face shield components. (Ryan McKibben)

More than 250 printers across Baltimore are now using a schematic for face shields designed by Prusa Research, an open-source 3D-printing company based in Prague and an industry leader. MICA’s engineer in residence, Paul Mirel, for example, is using a laser cutter at home to cut face shields. To coordinate this volunteer army, the Open Works makers are deploying an online tool called We the Builders. This site was made to help organize community printing projects, typically artworks, where everyone prints a different part of the whole; the Baltimore makers are using it to assign out and print components of face shields.

“It’s definitely not a perfect system,” Hoover says. “It’s not really how you’d design a system for this, but it’s a system that does most of what you need.”

The Baltimore initiative, led by Open Works director Will Holman, is part of a global push to mobilize 3D printers. Makers and manufacturers around the world are rallying to turn this technology into a massive wave. Just the latest example from my inbox: Camper, a Spanish shoemaker, is using its company’s 3D printers to churn out face shields and (pending medical approval) components for ventilators.

There are countless examples of everyday people stepping up to do their part to combat the coronavirus pandemic. Even knowledge workers. Kyle Wiens, a right-to-repair advocate based in San Luis Obispo, California, is tracking down and publishing service manuals for ventilators, since keeping them running will be as critical as putting them in place. These individual efforts are contributing to the local, regional and national campaigns to arrest the virus.

Parts of the new maker economy are building entirely new networks in order to contribute. There’s a fire underneath old-school manufacturing, too. Galiazzo says that if there’s one bright spot to factories turning on a dime to build new medical supplies, it’s that today’s crisis will help companies adjust to new standards of communication and digitization. “When we get out of this mess, we’re going to see that there’s a real benefit to accelerate our march toward Industry 4.0, which is all about the digital society,” Galiazzo says. “There’s going to be huge shifts in how businesses are organized to do work in the future.”

In the coronavirus era, there’s an advantage to having a regional manufacturing center, especially for cities that have been written off as post-industrial dead zones. If Rust Belt centers can shake off their rust, then they may be critical production centers for the home front. There’s no question that major manufacturers such as Apple and GM can bring tremendous corporate resources to bear. But if the federal government is outbidding states for medical equipment, then the distribution of these resources is at the mercy of the Trump administration. Even as some cities and states worry where they stand in the queue being overseen by the president’s son-in-law, Jared Kushner, many workers know that they won’t be getting the equipment they need in time.

Working together or going it alone, makers are giving what they can, despite a lack of clear instructions or assistance from the government. But then, a certain loose adherence to the rules of officialdom has always been part of the movement’s ethos.

“It seems like a very Baltimore thing to me,” Hoover says. “We’re used to the powers that be that were supposed to do a job not doing their job.”

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The Geography of Coronavirus

The Covid-19 pandemic rages around the world, hitting cities in Asia, Europe and the U.S. in waves: first Wuhan, then Milan and Madrid, and now Seattle, New York City, Detroit and New Orleans. No place seems immune. But some cities seem more vulnerable to its devastating spread, and more vulnerable to the virus’s most insidious impacts.

In trying to understand the factors that exacerbate this pandemic, a chorus of .

On the whole, rural recreation counties suffer from a rate of Covid-19 cases that is more than two and a half times higher than for other rural counties, according Bishop and Marena.

The next chart, also by Kolko, shows the U.S. metro areas that have suffered the highest death rates from Covid-19. (Even with variations in testing, deaths remain the best barometer of the effect of the Covid-19 crisis.)

(Jed Kolko)

Four of the 10 are large dense metros: New Orleans, New York, Seattle and Detroit. But other metros on this list defy the density narrative. In the small metro of Albany, Georgia, for example, the virus spread through two funerals.

As to the question of density itself: Kolko’s analysis finds density to be significantly associated with Covid-19 deaths across U.S. counties. But density is not the only factor at play. His analysis also finds that Covid-19 death rates per capita are higher in counties with older populations and larger shares of minorities, and colder, wetter climates. It’s important to remember that this analysis only looks at the U.S., and in other parts of the world, denser cities have had more success controlling the spread.

But even in the U.S., it is not density in and of itself that seems to make cities susceptible, but the kind of density and the way it impacts daily work and living. That’s because places can be dense and still provide places for people to isolate and be socially distant. Simply put, there is a huge difference between rich dense places, where people can shelter in place, work remotely, and have all of their food and other needs delivered to them, and poor dense places, which push people out onto the streets, into stores and onto crowded transit with one another.

This density divide is vividly apparent in geographic breakdown of the virus across New York City: Covid-19 is hitting hardest not in uber-dense Manhattan but in the less-dense outer boroughs, like the Bronx, Queens, and even far less dense Staten Island.

The density that transmits the virus is when people are crammed together in multifamily, multi-generational households or in factories or frontline service work in close physical proximity to one another or the public. Such density is why the earlier 1918 flu pandemic ravaged the working-class neighborhoods of industrial centers of Pittsburgh and Philadelphia.

There are a number of other factors in addition to density that merit closer attention as we continue to track the virus’s spread. Two obvious one are the age of population and pre-existing health conditions like smoking, obesity, diabetes and heart disease. It is critically important to look closely at the uneven impact of the virus on poor and minority communities. We’ll also want to zero in the differences in the kinds of work people do: the shares of the workforce that are able to engage in remote work versus the share of frontline workers in health care, delivery and grocery stores that are particularly vulnerable to the virus. We may also find that high levels of religiosity, where people gather in large groups to worship, or places with large shares of multi-generational families also have greater vulnerability. In a divided nation like ours, it will be interesting to see to what degree political orientation matters: Blue states and cities have tended to move much quicker on social distancing that their Red counterparts.

We may find that some things we want to encourage in cities, like tight social bonds and civic capital, make them more vulnerable.  “When it’s all said and done, we’re going to find that COVID was uniquely lethal to people with high social capital,” demographer Lyman Stone suggested on Twitter. Conversely, we may also find that some things people criticize cities for — like childlessness, relatively few children and low levels of families with kids — worked to protect them, for the simple reason that kids can be vectors for the disease’s spread.

Some of these factors may also help explain why San Francisco, the second-densest place in the U.S. after New York City, appears to have had more success in flattening its curve. It may not just be that San Francisco locked down earlier than other places, though that certainly helped. With fewer children per capita, a higher rate of remote workers who can shelter in place, and one of the highest rates of educational attainment in the U.S., the city may have a list of factors that made it more resilient than Detroit, New Orleans or even New York, which are far more diverse across class and demographic lines.

The full impact of the Covid-19 pandemic on our geography and our cities remains to be seen. Distressingly, it appears that the virus may reinforce some key faultiness of our existing economic and geographic divides.

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