1 YEAR LATER: HOW THE VIRUS SPREAD TO ALL CORNERS OF COOK COUNTY
KYRA SENESE AND ERIC FAN OF BROWN INSTITUTE FOR MEDIA INNOVATION
When the coronavirus first hit Chicago and Cook County last spring, Black residents bore the brunt of the surging death toll.
But over the past year, as Cook County deaths have climbed toward 10,000, the virus has wreaked havoc in nearly every corner of the region. Low-income communities of all ethnicities have been hit especially hard, from the heavily Hispanic neighborhoods around Cicero to majority-white areas like Niles and Oak Lawn.
Early pandemic hot spots like South Shore have been surpassed by communities like Cicero, where two low-rated nursing homes and a profusion of multifamily apartment buildings have led to consistently high death rates, according to interviews with public health experts and government officials and an analysis of Cook County death data and medical records by the Chicago Sun-Times and the Brown Institute for Media Innovation’s Documenting COVID-19 project.
The number of total deaths in Cook County is only below the dense counties that make up New York City and Los Angeles. Cook County also ranks in the top third of large U.S. counties in per-capita COVID-19 death rate, at 193 deaths per 100,000 people — far behind the nation’s hardest-hit areas, such as the Bronx, Queens
and Brooklyn, but far worse than metro areas like Cleveland, Dallas and Manhattan.
“Things have evolved over time,” said Dr. Ngozi Ezike, director of the Illinois Department of Public Health. “At the beginning of the first wave, we did see a very disproportionate effect in case rates — the likelihood of being positive — if you were Black or Brown. You also had a higher rate of dying if you were Black or Brown, and you could tie that initially to the lack of testing. We had lower rates of testing in these same communities that were more likely to be positive and have these severe outcomes.”
The medical examiner’s data — including death location details obtained through public-records requests, and investigative death reports — show:
◆ At the height of the first wave of the pandemic last April, a majority of monthly Cook County COVID-19 deaths, 42.5%, were of Black residents, while 36% of deaths were of white residents and 15.4% were of Latinos. Those figures stood in stark contrast to the county’s racial makeup, which is 42% white, 23.8% Black and 25.6% Latino.
◆ But since the spring, COVID-19 deaths in Cook County have become more representative of the Chicago area’s racial makeup, reflecting the widespread community transmission of the virus. By the end of February, 43.8% of all COVID deaths were white; 21.9% were Latino; and 27.6% were Black.
◆ Even as the racial makeup of deaths has become more reflective of the area’s demographics, an analysis of deaths by ZIP codes shows the pandemic’s heavy impact on places like majority Latino Cicero and the neighboring western suburbs. Three of the 10 ZIP codes that saw the most COVID deaths in January are in or surrounding Cicero. The three ZIP codes — 60804, 60623 and 60632 — have lost at least 600 residents to the coronavirus. Cicero saw few cases of the virus prior to September of last year but is now one of the hardest-hit communities. In January, 28 Cicero residents died of the virus — the most in all ZIP codes in Cook County.
◆ With median ages of 68 and 73, Hispanics and Blacks killed by COVID-19 have been much younger than white and Asian victims in Cook County, who have a median age at death of 80. The gap mirrors long-standing disparities in lifespans from all causes.
◆ About 5% of Hispanic deaths took place before reaching a health facility, double the 2.4% rate for white deaths. About 3.7% of the Asian and Black deaths occurred at home. The rate was far higher in Cicero, where an analysis of street addresses of COVID-19 victims shows that more than one-third died at home.
◆ “A much greater rate of African Americans and Latinos die in their home because they have a higher percentage of people who are uninsured or undocumented, people who don’t have cars to get them to the hospital,” said Dr. Howard Ehrman, a former assistant commissioner of the Chicago Department of Public Health. “They don’t want to pay for ambulances.”
‘Mom, I’m not feeling well’
Despite battling chronic myeloid leukemia for four years, Joanna Bermudez had managed to raise two teenage sons in Cicero with the help of her mother while working as a medical assistant and studying to become a registered nurse.
Bermudez, at 36, already had undergone bone-marrow and stem-cell transplants. So, during the first week of August, when she contracted COVID-19, it didn’t catch her or her family off-guard that she was again hospitalized. Bermudez was admitted to the same hospital — Loyola University Medical Center in Maywood — where she had been treated for her cancer. She was released after about a week with instructions to rest, drink fluids and take antibiotics.
The doctors told Bermudez that the antibiotics would help. She was worried about infecting her mother and two sons, but they were instructed to wear masks and gloves.
“Everything was fine,” said Nancy Rodriguez, her mother.
But, after she left the hospital, Bermudez began feeling weaker than normal. She called her mother, who had been visiting the cemetery to see the new headstone placed at her father’s grave, who recently had died of Alzheimer’s.
“Mom, I’m not feeling well,” she said.
Rodriguez told her to immediately call 911 for an ambulance.
She didn’t listen, waiting until her mother returned home. She packed up her laptop so she could study from her ICU bed.
“Every time she went to the hospital, because of COVID-19 they had to test her,” Rodriguez said. “Every time she got admitted, she was always OK.”
She would never leave Loyola. When she spoke days later to her brother Luis Bermudez, she struggled to breathe. Moments later, as she was about to be intubated and with the knowledge that her lungs were badly damaged, she told her family to begin making preparations to care and provide for her 14- and 17-year-old sons.
“She had a lot of faith in God that there was always the potential that she could pull out of it,” Luis Bermudez said. “But she was also a realist when it came to the conditions of the body.”
Joanna Bermudez was put into a medically induced coma. She died a week later, on Aug. 12, from acute hypoxic respiratory failure due to COVID-19. Her death was one of four from the coronavirus documented that month in Cicero.
By August, the spread of COVID-19 nationwide had begun to blanket nearly every corner of the United States. Like many Americans, Bermudez had felt isolated even before the pandemic began. And six months into the pandemic, people were getting restless after months of COVID restrictions and closings.
“My sister was a clown,” Luis Bermudez said. “She loved joking, dancing.”
‘Why you see really staggering numbers’
As the pandemic ebbed in Cook County through the summer and fall, an increasingly larger share of
white residents became infected. Cook County medical examiner’s office records show 4,190 white, non-Hispanic Cook County residents have died of coronavirus. The two hardest-hit ZIP codes have been 60714 in Niles, with 217 deaths, and 60453 in Oak Lawn, with 183 deaths.
Higher poverty rates and death have long been intertwined, and that correlation is most apparent in the north suburbs. Compared with Winnetka and Wilmette, Northbrook and Skokie have half the median income. And their residents are five times more likely to die from COVID-19, according to the data analysis.
Despite relatively lower case counts and deaths earlier in the pandemic, the Chicago suburbs saw a late-summer surge of the virus among young people, and bars, restaurants and fitness centers were directed to reduce capacity limits.
“In the white community, that’s where we’ve seen the numbers rise,” said Natalia Derevyanny, a spokeswoman for the Cook County Bureau of Administration. “What we saw was in the beginning those numbers were lower, but they kept on ticking upward.”
Even as the number of deaths of whites rose, other socioeconomic factors have affected health outcomes at every stage of the pandemic. And even as deaths have tapered off in some areas of the state, disparities among those who have been hardest hit remained constant throughout much of 2020 and into 2021.
In the spring, testing sites were limited throughout the Chicago area, and the sites that were open often required internet access to sign up for a test and a vehicle to use drive-up testing centers.
“Early on, it was much easier to get a test in the rich, well-off neighborhoods, which were, of course, least impacted by the pandemic,” said Dr. William Parker, an assistant professor of pulmonary critical care medicine who is assistant director for the University of Chicago MacLean Center for Medical Ethics. “There’s a systemic lack of service in our system that can cost a lot of lives and make the pandemic a lot worse.”
Nursing homes with larger populations of Blacks and Hispanic residents have seen a disproportionately high number of deaths throughout the pandemic — not surprising to public health experts because many of the homes for years have had conditions far worse than those homes with whiter populations.
In Chicago, working-class and poor Hispanic families tend to live in larger numbers in the same space, particularly in the past 10 years since the recession.
“It’s the same population with limited health resources that have a lot of preexisting diseases that put them at a higher risk for complications of COVID-19,” said Dr. Robert Murphy, executive director for the Institute for Global Health at Northwestern University. “Everything just compounds, and that’s why you see these really staggering numbers.”
On top of that, government officials said the COVID-19 death tallies vastly understate the death rates among Black and Hispanic residents. Like many large municipalities, Cook County is not performing postmortem COVID tests on those who weren’t tested before they died.
And the Cook County medical examiner’s office’s race and ethnicity data underreports non-white
deaths, especially Hispanics, according to Dr. Ponni Arunkumar, the chief medical examiner. When a case is reported to her office, investigators collect information from the agency calling in the death, she said, and the office typically must rely on whatever initial race and ethnicity information is provided, which at times is guesswork.
Cicero’s struggles
Researchers and government officials attribute the recent surge of deaths in Cicero to multiple factors, including a stubbornly high infection rate at the suburb’s two nursing homes, the high number of multigenerational households and the population density, with families often packed into apartment buildings as tall as 27 stories.
City View Multicare Center, an eight-story nursing home on Cermak Road, is one of the largest facilities in Illinois. It has a two-star rating on a five-star scale from the federal Centers for Medicare and Medicaid Services, which rates nursing homes based on health inspections and other quality-ofcare measures. More than 160 of the facility’s 320 residents were infected with the coronavirus during an April outbreak.
The town sought help from the state after 10 residents died and at least 216 people became infected. It filed a lawsuit last May to transfer all nursing home residents from City View to hospitals or to have public health guidelines more effectively enforced. A Cook County judge ordered the facility to enforce state safety orders by requiring social distancing within the nursing home, mandating the use of masks and allowing town officials to inspect the facility without first alerting City View.
Workers at City View and 10 other facilities owned by Infinity Healthcare Management went on strike last fall, saying ownership wasn’t providing enough personal protective equipment during the pandemic and was refusing to give hazard pay. The owners agreed to boost their wages and provide other protections. But employees say the home is “failing” to vaccinate workers and residents.
“We continue to fight with them and insist that we have access to monitor that they’re following the procedures that are required to preserve safety for the residents and staff,” Cicero town spokesman Ray Hanania said.
Officials with City View, which is still operating and has had 249 reported cases and 15 deaths, did not respond to requests for comment.
Cicero’s other nursing home, Alden Town Manor Rehab, is a one-star-rated facility on Ogden Avenue. In a written statement, Alden did not answer questions about the facility’s initial response to the virus, its 137 cases and 27 deaths or whether the facility’s Medicare rating is reflective of the care it provides.
“Ensuring residents are cared for in a safe, and healthy environment is our greatest concern,” said Janine Schoen, a spokeswoman for Alden Management Services, which owns Alden Town Manor Rehab and dozens of facilities across the county.
The two long-term-care centers give Cicero an unusually large population that requires skilled care in settings in which COVID-19 has spread. More than 3,350 nursing home residents and staffers have died from COVID-19 in Cook County — more than one-third of the county’s death count.
“We feel we’ve done our best, but, with the population density of this town, it’s been a challenge,” said Michael Piekarski, director of Cicero’s emergency operations center.
Cicero’s density is partially due to its “Safe Space Resolution,” a 2008 ordinance providing a safe haven for undocumented immigrants by not enforcing federal immigration laws. The town’s official census count — roughly 80,000 residents — balloons to more than 100,000 when undocumented immigrants are counted, Hanania said.
To combat the virus, the town was one of the first Chicago suburbs to adopt a mask mandate in April 2020, opened multiple testing sites and conducted hundreds of on-site inspections and issued citations and fines at facilities with code or infection-control violations.
“We’re teaching our young people that, just because they feel healthy and maybe don’t have any symptoms, we need them to be careful and not bring COVID into their homes,” Piekarski said.
It more recently opened large vaccination sites at Morton East High School and other locations.
‘It came out of nowhere’
As the number of coronavirus deaths in the United States surpassed 500,000, Joanna Bermudez’s relatives largely left Chicago and spread out across the country.
Before she died, Bermudez had made plans to move to Texas to live near her brother. Now, her mother has moved there. Her two sons have since moved out of state to live with their father.
“Honestly, what pissed me off more about the whole situation was she made it through cancer just to be taken down by COVID,” her brother said. “It’s kind of like the world was robbed of someone.”
The family has not had a service for Joanna but plans to hold an outdoor event this spring, when they will spread her ashes near her mother’s new home in San Antonio.
“Joanna asked for something special,” Nancy Rodriguez said. “She wants to be planted as a tree. We’re going to do that in front of the house where I’m living now.”
Bermudez’s death at such a young age left her family in a state of disbelief.
“I stood in the apartment alone and packed everything up,” her mother said. “It was hard seeing everything packed up and giving it out. It came out of nowhere.”