What makes a COVID-19 hotspot?

IT’S NO SECRET that the coronavirus is not evenly spread across Massachusetts. New statistics released Wednesday confirmed that Chelsea remains a hotspot of the virus, with the most cases per capita. Brockton was next, followed by Everett, Lynn, Randolph, Lawrence and Revere, according to CommonWealth’s analysis of state statistics.

Earlier this month, the Boston Globe published a piece that looked at Chelsea and argued that its Latino immigrant population – many of whom lack legal status – are uniquely vulnerable because they lack access to health care and public supports. Many people in Chelsea live in overcrowded conditions. Many low-income individuals hold jobs where they are unable to work from home.

Many of the other communities emerging as hotspots are also dense, urban, and low-income neighborhoods.

A story in the Boston Globe Wednesday adds another interesting commonality: All six of the hardest hit Massachusetts communities are also communities with environmental problems – namely, high rates of asthma and environmental-related respiratory diseases.

The story focuses on a nationwide study by researchers at Harvard’s T.H. Chan School of Public Health, which found that people who live in areas with high levels of air pollution are more likely to die of COVID-19 than people who live in less polluted areas. The study found that even controlling for other factors – socioeconomics, weather, population size, and others – increased exposure to air pollution was correlated with a higher death rate from COVID-19. The findings were not shocking since air pollution is already known to lead to higher risks of death from other respiratory ailments.

The Globe story notes that there is no evidence that air pollution affects who gets infected in the first place. But experts say the environmental facet is simply another factor to add to the myriad reasons why certain communities are more vulnerable – others include overcrowded housing, reliance on public transit, and people working in essential jobs, like delivery services or grocery stores.

Many of these hard-hit areas are also communities of color, which is why advocates for minority groups are increasingly calling for a focus on the disparate impact of the disease. A task force on coronavirus and equity, coordinated by the Massachusetts Public Health Association, has called for a range of actions, including passing emergency paid sick time for workers who are ineligible under other laws, providing safe quarantine spaces for homeless people, and ensuring all immigrants, regardless of legal status, have access to testing and treatment.

The Massachusetts House passed a bill that would create a diversity task force to look at disparities in the health care system related to the COVID-19 pandemic and make policy recommendations. The Senate has not passed the bill, although Senate President Karen Spilka said she is continuing to work on the issue of addressing the disparate impacts COVID-19 is having on communities of color.

As state Rep. Jon Santiago, a Boston Democrat and physician who works in the emergency room at Boston Medical Center, told Boston.com, “So much of a person’s health, even pre-COVID-19, is related to the zip code they live in… All COVID-19 has really done is expose that to the person who maybe wasn’t paying attention before.”