COVID Lockdowns and Healthcare Access in Bronx's Tremont

Introduction and Community Context

The panic surrounding the 2020 COVID-19 pandemic created new administrative challenges in simultaneously protecting and serving communities. Many cities across America reacted to COVID-19 by attempting to curb the virus's spread through 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 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, restrictions on 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 communities affected, 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 socioeconomic 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 make up 46.46% of the population and females 53.54%. US-born citizens account for 54.9% of residents, non-US-born citizens for 25.36%, and non-citizens for 19.74%. The neighborhood is predominantly African American (11%), Asian (23%), and Hispanic (57%)—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 March through September 2020, the NYC 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 responded to this infection rate by restricting the movements of people whose activities were not deemed essential. If one was not a frontline worker—in healthcare, for example—there was no sanctioned reason to be outdoors. It was believed this approach would help stop the spread (Erwin et al., 2021).

However, the COVID-19 lockdown response 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 socioeconomic conditions of low-income residents in the Tremont neighborhood—with particular focus on how these policies affected access to healthcare for the minority population in this community.

Understanding the pre-pandemic socioeconomic 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 socioeconomic conditions have long contributed to health disparities in the borough, with minority communities experiencing higher rates of chronic diseases compared to residents in other parts of the city (Shiman, 2021).

The social determinants of health also include environmental factors that have significantly impacted 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 allowed hazardous industrial activities in the area, which contributed to high rates of respiratory illness among residents. These pre-existing conditions made the Tremont community particularly vulnerable before the pandemic began.

Tremont residents have also 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 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 option to work 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). Tremont's residents experience higher rates of these conditions compared to other NYC neighborhoods, placing them at elevated risk of severe COVID-19 outcomes (Huang & Li, 2022). Case studies on NYC and the Bronx found that COVID-19 hospitalizations and mortality were particularly high among residents with such pre-existing conditions, underscoring the need for targeted health interventions and equitable resource allocation in these communities (Friedman & Lee, 2023; Huang & Li, 2022).

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 for underprivileged populations. The argument at the time was that lockdowns would help slow the spread of the virus (Hammond, 2021). Major cities like NYC followed federal guidelines, as did nearly all other states, with notable exceptions such as Florida, where the governor kept businesses open. For the most part, federal guidelines were accepted as necessary to meet the challenges of the pandemic. However, little attention was paid to the potential deepening of healthcare inequalities for low-income, minority communities like Tremont. Residents already faced barriers to healthcare access, 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. On top of all this, 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 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." 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 admit that "future qualitative research is needed in this area" to better explain what actually transpired. That is precisely what this research attempts to do through 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 help policymakers develop more equitable approaches to future public health crises, so that low-income and minority populations are not disproportionately affected by similar measures.

COVID-19 Lockdown Policies and Healthcare Impact

In response to the COVID-19 crisis, Mayor de Blasio's office implemented a months-long lockdown policy. Essential businesses such as grocery stores and healthcare providers were allowed to remain open but were required to implement 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.

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 reduced care access. 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. 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. Beyond facility closures, the policies of the mayor's office reinforced a social stigma already amplified by nonstop media coverage emphasizing the dangers of 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 experienced even greater systemic shock during the lockdown period. Huang and Li (2022) point out 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.

A core aspect of de Blasio's COVID response was promoting telemedicine, but research on digital health disparities 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, reliance on public transportation, and limited access to healthcare contributed to 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.

The core problem this research seeks to address is understanding how the COVID-19 lockdown policies implemented by the New York City government impacted the health and well-being of residents 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 socioeconomic and healthcare challenges faced by these communities is crucial for developing more equitable public health policies in the future.

The Bronx had a poverty rate of nearly 27% prior to the pandemic—the highest of all New York City boroughs (Clark & Shabsigh, 2022). This matters because social determinants of health affect health outcomes in significant ways for communities like Tremont. When healthcare access is restricted and social determinants of health are worsened by restrictive policies like lockdowns, the result can be a perfect storm 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 contributed to the poor health of the population. 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). This demonstrates that residents in Tremont were already in a poor health posture before the lockdowns began. Helmreich (2023) shows 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, social determinants of health can quickly erode, leaving residents without adequate health support. Tremont and similar neighborhoods in the Bronx faced far greater challenges than wealthier areas with more robust digital and healthcare infrastructures such as Manhattan. NYC Department of Health data from 2020–2021 showed that the Bronx consistently had higher COVID-19 mortality and infection rates than Manhattan, where residents generally had better healthcare access and digital infrastructure.

In 2020, in the two zip code areas in which Tremont is located, COVID-19 cases were between 39,000 and 44,000 per 100,000 people (NYC COVID-19 Data, 2024). The total death count across those two zip codes from COVID-related causes was 688 (NYC COVID-19 Data, 2024). The Bronx overall was the hardest-hit area of NYC, with 3,556 hospitalizations per 100,000 residents (NYC COVID-19 Data, 2024). The Black and Latino communities were the most affected, comprising most of Tremont's population (NYC COVID-19 Data, 2024). Per 100,000 Black and Latino residents citywide, approximately 3,000 of each group were hospitalized due to COVID. Furthermore, people in very high poverty were hospitalized at the highest rate—3,539 hospitalizations per 100,000 residents occurring citywide in that demographic (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. Under the headline "New Guidance for Health Providers," it 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). This directive, while seemingly mild in intention, carried significant gravity in light of the escalating press releases and notices that followed throughout 2020—each carrying a more intense tone of alarm about the spread of COVID. Intentionally or not, the sub-text of this and subsequent communications was that—unless one had a health emergency—one should not attempt to access healthcare.

The most consequential press release from the Mayor's Office came on March 22, 2020, when city officials began sounding alarms in earnest. Effective that evening, all non-essential businesses in New York City were ordered closed. Only businesses with essential functions—grocery stores, pharmacies, internet providers, food delivery, banks, financial institutions, and mass transit—were permitted to operate. The city enforced strict rules for non-vulnerable individuals, including no non-essential gatherings, social distancing of six feet or more in public, limited use of public transportation, and a directive that sick individuals should not leave home except to receive medical care. "Matilda's Law" imposed additional restrictions on New Yorkers over 70 or who were immunocompromised, requiring them to remain indoors, limit outdoor activity to solitary exercise, pre-screen all visitors, wear masks in the company of others, avoid multi-person households, and refrain from using public transportation unless absolutely necessary (De Blasio, 2020).

The message was clear: people should not be going about their lives normally, and by extension they should not try to access healthcare as they ordinarily would. Mayor de Blasio's guidance was followed three weeks later by Health Alert #10 on April 11, 2020, which reported 96,522 COVID-19 cases in New York City, with 27% hospitalized and 5,463 confirmed deaths, and urged residents to continue enforcing and adhering to all social distancing interventions (2020 Health Alert #10, 2020). The following month, Health Alert #13 alerted residents to a pediatric multi-system inflammatory syndrome, ratcheting up fears still further (2020 Health Alert #13, 2020).

By October 2020, the strategy meant to flatten the curve was not only still being implemented but also becoming more restrictive, as the city issued a notice implementing red, orange, and yellow restriction zones across certain neighborhoods (NYC, 2020c). By December 2020, a city press release suggested there would be no return to pre-COVID normalcy: "The COVID-19 pandemic has changed how we live and work in New York City in many ways…" (NYC, 2020d). In May 2021, more than a year after the initial lockdown, a notice on "Managing the Return to the Office in the Age of COVID-19" outlined extensive requirements for returning workers, including six-foot markers, occupancy limits, and mandatory hygiene signage throughout all workspaces (NYC, 2021). Whatever sense New Yorkers had of being part of a community in which they could live, breathe, and mingle as one people without fear had been effectively dismantled. This approach to a public health crisis inevitably influenced the extent to which the people of Tremont enjoyed access to regular healthcare.

State and City Resource Disparities

De Blasio's COVID-19 policies in New York City were designed to align with state and federal public health guidelines, particularly those from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Although challenging to implement in a densely populated and transit-reliant city like NYC, these policies mirrored broader state and city efforts across the United States (Erwin et al., 2021). The differences in resources and logistical challenges between NYC and the rest of New York State provide context for the difficulties encountered during the initial response phase (Tolentino et al., 2021).

New York City's first official lockdown order was issued on March 22, 2020, just three days after similar orders were implemented in California, where San Francisco and Los Angeles enacted a statewide shelter-in-place order on March 19, 2020. By late March 2020, New York City had already become one of the hardest-hit major US cities, with significantly higher infection and hospitalization rates than many other metropolitan areas (Tolentino et al., 2021). NYC's early cases grew rapidly due to high population density, reliance on public transit, and what some critics called a slower lockdown implementation relative to West Coast cities (Tolentino et al., 2021). The NYC Department of Health reported nearly 96,522 confirmed cases and over 5,463 deaths by April 11, 2020.

NYC's policies under de Blasio were intended to align with CDC guidance issued in early 2020, which focused on social distancing, mask mandates, closures of non-essential businesses, and lockdowns. These guidelines served as a blueprint for both state and city-level responses (Erwin et al., 2021). However, NYC faced unique challenges, including high population density and dependence on public transportation, which required stricter enforcement measures compared to other parts of the state.

New York City's hospitals in densely populated areas faced severe resource shortages, including ICU beds and ventilators (Jarrett et al., 2022). The rapid surge in COVID-19 cases created significant strain on the healthcare system, with hospitals forced to adapt hurriedly to meet patient demand. Jarrett et al. (2022) reported that many hospitals were unable to maintain adequate levels of critical supplies and personnel, which frustrated their ability to follow CDC-recommended infection control measures consistently. As New York City hospitals experienced shortages of personal protective equipment (PPE), frontline healthcare workers faced increased risks. Tolentino et al. (2021) found that PPE rationing was common, causing delayed and inconsistent use of protective gear. Hick et al. (2021) found that PPE access disparities were more pronounced in larger cities like NYC compared to smaller regions, due to supply chain constraints and higher demand in urban hospitals.

Compared to rural and suburban areas of New York State, NYC's hospitals also lacked adequate surge capacity for pandemics. Thakur et al. (2020) highlighted that other regions were better able to maintain PPE supplies and expand bed capacity, partly due to lower patient density and more flexible infrastructure. These disparities reveal the challenges that NYC faced in aligning with state and federal pandemic standards and underscore the importance of strategic resource allocation and stockpiling of critical supplies for future pandemics. Long (2021) argued that urban areas like NYC should have robust stockpiling policies and rapid-response frameworks to avoid similar shortages in the future, as outlined in CDC pandemic preparedness guidelines. Unlike many other parts of New York State, NYC's public health policies also needed to account for dense urban living and extensive reliance on mass transit, making social distancing especially difficult to enforce (Park et al., 2020).

New York City's lockdowns in 2020 delayed serious healthcare procedures for many in the Bronx. Cancer and mental health treatments were postponed 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 failures succinctly: the state's early response was undermined by flawed guidance from the federal government, inadequate planning and stockpiling, limited consultation with experts, exaggerated projections, and poor cooperation between federal, state, and local officials. He noted that 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).