Covid Lockdowns Healthcare Access Minority Communities Tremo Capstone Project

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How Did Mayor Bill de Blasio’s COVID Lockdowns Affect Access to Healthcare for the Minority Population in Tremont?

Chapter 1


Introduction


The panic regarding the 2020 COVID-19 pandemic led to new administrative challenges regarding protecting and serving communities at the same time. Many cities across America reacted to COVID by trying to curb the virus\'s spread through the implementation of lockdowns. Local governments implemented drastic measures that changed daily life overnight and exposed the vulnerabilities of already underserved and marginalized communities.
In New York City, the epicenter of the pandemic in the United States, Mayor Bill de Blasio\'s office issued a series of lockdown policies starting in March 2020 (NYC, 2020) These policies included the closure of non-essential businesses, the implementation of remote learning, the restriction of public gatherings, and the enforcement of social distancing in essential services (NYC, 2020). The media by and large reported on these measures as necessary to contain the public health crisis; however, for the public affected by these measures, there were far-reaching consequences—particularly for the population of Tremont in the Bronx.
Tremont is a predominantly minority community in the Bronx. It has long been characterized by socio-economic disparities, such as high poverty rates and inadequate access to healthcare (NYC, 2020). There are 28,095 residents in Tremont, with a median age of 32. 46.46% are males and 53.54% are females. US-born citizens make up 54.9% of the residents in Tremont, and non-US-born citizens account for 25.36%. 19.74% of the population consists of non-citizens. The neighborhood\'s residents are mostly African American (11%), Asian (23%), and Hispanic (57%), all groups that have historically dealt with systemic barriers to economic mobility and healthcare equity (Census Reporter, 2024; Gilbert et al., 2022). The COVID-19 pandemic lockdown response essentially aggravated already existing challenges for this population by further limiting access to critical services. The purpose of this dissertation is to explore the specific impact of the lockdown policies implemented between March 2020 and September 2020 on the socio-economic conditions of low-income residents in the Tremont neighborhood. In particular, the research will focus on how these policies affected access to healthcare for the minority population in this community.

Contextualizing the Tremont Neighborhood in the Bronx


It is important to understand the pre-pandemic socio-economic condition of Tremont. Like many other neighborhoods in the South Bronx, Tremont is home to a low-income, minority population that has experienced continual challenges related to poverty, healthcare access, and environmental racism (Brennan, 2021; Estevez, 2020). Indeed, the Bronx has one of the highest poverty rates in New York City, with many residents relying on public assistance and living in overcrowded housing (Clark & Shabsigh, 2022). These socio-economic conditions have long contributed to health disparities in the borough, as minority communities experiencing higher rates of chronic diseases compared to other parts of the city (Shiman, 2021).
The social determinants of health also include environmental factors which have certainly impacted the health of Tremont residents. The South Bronx, including Tremont, has been disproportionately affected by environmental hazards, such as poor air quality and high levels of pollution. Estevez (2020) notes that the South Bronx has historically been subject to political practices that have allowed hazardous industrial activities in the area, which have in turn contributed to high rates of respiratory illnesses among residents. These pre-existing conditions made the Tremont community particularly vulnerable.
Additionally, Tremont residents have faced systemic barriers to accessing quality healthcare (Shiman et al., 2021). The Bronx is home to several public hospitals and community health…

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HowDidMayorBilldeBlasio’sCOVIDLockdownsAffectAccesstoHealthcarefortheMinorityPopulationinTremont?

Chapter1


Introduction


Thepanicregardingthe2020COVID-19pandemicledtonewadministrativechallengesregardingprotectingandservingcommunitiesatthesametime.ManycitiesacrossAmericareactedtoCOVIDbytryingtocurbthevirus\'sspreadthroughtheimplementationoflockdowns.Localgovernmentsimplementeddrasticmeasuresthatchangeddailylifeovernightandexposedthevulnerabilitiesofalreadyunderservedandmarginalizedcommunities.
InNewYorkCity,theepicenterofthepandemicintheUnitedStates,MayorBilldeBlasio\'sofficeissuedaseriesoflockdownpoliciesstartinginMarch2020(NYC,2020)Thesepoliciesincludedtheclosureofnon-essentialbusinesses,theimplementationofremotelearning,therestrictionofpublicgatherings,andtheenforcementofsocialdistancinginessentialservices(NYC,2020).Themediabyandlargereportedonthesemeasuresasnecessarytocontainthepublichealthcrisis;however,forthepublicaffectedbythesemeasures,therewerefar-reachingconsequences—particularlyforthepopulationofTremontintheBronx.
TremontisapredominantlyminoritycommunityintheBronx.Ithaslongbeencharacterizedbysocio-economicdisparities,suchashighpovertyratesandinadequateaccesstohealthcare(NYC,2020).Thereare 28,095residents inTremont,withamedianageof32.46.46%aremalesand53.54%arefemales.US-borncitizensmakeup54.9%oftheresidentsinTremont,andnon-US-borncitizensaccountfor25.36%.19.74%ofthepopulationconsistsofnon-citizens.Theneighborhood\'sresidentsaremostlyAfricanAmerican(11%),Asian(23%),andHispanic(57%),allgroupsthathavehistoricallydealtwithsystemicbarrierstoeconomicmobilityandhealthcareequity(CensusReporter,2024;Gilbertetal.,2022).TheCOVID-19pandemiclockdownresponseessentiallyaggravatedalreadyexistingchallengesforthispopulationbyfurtherlimitingaccesstocriticalservices.ThepurposeofthisdissertationistoexplorethespecificimpactofthelockdownpoliciesimplementedbetweenMarch2020andSeptember2020onthesocio-economicconditionsoflow-incomeresidentsintheTremontneighborhood.Inparticular,theresearchwillfocusonhowthesepoliciesaffectedaccesstohealthcarefortheminoritypopulationinthiscommunity.

ContextualizingtheTremontNeighborhoodintheBronx


Itisimportanttounderstandthepre-pandemicsocio-economicconditionofTremont.LikemanyotherneighborhoodsintheSouthBronx,Tremontishometoalow-income,minoritypopulationthathasexperiencedcontinualchallengesrelatedtopoverty,healthcareaccess,andenvironmentalracism(Brennan,2021;Estevez,2020).Indeed,theBronxhasoneofthehighestpovertyratesinNewYorkCity,withmanyresidentsrelyingonpublicassistanceandlivinginovercrowdedhousing(Clark&Shabsigh,2022).Thesesocio-economicconditionshavelongcontributedtohealthdisparitiesintheborough,asminoritycommunitiesexperiencinghigherratesofchronicdiseasescomparedtootherpartsofthecity(Shiman,2021).
ThesocialdeterminantsofhealthalsoincludeenvironmentalfactorswhichhavecertainlyimpactedthehealthofTremontresidents.TheSouthBronx,includingTremont,hasbeendisproportionatelyaffectedbyenvironmentalhazards,suchaspoorairqualityandhighlevelsofpollution.Estevez(2020)notesthattheSouthBronxhashistoricallybeensubjecttopoliticalpracticesthathaveallowedhazardousindustrialactivitiesinthearea,whichhaveinturncontributedtohighratesofrespiratoryillnessesamongresidents.Thesepre-existingconditionsmadetheTremontcommunityparticularlyvulnerable.
Additionally,Tremontresidentshavefacedsystemicbarrierstoaccessingqualityhealthcare(Shimanetal.,2021).TheBronxishometoseveralpublichospitalsandcommunityhealthclinics,butmanyofthesefacilitiesareunderfundedandunderstaffedduetostructuralracismwithinthehealthcaresystem,whichhascontributedtodisparitiesinhealthcareaccess,withminoritycommunitiesinneighborhoodslikeTremontreceivinglower-qualitycarecomparedtowealthier,predominantlywhiteareas(Shimanetal.,2021).


ResearchSignificance


InTremont,manyresidentsworkinlow-wage,essentialjobs,oftenwithouttheluxuryofworkingfromhome,whichincreasedtheirvulnerabilityduringthepandemiclockdowns.Theareahaslongfacedsystemicinequitiesinhousing,healthcare,andemploymentopportunities,makingitoneofthemostvulnerablecommunitiesinthecity.Residentswerealreadyathigherriskforpoorhealthoutcomesduetounderlyingconditionssuchasasthma,diabetes,andhypertension(Clark&Shabsigh,2022;Estevez,2020).
TheimportanceofresearchingtheimpactofMayorBilldeBlasio\'sCOVID-19lockdownpoliciesonTremontliesinunderstandinghowthesepublichealthmeasuresworsenedexistingsocialandeconomicdisparities.Theargumentatthetimewasthatlockdownswouldhelptoslowthespreadofthevirus(Hammond,2021).However,littleattentionwasgiventothepotentialproblemofinequalitiesinhealthcareaccessworseningforlow-income,minoritycommunitieslikeTremont.Tremontresidentsalreadyfacedbarrierstoaccessinghealthcare,andin2020,duetoclinicclosures,overwhelmedhospitalsystems,andthelackoftechnologyfortelehealthservices,thehealthsituationofthecommunityworsened.Economically,theshutdownofserviceindustryjobshitthecommunityhard,leadingtounemployment,foodinsecurity,anddifficultiesinobtainingunemploymentbenefits,allofwhichaffectedthesocialdeterminantsofhealthforpoorcommunitieslikeTremont(Shimanetal.,2021).
Researchingtheseissuesisimportantbecauseitallowsforgaininginsightsintotheunintendedconsequencesofpandemicpoliciesonmarginalizedpopulations.ThereisaneedtoknowandunderstandthespecificchallengesfacedbycommunitieslikeTremont,sothatpolicymakersinthefuturecandevelopandadoptmoreequitableapproachestopublichealthcrisesinthefuture,andsothatlow-incomeandminoritypopulationsarenotdisproportionatelyaffectedbysimilarmeasures?.

COVID-19LockdownPoliciesinNewYorkCity


InresponsetotheCOVIDcrisis,MayordeBlasio’sofficeusheredinapolicyoflockdownthatlastedformonths.Essentialbusinesseslikegrocerystoresandhealthcareproviderswereallowedtoremainopenbutwererequiredtoimplementstrictsocialdistancingandhygieneprotocolstoprotectbothemployeesandcustomers(NYC,2020).ManyTremontresidentswereemployedinthesesectorsandwereunabletoworkremotely.Helmreich(2023)notesthattheeconomicimpactofthelockdownwasparticularlysevereintheBronx,wherealargeproportionofresidentsrelyonhourlywagesanddonothavethefinancialsafetynetsthatwealthierindividualsmightpossess.
Moreover,theclosureofschoolsandtheshifttoremotelearningposedadditionalchallengesforlow-incomefamiliesinTremontduetothepre-existingdigitaldivide.Thelong-termeffectsofthiseducationaldisruptionarestillbeingstudied,butearlyresearchsuggeststhatstudentsfromlow-incomehouseholdsexperiencedsignificantlearninglossduringthepandemic(Friedmanetal.,2023).
PerhapsoneofthemostcriticalareasaffectedbytheCOVID-19lockdownpolicieswashealthcareaccess.ForresidentsofTremont,whoalreadyfacedsignificantbarrierstohealthcare,thelockdownpoliciesfurtherlimitedtheirabilitytoaccessmedicalservices(Roldósetal.,2024).Theclosureofnon-essentialmedicalfacilities,suchasprimarycareclinicsanddentaloffices,meantthatmanypeoplewereunabletoreceiveroutinecare—nottomentionthefactthatthepoliciesofthemayor’sofficesupportedasocialstigmaalreadyintroducedbynon-stopmediahypeofthedangersofgoingoutinpublic.Peoplewerescaredandhesitanttoseekmedicalcareduetoconcernsaboutexposuretothevirus.Asaresult,conditionsthatmighthavebeenmanageableundernormalcircumstancesworsenedduringthelockdownperiod.HuangandLi(2022)pointoutforinstancethatspatialhealthdisparitieswereworsenedduringthepandemic,withlow-incomeandminoritycommunitiesexperiencinghigherratesofsevereillnessanddeathduetodelayedcareandreducedaccesstohealthcareresources.
Thepandemicalsorevealedlong-standingissuesrelatedtohealthequityinNewYorkCity.COVID-19mortalityratesweredisproportionatelyhighinneighborhoodswithlargeminoritypopulations,suchastheSouthBronx(Friedman&Lee,2023).Factorssuchasovercrowdedhousing,aneedtorelyonpublictransportation,andlimitedaccesstohealthcarecontributedtothehigherratesofinfectionanddeathinthesecommunities(Friedmanetal.,2023).Thelockdownpoliciesshowedlittleconsiderationfortheunderlyingstructuralissuesandmayhaveworsenedexistingdisparities.Isthishowpolicyservesacommunity?


ProblemStatement


ThecoreproblemthisresearchseekstoaddressistounderstandhowtheCOVID-19lockdownpoliciesimplementedbytheNewYorkCitygovernmentimpactedhealthcareaccessandsocio-economicconditionsinTremont.Thepolicieswereintendedtomitigatethepublichealthcrisis,buttheymayhaveactuallyworsenedthesituationforlow-income,minoritypopulations.Understandingthespecificsocio-economicandhealthcarechallengesfacedbythesecommunitiesiscrucialfordevelopingmoreequitablepublichealthpoliciesinthefuture.
TheBronxhasconsistentlyexhibitedhighpovertyratesandunemployment,particularlyinlow-incomeneighborhoodssuchasTremont.Priortothepandemic,theBronxhadapovertyrateofnearly27%,thehighestofallNewYorkCityboroughs(Clark&Shabsigh,2022).Thisisanimportantpointbecauseofthesocialdeterminantsofhealth,whichaffecthealthoutcomesinbigwaysforcommunitieslikeTremont.Whenhealthcareaccessisrestricted,andthesocialdeterminantsofhealthareworsenedduetorestrictivepolicieslikelockdowns,itcancreateaperfectstormthatwreakshavoconcommunityhealth.
AccordingtoShimanetal.(2021),structuralracismandinadequatehealthcareinfrastructurehavelongaffectedminoritycommunitiesintheBronx,andhavealreadycontributedtopoorhealthofthepopulation.TheCOVID-19pandemicfurtherstrainedthesealreadylimitedhealthcareresources.
TremontandotherpartsoftheSouthBronxhavealsosufferedfrompoorairqualityandotherenvironmentalhazards,whichhavecontributedtohigherratesofasthmaandotherrespiratorydiseases(Estevez,2020).ThispointjustgoestoshowthatresidentsinTremontwerealreadyinapoorhealthposturebeforethelockdowns.
Helmreich(2023)showsthatthelockdownmeasuressignificantlyincreasedunemploymentratesintheBronx,wheremanyresidentsworkedinsectorshardesthitbythepandemic,suchasretailandhospitality.Withouteconomicsupportandstability,socialdeterminantsofhealthcanquicklydisappearleavingresidentswithouthealthsupport.

ResearchObjectives


Themainobjectiveofthisdissertationistoexaminethesocio-economicandhealthcareimpactsoftheCOVID-19lockdownpoliciesontheTremontneighborhoodintheBronx.Specifically,theresearchaimstoanswerthefollowingquestions:HowdidthelockdownpoliciesaffectaccesstohealthcarefortheminoritypopulationinTremont?Whatwerethebroaderconsequencesofthesepolicies,particularlyintermsofpublichealth?Throughanexplorationofthesequestions,thisdissertationlookstocontributetoadeeperunderstandingofhowemergencypublichealthmeasurescanimpactvulnerablecommunitiesandtoprovideinsightsintohowfuturepoliciescanbedesignedtoconsidersucheffects.
Indoingso,thisresearchwilldrawonarangeofprimaryandsecondarysources,includingpublichealthdata,governmentreports,andacademicstudies.ItwillalsoconsidertheperspectivesofcommunitymembersandhealthcareprovidersinTremont,whocanoffervaluableinsightsintothelivedexperiencesofresidentsduringthepandemic.Ultimately,thegoalofthisdissertationistoshedlightonthespecificchallengesfacedbylow-income,minoritycommunitiesduringtheCOVID-19pandemicandtoproviderecommendationsforaddressingthesechallengesinfuturepublichealthemergencies.
Toachieveitsobjective,thisstudyusesaqualitativeresearchmethodology,whichissuitedbecausethisresearchrequiresin-depthexplorationofthelivedexperiencesofresidentsandstakeholdersduringthepandemic(Crabtree&Miller,2023).Afocusonsubjectiveexperiencesandcommunity-specificissuescanbeappliedbywayofthequalitativemethodology,whichsupportsdeepunderstandingofhowthelockdownpoliciesinfluencedhealthcareaccessandsocio-economicconditionsinthislow-income,minorityneighborhood(Crabtree&Miller,2023).
Datawillbecollectedprimarilythroughsemi-structuredinterviewswithresidentsofTremont,healthcareprofessionals,localbusinessowners,andeducators.Theseinterviewswillexploretheirperceptionsofthelockdownpolicies,focusingontheireffectsonaccesstohealthcare.Thesemi-structurednatureoftheinterviewsallowsforflexibility,enablingparticipantstosharepersonalexperienceswhileensuringthatkeyresearchquestionsareaddressed(Crabtree&Miller,2023).Additionally,focusgroupswillbeconductedwithcommunity-basedorganizationstogathercollectiveinsightsintohowthepandemicaffectedthebroaderneighborhood.
Documentanalysiswillalsobeemployed,reviewinglocalgovernmentreports,publichealthdata,andnewsarticlesthatdocumenttheimplementationofCOVID-19policiesinNewYorkCity.Thiswillprovidecontextualbackgroundandhelptriangulatethefindingsfrominterviews.
Thematicanalysiswillbeusedtoidentifypatternsandthemesemergingfromthequalitativedata.Thisapproachallowstheresearchertocategorizeandinterpretthedatabasedonrecurringconcepts,suchasbarrierstohealthcareoreconomichardships.Theuseofqualitativemethodswillofferrich,detailedinsightsintothesocialandhealthcareinequalitiesexacerbatedbytheCOVID-19lockdown,contributingtoadeeperunderstandingofitsimpactonvulnerablecommunities.


Chapter2:ImpactofCOVID-19LockdownPoliciesonHealthcareAccessinTremont


IntroductiontoTremont


Tremontisanoverwhelminglylow-income,minorityneighborhoodlocatedintheSouthBronx,NewYorkCity.LikemanyneighborhoodsintheBronx,Tremonthasapoortrackrecordwhenitcomestothesocialdeterminantsofhealth,duetohighpovertyrates,environmentalhazards,andinadequateaccesstohealthcareservices.ThecommunityisprimarilycomposedofAfricanAmericanandHispanicpopulations,manyofwhomhavehistoricallyfacedsystemicbarrierstohealthcare.TheseexistingdisparitiesmadeTremontparticularlyvulnerableduringtheCOVID-19pandemic,asresidentswerealreadyathigherriskforpoorhealthoutcomesbecauseofunderlyingpre-existinghealthconditionslikeasthma,diabetes,andhypertension(Clark&Shabsigh,2022;Estevez,2020).
ThisresearchfocusesspecificallyonthehealthcareimplicationsoftheCOVID-19lockdownpoliciesimplementedbyMayorBilldeBlasio’sofficebetweenMarch2020andSeptember2020.Throughtheclosingofnon-essentialbusinessesandmandatingsocialdistancingandremotelearning,themayor’spolicieshadfar-reachingeffectsonaccesstohealthcareforminoritypopulationsintheneighborhoodofTremont.Tremontcouldstandinasrepresentative,infact,oflow-income,marginalizedminorityneighborhoods.Thus,understandinghowthemayor’spoliciesaffectedhealthcareaccessinTremontishelpfulfromapublicadministrationstandpointbecauseitcanshedlightonthestructuralvulnerabilitiesofmarginalizedcommunitiesduringpublichealthcrisesandtheextenttowhichpublicadministrators’policiesandactionsworsenorhelpalleviatethosevulnerabilities.Furthermore,itcanprovideimportantinsightsintohowfutureemergencymeasurescanbedesignedtoprotectandsupportlow-income,minoritypopulationsmoreeffectively.

COVID-19LockdownPoliciesandTheirRelevancetoHealthcareinNYCandTremont


In2020,inthetwozipcodeareasinwhichTremontislocated,COVID-19caseswerebetween39,000and44,000per100,000people(NYCCOVID-19Data,2024).TotaldeathcountofthetwozipcodesforCOVID-relateddeathswas688(NYCCOVID-19Data,2024).TheBronxoverallwasthehardesthitareaofNYCwith3,556hospitalizationsper100,000(NYCCOVID-19Data,2024).Likewise,theBlackandLatinocommunitieswerethemostaffected,whichiswhatmakesupthemajorityoftheTremontpopulation(NYCCOVID-19Data,2024).Per100,000BlacksandLatinosinallofNYC,3,000ofeachwerehospitalizedduetoCOVID(NYCCOVID-19Data,2024).Furthermore,peopleinveryhighpovertywerehospitalizedthemost,with3,539hospitalizationsoftheveryhighpovertydemographicper100,000residentsoccurringcitywide(NYCCOVID-19Data,2024).
OnMarch15,2020,theOfficeoftheMayorissuedapressreleasethatcoveredavarietyofactionsthattheresidentsofthecitywereexpectedtofollowregardingCOVID.Actionpertainingtohealthcareincludedthefollowingundertheheadline“NewGuidanceforHealthProviders”:“Tominimizepossibleexposurestohealthcareworkers,vulnerablepatientsandreducethedemandforpersonalprotectiveequipment,theDepartmentofHealthandMentalHygienewilladvisepatientswithmildtomoderateillnessestostayhome.”(NYC,2020b).Thisdirective,whileseemingperhapsmildinintention,carriedagreatdealofgravityinlightoftheensuingpressreleasesandnoticesthatfollowedoverthecourseof2020—allofwhichcarriedanintensifyingtoneofworry,concern,causeforalarm,andoverallfearforthespreadofCOVID.Essentially,itlaidthegroundworkforresidentstobeginpullingbackfromalifeofnormalcy;thesuggestionappearedtobethat—unlessonehasahealthemergency—donottrytoaccesshealthcare.Intentionalornot,thatmessageisconveyedinthesub-textofthispressreleaseofMarch15,andreinforcedbythenumerousnoticesthatfollowed.
PerhapsthemostimportantpressreleasefromtheMayor’sOfficecameonMarch22nd,2020,whenalarmbellsbegantoberungbycityofficialsinearnest.


Mayor’sOfficePressRelease:


NewGuidanceforNewYorkers


“EffectiveSunday,March22nd,at8:00PM,allnon-essentialbusinessesinNewYorkCitywillbeclosed. Onlybusinesseswithessentialfunctionswillbepermittedtooperate,suchasgrocerystores,pharmacies,internetproviders,fooddelivery,banks,financialinstitutionsandmasstransit.Businessesthatprovideessentialservicesmustimplementrulesthathelpfacilitatesocialdistancing.TheNYPDwillbeoutinneighborhoodsacrosstheCitytoensurecompliancewiththepolicies.
“TheCitywillalsoenforcethefollowingrulesfornon-vulnerableindividualswithfinesandmandatoryclosures:
·Nonon-essentialgatherings;anyconcentrationofpeopleoutsidetheirhomemustbelimitedtoworkersprovidingessentialservices

·Practicesocialdistancinginpublic(6feetormore)


·Individualsshouldlimitoutdoorrecreationalactivitiestonon-contact.
·Limituseofpublictransportationtoonlywhenabsolutelynecessary.
·Sickindividualsshouldnotleavehomeexcepttoreceivemedicalcare.
“TheCitywillalsoenforce“Matilda’sLaw,”whichsetsthefollowingrestrictionsforvulnerableNewYorkerswhoareovertheageof70and/orimmune-compromised:

o  Remainindoors


o  Limitoutdooractivitytosolitaryexercise


o  Pre-screenallvisitorsandaidesbytakingtemperature


o  Wearamaskwhenincompanyofothers


o  Donotvisithouseholdswithmultiplepeople


o  Everyoneinpresenceofvulnerablepeopleshouldwearamask


o  Staysixfeetfromotherpeople


o  Donottakepublictransportationunlessabsolutelynecessary”(DeBlasio,2020).
Themessagewasclear:peopleshouldnotbeoutandabout,shouldnotbegoingabouttheirlivesnormallyastheywouldotherwise;andbyextensiontheyshouldnottrytoaccesshealthcareastheynormallywould.MayordeBlasio’sguidancewasfollowedthreeweekslaterbythefollowinghealthalert:
“April11,2020DearColleagues:IthasbeenmorethanfiveweekssinceNewYorkCityreporteditsfirstpersondiagnosedwithCOVID-19.WecontinuetoseeanincreasingnumberofpersonsdiagnosedwithCOVID-19,includingthosewhorequirehospitalization.AsofApril11,2020,therewere96,522COVID-19casesreportedinNewYorkCity,with27%hospitalized,and5,463confirmeddeaths.Tocontinuetoflattenthecurveofthispandemicandtoprotecthealthcaredeliverysystems,itiscriticaltocontinuetoenforceandadheretoexistingmitigationmeasures,includingallsocial(physical)distancinginterventions”(2020HealthAlert#10,2020).
Again,themessagetoresidentswasclearandominous:sociallydistance,anddonotgooutorbenearothers.FearcontinuedtobeamplifiedandNewYorkerscontinuedtobewarnedthattheymustadheretoMayordeBlasio’slockdownprotocolsto“flattenthecurve.”Insuchaheightenedstateofalarm,allnormalcycouldbeexpectedtobeabandoned—includingthereceptionofregularhealthcareservices.Thesemaywellindeedhaveremainedavailable,technically,buttheMayor’sOfficewasclearlywarningresidentsthattheyshouldhide.
Thefollowingmonth(May4,2020)HealthAlert#13wentoutalertingresidentsofanotherinfectiousdiseasespreading:“apediatricmulti-systeminflammatorysyndrome”whichratchetedupfearsstillfurther,asthoughNewYorkersneededmorefuelfortheirworry(2020HealthAlert#13,2020).
ByOctober2020,thestrategymeanttoslowthespreadandflattenthecurvewasnotonlystillbeingimplementeditwasalsobecomingmoredraconian,asthecityissuedyetanotherNOTICEtoNewYorkers:


October9,2020NOTICE:


NewYorkCity’sLocalizedCOVID-19RestrictionsToalllicenseesandregistrants:


“TheCityofNewYorkhastakenactioninresponsetotheincreasedspreadofCOVID-19casesinparticularneighborhoodsbyimplementingrestrictionsinthreezonesidentifiedbytheState—designatedred,orange,andyellow.Visitnyc.gov/COVIDZonetoidentifytheareasineachzoneandfamiliarizeyourselfwiththerestrictionsrelatingto:•Publicandnon-publicschools•Businesses•Foodserviceestablishmentsincludingindoorandoutdoordining•Housesofworship•Non-essentialgatherings
Restaurantslocatedintheredzonesareprohibitedfromindoorandoutdoordiningandmayonlyoffercarryoutanddeliveryoptions.Restaurantslocatedintheorangezonescanofferoutdoordiningandtakeoutanddeliveryserviceonly.Thereisafour-personmaximumpertable;noindoordiningisallowed.OnlyessentialbusinessesasdesignatedbyNewYorkStateEmpireStateDevelopmentCorporationcanremainopenintheredzones.Allnonessentialbusinesseslocatedintheredzonesmustclose.Licenseesandregistrantsshouldcommunicatewiththeircustomerstoensurewasteiscollectedpromptlyandsafely.BusinessIntegrityCommissionenforcementagentswillbepatrollingtheaffectedareas”(NYC,2020c).
ByDecember2020,thecityessentiallyannouncedthattherewouldbenoreturntothepre-COVIDnormal—lifewasnowchangedforeverfromhereonout:“TheCOVID-19pandemichaschangedhowweliveandworkinNewYorkCityinmanyways…”thepressreleasebegan(NYC,2020d).Itpertainedprimarilytoroadsafety—buttheominoustonetoldfarmorethanthetextonthestatementdid.MayordeBlasio’sCOVIDresponsehadalteredthewaythepeopleofNewYorklivedtheirlives—and,tosomeextent,howtheycaredforthem.
Finally,onMay1,2021,alittleoveroneyearaftertheinitialpressreleasegivenbytheMayor,anoticeentitled“ManagingtheReturntotheOfficeintheAgeofCOVID-19”wasissued.NotonlywasallpretensetoslowingthespreadgoneforgoodbuttheOfficewasnowusingthetragic-sounding“AgeofCOVID-19”todefinethetimesinwhichpeoplenowfoundthemselvesliving.AmongtherequirementsofpeoplereturningtoworkoneyearaftertheattemptbytheMayortobeginflatteningthecurvewithlockdownswerethefollowing:
·PublicareasarebeingcleanedinaccordancewithDOHMH’sguidance
·6ft.markershavebeenimplementedandposteforenforcingtheCity’shealthassessmentrequirementsforemployers,visitors,andclients.
·Occupancylimitationsforsharedspaces(e.g.,conferencerooms,huddlespaces,pantries,breakrooms,copyrooms)havebeenposted.
·Signagehasbeenpostedthroughoutallworkspacesremindingindividualstoadheretoproperhygiene,physicaldistancingrules,facecoveringrequirements,andcleaninganddisinfectingprotocols.
·Workspacesthatdonotallowforphysicaldistancinghavebeenblockedoff(NYC,2021).
Incaseanyonehadfailedtorealize,MayordeBlasio’sOfficehad,toputitcolloquially,doubled,tripled,andquadrupleddownonhisinitialCOVIDresponsestrategy.WhateversenseNewYorkershadofbeingpartofacommunityinwhichtheycouldlive,breathe,andmingleasonepeoplewithoutfearorworrywaseffectivelyallbutgone.Surely,thisapproachtoapublichealthcrisishadaneffectontheextenttowhichthepeopleofTremontenjoyedaccesstoregularhealthcare.


OtherConsiderations


NewYorkCity’slockdownsin2020delayedserioushealthcareproceduresformanyintheBronx.Cancerandmentalhealthtreatmentswerepostponedduring2020atalarminglyhighrates(Dorviletal.,2023).Indeed,Dorviletal.(2023)foundthat“morethanhalfofparticipants(54%)reporteddisruptiontoeitherroutinephysicalhealthcareormentalhealthservices.ConcernaboutgettingCOVID-19(61%),stay-at-homepolicies(40%),beliefthatcarecouldsafelybepostponed(35%),andappointmentchallenges(34%)wereamongreasonsfordelayingroutinehealthcare.ConcernaboutgettingCOVID-19(38%)andreducedhoursofservice(36%)wereprimaryreasonsfordelayingmentalhealthcare.Reportedreasonsforthesustaineddelayofcarepast18?monthsinvolvedCOVIDconcerns,appointment,andinsurancechallenges”(p.1).

Ultimately,Hammond(2021)boileditdowntoafewpoints:


·“Thestate’searlyresponsewasunderminedbyflawedguidancefromthefederalgovernment,inadequateplanningandstockpiling,limitedconsultationwithexperts,exaggeratedprojectionsandpoorcooperationbetweenfederal,stateandlocalofficials,amongotherissues.
·“Todate,noneoftheLegislature’spandemic-relatedhearingshasfocusedonthecriticalmisstepsofthestate’searlyresponse.
·“Better-controlledoutbreaksincountriessuchasSouthKoreademonstratethevalueofpublichealthpreparednessandcouldserveasamodelforNewYork”(p.1).
Clearly,theCOVID-19lockdownshadbigconsequencesforlow-incomecommunities.TheeffectswereparticularlysevereintermsofaccesstohealthcareforthepeopleofTremont,however.
Tremontexperiencednewbarrierstohealthcareduringthelockdown.Theclosureofclinicsandrestrictedpublictransportationoptionsmadeitdifficultforresidentstoaccessessentialmedicalservices,asDorviletal.(2023)pointedout,iftheyevenwantedtotryinthefaceoftheMayor’sOffice’swarnings.Theshifttotelemedicinealsolikelyaffecteddisparities,asmanylow-incomehouseholdslackedaccesstostableinternetorthenecessarytechnologytoparticipateinvirtualhealthcarevisits(OfficeoftheStateComptroller,2021).ThisdigitaldividewasamajorissueforthecommunityofTremont,whereresidentsalreadyfacedsystemicbarrierstohealthcarebeforethepandemic.
InTremont,aselsewhereintheUS,therewasreducedaccesstopreventivecare,chronicdiseasemanagement,andevennecessarymentalhealthservices(Irimataetal.,2023).Thelockdownordersessentiallyexposedhealthcareinequitiesforthosedealingwithdiabetesandotherchronicconditionsthatrequireconsistent,regularmanagement.Theclosureofnon-essentialbusinessesandhealthcarefacilitieslimitedresidents’accesstoroutinemedicalservices,preventivecare,andmanagementofchronicconditions.ThiswasparticularlyproblematicforTremont’sminoritypopulation,manyofwhomrelyonlocalcommunityhealthcentersandpublichospitalsforaffordablehealthcare.Thesefacilities,alreadyunderfundedandstrainedbeforethepandemic,werefurtheroverwhelmedbythesurgeofCOVID-19cases,makingitdifficultforresidentstoreceivetimelyandadequatemedicalcare(Shimanetal.,2021).


HealthcareAccessChallengesDuringtheLockdown


OneofthemostsignificantconsequencesofthelockdownpolicieswasthedisruptionofhealthcareservicesinTremont,asintheotherlow-incomecommunitiesoftheBronx(OfficeoftheComptroller).Thecitywideshutdownofnon-essentialservicesincludedmanyhealthcareproviders,suchasprimarycareclinicsandspecialists,whichplayedanimportantpartinmanagingchronicconditionsforresidentsoflow-incomeneighborhoodslikeTremont.Chronicconditions,includingasthma,diabetes,andcardiovasculardisease,areprevalentintheBronxanddisproportionatelyaffectminoritypopulations(Clark&Shabsigh,2022).Withlimitedaccesstohealthcareprovidersduringthelockdown,manyresidentswereunabletoreceiveessentialcare,leadingtoadeteriorationintheirhealth.TheOfficeoftheComptroller(2023)concluded:
“AccordingtothemostrecentNewYorkCityCommunityHealthProfiles,eachofthe10neighborhoodsintheboroughhadratesofdiabetes,obesityandhypertensionthatweresimilarorhigherthanthecitywideaverage,withnoneexperiencingratesbelowtheaverage.TheNewYorkCityDepartmentofHealthandMentalHygienehasnotedtheprevalenceofthesepoorerhealthoutcomesinlow-income,minoritycommunitieswhereeconomicstressanddiscriminationcanlimitaccesstoqualityhealthcare.
“AnalysisofthecorrespondencebetweenCOVID-19healthoutcomesintheBronxandmedianhouseholdincomeandshareofminorityresidentsfoundanassociationwithmoreseverehealthimpacts.Ingeneral,throughoutthepandemic,thesixneighborhoodswiththelowesthouseholdincomesintheBronx,amongthelowestcitywide,havebeenamongthosewiththehighesthospitalizationratesfromCOVID-19.MostZIPcodesassociatedwiththeseneighborhoodsfellwithinthetopthirdofhospitalizationratescitywide.ThefourBronxneighborhoodsthathadmoremoderatemedianhouseholdincomesalsohadlowerhospitalizationrates.
“NeighborhoodsintheCitythathadahighershareofminorityresidentsgenerallyexperiencedhighercumulativecaseratesanddeathrates.EighteenoftheCity’s55Census-definedneighborhoodshadaminoritypopulationinthetopthirdin2019,greaterthan83percent. Ofthese18Cityneighborhoods,eightwereintheBronx.The20ZIPcodescoveringtheseeightBronxneighborhoodsallhadcumulativedeathrateswithinthetophalfofallCityZIPcodes,and11wereinthetopthird.Theresultsareverysimilarforcaserates.
“Whilesimilarneighborhoodsarealsolocatedinotherboroughs(andwereaffectedsimilarlytothoseintheBronx),thoseboroughsalsoincludemoremiddle-andhigh-incomeareas,whichwereaffectedlessseverelyandgenerallysufferedfromlowerratesofhospitalizationsanddeaths.”
Additionally,thehealthcaresystemintheBronxwasoverwhelmedbythepandemic,withhospitalsinundatedbyCOVID-19patients(OfficeoftheComptroller,2023).Thisstrainonthesystemresultedindelaysintreatmentfornon-COVIDconditions,furtherexacerbatinghealthcaredisparitiesinTremont.Residentsfacedlongerwaittimesformedicalappointments,reducedaccesstotestingandtreatmentforchronicconditions,andlimitedavailabilityofhealthcareprofessionalsduetothereallocationofresourcestowardCOVID-19care(Friedman&Lee,2023).ThelackofaccessiblehealthcareduringthiscriticalperiodmayhavecontributedtoworsenedhealthoutcomesinTremont,asresidentswereunabletomanagetheirexistinghealthissueseffectively.


DisproportionateImpactonMinorityPopulationsinTremont


TheCOVID-19pandemicdisproportionatelyaffectedminoritypopulationsacrossNewYorkCity,withAfricanAmericanandHispaniccommunitiesexperiencinghigherratesofinfection,hospitalization,anddeath(OfficeoftheComptroller,2023).InTremont,wherethemajorityofresidentsbelongtotheseminoritygroups,thelockdownpoliciescompoundedexistinghealthcaredisparities.Structuralfactorsincludedovercrowdedhousing,relianceonpublictransportation,loweraccesstohealthcare,andlowerratesofhealthinsurancecoverage,allofwhichincreasedresidents’vulnerabilityandlimitedtheirabilitytoaccesshealthcareservicessafelyduringthelockdown(Friedmanetal.,2023).
Moreover,manyTremontresidentsfacedlanguagebarriers,lackofinternetaccess,andlimitedhealthliteracy,whichfurtherhinderedtheirabilitytonavigatethehealthcaresystemduringthepandemic(OfficeoftheComptroller,2023).Thetransitiontotelemedicineservices,whichbecamemoreprevalentduringthelockdown,posedadditionalchallengesforlow-incomeresidentswholackedreliableinternetaccessorthedigitalliteracyneededtoparticipateinvirtualhealthcareappointments(Roldós,Jones,&Rajaballey,2024).Asaresult,manyresidentswereunabletoreceivetimelymedicaladviceorfollow-upcare,furtherexacerbatinghealthdisparitiesinthecommunity.

TheRoleofPublicHospitalsandCommunityHealthCenters


Publichospitalsandcommunityhealthcentersareessentialinprovidinghealthcaretolow-incomeresidentsinneighborhoodslikeTremont.However,theseinstitutionswereseverelyimpactedbythepandemic,astherewereresourceshortages,staffburnout,andanoverwhelminginfluxofCOVID-19patients.AccordingtoHuangandLi(2022),hospitalsintheBronx,includingthoseservingTremont,wereamongthehardesthitduringtheearlymonthsofthepandemic,withmanyreachingcapacityandstrugglingtoprovideadequatecare.
Communityhealthcenters,whichprovideessentialservicessuchasprimarycare,dentalcare,andmentalhealthsupport,wereforcedtoreduceservicesorclosetemporarilyduetothelockdownpolicies.ThisleftmanyTremontresidentswithoutaccesstobasichealthcareservices,whicharecriticalformanagingchronicconditionsandmaintainingoverallhealth.Thereducedavailabilityoftheseservicesduringthelockdownmayhavecontributedtothedeteriorationofhealthoutcomesintheneighborhood,particularlyforvulnerablepopulationswhorelyonaffordable,accessiblehealthcare(Shimanetal.,2021).

TheConsequencesofDelayedandReducedHealthcareAccess


Thedelayedandreducedaccesstohealthcareduringthelockdownhadsignificantconsequencesforthehealthandwell-beingofTremontresidents.Forindividualswithchronicconditions,suchasdiabetesorhypertension,regularmedicalvisitsareessentialformonitoringandmanagingtheirhealth.Theinabilitytoaccesstheseservicesduringthelockdownlikelyledtotheworseningoftheseconditions,increasingtheriskofcomplicationsandhospitalizations(Clark&Shabsigh,2022).
Furthermore,thedelayinseekingcareduetofearofcontractingCOVID-19inhealthcaresettingscontributedtopoorerhealthoutcomes.Manyresidentswerehesitanttovisithospitalsorclinicsduringthepandemic,evenforurgenthealthissues,duetoconcernsaboutexposuretothevirus.Thisfear,combinedwiththeoverwhelmedhealthcaresystem,resultedinmanyindividualsdelayingorforgoingnecessarymedicalcare,leadingtopreventablehealthcomplications(Huang&Li,2022).


AddressingtheHealthcareDisparitiesExacerbatedbytheLockdown


TheCOVID-19pandemicunderscoredthedeep-rootedhealthcaredisparitiesthatexistinlow-income,minorityneighborhoodslikeTremont.Thelockdownpolicies,whilenecessarytocontrolthespreadofthevirus,furtherlimitedaccesstohealthcareforvulnerablepopulationsandexacerbatedexistinginequalities.Movingforward,itisessentialforpolicymakerstoconsidertheuniqueneedsofmarginalizedcommunitieswhendesigningpublichealthinterventions.Ensuringequitableaccesstohealthcare,particularlyduringpublichealthemergencies,iscriticaltopreventingfurtherharmtothesecommunities.
Policyrecommendationsforfuturepublichealthcrisesshouldincludeincreasedfundingforpublichospitalsandcommunityhealthcenters,expandedaccesstotelemedicineserviceswithsupportfordigitalliteracyandinternetaccess,andtargetedoutreacheffortstoensurethatminoritypopulationsreceivetimelyandaccuratehealthinformation.Byaddressingthesesystemicissues,policymakerscanhelpreducehealthcaredisparitiesandimprovehealthoutcomesforlow-income,minoritycommunitieslikeTremontduringfuturecrises(Shimanetal.,2021;Friedman&Lee,2023).

Conclusion


TheCOVID-19pandemicandthesubsequentlockdownpoliciesenactedbyMayorBilldeBlasio’sofficebetweenMarch2020andSeptember2020hadseriouseffectsonlow-incomecommunitiesacrossNewYorkCity,particularlyinneighborhoodslikeTremontintheBronx.Asthisresearchhasshown,Tremontishometoapredominantlyminorityandlow-incomearea,andwasalreadygrapplingwithsignificantsocio-economicchallenges,includinginadequateaccesstohealthcare,highratesofchronicillnesses,andenvironmentalinjustices,allofwhichcontributetothesocialdeterminantsofhealthanddisease.Thesepre-existingvulnerabilitieswereespeciallyworsenedbythepublichealthmeasuresofthemayor’soffice.
ThelockdownpoliciesresultedinthetemporaryclosureorlimitationofmanyhealthcarefacilitiesthatresidentsofTremontreliedonforessentialservices.Communityclinicsandpublichospitals,whichprovidecaretouninsuredandunderinsuredresidents,werealsooverwhelmedbythesurgeofCOVID-19patients.Thisledtodelaysincarefornon-COVID-relatedhealthissuesandareductioninroutinemedicalservices,suchaschronicdiseasemanagementandpreventivehealthcare,worseninghealthoutcomesformanyinthecommunity.
Furthermore,thehealthcaredisparitiesthatwerealreadypresentinTremontbecamemorepronouncedasaccesstocarediminishedduringthelockdown.Factorssuchasovercrowdedlivingconditions,relianceonpublictransportation,andlimitedaccesstodigitalresourcesfortelemedicinefurtherexacerbatedthesechallenges,placingTremont’sresidentsatahigherriskofsevereillnessanddeathfrombothCOVID-19anduntreatedpre-existingconditions.

Chapter3:Methodology


ThischapterdiscussestheresearchmethodsusedtoexplorehowMayordeBlasio’sCOVID-19lockdownpoliciesaffectedaccesstohealthcarefortheminoritypopulationinTremont.Asthisstudy’sintentionistoexploreandbetterunderstandthelivedexperiencesofamarginalizedcommunity,aqualitativeresearchmethodologyisutilized.Thisapproachallowsforadetailedinvestigationintotheperceptionsandhealthcare-relatedexperiencesandrealitiesfacedbyresidentsduringthepandemic.


ResearchDesign


ThestudyusesacasestudyapproachtofocusonTremont,alow-income,predominantlyminorityneighborhoodintheBronx.Thequalitativemethodologyischosenbecauseitprovidesanin-depthexaminationofpersonalexperiences,asdescribedbyCrabtreeandMiller(2023).Thisapproachenablestheresearchertoexploretheconsequencesoflockdownpoliciesonhealthcareaccess,employment,andeducationbygatheringprimarydatafromtheaffectedcommunity.
Thetwoprimarymethodsofdatacollectionusedweresemi-structuredinterviews,conductedwithresidentsofTremontandlocalhealthcareprofessionals;anddocumentanalysis,reviewinglocalgovernmentnoticesandpressreleases,publichealthdata,andmediaarticlesdocumentingtheimplementationofCOVID-19policies.

Sampling


ApurposivesnowballsamplingmethodwasusedtoensurethatparticipantsreflectdiverseperspectiveswithintheTremontcommunity.TheinterviewsampleincludedresidentsofTremont,i.e.,low-incomeindividualsandfamiliesaffectedbythecity’spolicies.Italsoincludedhealthcareprofessionals,i.e.,workersfromclinicsandhospitalsservingTremont.

ResidentsofTremont


Effortsweremadetoincludeindividualsfromvariousagegroups,genders,andethnicbackgroundstocapturetruedemographicrepresentationofresidentswithinthefullrangeofhealthcareaccessexperiences.Thisgroupofparticipantsoverallencompassedindividualswithchronichealthconditions,whohadamoreurgentneedforhealthcare,aswellasgenerallyhealthyresidentswhostillencounteredbarrierstohealthcareaccess.
Prioritywasgiventolow-incomeresidents,aseconomiclimitationsoftencompoundedbarrierstoaccessinghealthcareduringthepandemic.Residentswithdirectexperiencesofeitherdelayedordeniedcareduetofacilityclosures,transportationrestrictions,orlackoftelehealthresourceswerespecificallytargeted.

HealthcareProfessionalsServingTremont:


Thissubgroupconsistedofdoctors,nurses,andadministrativestafffromhealthcarefacilitiesinornearTremont.Theseprofessionalswereselectedfortheirfirsthandinsightsintothesystemicstrainplacedonlocalhealthcareresourcesandthechallengesofadaptingtotelemedicine,facilityrestrictions,andotherpandemic-relatedadjustments.
Includingvarioushealthcarerolesallowedthestudytocaptureamulti-layeredperspectiveonhowdifferentfunctionswithinhealthcarefacilitiesrespondedtotheincreaseddemandandlimitationsimposedbylockdownpolicies.Forexample,physicianscoulddescribetreatmentdelays,whileadministrativestaffcouldspeaktochallengesinschedulingandcommunicatingwithpatients.
Thissamplingapproachwasstructuredtoachievedatasaturation,sothatrecurringthemesandissuescouldbecapturedacrossdifferentparticipantgroups.WithafocusonresidentswithvariedexperiencesandroleswithinthehealthcareandresidentsectorsofTremont,thesamplewasdeemedlikelysufficienttoaddressthestudy’sresearchquestionscomprehensively,togaininsightsintothelivedexperiencesofhealthcareaccessandthecommunityimpactoflockdownpolicies.


DataCollection


Semi-structuredInterviews


Theinterviewsaresemi-structured,allowingflexibilitytocapturedetailedpersonalnarrativeswhileensuringkeyresearchquestionsareaddressed.Eachinterviewlastedapproximately45minutestoonehour.
Theinterviewswereconductedinperson,withaudiorecordingsofeach.Theaudiorecordingsweretranscribedverbatimforanalysis.

DocumentAnalysis


Toprovideabroadercontext,thestudyincorporatesananalysisofsecondarydatasources,including:
·PublichealthrecordsfromtheNewYorkCityDepartmentofHealth.
·ReportsissuedbytheMayor’sofficeonlockdownregulations.
·Localnewsandmediaarticlesdocumentingtheimplementationofthelockdowninthecity.Thesedocumentswereanalyzedtotriangulateinterviewfindingsandprovideinsightsintobroaderpolicyimpacts.

DataAnalysis


Thedatawereanalyzedusingthematicanalysis,whichinvolvesidentifyingrecurringpatternsandthemesfromtheinterviewtranscriptsanddocuments.Thematicanalysisiswell-suitedforthisstudyasitallowsforthecategorizationofcommonissuessuchasbarrierstohealthcareaccess,economichardship,andsocialinequalitiesexacerbatedbythelockdown.Importantstepsintheanalysisprocessincludedfamiliarization,coding,andthemedevelopment.Familiarizationinvolvedreadingthroughtranscriptsanddocumentstogainacompleteunderstandingofthedata.Codinginvolvedlabelingsegmentsoftextwithcodesthatrepresentkeyideasorconcepts(e.g.,\"healthcarebarriers,\"\"economicimpact\").ThemedevelopmentinvolvedgroupingrelatedcodesintothemesthatreflecttheprimaryissuesaffectingTremontresidents.

EthicalConsiderations


Thisresearchadherestostrictethicalguidelinestoensuretheconfidentialityandwell-beingofparticipants.Participantsprovidedinformedconsent,andalldatawereanonymizedtoprotecttheiridentities.Theinterviewswereconductedwithsensitivitytoparticipants\'experiencesduringthepandemic,andtheywereofferedemotionalsupportresourcesifneeded.

Semi-StructuredInterviewQuestions:HealthcareAccess


Thesemi-structuredinterviewprocesswassupportedthebythefollowinginterviewquestions:

ForResidents


1.AccesstoHealthcareServices


·HowdidtheCOVID-19lockdownaffectyourabilitytoaccesshealthcareservices(e.g.,doctor’sappointments,medications)?
·Werethereanyspecifichealthservicesthatbecameharderorimpossibletoaccessduringthelockdown?
·Howdidtheclosureofnon-essentialhealthcarefacilitiesimpactyourabilitytomanagechronichealthconditions,ifapplicable?

2.TelemedicineandDigitalAccess


·Wereyouabletousetelemedicineduringthelockdown?Ifso,howwasyourexperiencewithaccessingvirtualhealthcareservices?
·Didyouencounteranyissuesrelatedtotechnologyorinternetaccesswhentryingtousetelemedicine?
·Howdoyoufeelabouttheshiftfromin-persontovirtualhealthcareduringthelockdown?Wasitsufficientforyourneeds?


3.DelayedorForgoneCare


·DidyoudelayoravoidseekingmedicalcareduringthelockdownduetoCOVID-19concerns?Ifyes,why?
·Howdidanydelaysincareaffectyourhealthorthehealthoffamilymembers?
·Werethereanyspecifictreatmentsorproceduresyouhadtopostpone?Howdidthepostponementsimpactyourcondition?

4.HealthOutcomesandConcerns


·Inwhatwaysdidthelockdownpoliciesinfluenceyouroverallhealthandwell-being?
·Werethereanyhealthissuesthatworsenedduetothereducedaccesstohealthcareduringthelockdown?
·Whatwereyourbiggestconcernsregardinghealthcareaccessduringthepandemic?

5.PerceptionofHealthcareSystemResponse


·Howwouldyoudescribetheresponseoflocalhealthcarefacilitiesduringthelockdown?Didyoufeelsupportedorabandonedbythehealthcaresystem?
·Inyouropinion,howcouldthehealthcaresystemhaverespondedbettertomeettheneedsofpeopleinyourcommunityduringthelockdown?

6.BarrierstoAccess


·Whatweretheprimarybarriersyoufacedinaccessinghealthcareduringthelockdown(e.g.,transportation,fearofexposure,facilityclosures)?
·Didyouencounteranyfinancialbarrierstoreceivinghealthcareduringthisperiod?

7.GeneralReflection


·Lookingback,whatwouldyousaywerethebiggestchallengesrelatedtohealthcareaccessduringthelockdown?
·Ifanotherpublichealthcrisisweretohappen,whatimprovementsinhealthcareaccesswouldyouliketoseeforyourcommunity?

ForHealthcareProfessionals


1.Whatweresomeofthebiggestchallengesyourfacilityfacedinprovidinghealthcaretonon-COVIDpatientsduringthelockdown,especiallythosewithchronicconditions?
2.Howdidthelockdownimpactyourabilitytocommunicatewithandsupportpatientswhohadlimitedaccesstotechnologyorinternetfortelemedicineservices?
Thesequestionsweredesignedtoelicitdetailedandpersonalaccountsoftheexperiencespeoplefacedregardinghealthcareaccessduringthelockdown,sothatkeythemessuchasbarriers,delays,andtelemedicineusewerecovered.

PilotingoftheResearchQuestions


Beforeconductingthefullseriesofinterviewsforthestudy,apilottestoftheinterviewquestionswasconductedwithtwointerviewees.Thispreliminarystepaimedtoevaluatetheclarity,relevance,andeffectivenessofthequestionsincapturingthedesireddataonhealthcareaccessduringtheCOVID-19lockdown.Thetwoparticipantsselectedforthepilotwere:
1.ParticipantA:Alocalresidentwithachronichealthcondition(asthma)thatrequiredregularmedicalcare.
2.ParticipantB:AhealthcareprofessionalworkinginacommunityclinicinTremontduringthepandemic.
Thepilotingprocessprovidedvaluableinsightsintothesuitabilityoftheinterviewquestionsandallowedforadjustmentstobemadebeforethefulldatacollection.


ClarityofQuestions


Bothparticipantsfoundthequestionsgenerallyclearandeasytounderstand.However,ParticipantAexpressedsomeconfusionaboutthephrasingofthequestionregardingtelemedicineaccess,particularlywhenaskedabout“digitalbarriers.”Theyrequestedmorespecificpromptsrelatedtointernetaccessordeviceusage,whichledtotherewordingofthisquestiontoincludeexamplessuchas\"Didyouhavetroublewithinternetaccessorusingtelemedicineapps?\"

RelevancetoResearchObjectives


Thequestionseffectivelyeliciteddetailedresponsesfrombothinterviewees.ParticipantAsharedpersonalexperiencesaboutpostponingmedicalappointmentsandtheemotionalstresscausedbylackofhealthcareaccess.Thishelpedconfirmthatthequestionswerewell-alignedwiththeresearchobjectiveofunderstandingthelivedexperiencesofresidentsduringthelockdown.
ParticipantBofferedinsightsfromahealthcareprovider’sperspective,particularlyonthestrainfacedbyclinicsandthechallengesoftransitioningtotelemedicine.Thequestionsabouthealthcaresystemresponsesanddelayedcareprovidedrichdataonthehealthcaresystem\'slimitationsandthebarriersthatpatientsfaced.However,ParticipantBsuggestedincludingafollow-upquestionabouttheavailabilityofresourcesorsupportduringthetelemedicineshift,whichwaslateraddedtotheinterviewguide.

AbilitytoProduceIn-depthResponses


Bothparticipantsprovidedextensiveresponsestomostquestions,indicatingthatthesemi-structuredformatencouragedthemtosharetheirexperienceswithoutfeelingrestrictedbyoverlyrigidquestioning.ParticipantAgavedetailedaccountsoftheirinabilitytoaccessasthmamedication,andhowtheyattemptedtoself-managethecondition.ParticipantBexplainedtheoverwhelmingdemandforhealthcareservicesduringthelockdown,coupledwithlimitedresources,illustratingthechallengeshealthcareprovidersfaced.
However,thepilottestrevealedthatsomequestions,particularlythoseondelayedorforgonecare,couldbenefitfromadditionalprobing.Forinstance,whenParticipantAmentioneddelaysincare,afollow-upquestiononthespecifichealthimpactsofthosedelayselicitedmorenuancedresponses.Thisinsightledtotheadditionofpromptslike“Howdidthesedelaysimpactyourhealthorwell-being?”

EmotionalSensitivityandEthicalConsiderations


Thepilotinterviewsdemonstratedtheimportanceofemotionalsensitivity,especiallyforresidentswhofacedsignificanthealthchallenges.ParticipantAbecameemotionalwhendiscussingthestressofmanagingachronicconditionduringthelockdown,whichhighlightedtheneedforempatheticinterviewingtechniques.Thispromptedtheinclusionofmoresupportivelanguageinthefinalinterviews,suchasofferingparticipantsachancetotakeabreakorskipquestionsiftheyfeltuncomfortable.

AdjustmentsMadeBasedonPilotFeedback


Termswereclarifiedandquestionsrewordedabouttelemedicineanddigitalbarriersforbetterclarity.Also,morepromptswereadded,includingmorefollow-upquestionstoelicitdetailedaccounts,especiallyrelatedtotheconsequencesofdelayedcare.Somemoreempathywasalsogiventophrasingbyadjustingthelanguagetobemoresensitive,sothatparticipantsfeltcomfortablesharingemotionallychargedexperiences.
Overall,thepilotinterviewsconfirmedthattheresearchquestionswereeffectiveingeneratingthedesireddataonhealthcareaccess,whilealsoprovidinganopportunitytorefinetheinterviewguideforthefullstudy.Theseadjustmentshelpedensurethattheinterviewswouldnotonlyproducerich,detaileddatabutalsoallowparticipantstoexpresstheirexperiencesinasafeandsupportiveenvironment.


Chapter4:Findings


Thefindingsofthisstudyareorganizedaroundthemajorthemesidentifiedthroughthematicanalysisofinterviewdataandrelevantdocuments.ThesethemesarederivedfromtheresponsesofTremontresidentsandhealthcareprofessionals.TheyrevealthechallengesresidentsfacedinaccessinghealthcareduringtheCOVID-19lockdown.Theyalsoshowthecompoundedeffectsofsocio-economicfactors,technologyaccessdisparities,theresponseoflocalhealthcare,andthemessagingoftheOfficeoftheMayor.Firstpresentedareanswerstothequestions,andsecondarethethemesastheyappear.

ForResidents


1.AccesstoHealthcareServices


·HowdidtheCOVID-19lockdownaffectyourabilitytoaccesshealthcareservices(e.g.,doctor’sappointments,medications)?
·\"Theyshuteverythingdown.Myregularspotwasclosed.Icouldn’tgetmedslikeIusedto.I’dcall,theysay,‘Sorry,wefullup’ortheydon’tanswer.Ijustdealwithitonmyown.\"
·\"Forgetaboutit.Itriedgettinganappointment,buttheykeeppushback.Imisswholemonthbloodpressurepills‘causenobodyishelp.\"
·\"Itwasnearlyimpossibletoseemydoctorduringthelockdown.MyregularclinicwaseitherclosedorhadsuchlongwaitingtimesthatIgaveup.Iwentwithoutmymedicationforawhilebecausegettingarefillfeltlikesuchachallenge.\"
·\"Totalmess.Mydoctor’sofficeclosed,andwhenIcalledtheyjustsaid‘tryagainnextweek’orsomenonsenselikethat.Iwasleftjusttrynaholdittogetheronmyown.\"
·\"Itwasrealhard…Mymomgotcheck-ups,butallthatgotputonhold.Iwasworriedeveryday‘causewecouldn’tseethedoctorlikeusual.\"
·\"Appointmentswerecanceled.Itwasjusthard.Saidtheycouldonlyoffervirtualconsultations,likewhatthe----isthat?\"
·Werethereanyspecifichealthservicesthatbecameharderorimpossibletoaccessduringthelockdown?
·\"Yeah,Iwassupposedtogetmykneecheckedout,buteveryplacetoldme,‘Nah,weonlytakin’emergenciesrightnow.’BytimeIgotappointment,itwaswayworse.Couldn’tbarelywalkbythen.\"
·\"Ineededadentistbad‘causemytoothwaskillin’me,buttheywasn’ttakin’nobodyunlessitwasanemergency.Hadtolivewiththatpainformonths.\"
·\"Ineededphysicaltherapy.Nope,nothin’open,toobad.Whentheyfinallyopen,there’sawaitlistamilelong.\"
·\"Can’tevengetnodentist!Ihadatoothinfection,man!Nope!Theyain’tevengonnaopenup.\"
·\"Forreal,Ineededsomedentalwork,buttheywouldn’tevenletmeinthedoor.\"
·\"Icouldn’tgettomyregularasthmaappointments.Iwasjustouthere.IhadtojusthopeIdidn’tgetworse.\"
·Howdidtheclosureofnon-essentialhealthcarefacilitiesimpactyourabilitytomanagechronichealthconditions,ifapplicable?
·\"Ihavediabetes,soIneedregularcheck-upstomanagemybloodsugarlevels.Whentheclinicclosed,Icouldn’tgetthesupportormonitoringIneeded,whichledtoafewemergencyvisits.\"
·\"ThelockdownmeantIcouldn’tgoinformyasthmachecks,whichusuallyhelpmemanagemysymptoms.Withoutthosevisits,IendedupintheERmorethanoncebecauseIcouldn’tkeepitundercontrol.\"
·\"Igotasthma,Igotdiabetes,Igotitall.Igothighbloodpressure.Iusuallyseemydoctoreveryfewweekstokeepmeincheck.ButIcouldn’tgetnohelp,couldn’tgetnoinhalerontime.Nothin’.Iwasstrugglin’bad,andtherewasnoonearoundtohelp.\"
·\"Mysistergotasthma,andshecouldn’tseeherspecialist.Shestartedwheezingrealbad,andwehadnowheretogo.It’sliketheyjustforgotabouteverybodywhowasn’tdealingwithCOVID.\"
·\"Thediabetesgotrough.Mynumberswasallovertheplace‘causeIcouldn’tseemydoc.Theykepttellin’metocallback,butnoonewouldpickup,andIdidn’tknowwhattodo.\"


2.TelemedicineandDigitalAccess


·Wereyouabletousetelemedicineduringthelockdown?Ifso,howwasyourexperiencewithaccessingvirtualhealthcareservices?
·\"Nah,Iain’tgotnolaptoporfancyphone.Theytalkin’‘boutvideocalls,butIcouldbarelygetaphonecalltogothroughwithoutdroppin’.Ain’tnowaythatwasworkin’forme.\"
·\"Itrieditonce,butthedoctorcouldn’thearmehalfthetime.Plus,Igotaprepaidphone,andtheminutesrunoutquickwithvideo.Justwasn’tmadeforfolkslikeus,youknow?\"
·\"Telemedicinewasalltheyoffered,butIdon’thavegoodinternet.Itriedtouseitacoupleoftimes,butitwasdifficult.IwashangingupoutoffrustrationbecauseIcouldn’thearwhatthedoctorwassaying.\"
·\"Yes,Iusedtelemedicine,butitwasn’tveryeffectiveforwhatIneeded.Thedoctorcouldn’texaminemephysically,sotheyjustprescribedmedicationbasedonwhatIdescribed.Itfeltveryimpersonal.\"
·\"Yeah,Itried,butitwasweird.Icouldn’tgetagoodsignalhalfthetime,andIjustkeptsayin’,‘Hello?Youhearme?’Itwasn’tworkin’right.Feltliketheywasjustrushin’meoffthephone,youknow?\"
·Didyouencounteranyissuesrelatedtotechnologyorinternetaccesswhentryingtousetelemedicine?
·\"Absolutely.Idon’thaveasmartphoneoralaptop,andtheinternetconnectioninmyareaisn’treliable.Iendedupmissingafewappointmentsjustbecausethecallkeptdropping.\"
·\"Idon’tgotWi-Fi,soIwasjusttrynadoitoffmydata.Butthevideokeptfreezingup,andthenI’dgetkickedoff.Ihadtogiveup‘causeitwasjusttoostressfultrynamakeitwork.\"
·\"Ihadtoborrowmycousin’sphonejusttomakeitwork,andeventhen,itwasrough.Idon’tgotnocomputer,andmyoldphonekeptfreezin’up.Ifeltliketheywasspeakin’anotherlanguage.\"
·\"Iwasusingmyphone,anditwasfrustratingbecauseIcouldn’tgetclearinstructionsonmycondition,andIfeltlostmostofthetime.\"
·Howdoyoufeelabouttheshiftfromin-persontovirtualhealthcareduringthelockdown?Wasitsufficientforyourneeds?
·\"Notatall.Ipreferface-to-faceconsultationsbecausemydoctorcanactuallyseewhat’swrong.Virtualcaredoesn’tgivethesamelevelofattention,anditfeltliketheywerejusttryingtorushthroughthecall.\"
·\"Telemedicinemightbeokayforsomethings,butitdidn’tworkforme.Myneedsweren’tmetbecauseit’shardtoexplaincertainsymptomsoverthephonewithoutthedoctorseeingme.\"
·\"Itain’thelp.Theyactin’likeit’sallthesame,butit’snot.Sometimesyouneedsomeonetolookatyou,notjusttalkonsomescreen.\"


3.DelayedorForgoneCare


·DidyoudelayoravoidseekingmedicalcareduringthelockdownduetoCOVID-19concerns?Ifyes,why?
·\"Ohyeah,Istayedhome.Everyonewassayin’howdangerousitwasoutthere,soIjusttriedtohandleitmyself.Hadalottafearaboutcatchin’somethin’ifIwenttotheclinic.\"
·\"Ididn’teventhinkaboutgoin’nowhere‘causetheymadeitsoundlikeifyoustepoutside,yougon’getsick.Didn’twannaendupinthehospital,soIkeptputtin’itoff.\"
·\"IwasworriedaboutcatchingCOVIDattheclinic.Idecidedtowaitoutmysymptoms,butthatprobablymadethingsworse.\"
·\"Absolutely.Withallthefear,Ijustdidn’twanttogonearanyhealthcare.EvenwhenIfeltreallysick,Istayedhome,thoughtIcouldmanageonmyown.\"
·Howdidanydelaysincareaffectyourhealthorthehealthoffamilymembers?
·\"BythetimeIwenttogethelp,myconditionwaswayworse.Couldn’thardlybreathesomedays.IendedupintheER‘causeIcouldn’tmanageitnomore.AndfeltliketheyjustaboutkilledmeintherewithalltheircrazyCOVIDprotocols—feellikeI’mluckytobealive!DefinitelyfeellikeIwouldhavebeenbetterjuststayinghome,man.\"
·\"Mydiabeteswentouttacontrol.IknewIneededhelp,butIkeptwaitin’andwaitin’.NowIgotmoreissuesthanIdidbeforeallthisstarted.Endeduppassin’outoneday,andtheyhadtocallanambulance.Scaredmyfamily.\"
·\"Thedelaystookatoll.MybloodpressurespikedbecauseIwasn’tmonitored,allcouldhavebeenavoidedwithregularcheck-ups.\"
·\"Idelayedgoingtothedoctor,andmyconditionworsened.WhatwouldhavebeenasimpletreatmentturnedintoamoreseriousissuebecauseIwasn’tabletogethelprightaway.\"
·Werethereanyspecifictreatmentsorproceduresyouhadtopostpone?Howdidthepostponementsimpactyourcondition?
·\"Iwassupposedtogetsomekindascandoneonmyback.Hadtocancelit,though,‘causetheyweren’tseein’nobody.NowIgotmorepainthanbefore,andit’sliketheyjustdon’tcare.\"
·\"Iwasscheduledforaminorsurgerythatgotpostponedindefinitely.Withoutit,mysymptomsworsened,andIexperiencedalotofpainthatcouldhavebeenavoided.\"
·\"Hadanappointmenttofixabadtooth,buttheycanceledit.WhenIfinallygotseen,theyhadtopullitout.Allthatpain,justtolosethetooth.\"
·\"Iwassupposedtogetsometestsdoneformyheart,buttheyshutitdown.Idon’tevenknowwhat’sgoin’onwithme‘causeIain’tbeenabletoseenobody.\"
·\"Ihadtodelayadentalprocedureforacavity.EndedupIneededarootcanalinsteadofafilling,whatshouldhavebeenafilling,Imean.\"


4.HealthOutcomesandConcerns


·Inwhatwaysdidthelockdownpoliciesinfluenceyouroverallhealthandwell-being?
·\"Thelockdownaddedsomuchstresstomylife.Financialstruggles.Notbeingabletoseemydoctor.Depressiongotworse.\"
·\"Stress,straightup.Iwasstressedoutallthetime,worriedaboutgettin’sick,andmyhealthgotworse.Bein’stuckinside,notseein’mydoctor,itallstacksup.Ifeltdrainedeveryday.\"
·\"Iwasscared,honestly.Healthwasalreadyshaky,andwithnodoctoraround,Iwasjustprayin’Ididn’tgetworse.Myanxietywentthroughtheroof.\"
·\"Itmadememoreanxiousandisolated.Myphysicalhealthwentdownhilltoo,especiallybecauseIcouldn’tmanagemychronicconditionsaswellwithoutregularhealthcareaccess.\"
·Werethereanyhealthissuesthatworsenedduetothereducedaccesstohealthcareduringthelockdown?
·\"Yeah,myasthmawaswayworse.Icouldn’tgetmyrefillsontime,soIwasusin’whatIhadsparingly.Hadalotmoreattacks,anditscaredmetogototheER.\"
·\"Mysugarlevelswentupbad.Ididn’thavetheusualcheck-ups,couldn’tgooutandgetexercise,justeatin’bad,couldn’tkeepthingsundercontrol.Mydoctorcouldn’tseeme,soIjustgotbad.\"
·\"Mydiabetesgotoutofcontrol,andIhadothercomplicationsbecauseIcouldn’tgetadjustments.\"
·\"Myasthmawasworse.Wasastruggletobreatheattimes.Icouldn’tgethelpeasily.\"
·Whatwereyourbiggestconcernsregardinghealthcareaccessduringthepandemic?
·\"Iwasmostworriedaboutmyconditionworseningtoapointwhereitwouldbehardtorecover,simplybecauseIcouldn’tgetthecareIneededintime.\"
·\"IworriedthatIwouldendupwithseriouscomplicationsfrommyuntreatedissues.NotknowingwhenIcouldgethelpagainmademeveryanxious.\"
·\"Thebiggestthingwasnotknowin’whatwasgonnahappennext.Ineededhelp,buteverydoorwasshut.FeltlikeIwasonmyown,likenobodycared.\"

5.PerceptionofHealthcareSystemResponse


·Howwouldyoudescribetheresponseoflocalhealthcarefacilitiesduringthelockdown?Didyoufeelsupportedorabandonedbythehealthcaresystem?
·\"Ifeltlikewewasforgotten.Liketheyonlycared‘boutCOVIDpatientsandlefttherestofustodealonourown.Theysayin’tostayhome,butwhatifstayin’homeismakin’usworse?\"
·\"Ifeltabandoned.ThesystemwassofocusedonCOVID-19thatitfeltliketheyforgotaboutpeoplewithotherhealthissues.Therewasnoguidanceonwhattodoforpeoplelikeus.\"
·\"Itseemedlikethesystemdidn’tcareaboutus.Wewereonourown.Ineededhelp,buteverythingwaseitherclosedoroverwhelmed.Itwasadifficulttime.\"
·Inyouropinion,howcouldthehealthcaresystemhaverespondedbettertomeettheneedsofpeopleinyourcommunityduringthelockdown?
·\"Theycouldasetupsomething,soweain’tmixedwiththeCOVID.Separatespots,Idon’tknow.Itwouldamadeadifference.\"
·\"Theyshouldathought‘boutpeoplewithnointernet,notech.Iftheyreallycared,they’dmakesureeveryonehadaccess,notjusttheoneswhocangoonline.\"
·\"Thereshouldhavebeenmoreresourcesfornon-COVIDconditions,evenifthatmeantsettingupforchronicpatients.\"
·\"Thesystemcouldhavedonemoretosupportpeoplewhoneededregularcare.Keepingthingsopenwouldhavemadeabigdifference.\"…

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