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Plotting Post-Pandemic Recovery

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Photo by Carolyn Torma

In recent years, the development of local or regional recovery plans following major natural disasters has become increasingly common. The Federal Emergency Management Agency has long encouraged such planning, and I led the production of two major FEMA-funded reports from the American Planning Association on the topic—Planning for Post-Disaster Recovery and Reconstruction (PAS 483/484, 1998) and Planning for Post-Disaster Recovery: Next Generation (PAS 576, 2014). I’ve spoken repeatedly on the topic, trained planners, and valued the collective knowledge of the two teams we assembled to make those projects happen. The underlying idea is to help a community assess its losses, reassess its goals, and find the silver lining in the dark cloud of the disaster that will allow it to rebuild better and stronger than before. This is the central concept of community resilience: the capacity to learn from such events, adapt to the changes they require, and move forward.

The idea of natural disasters has generally encompassed those caused primarily by meteorological and geological disturbances, such as storms and earthquakes, though it includes impacts exacerbated by human mistakes in building and planning. Disasters necessarily involve the collision of natural forces with the human and built environment, which has caused some people to question the very use of the word “natural” in connection with disasters. Personally, I am comfortable with the term “natural disaster” so long as we understand that no disaster exists without this interaction.

But there are those disasters where damage to the built environment is a secondary consideration, and the loss of lives is primary. Drought is somewhere in the middle. Damage to structures can occur, but only as the result of the slow, nagging loss of moisture in the air and soil. Heat waves can take hundreds of lives without affecting a single structure, though they can put enormous stress on energy and transportation infrastructure.

Pandemics, however, fall into another category entirely as biological disasters. They occur when bacteria or viruses emerge in the environment and attack humans before we have developed any effective immunity or vaccines. The current COVID-19 crisis fits this mold precisely. It can be far more devastating than a natural disaster simply because it can roam far more freely across the planet, as did the 1918 influenza pandemic, striking down hundreds of thousands if not millions of people. Before the era of modern medicine, pandemics like the bubonic plague in the Middle Ages could kill half of the affected population. Even without vaccines, we at least have the huge advantage of understanding how such microbial threats spread. Our disadvantage in the U.S. has been national leadership, starting with the President, that has been psychologically allergic to scientific advice. The result has been needless loss of life on a colossal scale.

It was a matter of time before some community, even without such federal leadership, applied many of the principles of recovery planning to the coronavirus pandemic. One critical question related to recovery is identifying the point at which the crisis is over, or at least waning. In natural disasters, drought being again the exception, this point becomes clear within a matter of days, or even hours in the case of tornadoes, as the storm passes. However, weather systems such as that which produced the 1993 Midwest floods, can last for weeks or even an entire summer. But at some point, it becomes clear that the emergency is over, and planning for long-term recovery can begin. In the absence of a vaccine, however, it is less clear when we can use the “all clear” signal for a pandemic. Right now, in the U.S., it is painfully clear that the rush to reopen is producing unconscionable and shocking consequences across the South and Southwest, and in a few other locations as well. It is incredibly hard, perhaps even impossible, to plan meaningfully for recovery when you are still stoking the fire by facilitating the spread of the virus.

Nonetheless, some states, notably including New York, much of New England, and Illinois, have fought hard against the odds to bring down infection rates, which are now a fraction of what they were in April or May. Their victory remains tenuous, considering the larger national crisis that remains a growing threat to public health, but Chicago under Mayor Lori Lightfoot has announced a list of states whose residents must quarantine for 14 days upon arrival, notably including Florida, Arizona, and Texas. Later, Iowa was added. By July 17, the Cook County Department of Public Health expanded that quarantine area to include all of suburban Cook County except a handful of suburbs that maintain their own health departments, and 17 states are on the list with new case rates exceeding 15 per 100,000 people per day. While it is nearly impossible to monitor all arrivals, the message is clear: We don’t want to re-create the problems we so recently overcame.

That is the context in which a large Recovery Task Force the city assembled released a recent report, Forward Together: Building a Stronger Chicago, which examines how Chicago could build a vibrant recovery from the coronavirus experience. Because such reports, especially those involving dozens of contributors and participants, are never crafted overnight, it is worth noting that the effort was launched on April 23, at a time when the outcome was far from clear. Neither the city nor the state could be certain then how long the problem would last or whether the stay-at-home orders and other measures would succeed at all in the near term. As of July 18, Illinois had dramatically increased its testing rate and brought its positivity rate for coronavirus tests down to 2.9 percent, well below most rates elsewhere, although it remains higher in Chicago at 5.4 percent.

So far, the strict measures announced in March have produced measured success, and the task force used that time to look farther down the road to the kind of city that might emerge from this ordeal. Forward Together is, to be clear, not a true recovery plan; it is billed as an “advisory report.” But it is the closest thing to a recovery plan that I have seen so far, and merits scrutiny and consideration for what it offers. (New York Mayor Bill de Blasio promised his own “road map to recovery” on April 26.)

The task force itself was broadly based. Lightfoot co-chaired it with Samuel Skinner, a businessman, lawyer, and political operative who served as both Secretary of Transportation and White House Chief of Staff under President George H.W. Bush. He has a long track record in public affairs. Committee chairs and members included elected officials, among them Cook County Board President Toni Preckwinkle, who was Lightfoot’s run-off opponent in the 2019 mayor election, labor and community representatives, business leaders, academicians, and civic leaders, including some prominent activists. The task force was broadly inclusive, which bodes well for public buy-in on the resulting recommendations. Moreover, the report shows significant evidence of wide community outreach, including a youth forum that tapped the ideas of teens and young adults.

Like all big cities, Chicago has witnessed significant disparities in impacts of the pandemic on specific disadvantaged groups, including the elderly, but also Blacks and Latinx residents. While these two groups each comprise 28 percent of Chicago’s population, they respectively comprise 30 and 48 percent of the cases of coronavirus and 44 and 32 percent of the resulting deaths. This is an important backdrop to the discussion of goals in the report.

The report discusses four specific initiatives to move the city forward and address many of the inequities and vulnerabilities exposed by the coronavirus. Invest South/West aims to bring public and private investment to those neighborhoods in the city that have suffered historic disinvestment, and where COVID-19 rates have generally been highest. Racial and ethnic inequities in coronavirus impact have been notably more severe among both Blacks and Latinx residents, in large part because of lower levels of insurance coverage but also because of differences in job exposures, poverty levels, and living conditions. Solutions Toward Ending Poverty (STEP) is a new program, announced in February by Lightfoot, that is attempting to identify evidence-based metrics that can plot a road map toward reducing urban poverty in Chicago. We Will Chicago—Citywide Plan aims over three years to develop what amounts to a comprehensive plan, something lacking in Chicago until now. The report says We Will Chicago “will encompass all elements of citywide planning.” Finally, Chicago Connected will aim to shrink the digital gap between more affluent and poorer neighborhoods by making broadband more readily available, a need whose urgency has clearly been exposed by the closing of schools and the challenges of assisting children from poorer households with remote learning.

A significant part of the report focuses on the economic development opportunities that Chicago can pursue to restore prosperity as the pandemic recedes. It is clear that certain categories of jobs—food service, retail, administrative, and manufacturing, but also arts and entertainment and personal services—have suffered the brunt of economic displacement from the pandemic. The report notes the opportunity for Chicago, as a result of some economic changes wrought by the pandemic, including shifts to online retail, to focus on transportation, distribution, and logistics (TDL) segments of the economy. These would take advantage of a longstanding Chicago advantage as a transportation hub.

TDL, however, faces its own challenges of inequitable opportunity. Food insecurity represents a serious challenge in “food desert” neighborhoods. Resolving those inequities is the intended purpose of the four initiatives, but it is hardly a challenge that will be resolved overnight. It has taken years of unequal opportunity, to say nothing of deliberate discrimination, to create the current dilemma. Failure to address these problems will slow down or even stagnate Chicago’s recovery from the current crisis.

The report makes what strikes me as an honest effort to address social services gaps that, if anything, grew under the previous administration of Mayor Rahm Emanuel, who closed some mental health centers in a bid to reduce budget deficits. The problem is that such reduced access to services only exacerbates problems among those needing such help and may increase other costs as a result. For example, a significant proportion of the inmates at the Cook County Jail (and many others around the nation) suffers from mental illness.

There is an urgent need to restore those services, but more importantly, the report shows that mental health services are far more prevalent on a per-person basis in more affluent, whiter neighborhoods than in poorer areas. For instance, 48 percent of whites with mental illness were receiving services in 2015, but just 31 percent of both Blacks and Latinx with mental illness were doing so. A map toward the end of the report shows differences shows a variation in presence of mental health providers ranging from zero or well below 0.25 per thousand residents in certain poorer areas of the city to well over 2 in predominantly white, middle-class areas and hundreds per thousand in downtown Chicago, a district well-nigh inaccessible to many South Side residents.

This may reflect, among other things, a disproportionate presence of white professionals in mental health and a need to bring more minority psychiatrists and psychologists to those neighborhoods. Reopening clinics in the neediest areas of the city would be a major step forward. As for the connection to coronavirus, the stress induced by greatly increased unemployment, to say nothing of job pressures within health care, can contribute to mental health challenges. Perhaps the most noteworthy proposal in this section of the plan is the recommendation to create a dedicated 211 line whereby residents can access a wide range of social services. It strikes me as essential, also, to reduce pressure on police to respond to personal mental health crises by instead responding to such incidents, to the extent possible, with mental health professionals and social workers.

As I noted, this is framed as an “advisory report.” I strongly suspect, however, given the tenor of the moment, that its recommendations will find widespread support among Chicagoans. What remains to be seen is how well voters and aldermen hold the administration’s feet to the fire to make it all happen. It is not enough to have confidence in a mayor who seems determined to make it happen. Implementation will require broad-based commitment to achieving the goals the report lays out. That includes embedding those goals in the comprehensive planning process that We Will Chicago envisions, and enacting measures to move them forward.

What is important about this effort for the rest of the country is the very idea of mounting such a broad-based effort to produce a forward-looking analysis of how our cities can recover from the coronavirus pandemic. Many may first have to learn how mayors and governors can exert the leadership, and evince the humility to consider the science, necessary to get the virus under control, as many other countries in Europe and Asia have done. These leaders must also be open to hearing from a widely representative cross-section of their citizens in preparing similar reports. Pandemic recovery planning is for all of us an experiment that can build on the foundations of other kinds of recovery plans while recognizing and thoroughly exploring the unique features of this monumental public health challenge. It is no small matter, and should not be treated as such, politics notwithstanding.

Jim Schwab

 

Inside the Hospital in the Time of Coronavirus

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It started last Thursday evening after dinner. By 8 p.m., suffering shivers and chills and fatigue, I retreated to bed, unsure what was affecting me but hoping a solid night of sleep might provide some respite. I was near the end of two busy weeks. The previous week, I had been deeply involved in a huge experiment by the American Planning Association, which it called NPC20 @Home, a three-day online professional conference that would replace its canceled National Planning Conference, which would have taken place in Houston April 25-28. Instead, on opening day, April 29, I was moderating a session with three speakers[i] on “Demanding Equity: Planning for Post-Disaster Recovery.” We had rehearsed our approach, and it came off seamlessly before more than 1,600 participants, which made all of us very happy.

The following Monday, as chair of APA’s Hazard Mitigation and Disaster Recovery Planning Division (HMDR), I led our annual business meeting, which also had gone online after the NPC was canceled. With the support of our executive committee, particularly Christine Caggiano, our secretary-treasurer, who played the Wizard of Oz for our Zoom controls, it too had been a remarkable success with attendance spread across four time zones. So it went through Thursday, when two other speakers[ii] and I presented a webinar for APA’s Michigan chapter on the 2020 update of APA’s Hazard Mitigation Policy Guide. That was over by mid-afternoon; we patted ourselves on the back, and I went on to other business, such as a blog post that remains unfinished. I will get to it, I hope.

It was only as the evening progressed that I sensed something was wrong.

My wife, Jean, began to share fears that I was the latest victim of coronavirus. She, of course, was simply reacting to visible symptoms and venting her worst fears. But as the night wore on, my intuition led me in other directions, and I was unwilling to succumb to simple answers. Only I could experience and report all of my symptoms, which included a few trips to the bathroom, and it reminded me too much of previous experiences with prostatitis. In April 2012, on a flight to Los Angeles, I experienced chills and fever somewhere over the Rockies. Chicago to Los Angeles is about a four-hour flight, so I had to endure two hours of personal deterioration before landing at LAX, where I struggled to hold myself together as I grabbed my luggage and found a taxi to the hotel, where I could check in for that year’s National Planning Conference at the nearby convention center. At the hotel, I was already sweating as I checked in and found my room, where I remained for the evening, under bed covers, skipping nearly every event at which I was expected.

I was basically a physical wreck throughout the five-day conference, but, on the advice of my primary physician, found my way to a nearby urgent care center, where I was diagnosed with prostatitis, an infection of the prostate gland that can, under the worst conditions, kill the patient, as my urologist in Chicago later explained. I will say it was one of the worst experiences of illness in my entire life, and people who saw me when I made an occasional appearance outside my room uniformly commented on how awful I looked, and asked what was wrong.

Thursday night was nowhere near that bad, but still, it reminded me symptomatically of that experience.

Yet, by Friday morning, I thought I had perhaps gotten past it all. I felt reasonably okay, ate breakfast, dressed, and joined an online faculty meeting for the School of Urban and Regional Planning (SURP) at the University of Iowa, where I teach a course on disaster planning. Our discussion with the dean of the Graduate College, John Keller, focused on what might happen with on-campus instruction this coming fall, a question for which the answer was indeterminate.

Somewhere in the middle of that discussion, the malaise began to reassert itself, and I felt weak and tired. I sent a chat note to Charles Connerly, the director of SURP, saying that if I disappeared from the Zoom screen, it was because I was not well. Less than an hour into the meeting, I did exactly that, and went upstairs to our bedroom to rest. My wife noticed that my fever was not abating and worried that I needed medical attention. By noon, she insisted on taking me to the emergency room at nearby St. Mary’s Presence Hospital, and I gave in, not because I had resisted the idea but because I needed to muster the energy to get up and do it.

At the hospital door, a small group of security and admitting staff sought to ensure that I was arriving as a patient as I exited the passenger door of our car. I explained the situation. My wife and grandson could not join me because, amidst the coronavirus pandemic, and with most of the hospital devoted to such patients, no visitors are permitted. They had to wait in the car or go home, which they eventually did after picking up take-out lunch at a nearby Wendy’s. Once inside and admitted, I was on my own.

The first step by the nursing staff was to administer a COVID-19 test, putting swabs deep into my nasal cavity; it later proved negative. However, my temperature was 100.6° F. They did a battery of other tests based on my symptoms and concluded over the next few hours, as I sat in an ER unit, that I was suffering from a urinary tract infection (UTI). How I acquired it, I will probably never know, just as I never learned how I acquired prostatitis. All that matters is the treatment. I learned, to my deep disappointment, that I would be kept overnight for monitoring because of my history of prostate issues, which has included an almost fruitless search for evidence of cancer. I say “almost” because elevated PSA scores triggered the search nearly a decade ago, before the incident in Los Angeles, and on one occasion a fusion biopsy discovered a tiny sliver of affected tissue. But that finding has never occurred in all the years since. As a result, no treatment has been necessary. But still, caution was apparently in order when a UTI materialized.

The one reservation, of course, is that most of the hospital by May 8 was occupied by COVID-19 patients. One floor was reserved for non-COVID patients requiring hospitalization, and by 9:30 p.m., that is where I was sent. In the meantime, as evening approached, the attending nurse, Jesse, offered the use of his cell phone so that I could call my wife and ask her to bring my cell phone, my Nook e-reader, reading glasses, and power cords to help me escape boredom. He could see that, with nothing to do during long spells when nothing needed to be done (I already had an IV in my arm for a broad-spectrum antibiotic), I was becoming slightly stir crazy. Jean obliged by delivering the goods to the ER door, where Jesse retrieved them. My Nook contains dozens of books. They would relieve my anxiety and let me feel connected to friends and family, so that we could discuss what was happening.

One situation that disturbed me early in the evening was that I had promised to be part of two online events from 5 to 6 p.m. The first was to host the Zoom “room” for HMDR as part of a much larger invitation for members of any APA divisions to participate in a virtual Divisions Happy Hour. Given that HMDR has more than 1,500 members, and APA now has 22 divisions and eight “interest groups,” the number of registrants may have been rather large, but I never had time to check. It was surely in the hundreds, though once they were dispersed to their own groups, each division may have had a few dozen attendees, at most. At the same time, SURP was hosting an online happy hour event for John Fuller, a 41-year veteran professor of the planning school who is retiring at the end of the spring semester. I had arranged to migrate between the two events by having two other executive officers of HMDR, Caggiano and Stacy Wright, our chair-elect, take over when I moved from the APA event to the University of Iowa event. John, in his early days, had hired me as a graduate research assistant when I entered the program, supported my career for its entirety, and played a role in my being hired as an adjunct professor at Iowa in 2008. Before Jean brought my iPhone, I felt guilty about my inability to let anyone know why I was not attending, even though I could do nothing about it. Once armed with the phone, I called Connerly to explain my absence at the university event, and he promised to inform John and Kathy Fuller. I also emailed Caggiano and Wright to let them know why I had not shown up. They assured me the event had gone well. My evening would have felt much worse if I had not been able to make those contacts.

I later learned that my two daughters had unwisely come to the hospital seeking information on my condition, which they could have attempted more safely by calling. One was put off by the cold response she got from the staff at the door, but I told her the staff had bigger concerns than her hurt feelings. It could instead be a lesson in using better judgment. She had also questioned Jean about why she took me to the hospital at all because she had come to understand that no one these days comes out alive. That is clearly not true, but probably not uncommon mythology among the public.

At one point while still in ER, I heard a PA announcement barking “Code Joy!” three times, followed by the opening bars of the theme song from Rocky. I wondered what that was about but could only make lame guesses. Later, from a nurse in my room, I learned it was a celebration of a patient who was being released from the COVID wards—someone who had fought the virus and won. Before I left the hospital, this happened five times. It became a reassuring indication that people do, indeed, fight the virus and win—every day. And not just every day somewhere, but every day in the same hospital. Five times in three days while I was there. I will surely never know who they were, but good luck to all, and God bless every one of them. The Great Virus is not invincible.

As noted, late that evening, I was wheeled out of ER, through the halls and onto an elevator, and up to the eighth floor, the only remaining non-COVID section of the hospital. After being tested for vitals, I quickly fell asleep. The next morning, I awoke early, around 5:30 a.m., and began a routine that would last for nearly two days. I would alternate between using my cell phone for a small number of e-mail and text messages, and occasional calls with relatives, watching one news channel or another, reading, and taking naps. With an IV in my arm and heart monitors on my chest, I could hardly be more adventurous.

The biggest commitment was to finish reading The Great Influenza, by John Barry, a 2004 book about the 1918 flu pandemic that killed tens of millions around the world at the end of World War I. That may seem a gruesome topic for someone in the hospital, but I had read three-fourths of the book before becoming ill, and I wanted to finish. Also, I approach such information more clinically, trying to understand what mistakes were made, what changes resulted, and how people were affected, and I enjoyed the opportunity to learn so much so quickly. By noon Sunday, I finished, even perusing the photo sections and some of the author’s acknowledgments. Certainly, I could not have been reading history more relevant to our current dilemma.

My selfie in a hospital bed. Nobody said such photos would be beautiful.

Then I was faced with the question of what to read next. I had no assurance that I was going home that day, although it was possible. The hospital had received the lab results by late Saturday evening, and they indicated nothing unusual or troubling that would make mine a difficult case. But there was some question of how soon an infectious disease specialist and the doctor would sign off on my release. At that point, it felt that the real issue was more bureaucratic logjam than substantive, and I began to voice some urgency both to the overnight nurse, Klaudia, and the day nurse who followed, Katorina, that I did not wish to waste space if my staying no longer served a legitimate purpose. They could only reassure me that it would happen sooner or later, but I must say that both were extremely attentive and remarkably pleasant, even when it was obvious how restive I had become about the need to be released. Given the pressures surrounding them, they seemed like angels.

It was Mother’s Day, after all, and I was also feeling regret about not only missing the Friday happy hour events, one to honor a long-time friend and colleague, but now draining the pleasure out of a day that should have been spent honoring Jean. It did not seem fair that my unexpected illness should rob her of this honor. I had planned to grill steaks and baked potatoes to accompany a lush salad for her dinner, but could do none of that. I could only wait.

I made an unusual choice of my next book—a 1950s theological essay, Your God Is Too Small, by J.B. Phillips. Despite its dated gender language in the introduction, it is remarkably lucid and straightforward in explaining how we “box” God into small roles in our lives because we cannot bring ourselves to understand God’s vastness and yet God’s importance to the minute details of our lives at the same time. There was something vaguely soothing about the message, given the situation. I did not finish the book in the hospital. That task still awaits. But I put a large dent in it.

Suddenly, around 6 p.m., Katorina came to the room to provide some medicine and the news that the doctor was authorizing my release, with the understanding that I should call to set up a follow-up telemedicine appointment with him a week later. Within the space of a half-hour, the nurse removed all the equipment hanging from my arm and chest; I changed clothes, packed up my limited belongings, signed the release papers, and she was walking me to the elevator, down to the lobby, and to the front door, where Jean had been alerted to find me. She arrived within minutes. Yes, non-COVID patients are also leaving hospitals these days, though far fewer than used to be the case. Non-essential surgeries, in many places including Chicago, have been pushed aside because those ill from coronavirus need the beds. But, clearly, they too often leave and return home, just as I was doing.

I took it easy on Monday. I was still a little light on energy, so I spent much of the day reading a few newspapers that had accumulated in my absence, but I had no special ambitions and no appointments. I did cook that steak dinner as a reward for Jean’s patience and a delayed Mother’s Day. But in the evening, I had difficulty sleeping because tension in my neck and shoulders, probably the result of stiffness induced by a lack of motion with all the equipment attached to my body in the hospital, was causing a mild headache. At Jean’s urging, I took two pain pills and a sleeping pill, but then she applied some massage to bring the congested energy around my neck down my spine to my legs and feet, and I felt some relief. In the end, I managed to sleep until 6:30, which is late for me, but very good in this instance. It was refreshing.

On the trail in Humboldt Park, a day and a half after release.

I have spent part of Tuesday composing this story, but part of it further releasing that pent-up energy by hopping on my bicycle and riding it to Humboldt Park, a 700-acre expanse of municipal open space just half a mile from our home. I wandered down one path after another, past lakes and lagoons and trees in the open air of a Chicago spring morning. I had written part of this before I left. I felt more energized to complete it when I came back, once I had eaten lunch. I learned you can enjoy nature much more when you have missed it for a few days. I can only imagine the restless agony of missing it for much, much longer.

Jim Schwab

 

[i] Shannon van Zandt, Texas A&M; Marccus Hendricks, Univ. of Maryland; and Chrishelle Palay, HOME Coalition, Houston.

[ii] Pete Parkinson and Kara Drane, who were also co-authors of the updated guide along with George Homewood, David Gattis, and myself.

Unequal Exposure

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On April 29, I will be moderating “Demanding Equity: Planning for Post-Disaster Recovery,” a 45-minute session in a special three-day virtual conference of the American Planning Association, NPC20 @HOME. The online conference is an attempt to replace the experience of the canceled National Planning Conference, which would have taken place in Houston, April 25-28. For the first time in APA history, the annual event will not go forward as planned. Like numerous other conferences, it was untenable to assemble thousands of participants in the middle of the coronavirus pandemic. But it is possible to provide a decent educational opportunity in its place by broadcasting and recording distance learning and letting participants ask questions remotely.

But why do I mention this one session, when APA is offering two dozen? Because it touches on some issues so central to the social and economic impacts of coronavirus, and speaks so directly to what planners and planning can do as we recover from this experience, that I wanted to highlight the subject in this post. It has been said often that the coronavirus does not discriminate. That may be true, but our society has done so and still does, often in ways people are reluctant to consider or admit. The result is that, as happens with most disasters, minorities and low-income people, those with fewer opportunities in life or greater exposure to danger, are disproportionately affected. And so it will be when the histories of this pandemic are written. The evidence is already stark enough for passionate discussion.

To give credit where it is due, the session was the brainchild of Adrian Freund, a veteran, semi-retired planner in Oregon. Before the NPC was canceled, however, Adrian was hospitalized (not because of coronavirus) and realized he would be unable to go to Houston. He reached out through a former president of APA, David Siegel, also of Oregon, to ask me to take over, and I agreed. We are on the same page on this issue. When APA decided to replace NPC with NPC20 @HOME, this was one of the sessions they felt must be included, and I reassembled the speakers to modify our plans for the new format.

All of them have a ton of wisdom to contribute on the subject. Shannon van Zandt is a professor of urban planning and department head at Texas A&M, and has authored numerous articles and led many projects on subjects related to equity in disaster recovery, particularly in the Texas context in which she works. Marccus Hendricks, an assistant professor of planning at the University of Maryland, is a Texas A&M graduate who has focused on infrastructure issues and environmental justice, writing his doctoral thesis on stormwater management in Houston. Chrishelle Palay is director at the HOME Coalition in Houston. Obviously, the panel has strong Texas roots, but there are few states where one can get better insights into the impacts of environmental inequities.

But it is the screaming headlines of the past week that have brought renewed attention to the issue in the context of coronavirus. In Chicago, we have learned that African Americans are dying from the virus at six times the rate of whites. Gary, a predominantly African American city, is the new coronavirus hot spot in Indiana. It is also where it gets personal for me. A 12-year-old granddaughter lives there and, as of yesterday (April 10), appears to have COVID-19 symptoms. Her mother called and was asked not to bring her to a hospital, but to isolate her at home. She will not be tested because, as everywhere else, this nation has not gotten its act together on testing. Will she even be included in the statistics, then, as a known case? Good question. I have no idea how Indiana is tallying such numbers. But she is in for a rough ride in the immediate future, and Gary and surrounding Lake County are certainly not fully prepared.

But what is happening in Chicago, as numerous commentators and public health officials have noted in the past week, is not only not unique, but to be expected. Detroit is emerging as a hotspot with major disparities in racial impact. State health data reveal that, while blacks make up 14 percent of Michigan’s population, they account for one-third of the cases and 40 percent of the deaths so far. In Louisiana, with one-third of the population, blacks account for 70 percent of the deaths. New Orleans has clearly emerged as a southern hot spot for coronavirus infections. Across the nation, one can find similar racial disparities.

Beneath those figures, however, are other disparities that weave in and out of racial and ethnic numbers. Age is perhaps the best-known factor, but so are many others. People in low-income service jobs, for instance, to the extent that they are still working, are more dependent on public transit and much less likely to be able to work from home like white-collar professionals. Public transit contributes greatly to mobility in urban centers, but does little for social distancing. It is still unclear just how transit will be affected for the long term, although it remains a vital link to jobs for many of the working poor. But coronavirus is clearly challenging the economic viability of many transit systems, one reason they were the target of assistance in the CARES Act.

It goes without saying that health care workers are significantly more exposed, but they are not just doctors. Their ranks include nurses, nursing assistants, and many others, some with much lower incomes, who nonetheless are risking their lives every day. Some of them work in nursing homes, which have not been the focus of any noticeable attention at the federal level. There are many ways to slice and dice the data to identify patterns of exposure, including those for access to health care, quite possibly the single most important factor driving disparities in this particular disaster. Lack of insurance coverage and inability to afford adequate health care leave many people untouched by the system and untested until it is too late. Poor or nonexistent health insurance coverage, especially for undocumented immigrants, accompanied by food deserts in many inner-city neighborhoods, endemic poverty in many rural areas and small towns, and exposure to job-related ailments, can produce numerous chronic conditions that make exposure to a new virus fatal or disastrous instead of merely survivable.

It remains remarkable, in view of these factors, that the Trump administration can maintain its drumbeat of opposition to the Affordable Care Act, including the recent refusal to allow newly jobless Americans to sign up for coverage. But this is one of many ways in which this nation, through both federal and state policy, continues to resist expanded, let alone universal, health care coverage to shore up health care deficiencies for the most vulnerable among us. There is both a meanness and short-sightedness that underlies much of this resistance. As I noted just two weeks ago, these health care vulnerabilities, with all the racial and socioeconomic inequities they embody, form the weak links in the chain of overall vulnerability for our communities when pandemic strikes.

And that brings me back to the point of the session I will moderate. One essential element of the planner’s skill set should be demographic analysis. The coronavirus pandemic highlights the critical value of addressing public health in comprehensive plans and other efforts to chart the future of cities, counties, and regions. Issues of national health care policy may be well beyond the reach of planners and their communities, but exposing the glaring disparities that have been made evident as the data on coronavirus cases grows is critical to knowing how resilient our communities are or how resilient we can make them. Access to health care is not merely a matter of insurance, as important as that is. It is also affected by the practices of local hospitals, the access to open spaces for densely populated areas, environmental regulations controlling industrial pollutants, public education around personal health, access to healthy food, the quality of our food distribution systems, and a myriad of other considerations that can be addressed to one degree or another through local or regional planning and through policy commitments to social equity.

That is precisely why, as the White House dithers, and federal management of the coronavirus crisis continues to fall short, dozens if not hundreds of mayors and governors and other local and state officials have stepped up to fill the gap. It is sad that there is not better national leadership in this crisis, but we are learning who our real leaders are. Enabling planners and other policy makers to support those officials with essential and meaningful data is an ongoing task, but if we are going to emerge from this disaster in a better place, identifying the inequities that weaken our communities and finding ways to build resilience across those weak links is going to be essential. There is no good alternative.

Jim Schwab