COVID Lockdowns and Healthcare Access in Bronx's Tremont

Introduction and Community Background

The panic surrounding the 2020 COVID-19 pandemic created new administrative challenges in protecting and serving communities simultaneously. Many cities across America responded to COVID-19 by attempting to curb the virus's spread through 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 beginning 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 largely reported on these measures as necessary to contain the public health crisis; however, for the populations affected by these measures, there were far-reaching consequences—particularly for the residents of Tremont in the Bronx.

Tremont is a predominantly minority community in the Bronx that has long been characterized by socio-economic disparities, including high poverty rates and inadequate access to healthcare (NYC, 2020). There are 28,095 residents in Tremont, with a median age of 32. Males account for 46.46% of the population and females for 53.54%. US-born citizens make up 54.9% of residents, non-US-born citizens account for 25.36%, and non-citizens constitute 19.74%. The neighborhood is primarily composed of African American (11%), Asian (23%), and Hispanic (57%) residents—groups that have historically faced systemic barriers to economic mobility and healthcare equity (Census Reporter, 2024; Gilbert et al., 2022). The COVID-19 pandemic lockdown response aggravated these already existing challenges by further limiting access to critical services. This dissertation explores the specific impact of the lockdown policies implemented between March 2020 and September 2020 on the socio-economic conditions of low-income residents in Tremont, with a particular focus on how these policies affected access to healthcare for the minority population.

Understanding the pre-pandemic socio-economic condition of Tremont is essential context. 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 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 experience higher rates of chronic diseases compared to other parts of the city (Shiman, 2021).

The social determinants of health also include environmental factors that have significantly 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, contributing to high rates of respiratory illness 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 clinics, but many of these facilities are underfunded and understaffed. Structural racism within the healthcare system has contributed to disparities in care, with minority communities in neighborhoods like Tremont receiving lower-quality healthcare compared to wealthier, predominantly white areas (Shiman et al., 2021).

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, 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).

The importance of researching the impact of Mayor de Blasio's COVID-19 lockdown policies on Tremont lies in understanding how these public health measures worsened existing social and economic disparities. The argument at the time was that lockdowns would help slow the spread of the virus (Hammond, 2021). However, little attention was paid to the potential worsening of healthcare access inequalities for low-income, minority communities like Tremont. Clinic closures, overwhelmed hospital systems, and the lack of technology for telehealth services further deteriorated the community's health situation in 2020. Economically, the shutdown of service industry jobs hit the community 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).

Researching these issues is important because it generates insights into the unintended consequences of pandemic policies on marginalized populations. Understanding the specific challenges faced by communities like Tremont allows policymakers to develop more equitable approaches to future public health crises so that low-income and minority populations are not disproportionately harmed by similar measures.

In response to the COVID-19 crisis, Mayor de Blasio's office implemented a policy of lockdown that lasted for months. Essential businesses such as grocery stores and healthcare providers were permitted to remain open but were required to follow strict social distancing and hygiene protocols (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 lack the financial safety nets available to wealthier individuals.

The closure of schools and the shift to remote learning posed additional challenges for low-income families in Tremont, exacerbated by a pre-existing digital divide. Early research suggests that students from low-income households experienced significant learning loss during the pandemic (Friedman et al., 2023).

Perhaps the most critical area affected by the 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. Compounding this, the mayor's office communications reinforced a social stigma around going out in public. People were frightened and hesitant to seek medical care due to concerns about virus exposure. As a result, conditions that might have been manageable under normal circumstances worsened during the lockdown. Huang and Li (2022) point out that spatial health disparities intensified 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.

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, reliance 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 these underlying structural issues and may have worsened existing disparities.

The core problem this research addresses is understanding how the COVID-19 lockdown policies implemented by the New York City government impacted healthcare access and socio-economic conditions in Tremont. The policies were intended to mitigate the public health crisis, but they may have actually worsened the situation for low-income, minority populations. Understanding the specific socio-economic and healthcare challenges faced by these communities is crucial for developing more equitable public health policies in the future.

The Bronx has consistently exhibited high poverty rates and unemployment, particularly in low-income neighborhoods such as Tremont. Prior to the pandemic, the Bronx had a poverty rate of nearly 27%—the highest of all New York City boroughs (Clark & Shabsigh, 2022). This is relevant because of the social determinants of health, which profoundly affect health outcomes for communities like Tremont. When healthcare access is restricted and the social determinants of health are worsened by restrictive policies such as lockdowns, the result can be a compounding crisis that wreaks havoc on community health.

According to Shiman et al. (2021), structural racism and inadequate healthcare infrastructure have long affected minority communities in the Bronx and have already contributed to poor population health. The COVID-19 pandemic further strained these already limited healthcare resources. Tremont and other parts of the South Bronx have also suffered from poor air quality and other environmental hazards, contributing to higher rates of asthma and other respiratory diseases (Estevez, 2020), underscoring that residents were already in a vulnerable health posture before the lockdowns began.

Helmreich (2023) documents that lockdown measures significantly increased unemployment rates in the Bronx, where many residents worked in sectors hardest hit by the pandemic, such as retail and hospitality. Without economic support and stability, the social determinants of health can quickly erode, leaving residents without adequate health support.

The main objective of this dissertation is to examine the socio-economic and healthcare impacts of the COVID-19 lockdown policies on the Tremont neighborhood in the Bronx. Specifically, the research seeks 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 aims to contribute to a deeper understanding of how emergency public health measures can affect vulnerable communities and to provide insights into how future policies can be designed to account for such effects.

This research draws on a range of primary and secondary sources, including public health data, government reports, and academic studies. It also considers the perspectives of community members and healthcare providers in Tremont, whose accounts offer valuable insights into the lived experiences of residents during the pandemic.

To achieve its objective, this study uses a qualitative research methodology, suited to this work because the research requires in-depth exploration of the lived experiences of residents and stakeholders during the pandemic (Crabtree & Miller, 2023). A qualitative approach supports a deep understanding of how lockdown policies influenced healthcare access and socio-economic conditions in this low-income, minority neighborhood (Crabtree & Miller, 2023).

Data were collected primarily through semi-structured interviews with residents of Tremont, healthcare professionals, local business owners, and educators. These interviews explored participants' perceptions of the lockdown policies and their effects on healthcare access. The semi-structured format allowed for flexibility, enabling participants to share personal experiences while ensuring that key research questions were addressed (Crabtree & Miller, 2023). Additionally, focus groups were conducted with community-based organizations to gather collective insights into how the pandemic affected the broader neighborhood.

Document analysis was also employed, reviewing local government reports, public health data, and news articles documenting the implementation of COVID-19 policies in New York City. This provided contextual background and helped triangulate the findings from the interviews. Thematic analysis was used to identify patterns and themes emerging from the qualitative data, allowing for the categorization and interpretation of recurring concepts such as barriers to healthcare and economic hardship.

COVID-19 Lockdown Policies and Their Impact on Healthcare in Tremont

Tremont is an overwhelmingly low-income, minority neighborhood located in the South Bronx, New York City. Like many neighborhoods in the Bronx, Tremont has a poor track record on the social determinants of health, owing to high poverty rates, environmental hazards, and inadequate access to healthcare services. The community is primarily composed of African American and Hispanic populations, many of whom have historically faced systemic barriers to healthcare. These existing disparities made Tremont particularly vulnerable during the COVID-19 pandemic, as 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).

This research focuses specifically on the healthcare implications of the COVID-19 lockdown policies implemented by Mayor Bill de Blasio's office between March 2020 and September 2020. Through the closing of non-essential businesses and the mandating of social distancing and remote learning, the mayor's policies had far-reaching effects on access to healthcare for minority populations in Tremont. Understanding how the mayor's policies affected healthcare access in Tremont is valuable from a public administration standpoint because it sheds light on the structural vulnerabilities of marginalized communities during public health crises and the extent to which public administrators' policies worsen or help alleviate those vulnerabilities. It also provides important insights into how future emergency measures can be designed to more effectively protect and support low-income, minority populations.

In 2020, in the two zip code areas in which Tremont is located, COVID-19 cases ranged between 39,000 and 44,000 per 100,000 people (NYC COVID-19 Data, 2024). The total death count across both zip codes for COVID-related deaths was 688 (NYC COVID-19 Data, 2024). The Bronx overall was the hardest hit borough in New York City, with 3,556 hospitalizations per 100,000 (NYC COVID-19 Data, 2024). Black and Latino communities were the most affected—groups that constitute the majority of the Tremont population. Per 100,000 Black and Latino residents citywide, 3,000 of each group were hospitalized due to COVID (NYC COVID-19 Data, 2024). Furthermore, people in very high poverty were hospitalized at the highest rate, with 3,539 hospitalizations per 100,000 in that demographic occurring citywide (NYC COVID-19 Data, 2024).

On March 15, 2020, the Office of the Mayor issued a press release covering a variety of actions residents of the city were expected to follow regarding COVID-19. Under the headline "New Guidance for Health Providers," the press release stated: "To minimize possible exposures to healthcare workers, vulnerable patients, and reduce the demand for personal protective equipment, the Department of Health and Mental Hygiene will advise patients with mild to moderate illnesses to stay home" (NYC, 2020b). While seemingly mild in intention, this directive carried significant weight in light of the press releases and notices that followed throughout 2020—each carrying an intensifying tone of worry, concern, and alarm about the spread of COVID-19. The guidance effectively laid the groundwork for residents to begin pulling back from normal life; the implication was that—unless one faced a health emergency—one should not attempt to access healthcare.

Perhaps the most significant press release from the Mayor's Office came on March 22, 2020, when city officials began raising alarm in earnest. The announcement read:

"Effective Sunday, March 22nd, at 8:00 PM, all non-essential businesses in New York City will be closed. Only businesses with essential functions will be permitted to operate, such as grocery stores, pharmacies, internet providers, food delivery, banks, financial institutions, and mass transit. Businesses that provide essential services must implement rules that help facilitate social distancing. The NYPD will be out in neighborhoods across the City to ensure compliance with the policies."

The announcement continued with rules for non-vulnerable individuals, including: no non-essential gatherings; social distancing in public of six feet or more; limitations on outdoor recreational activities to non-contact only; limiting use of public transportation to only when absolutely necessary; and that sick individuals should not leave home except to receive medical care.

The announcement also enforced "Matilda's Law," setting the following restrictions for vulnerable New Yorkers over the age of 70 and/or immunocompromised: remain indoors; limit outdoor activity to solitary exercise; pre-screen all visitors and aides by taking their temperature; wear a mask when in the company of others; do not visit households with multiple people; ensure everyone in the presence of vulnerable people wears a mask; stay six feet from other people; and do not take public transportation unless absolutely necessary (De Blasio, 2020).

The message was clear: people should not be out and about, should not be going about their lives as they normally would, and by extension should not try to access healthcare as they normally would. Mayor de Blasio's guidance was followed three weeks later by the following health alert:

"April 11, 2020 Dear Colleagues: It has been more than five weeks since New York City reported its first person diagnosed with COVID-19. We continue to see an increasing number of persons diagnosed with COVID-19, including those who require hospitalization. As of April 11, 2020, there were 96,522 COVID-19 cases reported in New York City, with 27% hospitalized, and 5,463 confirmed deaths. To continue to flatten the curve of this pandemic and to protect health care delivery systems, it is critical to continue to enforce and adhere to existing mitigation measures, including all social (physical) distancing interventions" (2020 Health Alert #10, 2020).

The message to residents was clear and ominous: socially distance, and do not go out or be near others. Fear continued to be amplified, and New Yorkers were continually warned that they must adhere to Mayor de Blasio's lockdown protocols to "flatten the curve." In such a heightened state of alarm, all normalcy could be expected to be abandoned—including the receipt of regular healthcare services. While healthcare services may technically have remained available, the Mayor's Office was clearly warning residents to stay home.

The following month, on May 4, 2020, Health Alert #13 alerted residents to another infectious disease spreading: "a pediatric multi-system inflammatory syndrome," which ratcheted fears still higher (2020 Health Alert #13, 2020). By October 2020, the strategy meant to slow the spread had not only been maintained but had become more restrictive, as the city issued a notice implementing localized COVID-19 restrictions across three zones designated red, orange, and yellow. The notice stipulated that restaurants in red zones were prohibited from indoor and outdoor dining and could only offer carryout and delivery, while all non-essential businesses in red zones were required to close entirely (NYC, 2020c).

By December 2020, the city essentially announced that there would be no return to the pre-COVID normal. A press release pertaining primarily to road safety carried the ominous opening line: "The COVID-19 pandemic has changed how we live and work in New York City in many ways…" (NYC, 2020d). Mayor de Blasio's COVID-19 response had fundamentally altered the way the people of New York lived—and, to some extent, how they cared for their health.

Finally, on May 1, 2021, just over one year after the initial press release, a notice entitled "Managing the Return to the Office in the Age of COVID-19" was issued. Among the requirements for people returning to work were the following: public areas being cleaned in accordance with the Department of Health and Mental Hygiene guidance; six-foot markers implemented and posted; occupancy limitations posted for shared spaces; signage reminding individuals to adhere to hygiene, physical distancing, face covering, and cleaning and disinfecting protocols; and workspaces not allowing for physical distancing blocked off (NYC, 2021).

Mayor de Blasio's Office had, in effect, doubled and tripled down on its initial COVID-19 response strategy. Whatever sense New Yorkers had of being part of a community in which they could live, breathe, and interact freely was effectively all but gone. This approach to a public health crisis had an undeniable effect on the extent to which the people of Tremont enjoyed access to regular healthcare.

New York City's lockdowns in 2020 delayed serious healthcare procedures for many in the Bronx. Cancer and mental health treatments were postponed during 2020 at alarmingly high rates (Dorvil et al., 2023). Dorvil et al. (2023) found that "more than half of participants (54%) reported disruption to either routine physical healthcare or mental health services. Concern about getting COVID-19 (61%), stay-at-home policies (40%), belief that care could safely be postponed (35%), and appointment challenges (34%) were among reasons for delaying routine healthcare. Concern about getting COVID-19 (38%) and reduced hours of service (36%) were primary reasons for delaying mental healthcare. Reported reasons for the sustained delay of care past 18 months involved COVID concerns, appointment, and insurance challenges" (p. 1).

Hammond (2021) summarized the broader systemic failures as follows: the state's early response was undermined by flawed federal guidance, inadequate planning and stockpiling, limited expert consultation, exaggerated projections, and poor cooperation between levels of government; none of the legislature's pandemic-related hearings focused on the critical missteps of the state's early response; and better-controlled outbreaks in countries such as South Korea demonstrate the value of public health preparedness and could serve as a model for New York (p. 1).

Tremont experienced new barriers to healthcare during the lockdown. The closure of clinics and restricted public transportation options made it difficult for residents to access essential medical services (Dorvil et al., 2023). The shift to telemedicine also exacerbated disparities, as many low-income households lacked access to stable internet or the necessary technology to participate in virtual healthcare visits (Office of the State Comptroller, 2021). This digital divide was a major issue for the community of Tremont, where residents already faced systemic healthcare barriers before the pandemic.

In Tremont, as elsewhere in the United States, residents experienced reduced access to preventive care, chronic disease management, and mental health services (Irimata et al., 2023). The lockdown orders exposed healthcare inequities for those managing diabetes and other chronic conditions that require consistent, regular care. Community health centers—already underfunded and strained before the pandemic—were further overwhelmed by the surge of COVID-19 cases, making it difficult for residents to receive timely and adequate medical care (Shiman et al., 2021).

Healthcare Access Challenges and Disproportionate Impact on Minority Populations

One of the most significant consequences of the lockdown policies was the disruption of healthcare services in Tremont and other low-income Bronx communities. The citywide shutdown of non-essential services included many healthcare providers, such as primary care clinics and specialists, who played an important role in managing chronic conditions for low-income residents. Chronic conditions including asthma, diabetes, and cardiovascular disease are prevalent in the Bronx and disproportionately affect minority populations (Clark & Shabsigh, 2022). With limited access to healthcare providers during the lockdown, many residents were unable to receive essential care, leading to a deterioration of their health. The Office of the Comptroller (2023) concluded:

"According to the most recent New York City Community Health Profiles, each of the 10 neighborhoods in the borough had rates of diabetes, obesity, and hypertension that were similar to or higher than the citywide average, with none experiencing rates below the average. The New York City Department of Health and Mental Hygiene has noted the prevalence of these poorer health outcomes in low-income, minority communities where economic stress and discrimination can limit access to quality health care."

"Analysis of the correspondence between COVID-19 health outcomes in the Bronx and median household income and share of minority residents found an association with more severe health impacts. In general, throughout the pandemic, the six neighborhoods with the lowest household incomes in the Bronx, among the lowest citywide, have been among those with the highest hospitalization rates from COVID-19. Most ZIP codes associated with these neighborhoods fell within the top third of hospitalization rates citywide. The four Bronx neighborhoods with more moderate median household incomes also had lower hospitalization rates."

"Neighborhoods in the City that had a higher share of minority residents generally experienced higher cumulative case rates and death rates. Eighteen of the City's 55 Census-defined neighborhoods had a minority population in the top third in 2019, greater than 83 percent. Of these 18 City neighborhoods, eight were in the Bronx. The 20 ZIP codes covering these eight Bronx neighborhoods all had cumulative death rates within the top half of all City ZIP codes, and 11 were in the top third."

Additionally, the healthcare system in the Bronx was overwhelmed by the pandemic, with hospitals inundated by COVID-19 patients (Office of the Comptroller, 2023). This strain on the system resulted in delays in treatment for non-COVID conditions, further exacerbating healthcare disparities in Tremont. Residents faced longer wait times for medical appointments, reduced access to testing and treatment for chronic conditions, and limited availability of healthcare professionals due to the reallocation of resources toward COVID-19 care (Friedman & Lee, 2023).

The COVID-19 pandemic disproportionately affected minority populations across New York City, with African American and Hispanic communities experiencing higher rates of infection, hospitalization, and death (Office of the Comptroller, 2023). In Tremont, where the majority of residents belong to these minority groups, the lockdown policies compounded existing healthcare disparities. Structural factors included overcrowded housing, reliance on public transportation, lower access to healthcare, and lower rates of health insurance coverage, all of which increased residents' vulnerability and limited their ability to access healthcare services safely during the lockdown (Friedman et al., 2023).

Moreover, many Tremont residents faced language barriers, lack of internet access, and limited health literacy, which further hindered their ability to navigate the healthcare system during the pandemic (Office of the Comptroller, 2023). The transition to telemedicine services, which became more prevalent during the lockdown, posed additional challenges for low-income residents who lacked reliable internet access or the digital literacy needed to participate in virtual healthcare appointments (Roldós, Jones, & Rajaballey, 2024). As a result, many residents were unable to receive timely medical advice or follow-up care, further exacerbating health disparities in the community.

Public hospitals and community health centers are essential in providing healthcare to low-income residents in neighborhoods like Tremont. However, these institutions were severely impacted by the pandemic due to resource shortages, staff burnout, and an overwhelming influx of COVID-19 patients. According to Huang and Li (2022), hospitals in the Bronx, including those serving Tremont, were among the hardest hit during the early months of the pandemic, with many reaching capacity and struggling to provide adequate care.

Community health centers, which provide essential services such as primary care, dental care, and mental health support, were forced to reduce services or close temporarily due to the lockdown policies. This left many Tremont residents without access to basic healthcare services that are critical for managing chronic conditions and maintaining overall health. The reduced availability of these services during the lockdown likely contributed to the deterioration of health outcomes in the neighborhood, particularly for vulnerable populations who rely on affordable, accessible care (Shiman et al., 2021).

The delayed and reduced access to healthcare during the lockdown had significant consequences for the health and well-being of Tremont residents. For individuals with chronic conditions such as diabetes or hypertension, regular medical visits are essential for monitoring and managing health. The inability to access these services during the lockdown likely led to the worsening of these conditions, increasing the risk of complications and hospitalizations (Clark & Shabsigh, 2022).

Furthermore, the delay in seeking care due to fear of contracting COVID-19 in healthcare settings contributed to poorer health outcomes. Many residents were hesitant to visit hospitals or clinics during the pandemic, even for urgent health issues, due to concerns about exposure to the virus. This fear, combined with the overwhelmed healthcare system, resulted in many individuals delaying or forgoing necessary medical care, leading to preventable health complications (Huang & Li, 2022).

The COVID-19 pandemic underscored the deep-rooted healthcare disparities that exist in low-income, minority neighborhoods like Tremont. The lockdown policies, while intended to control the spread of the virus, further limited access to healthcare for vulnerable populations and exacerbated existing inequalities. Moving forward, it is essential for policymakers to consider the unique needs of marginalized communities when designing public health interventions and to ensure equitable access to healthcare, particularly during public health emergencies.

Policy recommendations for future public health crises should include increased funding for public hospitals and community health centers, expanded access to telemedicine services with support for digital literacy and internet access, and targeted outreach efforts to ensure that minority populations receive timely and accurate health information. By addressing these systemic issues, policymakers can help reduce healthcare disparities and improve health outcomes for low-income, minority communities like Tremont during future crises (Shiman et al., 2021; Friedman & Lee, 2023).

Conclusion and Policy Recommendations

This study identified several critical themes highlighting the healthcare access challenges faced by Tremont's minority residents during the COVID-19 lockdown. A primary theme was limited access to essential healthcare services, as clinics closed or limited appointments, impacting residents' ability to manage chronic conditions. Many reported difficulty accessing regular medications and necessary treatments, leading to worsening health and emergency interventions.

Another significant theme was the digital divide and barriers to telemedicine, where residents lacking internet access or digital devices could not utilize virtual healthcare. Even those able to use telemedicine found it inadequate for diagnosing and treating chronic conditions, revealing an inequity in how healthcare adaptations during the lockdown overlooked low-income communities.

Delayed or forgone care was a common consequence, with many residents postponing or avoiding medical visits due to fear of exposure, compounded by inconsistent access to services. This delay led to deterioration in conditions like asthma, diabetes, and hypertension. Many residents, especially those managing chronic conditions, struggled to obtain medications and regular treatments, leading to health deterioration and, in severe cases, emergency interventions. The strain on healthcare resources and the focus on COVID-19 patients left many feeling neglected.

The emotional and psychological toll on residents was also significant, as fear of COVID-19 and isolation from healthcare support led to heightened anxiety and stress. Many expressed feeling abandoned by the healthcare system, citing a lack of support or accessible resources for non-COVID health issues.

The COVID-19 pandemic and the subsequent lockdown policies enacted by Mayor Bill de Blasio's office between March 2020 and September 2020 had serious effects on low-income communities across New York City, particularly in neighborhoods like Tremont in the Bronx. Tremont, a predominantly minority and low-income area, was already grappling with significant socio-economic challenges—including inadequate access to healthcare, high rates of chronic illness, and environmental injustices—all of which contribute to the social determinants of health. These pre-existing vulnerabilities were substantially worsened by the public health measures of the mayor's office.

The lockdown policies resulted in the temporary closure or limitation of many healthcare facilities that Tremont residents relied on for essential services. Community clinics and public hospitals were overwhelmed by the surge of COVID-19 patients, leading to delays in care for non-COVID-related health issues and a reduction in routine medical services such as chronic disease management and preventive healthcare. The healthcare disparities already present in Tremont became more pronounced as access to care diminished. Factors such as overcrowded living conditions, reliance on public transportation, and limited access to digital resources for telemedicine exacerbated these challenges, placing Tremont's residents at higher risk of severe illness and death from both COVID-19 and untreated pre-existing conditions.

Overall, the findings demonstrate a compounded impact of healthcare and socio-economic disparities on Tremont's residents during a public health crisis. Addressing such inequities in future healthcare responses will require targeted strategies, including better access to physical care for patients with chronic conditions, digital resources for low-income communities, and support systems that prioritize vulnerable populations to prevent further health disparities.

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