Zip codes with nursing homes and Brown and Black populations have been hardest hit by COVID-19 | Feature | Chicago Reader

Zip codes with nursing homes and Brown and Black populations have been hardest hit by COVID-19 

A map of Illinois coronavirus deaths

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The neighborhood of South Lawndale, aka Little Village, home to the recent power plant smokestack disaster, can add one more trophy to its showcase of immiseration: 149 residents in 60623 have died because of COVID, more fatalities than in any other Illinois zip code.

No COVID deaths were reported in the North Shore enclave of Glencoe, where the median home price is $885,000 and the median income is $162,460. And in Streeterville, the Loop, and University Village, just one to four people have died from COVID. Indeed, the Illinois Department of Public Health reports no COVID deaths for 1,732 Illinois zip codes. One hundred and eighty-three zip codes have only one to four deaths from COVID. Twenty-four of these are in Cook County, where being rich, white, and avoiding congregate care vastly improve your chances of surviving the pandemic.

The Reader recently obtained data on COVID-19 deaths by Illinois zip code through July 26. While IDPH websites disclose test outcomes, they omit COVID mortality data. For each zip code, the cells under the label "Deaths" all read "N/A."

And yet the IDPH has recorded COVID data on deaths by zip code for quite some time. In response to a Freedom of Information Act request, data released on Sunday reveal that within Cook County your chances of contracting and dying from COVID vary dramatically based on your residential zip code. The IDPH spokesperson Melaney Arnold did not respond to an e-mail asking why the IDPH was not publishing these data. (The IDPH denied my request for data on hospitalization; my appeal of this denial is under review by the Attorney General Office's public access counselor.)

The death data also reveal disparities in morbidity for those with COVID diagnoses. For instance, among the 304 COVID cases in 60415, just southwest of Oak Lawn, 34 people (11 percent) died. In DuPage County's 60188 zip code, 656 COVID diagnoses meant 29 deaths, a 4.4 percent morbidity rate.

The IDPH has privacy rules prohibiting the release of numbers indicating fewer than five cases. For zip codes with one to four deaths, IDPH inserts an asterisk. Of testing outcomes, IDPH states: "The testing data represents data reported to IDPH through Electronic Laboratory Reporting (ELR) only. It is based on the date results are reported into the ELR. It excludes testing data that are received from sites that have not implemented ELR. This excludes 3-5% of test data." A COVID media spokesperson for the agency stated in an e-mail that racial and ethnic testing data are incomplete because testing sites may not ask or report demographic data and those tested may not be answering these questions. And experts have long noted that official COVID death counts may be understating the true numbers.

Largely Black communities also were hard hit. South Shore, 96 percent Black, lost 119 lives to COVID, or five out of 2,000 residents. DPH data show a South Shore death rate after COVID diagnosis of 11 percent. Lake Forest, 92 percent white, had 160 COVID cases, but only one to four deaths (.06 percent to 2.5 percent) among these. This is a pattern researchers are beginning to document nationwide, including a Harvard study of Massachusetts finding that "the surge in excess death rates, both relative and absolute, was evident starting in early April, and was greater in city/towns with higher poverty, higher household crowding, higher percentage of populations of color, and higher racialized economic segregation." A New York Times report found "Black and Latino people have been disproportionately affected by the coronavirus in a widespread manner that spans the country, throughout hundreds of counties in urban, suburban and rural areas, and across all age groups."

The Illinois zip code with the highest number of COVID deaths per capita is Niles, with 128 deaths. About one out of every 250 residents in that community have died from COVID in the last five months. Of these deaths, 96 of them lived in three nursing homes, including 47 in the Niles Nursing and Rehabilitation Center.

Nursing homes, not an older population, appear to be driving the high death toll in Niles. One out of four Streeterville residents are 60 years or older. One-third of Niles residents are in that age bracket. The 8 percent difference does not explain why Niles has over 120 more deaths than Streeterville.

And in Little Village, fewer than one in ten residents are over 60. Yet for every 2,000 residents, three have died from COVID, compared to Streeterville's mortality rate of one in 7,000 (on the higher end of the IDPH range) to one in 28,000 (the lower end).

Nursing homes are of course well-known hot spots, accounting for 55 percent of COVID deaths in Illinois. The Pritzker administration recently appointed Daniel Levad to run the division within IDPH responsible for nursing home oversight, the Office of Health Care Regulation. Levad is replacing his boss, Debra Bryars, the previous deputy director in that position.

Despite fanfare about the personnel moves, failures of regulatory enforcement in nursing homes were at the behest of Pritzker himself. During the pandemic, Pritzker issued and twice renewed an emergency order telling Bryars and others in IDPH not to enforce a vast array of long-term care regulations enacted by the state legislature. The official summary of Pritzker's EO 2020-35 reads: "Suspends provisions in the Assisted Living and Shared Housing Act, the Nursing Home Care Act and the Community Care Act. For example, suspends IDPH conducting an on-site review at each facility annually."

In the wake of the Reader releasing details about Pritzker giving immunities for negligence to nursing homes and hospitals—including e-mails revealing that malpractice defense attorneys were personally editing the immunity order's text—and a subsequent news report by the local NBC investigative team, Pritzker did not renew the immunities. The orders lapsed on June 27. (E-mails released to me after the article was published can be accessed here, including one from the University of Chicago Medicine lobbyist with language that the final order closely tracks.) The Reader article did not discuss 2020-35, the order suspending nursing home regulation enforcement.

Syracuse University College of Law professor Nina Kohn published criticism of nursing home and hospital immunity orders in Illinois and elsewhere. Alerted recently to 2020-35 and its renewals, Kohn wrote in an e-mail, "Just when you think it can't get worse, you see that what Illinois did was simultaneously suspend substantial portions of both the public system for protecting residents and the private system for protecting residents."

Kohn added, "I think section 2 of 2020-35's suspension of timely investigation of complaints (other than those of abuse and neglect) is particularly concerning. The Governor is essentially giving the agency the freedom not to respond to even serious known problems."

Steven Levin is a partner in a law firm that has been suing Illinois nursing homes for COVID deaths. Asked about EO 2020-35, he said, "It's ludicrous. My belief is that this is a period of time where the IDPH, to the extent they have the resources, needs to double their efforts to inspect nursing homes. COVID is going to be used as an excuse to not provide care in all the traditional areas where nursing homes fail anyway. 'We can't prevent malnutrition, we can't prevent falls, we can't do anything because we're so focused on COVID,'" he said, paraphrasing the anticipated defenses from the nursing homes.

The Reader asked the governor's press secretary Jordan Abudayyeh by e-mail why Governor Pritzker had been renewing suspensions of IDPH regulations for nursing homes, despite copious evidence that people were dying in these facilities in numbers vastly exceeding deaths of the elderly in noncongregate settings and evidence of neglect and negligence in nursing homes. Abudayyeh replied by referencing an order issued on July 24, just a few days earlier: "In recognition of the changing circumstances in this pandemic, EO 2020-48 has signaled that the provisions in EO 2020-35 will sunset at the end of next month, except for Section 2, which has been rescinded."

Pritzker's order telling IDPH not to enforce nursing home regulations and suspending annual inspections was first issued on May 1. The governor renewed it on May 29 and June 26, all time frames in which the threats COVID posed to those in nursing homes had been well established and widely reported. An April 17 article in the Tribune cited Centers for Disease Control analyses of nursing homes as an "accelerator" of COVID and provided Pritzker administration data on "587 patients and nursing home staffers who tested positive, at a total of 305 nursing homes. At least 125 facilities have had at least one patient or staffer die." A photo caption reads: "Man takes a smoke break outside the Joliet nursing home with 23 virus-related deaths."

The order issued on July 24 states: "Sections 1 and 3-17 of Executive Order 2020-35 are re-issued and extended through August 22, 2020, whereafter Sections 1 and 3-13 shall be rescinded." Abudayyeh attributed Pritzker's July 24 decision ending portions of EO 2020-35 going forward to "changing circumstances," but did not identify any changes in nursing home risks for COVID since May 1. (EO 2020-48 did not "rescind" Section 2, as Abudayyeh claimed, but allowed it to expire on July 26.)

Discussing the months of Pritzker's deregulation of nursing homes during the pandemic, Levin said, "We're basically saying trust the industry to provide care in all the other areas where they've historically failed. No one is watching them and they have the COVID excuse. This may have been the worst time to relax oversight."   v

Jacqueline Stevens is a political science professor at Northwestern University. Research assistance from ĺnes Hinojosa and Caleb Young.

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