COVID-19 in your ZIP code: Race, income can double your chance of getting sick in NJ
Dava Salas, 41, walks 5 miles one way from her home in Camden to her job as a cook in Philadelphia. For a shift that starts at 1:30 p.m., during which she said she earns $7-something an hour, she’s out the door by 9:45 a.m.
By that time her husband, Benny, 43, has been at work at a Cherry Hill long-term care facility for nearly 3 hours. He makes $11 an hour, the state's minimum wage. Because the family doesn't have a car, Benny has to ride two buses that take an hour to get there.
The couple's jobs put them at risk of catching the coronavirus — from a customer, a sick resident or on a crowded bus — to earn $150 a day. They have no choice.
“We both have to work to be able to survive,” Dava said. “I mean, we’re trying.”
Coronavirus has spared no part of the state. Yet the fabric of New Jersey communities can increase residents’ chances of contracting COVID-19.
Areas of the state with higher nonwhite populations, higher density, lower access to health insurance and lower household income have higher COVID-19 infection rates, according to an analysis by the Trenton Bureau of the USA TODAY NETWORK New Jersey. It's the most detailed look yet at socioeconomic data and specific case numbers on the ZIP code level, instead of the state's broad reporting ranges.
For instance, COVID-19 infection rates in majority nonwhite ZIP codes are double that of New Jersey’s primarily white ZIP codes.
While mostly nonwhite communities have seen about 26 people per 1,000 residents infected, majority white communities have seen nearly 15 out of 1,000 people test positive for the virus.
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That trend mirrors a troubling national picture: Majority nonwhite communities across the country saw nearly 11 COVID-19 cases per 1,000 residents, but those with a 50%-to-75% white population had an infection rate half that, or 5 cases per 1,000 residents, according to a USA TODAY Network analysis of 8,500 ZIP codes across America.
Based on the Network data and 2018 U.S. Census demographic information, the Trenton Bureau analysis found:
- High infection rates for low-income residents. New Jersey communities with a lower-than-average household income have almost double the infection rate (24.5 cases per 1,000 residents) compared to those with a median household income of the state average of $79,363 or higher (14.6 cases per 1,000 residents).
- More densely populated ZIP codes had higher infection rates. Communities with multi-unit living spaces, such as apartment buildings, making up more than 25% of all housing, had double the infection rate than those with less than 25%, or 23.8 cases per 1,000 compared to 13.5 cases per 1,000 residents.
- Roughly 8% of New Jerseyans didn’t have access to health insurance in 2016. ZIP codes that had higher than 8% of residents without health insurance had twice the rate of COVID-19 infection. That's compared to ZIP codes with populations where more than average were insured, or 27.7 cases compared to 13.7 out of 1,000 residents.
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Knowing socioeconomic identities can help leaders prepare for an inevitable second wave. Such information can help officials understand where mobile test sites should be located, who needs to stock up on personal protective gear, and who needs help getting food and supplies.
"Public health crises expose the cracks in our foundation, and form earthquakes in Black and other vulnerable communities,” said Tiara Moultrie with the New Jersey Institute for Social Justice, a Newark-based racial and economic justice group. “Generations of structural racism and other oppressive systems show up as underlying health conditions, inadequate access to health care, jobs that don't allow for social distancing and close living quarters — all factors upon which the virus preys. Until we repair these underlying inequitable systems, we will continue to see devastating disparities such as these explode in times of crisis, because we see them in different forms every day."
This Network data provides the state with one of the most detailed public looks at how individual communities were hit and shows how vulnerable populations bore the brunt of the pandemic, regardless of geography.
USA TODAY collected data from 167 ZIP codes from North to South Jersey during the week of June 15 from state, county and local health departments that cover about 5.7 million residents. That means about 30% of residents are not captured in these numbers.
Search your ZIP code to see the number of COVID-19 cases in your community. Story continues below:
That gap also translates to missing 50,000 cases. The data includes more than 115,000 positive COVID-19 tests, but the state reported 166,829 positive cases on June 15. The state department of health only publishes ranges of cases and deaths for ZIP codes with more than 20,000 residents, about the same universe with less specificity as the USA TODAY data. The state covers data through June 8. The agency said it would update this map monthly, but has yet to do so.
The Department of Health also posts statewide statistics on the race of those who died due to COVID-19 complications. But few counties give this level of detail, though Ocean County stands out as an exception and posts the race of about three-fourths of those who contracted the virus.
And although Gov. Phil Murphy signed a bill in April that required public data on age, ethnicity, gender and race of those who contracted the virus, as well as by county and municipality, so far, no such numbers have been posted on the state's public dashboard.
"What we actually need is more clear data so that we can promote policy options that are going to reach those communities most in need when a second wave hits,” Moultrie said.
A tale of two ZIP codes
Proximity doesn’t equal similar infection rates. The data showed striking differences in certain neighboring ZIP codes. Take Passaic County in North Jersey.
One of the highest infection rates in the state appears in a Paterson ZIP code (07501), which borders the Passaic River and covers the neighborhoods of Stoney Road, Sandy Hill and Wrigley Park and houses more than 32,000 residents. The densely populated city had about 44 cases per 1,000 residents, for a total of 1,424 cases as of mid-June.
Compare that to the neighboring ZIP code of 07424, which covers Little Falls and Woodland Park, formerly called West Paterson. The southwestern suburbs faced 18 cases per 1,000 residents through mid-June. That was 475 cases for the population of 27,000 in the area.
Paterson was at the epicenter of the pandemic, said Paterson Health Officer Paul Persaud, whose health department became a model for tracking the disease quickly and notifying people at risk. As the first cases in the state began popping up in Teaneck in March, factory workers in the city who commuted from Paterson spread the cases there, he said.
And although a city may be a neighbor to another, community spread is just that: spread within a specific community, Persaud said. “If there’s no intermixing like social gatherings between cross border areas, then you wouldn’t expect the same infection rate.”
The demographics of the two ZIP codes is also striking: Little Falls and Woodland Park’s median household income is around $85,000; Paterson’s is $28,000. The suburbs’ population is about 32% nonwhite; Paterson’s is 93% nonwhite. The suburbs’ housing population consists of about 43% of buildings with more than one unit; Paterson's has 91% multi-unit dwellings.
Especially at the beginning of the pandemic, it was very difficult to get protective gear like masks and gloves in Paterson, said Zellie Thomas, a Paterson public school teacher and activist. He had to drive some 20 miles south to Hillside, but he was fortunate because he has a car, he said, while a large portion of the city does not.
“How are they able to get PPE, if there is very scarce PPE in Paterson, or Paterson shops jacked up the prices?” Thomas said about personal protective equipment, like face masks.
On top of that, the lack of transportation made it difficult to access mostly drive-thru testing sites in the area in the beginning, Thomas said.
“So the fact that a lot of people don’t even have cars, you’re putting people at risk because you’re asking them to get in an Uber or taxi or have their friends drive them, and may expose their friends or family members with someone who may have COVID-19,” Thomas said.
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State Assemblyman Benjie Wimberly, D-Passaic, who represents Paterson, added, “Our testing needs to be in the belly of the city, where the problems are, not the outskirts, like our initial testing was in. Now we have mobile testing, but how did it make sense that senior citizens had to travel to William Paterson University out in Wayne, where there’s no bathrooms, to stand in line for two hours or more?”
Other residents Thomas knew left the house to get food or medicine, because they had no support system to help them, which could have spread the virus. To address this issue of food insecurity in Paterson, Thomas created a mutual aid network to accept donations and distribute food and supplies like toilet paper, soap, and hand sanitizer to seniors, and delivered more than 6,000 meals and served about 200 people each day, he said.
Paterson is one of the densest cities in the nation, with more than 17,000 people per square mile, and when hundreds or thousands of people are packed in close quarters, the virus spreads more easily.
“I saw a family of 12 people, where one person got infected and because they don’t have a basement where to isolate, the entire family got infected,” said Mayor Andre Sayegh, who himself contracted COVID-19 in April and lost his sense of smell and developed pneumonia. He, along with his wife and daughter, who also tested positive for the virus, have since recovered.
But packed quarters don't prove to be the only factor when determining if someone will contract COVID-19.
Hudson County’s Union City and neighboring Hoboken, for instance, both have high population density and numbers of multi-unit housing. But Union City’s 07087 ZIP code had the highest infection rate in the state as of mid-June at 49 cases per 1,000, compared to Hoboken’s 11 cases per capita.
“Hoboken has gone through massive waves of gentrification, while Union City has not,” said Adam Gordon, executive director of the Fair Share Housing Center, which aims to end exclusionary housing policies in New Jersey. “You can live in a dense environment and have lower exposure. It’s more about what resources are available, if you work at a high-risk essential job and live in a multi-generational family household or stay at home to work in your condo.”
Hoboken’s ZIP code, which is 71% white, has a median household income of $136,000. Union City’s ZIP code, on the other hand, is 84% nonwhite, with a median household income of $46,000.
The lack of economic and health resources within certain immigrant communities can also exacerbate health issues, immigrant rights groups say.
Union City’s ZIP code has a 58.2% population of people born in another country; Hoboken’s immigrants make up about 16.5% of its population.
“A lot of our members got sick because they continued to work in unsafe conditions, and then brought it home,” said Sara Cullinane, director of Make the Road NJ, an immigrant and workers’ rights organization with centers in Passaic, Perth Amboy, Elizabeth and Newark. “Warehouses and temp agencies spread the virus like tinderboxes. And the government won't provide undocumented workers money if they stayed home.”
Many immigrants didn’t have access to health insurance. And undocumented immigrants can’t yet get driver’s licenses, so they couldn’t drive to get tested, so these positive case numbers could also be much larger, Cullinane said.
One of New Jersey's fastest-growing townships, Lakewood has grown into an urban center of Ocean County. More than 106,000 people live in the 25-square mile municipality, which is home to a large immigrant population and tens of thousands of Orthodox Jewish families.
The township has one of the lower median household incomes in the area and is one of the densest ZIP codes in the county. It also has the highest infection rate, which Mayor Ray Coles attributed to density and the Jewish culture, in which gathering with family and neighbors is a daily ritual for prayer and a preference on the sabbath and holidays.
Coles said cases spiked after Purim, a Jewish holiday that commemorates the saving of the Jewish people as documented in the biblical book of Esther. Sometimes compared to Halloween, the holiday is marked by large, costumed parties at night and visiting relatives to share gifts and give charity the next day.
This year, the celebration fell in March, five days after New Jersey announced its first coronavirus case and on the same day the first person in the state died from the virus.
"If we had two weeks' notice, if we had known what we did after Purim just two weeks before, it probably wouldn't have been as much," Coles said.
Furthering the divide
The coronavirus has only magnified challenges that urban communities have long faced and amplified the divide from the suburbs, said Amir Khan, a Camden native, pastor and activist. Just as the virus spread tentacles through Paterson and Lakewood, it struck Camden County’s urban core: one of the nation’s poorest cities that has long grappled with the binds between socioeconomic status and health outcomes.
The coronavirus infection rate in Camden, at 32 cases per 1,000 residents, is more than twice that in nearby Cherry Hill, where there have been about 15 cases per 1,000 people.
“A lot of residents in the city are the individuals who work in food service, individuals who work in landscaping,” said Camden Mayor Francisco “Frank” Moran. “That didn’t stop.”
In Camden, 94% of residents are nonwhite. In Cherry Hill, just 30% are not white. Camden’s median household income is $27,000 compared to Cherry Hill’s $100,000, according to Census estimates. One square mile in Camden is home to 8,700 residents. One square mile in Cherry Hill is home to 2,950 people.
“You have more people getting infected in Camden city because of the way they live,” County Health Officer Paschal Nwako said. “People live in close quarters, they live in apartment buildings and you have one member of the family getting infected and other members get it.”
The city is home to a large number of immigrants, and at one point there was an uptick of cases in their families, Moran said. The city began distributing public health information in English and Spanish, as well as thousands of masks. More testing sites were set up in the city than elsewhere in the county, and this month Nwako hopes to roll out a pop-up testing location in Camden’s largest multi-unit buildings.
Several community groups have ramped up efforts to provide families with healthy food. Demand has only grown as the coronavirus swept this city, which is considered a food desert and has no full-service grocery store, and residents lost their jobs.
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Benny and Dava Salas of Camden were out of work for months during the height of the pandemic. Their bills began to stack up: property taxes were due, the electric bill accumulated to almost $1,000, every two weeks meant another payment on the family’s rented furniture.
Dava, who identifies as part Irish, part Puerto Rican, walked to food banks at least twice each week since March, but even that hasn’t been enough, she said. She and Benny, who is Puerto Rican, for a while ate only one meal a day in order to make sure their children could eat, she said. Their blended family has four children; a 7-year-old is home all the time, a 10-year-old who visits a few days a week and two adults.
A farmer’s market truck operated by Virtua Health switched from selling below-cost fresh fruits and vegetables to become a food pantry, providing fresh and shelf-stable food for free at 116 stops around Camden. Since March, more than 52,000 pounds of food have been distributed from the truck, according to April Schetler, assistant vice president of community health engagement for Virtua, a network that operates five hospitals and 280 health care offices in South Jersey. That’s about 70% of what the mobile farmer’s market distributed in all of 2019, she said.
Limited access to healthy food can further chronic health conditions that make residents susceptible to the virus, Nwako said.
“People with more high blood pressure, diabetes and obesity just based on the way they are living,” he said. “It goes back to their income.”
The coronavirus and its economic fallout, including record-breaking unemployment, has not spared neighboring communities.
The Food Bank of South Jersey, which serves four counties, has seen a more than 200% increase in need for food since the coronavirus pandemic began, according to Marie Alonso, a spokeswoman. More than 40% of the people served are relying on the food bank for the first time, and many are members of the middle class, she said. Though all cities have an increased need, many new visitors are from Cherry Hill or Mount Laurel.
“Simply put, every community in South Jersey has been touched,” she said.
While infection rates are high in Camden, there have been more than twice as many deaths in Cherry Hill.
Nwako said that is because of high rates of coronavirus in long-term care facilities. There are 11 in Cherry Hill, and just two in Camden with outbreaks, according to state data. Cases in those facilities can push up an infection rate for an entire city or ZIP code, Nwako said.
They also show how the virus can spread between neighborhoods, especially in places like Camden, where residents leave the city to work each day.
Benny Salas takes precautions to make sure he doesn’t bring the virus home after his shifts at the Cherry Hill nursing home, his wife said. When he gets home, Dava sends their 7-year-old daughter upstairs to her bedroom and tells her to close the door. Benny takes off his clothes and goes right to the shower while Dava bags the clothes. She washes them at a laundromat on her day off.
“If I get it, my husband gets it, we can fight it,” Dava said. “My daughter’s immune system is low.”
Dava was laid off from her previous job as a server in Philadelphia in March. Her typical summer job on the Shore fell through because of the sweeping closures put in place to halt the coronavirus. Like many other New Jerseyans, she hasn’t been able to collect unemployment — she says there's confusion between states because she works in one and lives in another — and food stamps haven’t come through, leading to stress and irritation.
“I’ve broken down crying a few times,” she said. “I took back up smoking cigarettes. My nerves are just so bad.”
As businesses began to reopen, two weeks ago Dava took the first job she could find, even if meant walking to work in a hot kitchen where she is at risk.
Dava got her first paycheck since March on Saturday. She said the check, for two weeks of work, was for $366.
USA TODAY reporters Mark Nichols, Mitchell Thorson and Carlie Process contributed to this report.
Ashley Balcerzak is a reporter in the New Jersey Statehouse. For unlimited access to her work covering New Jersey’s legislature and political power structure, please subscribe or activate your digital account today.