Spanish Flu Covid Public Administration Responses

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 strict measures that changed daily life overnight and exposed the vulnerabilities of already underserved and marginalized communities.

In New York City, one of the worst hit cities 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; Tolentino et al., 2021). 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). Legacy media 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 (Forster et al., 2024). 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).

During the major COVID months of 2020, essentially March 2020 to September 2020, the New York City Department of Health reported a cumulative infection rate of over 40,000 per 100,000 residents in certain Bronx zip codes, with the Bronx consistently leading New York City in infection metrics due to social determinants of health?. De Blasio’s office acted in a manner to address this infection rate by restricting the movements and interactions of people whose movements were not deemed to be essential. In other words, if one was not a frontline worker, for example, in health care, one had no need to be outdoors, the goal of De Blasio’s office being to stop the spread (Erwin et al., 2021).

However, the COVID-19 pandemic lockdown response essentially aggravated already existing challenges for this population by further limiting access to critical services (Tolentino et al., 2021). 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.

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). The result is that minority communities experiencing higher rates of chronic diseases compared to other parts of the city (Shiman, 2021). For example, the social determinants of health 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. The fact that 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, makes it particular vulnerable, as socio-economic conditions have long contributed to health disparities in the borough (Clark & Shabsigh, 2022).

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 clinics, but many of these facilities are underfunded and understaffed due to structural racism within the healthcare system, which has contributed to disparities in healthcare access, with minority communities in neighborhoods like Tremont receiving lower-quality care compared to wealthier, predominantly white areas (Shiman et al., 2021).

In Tremont, many residents work in low-wage, essential jobs, often without the luxury of working from home, which increased their vulnerability during the pandemic lockdowns. The area has long faced systemic inequities in housing, healthcare, and employment opportunities, making it one of the most vulnerable communities in the city. Residents were already at higher risk for poor health outcomes due to underlying conditions such as asthma, diabetes, and hypertension (Clark & Shabsigh, 2022; Estevez, 2020). Indeed, Tremont's residents experience higher rates of diabetes, asthma, and hypertension compared to other New York City neighborhoods, which means they were at elevated risks of severe COVID-19 outcomes (Huang & Li, 2022). Case studies on New York City and on the Bronx in particular noted that COVID-19 hospitalizations and mortality were particularly high among residents with such preexisting conditions, which shows the need for targeted health interventions and resource allocation in these communities? (Friedman & Lee, 2023; Huang & Li, 2022).

The importance of researching the impact of Mayor Bill de Blasio's COVID-19 lockdown policies on Tremont lies in understanding how these public health measures worsened existing social and economic disparities for underprivileged populations like the one in Tremont. The argument at the time was that lockdowns would help to slow the spread of the virus (Hammond, 2021). Major cities like New York City followed federal guidelines in almost all states except those like Florida, where the governor pushed to keep businesses open and people going about life as they were accustomed to do. For the most part, the federal guidelines have been accepted as necessary to meet the challenges of the pandemic. However, little attention has been given to the potential problem of inequalities in healthcare access worsening for low-income, minority communities like Tremont. Tremont residents already faced barriers to accessing healthcare, and in 2020, due to clinic closures, overwhelmed hospital systems, and the lack of technology for telehealth services, the health situation of the community worsened; and on top of all that the Bronx in general and Tremont in particular was “home to a uniquely vulnerable population to SARS-CoV-2 infection and severe COVID-19” (Forster et al., 2024). Economically, the shutdown of service industry jobs hit the community especially hard, leading to unemployment, food insecurity, and difficulties in obtaining unemployment benefits, all of which affected the social determinants of health for poor communities like Tremont (Shiman et al., 2021).

Research by Zhong et al. (2022) found that the Bronx communities have the lowest percentage of white residents and that “neighborhoods with a higher percentage of Black and Hispanic populations had a higher incidence rate and death rate per capita relative to predominantly white neighborhoods in wave 1 but not in wave 2.” This shows that Tremont was vulnerable. According to Zhong et al. (2022), “these findings suggest that, neighborhoods at higher risk of morbidity and mortality were less affected by the second wave of the pandemic than the first wave.” Overall, the implication is that something happened among these residents to mitigate risk during the second wave. What was it? Zhong et al (2022) offer one explanation: “changes in the risk perception and protective behavior among residents in these neighborhoods to better protect themselves from infection.” Yet, they admit that “future qualitative research is needed in this area” to better explain what actually transpired for these residents. That is precisely what this research attempts to do with its qualitative approach.

Researching these issues is important because it allows for gaining insights into the intended and unintended consequences of pandemic policies on marginalized populations. There is a need to know and understand the specific challenges faced by communities like Tremont, so that policymakers in the future can develop and adopt more equitable approaches to public health crises in the future, and so that low-income and minority populations are not disproportionately affected by similar measures?.

The 2020 COVID-19 pandemic presented unprecedented challenges to public administration, forcing governments to balance protecting public health with maintaining essential services and supporting communities. This crisis exposed the important part that public administrators have to play when it comes to emergency management, policy implementation, and equitable service delivery. Local governments, as the level of government closest to the people, were at the forefront of responding to the pandemic. They implemented a range of measures, including lockdowns, that heavily impacted daily life and affected already highly vulnerable and marginalized communities.

Examining historical pandemics and crises provides a good backdrop for understanding the complexities of the COVID-19 response. Prior pandemics, such as the Spanish Flu of 1918, also led to significant public health interventions and social disruptions. Tambolkar et al. (2022) compared the response of public administrators during the Spanish Flu to the response during COVID and found that

All the measures implemented in 2020 were the same as those implemented in 1918–1919, with the same trend, uncertainty, early relaxing, and rapid reversals. Even from a scientific standpoint, all the elements were already known. All the issues such as social isolation, intra-family spread, personal protective equipment, medicine types (quinine, aspirin, anti-inflammatories, etc.), immunization requirements, and so on had already been addressed (p. 1642).

Interestingly, Tambolkar et al. (2022) note that with respect to the Spanish Flu of 1918

The most prominent example comes from the United States, in Philadelphia, where the first case was discovered on September 17, but societal measures to limit the spread, such as restricting crowds in public locations, were implemented on October 3, when there were 40 deaths per 100,000 people. Unfortunately, the subsequent steps were ineffective, and by the middle of October, the number had risen to 250/100,000 persons (p. 1643).

The resemblance in approaches by public administrators separated by the span of more than a century reveals a remarkable kind of stagnation in terms of progressive thinking. While a surface level comparison of the two responses can perhaps offer valuable lessons about the importance of preparedness, communication, and the need to address social inequities in emergency response, the COVID-19 pandemic is unique for a number of reasons: first, it happened in the 21st century at a point in modern history wherein public administration is expected to be mindful of equitability in it services; second, in its modern context, due to the instantaneous spread of news information via social media, globalization, and technological advancements that relate to both fears of the spread of contagion and expectations of appropriate public health response.

In response to the COVID crisis, Mayor de Blasio’s office implemented a months-long policy of lockdown. Essential businesses like grocery stores and healthcare providers were allowed to remain open but were required to implement strict social distancing and hygiene protocols to protect both employees and customers (NYC, 2020). Many Tremont residents were employed in these sectors and were unable to work remotely. Helmreich (2023) notes that the economic impact of the lockdown was particularly severe in the Bronx, where a large proportion of residents rely on hourly wages and do not have the financial safety nets that wealthier individuals might possess.

Lockdown policies aimed at controlling COVID-19 spread had significant unintended effects on healthcare access in marginalized areas like Tremont. These disruptions revealed systemic inequities, as many Bronx residents, particularly those with chronic conditions, faced increased barriers to essential care. For example, Dorvil et al. (2023) found that over 54% of New York City residents reported disruptions in accessing healthcare services, with emergency room visits spiking in areas like the Bronx due to limited access to routine medical care during lockdowns. Chronic conditions prevalent in the Bronx required regular management, which was impeded by lack of access care. Consequently, the Bronx saw higher hospitalization rates as residents with unmanaged chronic conditions were forced to seek urgent care?? (Dorvil et al., 2023). Moreover, the closure of schools and the shift to remote learning posed additional challenges for low-income families in Tremont due to the pre-existing digital divide. The long-term effects of this educational disruption are still being studied, but early research suggests that students from low-income households experienced significant learning loss during the pandemic (Friedman et al., 2023).

Perhaps one of the most critical areas affected by the COVID-19 lockdown policies was healthcare access. For residents of Tremont, who already faced significant barriers to healthcare, the lockdown policies further limited their ability to access medical services (Roldós et al., 2024). The closure of non-essential medical facilities, such as primary care clinics and dental offices, meant that many people were unable to receive routine care—not to mention the fact that the policies of the mayor’s office supported a social stigma already introduced by non-stop media hype of the dangers of going out in public. People were scared and hesitant to seek medical care due to concerns about exposure to the virus. As a result, conditions that might have been manageable under normal circumstances experienced even greater systemic shock during the lockdown period. Huang and Li (2022) point out for instance that spatial health disparities were exacerbated during the pandemic, with low-income and minority communities experiencing higher rates of severe illness and death due to delayed care and reduced access to healthcare resources. Likewise, a core aspect of de Blasio’s COVID response was to promote telemedicine, but research on digital health disparities has found that nearly 50% of households in the Bronx lacked consistent internet access. Watts and Abraham (2020) indicated that low broadband connectivity in the Bronx limited residents' ability to engage in virtual healthcare consultations, particularly those without smartphones or other devices necessary for accessing telehealth. This gap left many low-income residents with fewer options for medical consultations during the pandemic??.

The pandemic also revealed long-standing issues related to health equity in New York City. COVID-19 mortality rates were disproportionately high in neighborhoods with large minority populations, such as the South Bronx (Friedman & Lee, 2023). Factors such as overcrowded housing, a need to rely on public transportation, and limited access to healthcare contributed to the higher rates of infection and death in these communities (Friedman et al., 2023). The lockdown policies showed little consideration for the underlying structural issues and may have worsened existing disparities. Is this how policy serves a community?

The COVID-19 pandemic and the subsequent lockdown policies implemented by the New York City government presented a complex problem for public administration: how to balance the need to protect public health with the responsibility to support equitable treatment and assistance for all communities. This research seeks to address the core problem of understanding how these lockdown policies impacted the health and well-being of residents in the Tremont neighborhood, a low-income, minority community in the Bronx. While the policies were intended to mitigate the public health crisis, there is evidence suggesting that they may have disproportionately worsened the socio-economic conditions and health outcomes for vulnerable populations.

Prior to the pandemic, Tremont already faced significant challenges, including high rates of poverty and unemployment, limited access to quality healthcare, and environmental hazards. The social determinants of health are widely known to affect community health outcomes. Restrictive policies like lockdowns have the potential to disrupt these determinants and trigger severe consequences for community health (Abrams et al., 2022).

This research thus aims to investigate the specific ways in which the COVID-19 lockdown policies affected the residents of Tremont, with a focus on the impact on healthcare access and the broader public health implications. By examining the lived experiences of community members and stakeholders, this study seeks to provide insights that can inform more equitable and effective public health policies in the future.

The purpose of this dissertation is to examine the impact of the COVID-19 lockdown policies implemented in New York City between March 2020 and September 2020 on the health and well-being of residents in the Tremont neighborhood of the Bronx. Specifically, this research investigates how these policies affected access to healthcare for this predominantly minority community and the health consequences experienced by its residents. Through an exploration of the lived experiences of Tremont residents and stakeholders, this study aims to obtain insights that can inform the development of more equitable and effective public health policies and practices in the future.

Researching the impact of Mayor Bill de Blasio's COVID-19 lockdown policies on Tremont is important for understanding how public health measures can exacerbate existing social and economic disparities for vulnerable populations. The lockdown policies, while intended to slow the spread of the virus, had unintended consequences that disproportionately affected low-income, minority communities like Tremont.

In the long run, the consequences of these disparities can be severe and far-reaching. Residents of communities like Tremont already experience higher rates of chronic diseases, such as asthma, diabetes, and hypertension, which increase their vulnerability to severe illness and mortality from events like the COVID-19 pandemic. Lockdowns further limited access to healthcare services, disrupted essential support systems, and led to economic instability, creating a "perfect storm" that worsened health outcomes and increased mortality rates in these communities. For example, research indicates that COVID-19 mortality rates were disproportionately high in neighborhoods with large minority populations, such as the South Bronx (Miller et al., 2021).

Understanding the specific challenges faced by communities like Tremont is needed for several reasons. First, such understanding can better inform the development of equitable policies by allowing policymakers to create fairer public health strategies that address the unique needs of vulnerable populations while at the same time taking care to make sure that future responses do not worsen existing disparities. Second, such understanding can improve public health outcomes in the long run by aiding public administrators in identifying the factors that contribute to poor health outcomes in these communities; with this information, interventions can be designed to address these factors. Third, addressing the disproportionate impact of public health crises on marginalized communities is a matter of social justice, the pursuit of which this research supports as should all public administrators.

This research seeks to explore the impact of COVID-19 lockdown policies on the Tremont neighborhood in the Bronx, with a focus on how these policies affected the lived experiences of its residents and how these experiences can inform future policy implementation.

How can an analysis of the lived experiences of residents in Tremont, Bronx, during and after the COVID-19 lockdown period, inform more equitable and effective public health policy implementation in future crises?

To address the central research question, the following sub-questions will guide the data collection and analysis:

How did Tremont residents perceive and experience the impact of COVID-19 lockdown policies on their access to healthcare and their overall socio-economic well-being?

What challenges and adaptations did healthcare professionals, local business owners, and educators in Tremont encounter in delivering services and support to residents during the COVID-19 lockdown period?

How do public health data, government reports, and news articles corroborate and contextualize the lived experiences of Tremont residents and stakeholders regarding the impact of COVID-19 lockdown policies?

These research questions are designed to provide a comprehensive understanding of the impact of lockdown policies on the Tremont community. The central question focuses on the application of the research findings to future policy, while the sub-questions align with the specific data collection methods to ensure a targeted and in-depth investigation.

The main objective of this dissertation is to examine the impacts of the COVID-19 lockdown policies on the health and well-being of residents in the Tremont neighborhood in the Bronx. Specifically, the research aims to answer the following questions: How did the lockdown policies affect access to healthcare for the minority population in Tremont? What were the broader consequences of these policies, particularly in terms of public health? Through an exploration of these questions, this dissertation looks to contribute to a deeper understanding of how emergency public health measures can impact vulnerable communities and to provide insights for public administrators into how future policies can be designed to consider such effects. In doing so, this research will draw on a range of primary and secondary sources, including public health data, government reports, and academic studies. It will also consider the perspectives of community members and healthcare providers in Tremont, who can offer valuable insights into the lived experiences of residents during the pandemic. Ultimately, the goal of this dissertation is to shed light on the specific challenges faced by low-income, minority communities during the COVID-19 pandemic and to provide recommendations for addressing these challenges in future public health emergencies.