On March 14, two weeks after the first U.S. coronavirus death was announced here in King County and as an onslaught of social distancing policies descended on our communities, we began a research study to understand how 500 King County residents were coping with all of it. Every evening, study participants have been generously sharing with us how they are doing, specifically in terms of their mental health.
Because of our work on health-care inequities and racism, we were concerned about the impacts on communities of color. As it turned out, there was much reason for concern. Three months later, it is crystal clear that socially marginalized communities have been disproportionately impacted by COVID-19. Across America, many Black, Asian, Latinx and indigenous people, and poor white people, are living and working in conditions that make it harder to avoid the virus, have more underlying health conditions increasing risk, have less access to testing and medical care, and are dying at staggeringly higher rates. In King County, Black, Latinx, those with limited English proficiency and indigenous people are showing higher rates of infection, and Spanish-speaking Latinx people, in particular, are showing higher death rates.
So what can our study tell us about how this is playing out in terms of mental health?
Importantly, while our study has failed so far to enroll a representative number of Black, Latinx, indigenous and other respondents of color, those who are in our study indicate that there are no major ethnic differences in how the pandemic is affecting mental health. For most Seattleites, regardless of ethnicity, anxiety, depression and feeling overwhelmed peaked early on. Day by day, these feelings have been gradually decreasing. The “average” King County resident is acclimating to the tectonic shift of everyday life, is certainly suffering in many ways, but is not falling apart.
Our findings, however, do not tell the whole story. Hidden in this top-line conclusion are multiple narratives of suffering, strength and resilience. We all differ in terms of how much stress is landing on our shoulders and how we cope with it. Some are coping relatively well because they have relatively less stress to deal with. But others who are facing more stress are coping relatively well because such stress is not unfamiliar to them.
In fact, for many marginalized communities, the COVID-19 crisis has presented little choice but to continue living through a web of social inequities. Meanwhile, it’s forcing other Seattleites to personally experience and live with social conditions already quite familiar to those who have been marginalized — an inability to move about freely and safely, being looked at strangely because of a face mask, large gatherings broken up by police, unemployment, financial stress, chronic health conditions, difficulty accessing care, and an ongoing proximity to death. Learning how to navigate at least some of the stressors of the COVID-19 crisis, for some of us, is nothing new.
Having the ability to cope with stress does not mean there are no consequences. According to the legend of John Henry, a Black man equipped only with tenacity, strength and a hammer outworked a steam-powered drill only to die of heart failure in victory. “John Henryism” is now a term used to help doctors understand the high rates of heart disease and other chronic health conditions that plague communities of color. Learning to live with chronic stress — even coping well by using one’s strengths and social support — does not prevent impact on our bodies and physical health.
Seattle’s most marginalized groups, while they may provide lessons to the rest of the city on mental-health resilience and adaptivity, are facing more significant and severe challenges every day that test these strengths and take a tremendous physical toll. The growing financial crisis that has evolved from the COVID-19 crisis undoubtedly will add another layer of disproportionate challenges and impacts.
Whether it be pre-COVID-19 or in the heart of it, our country’s tolerance for racial inequities has been shameful. If there is any silver lining to this crisis, it may be how it lays bare these continuing inequities for all to see, allows for a deepening of understanding and engenders a stronger call to action.