COVID-19 Lockdown Policies and Health Equity in Tremont, Bronx

Introduction and Overview

The panic surrounding the 2020 COVID-19 pandemic led to new administrative challenges regarding protecting and serving communities simultaneously. Many cities across America reacted to COVID-19 by trying to curb the virus's spread through the implementation of lockdowns. Local governments enacted 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 in the United States, Mayor Bill de Blasio's office issued a series of lockdown policies beginning in March 2020 (NYC, 2020; Tolentino et al., 2021). 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). Legacy media reported on these measures as necessary to contain the public health crisis; however, for the public affected by them, 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 male and 53.54% are female. US-born citizens make up 54.9% of residents, non-US-born citizens account for 25.36%, and non-citizens constitute 19.74% of the population. The neighborhood's residents are mostly African American (11%), Asian (23%), and Hispanic (57%)—all groups that have historically faced systemic barriers to economic mobility and healthcare equity (Census Reporter, 2024; Gilbert et al., 2022).

During the major COVID months of 2020—essentially March through September—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. The Bronx consistently led New York City in infection metrics due to social determinants of health. Mayor de Blasio's office responded to this infection rate by restricting the movements and interactions of people whose activities were not deemed essential. In other words, if one was not a frontline worker—for example, in healthcare—one had no need to be outdoors; the goal of the mayor's office was 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 focuses on how these policies affected access to healthcare for the minority population in this community.

The Setting: Tremont Before the Pandemic

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). As a result, minority communities in the area experience higher rates of chronic diseases compared to other parts of the city (Shiman, 2021). For example, the social determinants of health include environmental factors that have certainly affected 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 permitted hazardous industrial activities in the area, which 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, further compounds this vulnerability, 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. This 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).

Research Significance and Background to the Problem

In Tremont, many residents work in low-wage, essential jobs, often without the option 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). Tremont's residents experience higher rates of these conditions compared to other New York City neighborhoods, meaning they faced elevated risks of severe COVID-19 outcomes (Huang & Li, 2022). Case studies on New York City and the Bronx noted that COVID-19 hospitalizations and mortality were particularly high among residents with such pre-existing conditions, underscoring 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. The argument at the time was that lockdowns would help slow the spread of the virus (Hammond, 2021). Major cities like New York City followed federal guidelines, in contrast to states like Florida, where the governor pushed to keep businesses open. For the most part, federal guidelines were accepted as necessary to meet the challenges of the pandemic. However, little attention was given to the potential worsening of healthcare access inequalities for low-income, minority communities like 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 in the community worsened. Beyond 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 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." 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." The implication is that something happened among these residents to mitigate risk during the second wave. 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 acknowledge that "future qualitative research is needed in this area" to better explain what actually transpired. 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. Understanding the specific challenges faced by communities like Tremont can enable policymakers to develop and adopt more equitable approaches to public health crises, ensuring that low-income and minority populations are not disproportionately affected by similar measures in the future.

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 critical role that public administrators play in emergency management, policy implementation, and equitable service delivery. Local governments, as the level of government closest to the people, were at the forefront of the pandemic response. 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 useful 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).

Tambolkar et al. (2022) also 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 more than a century reveals a remarkable stagnation in progressive thinking. While a surface-level comparison of the two responses can 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 several reasons: first, it occurred in the 21st century, at a point in modern history when public administration is expected to be mindful of equitability in its services; second, in its modern context, the instantaneous spread of information via social media, globalization, and technological advancements shaped both fears of contagion and expectations of appropriate public health response in ways that have no historical precedent.