How Did Mayor Bill de Blasios COVID Lockdowns Affect Access to Healthcare for the Minority Population in Tremont?

Chapter 1

Introduction

The panic regarding the 2020 COVID-19 pandemic led to new administrative challenges regarding protecting and serving communities at the same time. Many cities across America reacted to COVID by trying to curb the virus's spread through the implementation of lockdowns. Local governments implemented strict measures that changed daily life overnight and exposed the vulnerabilities of already underserved and marginalized communities.

In New York City, one of the worst hit cities of the pandemic in the United States, Mayor Bill de Blasio's office issued a series of lockdown policies starting in March 2020 (NYC, 2020; Tolentino et al., 2021). 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 by and large reported on these measures as necessary to contain the public health crisis; however, for the public affected by these measures, there were far-reaching consequencesparticularly for the population of Tremont in the Bronx.

Tremont is a predominantly minority community in the Bronx. It has long been characterized by socio-economic disparities, such as high poverty rates and inadequate access to healthcare (NYC, 2020). There are28,095 residentsin Tremont, with a median age of 32. 46.46% are males and 53.54% are females. US-born citizens make up 54.9% of the residents in Tremont, and non-US-born citizens account for 25.36%. 19.74% of the population consists of non-citizens. The neighborhood's residents are mostly African American (11%), Asian (23%), and Hispanic (57%), all groups that have historically dealt with systemic barriers to economic mobility and healthcare equity (Census Reporter, 2024; Gilbert et al., 2022).

During the major COVID months of 2020, essentially March 2020 to September 2020, the 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 NYC in infection metrics due to social determinants of health?. De Blasios office acted in a manner to address this infection rate by restricting the movements and interactions of people whose movements were not deemed to be essential. In other words, if one was not a frontline worker, for example, in health care, one had no need to be outdoors. It was believed that this would help to stop the spread (Erwin et al., 2021).

However, the COVID-19 pandemic lockdown response essentially aggravated already existing challenges for this population by further limiting access to critical services (Tolentino et al., 2021). The purpose of this dissertation is to explore the specific impact of the lockdown policies implemented between March 2020 and September 2020 on the socio-economic conditions of low-income residents in the Tremont neighborhood. In particular, the research will focus on how these policies affected access to healthcare for the minority population in this community.

Contextualizing the Tremont Neighborhood in the Bronx

It is important to understand the pre-pandemic socio-economic condition of Tremont. Like many other neighborhoods in the South Bronx, Tremont is home to a low-income, minority population that has experienced continual challenges related to poverty, healthcare access, and environmental racism (Brennan, 2021; Estevez, 2020). Indeed, 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 experiencing higher rates of chronic diseases compared to other parts of the city (Shiman, 2021).

The social determinants of health also include environmental factors which have certainly impacted the health of Tremont…

How Did Mayor Bill de Blasios COVID Lockdowns Affect Access to Healthcare for the Minority Population in Tremont?

Chapter 1

Introduction

The panic regarding the 2020 COVID-19 pandemic led to new administrative challenges regarding protecting and serving communities at the same time. Many cities across America reacted to COVID by trying to curb the virus's spread through the implementation of lockdowns. Local governments implemented strict measures that changed daily life overnight and exposed the vulnerabilities of already underserved and marginalized communities.

In New York City, one of the worst hit cities of the pandemic in the United States, Mayor Bill de Blasio's office issued a series of lockdown policies starting in March 2020 (NYC, 2020; Tolentino et al., 2021). 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 by and large reported on these measures as necessary to contain the public health crisis; however, for the public affected by these measures, there were far-reaching consequencesparticularly for the population of Tremont in the Bronx.

Tremont is a predominantly minority community in the Bronx. It has long been characterized by socio-economic disparities, such as high poverty rates and inadequate access to healthcare (NYC, 2020). There are28,095 residentsin Tremont, with a median age of 32. 46.46% are males and 53.54% are females. US-born citizens make up 54.9% of the residents in Tremont, and non-US-born citizens account for 25.36%. 19.74% of the population consists of non-citizens. The neighborhood's residents are mostly African American (11%), Asian (23%), and Hispanic (57%), all groups that have historically dealt with systemic barriers to economic mobility and healthcare equity (Census Reporter, 2024; Gilbert et al., 2022).

During the major COVID months of 2020, essentially March 2020 to September 2020, the NYC Department of Health…

How Did Mayor Bill de Blasios COVID Lockdowns Affect Access to Healthcare for the Minority Population in Tremont?

Chapter 1

Introduction

The pani regarding the 2020 COVID-19 pandemic led to new administrative challenges regarding protecting and serving communities at the same time. Many cities across America reacted to COVID by trying to curb the virus's spread through the implementation of lockdowns. Local governments implemented strict measures that changed daily life overnight and exposed the vulnerabilities of already underserved and marginalized communities.

In New York City, one of the worst hit cities of the pandemic in the United States, Mayor Bill de Blasio's office issued a series of lockdown policies starting in March 2020 (NYC, 2020; Tolentino et al., 2021). 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 by and large reported on these measures as necessary to contain the public health crisis; however, for the public affected by these measures, there were far-reaching consequencesparticularly for the population of Tremont in the Bronx.

Tremont is a predominantly minority community in the Bronx. It has long been characterized by socio-economic disparities, such as high poverty rates and inadequate access to healthcare (NYC, 2020). There are28,095 residentsin Tremont, with a median age of 32. 46.46% are males and 53.54% are females. US-born citizens make up 54.9% of the residents in Tremont, and non-US-born citizens account for 25.36%. 19.74% of the population consists of non-citizens. The neighborhood's residents are mostly African American (11%), Asian (23%), and Hispanic (57%), all groups that have historically dealt with systemic barriers to economic mobility and healthcare equity (Census Reporter, 2024; Gilbert et al., 2022).

During the major COVID months of 2020, essentially March 2020 to September 2020, the 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 NYC in infection metrics due to social determinants of health?. De Blasios office acted in a manner to address this infection rate by restricting the movements and interactions of people whose movements were not deemed to be essential. In other words, if one was not a frontline worker, for example, in health care, one had no need to be outdoors. It was believed that this would help to stop the spread (Erwin et al., 2021).

However, the COVID-19 pandemic lockdown response essentially aggravated already existing challenges for this population by further limiting access to critical services (Tolentino et al., 2021). The purpose of this dissertation is to explore the specific impact of the lockdown policies implemented between March 2020 and September 2020 on the socio-economic conditions of low-income residents in the Tremont neighborhood. In particular, the research will focus on how these policies affected access to healthcare for the minority population in this community.

Contextualizing the Tremont Neighborhood in the Bronx

It is important to understand the pre-pandemic socio-economic condition of Tremont. Like many other neighborhoods in the South Bronx, Tremont is home to a low-income, minority population that has experienced continual challenges related to poverty, healthcare access, and environmental racism (Brennan, 2021; Estevez, 2020). Indeed, 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 experiencing higher rates of chronic diseases compared to other parts of the city (Shiman, 2021).

The social determinants of health also include environmental factors which have certainly impacted the health of Tremont residents. The South Bronx, including Tremont, has been disproportionately affected by environmental hazards, such as poor air quality and high levels of pollution. Estevez (2020) notes that the South Bronx has historically been subject to political practices that have allowed hazardous industrial activities in the area, which have in turn contributed to high rates of respiratory illnesses among residents. These pre-existing conditions made the Tremont community particularly vulnerable.

Additionally, Tremont residents have faced systemic barriers to accessing quality healthcare (Shiman et al., 2021). The Bronx is home to several public hospitals and community health clinics, but many of these facilities are underfunded and understaffed due to structural racism within the healthcare system, which has contributed to disparities in healthcare access, with minority communities in neighborhoods like Tremont receiving lower-quality care compared to wealthier, predominantly white areas (Shiman et al., 2021).

Research Significance

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

The importance of researching the impact of Mayor Bill de Blasio's COVID-19 lockdown policies on Tremont lies in understanding how these public health measures worsened existing social and economic disparities for underprivileged populations like the one in Tremont. The argument at the time was that lockdowns would help to slow the spread of the virus (Hammond, 2021). Major cities like NYC followed federal guidelines in almost all states except those like Florida, where the governor pushed to keep businesses open and people going about life as they were ccustomed to do. For the most part, the federal guidelines have been accepted as necessary to meet the challenges of the pandemic. However, little attention has been given to the potential problem of inequalities in healthcare access worsening for low-income, minority communities like Tremont. Tremont residents already faced barriers to accessing healthcare, and in 2020, due to clinic closures, overwhelmed hospital systems, and the lack of technology for telehealth services, the health situation of the community worsened. 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 allows for gaining insights into the unintended consequences of pandemic policies on marginalized populations. There is a need to know and understand the specific challenges faced by communities like Tremont, so that policymakers in the future can develop and adopt more equitable approaches to public health crises in the future, and so that low-income and minority populations are not disproportionately affected by similar measures?.

COVID-19 Lockdown Policies in New York City

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

Lockdown policies aimed at controlling COVID-19 spread .......sruptions revealed systemic inequities, as many Bronx residents, particularly those with chronic conditions, faced increased barriers to essential care. For example, Dorvil et al. (2023) found that over 54% of New York City residents reported disruptions in accessing healthcare services, with emergency room visits spiking in areas like the Bronx due to limited access to routine medical care during lockdowns. Chronic conditions prevalent in the Bronx required regular management, which was impeded by lack of access care. Consequently, the Bronx saw higher hospitalization rates as residents with unmanaged chronic conditions were forced to seek urgent care?? (Dorvil et al., 2023).

Moreover, the closure of schools and the shift to remote learning posed additional challenges for low-income families in Tremont due to the pre-existing digital divide. The long-term effects of this educational disruption are still being studied, but early research suggests that students from low-income households experienced significant learning loss during the pandemic (Friedman et al., 2023).

Perhaps one of the most critical areas affected by the COVID-19 lockdown policies was healthcare access. For residents of Tremont, who already faced significant barriers to healthcare, the lockdown policies further limited their ability to access medical services (Rolds 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 carenot to mention the fact that the policies of the mayors office supported a social stigma already introduced by non-stop media hype of the dangers of going out in public. People were scared and hesitant to seek medical care due to concerns about exposure to the virus. As a result, conditions that might have been manageable under normal circumstances worsened during the lockdown period. Huang and Li (2022) point out for instance that spatial health disparities were worsened during the pandemic, with low-income and minority communities experiencing higher rates of severe illness and death due to delayed care and reduced access to healthcare resources.

Likewise, a core aspect of de Blasios COVID response was to promote telemedicine, but research on digital health disparities has found that nearly 50% of households in the Bronx lacked consistent internet access. Watts and Abraham (2020) indicated that low broadband connectivity in the Bronx limited residents' ability to engage in virtual healthcare consultations, particularly those without smartphones or other devices necessary for accessing telehealth. This gap left many low-income residents with fewer options for medical consultations during the pandemic??.

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

Problem Statement

The core problem this research seeks to address is to understand 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 an important point because of the social determinants of health, which affect health outcomes in big ways for communities like Tremont. When healthcare access is restricted, and the social determinants of health are worsened due to restrictive policies like lockdowns, it can create 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 have already contributed to 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, which have contributed to higher rates of asthma and other respiratory diseases (Estevez, 2020). This point just goes to show that residents in Tremont were already in a poor health posture before the lockdowns.

Helmreich (2023) shows that the 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 disappear leaving residents without health support.

All in all, Tremont and similar neighborhoods in the Bronx faced far greater challenges than wealthier areas with more robust digital and healthcare infrastructures, such as Manhattan. These disparities intensified under lockdown. 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.

Research Objectives

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 aims to answer the following questions: How did the lockdown policies affect access to healthcare for the minority population in Tremont? What were the broader consequences of these policies, particularly in terms of public health? Through an exploration of these questions, this dissertation looks to contribute to a deeper understanding of how emergency public health measures can impact vulnerable communities and to provide insights into how future policies can be designed to consider such effects.

In doing so, this research will draw on a range of primary and secondary sources, including public health data, government reports, and academic studies. It will also consider the perspectives of community members and healthcare providers in Tremont, who can offer valuable insights into the lived experiences of residents during the pandemic. Ultimately, the goal of this dissertation is to shed light on the specific challenges faced by low-income, minority communities during the COVID-19 pandemic and to provide recommendations for addressing these challenges in future public health emergencies.

To achieve its objective, this study uses a qualitative research methodology, which is suited because this research requires in-depth exploration of the lived experiences of residents and stakeholders during the pandemic (Crabtree & Miller, 2023). A focus on subjective experiences and community-specific issues can be applied by way of the qualitative methodology, which supports deep understanding of how the lockdown policies influenced healthcare access and socio-economic conditions in this low-income, minority neighborhood (Crabtree & Miller, 2023).

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

Document analysis will also be employed, reviewing local government reports, public health data, and news articles that document the implementation of COVID-19 policies in New York City. This will provide contextual background and help triangulate the findings from interviews.

Thematic analysis will be used to identify patterns and themes emerging from the qualitative data. This approach allows the researcher to categorize and interpret the data based on recurring concepts, such as barriers to healthcare or economic hardships. The use of qualitative methods will offer rich, detailed insights into the social and healthcare inequalities exacerbated by the COVID-19 lockdown, contributing to a deeper understanding of its impact on vulnerable communities.

Chapter 2: Impact of COVID-19 Lockdown Policies on Healthcare Access in Tremont

Introduction to 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 when it comes to the social determinants of health, due 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 because of underlying pre-existing health conditions like 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 Blasios office between March 2020 and September 2020. Through the closing of non-essential businesses and mandating social distancing and remote learning, the mayors policies had far-reaching effects on access to healthcare for minority populations in the neighborhood of Tremont. Tremont could stand in as representative, in fact, of low-income, marginalized minority neighborhoods. Thus, understanding how the mayors policies affected healthcare access in Tremont is helpful from a public administration standpoint because it can shed light on the structural vulnerabilities of marginalized communities during public health crises and the extent to which public administrators policies and actions worsen or help alleviate those vulnerabilities. Furthermore, it can provide important insights into how future emergency measures can be designed to protect and support low-income, minority populations more effectively.

Comparison to NY State Standards

De Blasios 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 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 U.S. (Erwin et al., 2021). The differences in resources and logistical challenges between NYC and the rest of New York State provide context for perceived delays and the difficulties encountered during the initial response phase (Tolentino et al., 2021).

Alignment with CDC Guidelines and State Standards

There was nothing comparatively slow about NYCs response to the COVID pandemic. Essentially, major US cities responded lockstep in unison in terms of strategic response. New York Citys first official lockdown order was issued on March 22, 2020. This came just three days after similar orders in California, where San Francisco and Los Angeles implemented a statewide shelter-in-place order earlier, on March 19, 2020.

By late March 2020, New York City had already become one of the hardest hit major US cities of the pandemic, with significantly higher infection and hospitalization rates than many other metropolitan areas (Tolentino et al., 2021). New York City'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.

NYCs 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??.

State and City Resource Disparities

New York City, as the one of the worst hit areas of the pandemic, encountered overwhelming demand for healthcare services and PPE, resulting in delayed response times (Tolentino et al., 2021). The citys limited hospital capacity and strained resources affected its ability to meet CDC-recommended guidelines consistently, compared to less populated regions in New York State? (Tolentino et al., 2021).

First, NYC faced high demand for healthcare and limited capacity. New York Citys hospitals in densely populated areas faced severe resource shortages, including ICU beds and ventilators (Jarrett et al., 2022). The citys high population density and the rapid surge in COVID-19 cases created significant strain on its 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?.

Second, Aas New York City hospitals experienced shortages of PPE, frontline healthcare workers faced increased risks. Tolentino et al. (2021) found that PPE rationing was common, which caused delayed and inconsistent use of protective gear. These shortages exposed healthcare workers and patients to higher infection risks and impacted the citys ability to adhere strictly to CDC guidelines for PPE usage and sanitization protocols?. Additionally, 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?.

Third, compared to rural and suburban areas of New York State, NYCs hospitals 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 quickly, partly due to lower patient density and more flexible infrastructure. These disparities reveal the challenges that NYC, as a densely populated urban center, faced in aligning with state and federal pandemic standards?. The situation showed the importance of strategic resource allocation and stockpiling of critical supplies for future pandemics. Long (2021), for instance, 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, NYCs public health policies also needed to account for dense urban living and extensive use of mass transit. This reliance on public transit made it more difficult to enforce social distancing at a time when the city was trying to stop the spread of the virus by every means possible. Public health policies had to adapt to balance CDC recommendations with the citys logistical constraints? (Park et al., 2020).

COVID-19 Lockdown Policies and Their Relevance to Healthcare in NYC and Tremont

In 220, 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). Total death count of the two zip codes for COVID-related deaths was 688 (NYC COVID-19 Data, 2024). The Bronx overall was the hardest hit area of NYC with 3,556 hospitalizations per 100,000 (NYC COVID-19 Data, 2024). Likewise, the Black and Latino communities were the most affected, which is what makes up the majority of the Tremont population (NYC COVID-19 Data, 2024). Per 100,000 Blacks and Latinos in all of NYC, 3,000 of each were hospitalized due to COVID (NYC COVID-19 Data, 2024). Furthermore, people in very high poverty were hospitalized the most, with 3,539 hospitalizations of the very high poverty demographic per 100,000 residents occurring citywide (NYC COVID-19 Data, 2024).

On March 15, 2020, the Office of the Mayor issued a press release that covered a variety of actions that the residents of the city were expected to follow regarding COVID. Action pertaining to healthcare included the following under the headline New Guidance for Health Providers: