COVID-19 Community Response: Emerging Themes Across Sentinel Communities

Rural Finney County is a diverse and young community where many work in the meatpacking industry—a field that saw some of the earliest COVID-19 outbreaks. The county is nearly two-thirds Latino, has a large immigrant population, and children make up one-third of the overall population. Despite this diversity, the county has no concrete plans to address persistent health equity gaps.

CARES Act funding and a small amount of philanthropic support went to directly support families as well as the organizations that serve them. A perceived “hands-off approach” by political leaders to mitigate the pandemic’s effects has left public health protections up to health care, private, and nonprofit organizations.

A preponderance of essential employers and occupations in Finney County sheltered the community from much of the economic fall-out from COVID-19. However, outbreaks at meatpacking facilities and in the community at-large resulted in significant numbers of cases and deaths from the pandemic, particularly in the winter months.

Political leaders in Finney County prioritized “getting back to normal” after early economic shutdowns, eschewing mask mandates and offering limited support to the Finney County Health Department’s mitigation efforts. Local vaccination efforts coordinated by the health department, LiveWell, health care agencies, schools, and the meatpacking industry gave hope for helping the county truly resume a sense of normalcy, though vaccination efforts were hindered by vaccine hesitancy, especially in a politicized environment surrounding the pandemic. These trends reflected long-standing beliefs that the government should avoid involvement in health efforts, according to local nonprofit leaders.

Finney County has a diverse population in terms of race, language, and national origin. However, isolation, language barriers, and lack of political representation meant that low-income residents and residents of color were largely overlooked by political leaders. Nonprofit and health care organizations, led by the local health coalition, stepped in to address health and well-being challenges for these communities, including food insecurity and mental health, and to facilitate remote learning for students. The private sector, acknowledging that employee health was critical to maintaining continuity, also contributed to COVID-19 mitigation efforts in the county.

Findings on Finney County’s COVID-19 response:

• The pandemic’s early days (released July 2020)
• Cross-sector collaborations in recovery efforts (released October 2020)
• Impacts on children and families (released March 2021)
• COVID-19 one year later (released July 2021)

Harris County, home to Houston and one of the most populous and diverse areas in the nation, offers insight into how the pandemic has affected different populations in different ways—even in a community with good equity practices and deep experience with disaster response.

The state of Texas prioritized re-opening the economy and lifting mask mandates while the pandemic continued to spread in the county. County leaders struggled to balance community health and economic interests and were often in conflict with state leadership, which typically only gave them the authority to offer unenforceable recommendations.

Where they could, Harris County Public Health and other public health and health care stakeholders prioritized an equitable response in the large and diverse community, tracking COVID-19 cases, tests, and vaccinations by race and geography, and using innovative strategies to reach communities experiencing vulnerability.

Nonprofit and philanthropic networks established during prior emergency situations were able to quickly mount a response to emerging health issues, including food insecurity and mental health challenges.

Harris County and the city of Houston partnered to disperse federal funding provided by the CARES Act, and later the ARP, for direct aid to residents through a single portal. This rapid response was especially critical as eviction moratoriums expired and low-wage sectors of the economy were slow to bounce-back. Local school districts also strived to provide safe learning environments as the state of Texas prioritized in-person education and later prevented schools from enforcing mask mandates, closely tracking COVID-19 cases, offering rapid testing, and convenient opportunities for staff and students to be vaccinated.

Findings on Harris County’s COVID-19 response:

• The pandemic’s early days (released July 2020)
• Cross-sector collaborations in recovery efforts (released October 2020)
• Impacts on children and families (released March 2021)
• COVID-19 one year later (released July 2021)

Milwaukee is one of the nation’s most segregated cities where communities of color have experienced wide disparities. But, leaders are committed to addressing equity and systemic racism.

When the pandemic began, several established partnerships and cross-sector collaborations expanded their efforts to meet emerging needs in the community. Milwaukee’s trajectory of response and response has been shaped immensely by the work of state and local leadership, philanthropic investment, diverse businesses and industries, and nonprofit and local organizations who stepped up to meet the varied and evolving needs of Milwaukee residents. This included multi-million dollar investments to help families stay in their homes and keep business afloat.

Organizations also collaborated to address food insecurity and the safety and care of children while parents on the front lines had to work. Although for many, the reopening of schools and businesses, the loosening of capacity restrictions, and the increase in vaccines is promising, signaling a return to work and a “pre-pandemic normal,” many individuals, families, and businesses continue to struggle to pay off debt that has been accumulating during periods of closure or job loss. A full return to work may not be feasible for some until the fall given continued restrictions and reduced programming for many summer activities for children and youth.

Full response is likely to have a long tail as this disruption has created lasting impacts, particularly for children and youth. Some students have partially or completely disengaged from the education system and it is not clear whether or in what capacity they will return, which can have life-long impacts with respect to future employment opportunities and earning trajectories. There is also concern that learning gaps have widened between those who were able to stay connected through remote learning and those that were not, widening disparities.

Equally concerning is the increase in mental and behavioral health needs of both children and adults in the Milwaukee area as a result of the pandemic. Although Milwaukee is actively working to address this need through new investments and partnerships, the benefits of such services may take time to be realized and the implications may be long-lasting.

Findings on Milwaukee’s COVID-19 response:

• The pandemic’s early days (released July 2020)
• Cross-sector collaborations in recovery efforts (released October 2020)
• Impacts on children and families (released March 2021)
• COVID-19 one year later (released July 2021)

In Mobile, where Black residents outnumber whites by seven percentage points, and nearly one in four people experience poverty, equitable pandemic response has been especially challenging. When the pandemic began, Mobile County Health Department spearheaded the COVID-19 response, including ongoing dialogues around the need for a response that addresses racial equity.

Racial disparities in COVID-19 infection and death rates have caused tension between Black community members and government officials, whose aggressive reopening plans and lack of a mask mandate placed Black residents of Mobile at particular risk considering their high rates of poverty, lack of health insurance, and higher prevalence of other health conditions.

However, over the course of the pandemic, there has been a slight shift in how Mobile and the state of Alabama think about and prioritize health and factors that can affect residents’ health, such as Medicaid expansion and addressing vaccine hesitancy. Although these activities suggest some movement, it is not known if these activities will lead to lasting change.

Despite periodic disagreements with the mayor about the best course of action for the city, the Mobile County Health Department appeared to be a strong foundation for COVID-19 related efforts over the past year, working in collaboration with local health care providers and schools, and other activities noted in prior sentinel community reports including coordinating with local Tribal populations on COVID-testing efforts and serving on the diversity and inclusion committee of the United Way.

Mobile’s focus on supporting the business community was unwavering throughout the pandemic. Even prior to the pandemic, economic development was a key area of focus for city leadership, and investments during the pandemic reiterated this commitment, particularly for small business. Mobile was successful in securing new economic development projects, bringing new jobs to the area, and staying committed to the launch of the Tourism Improvement District.

Prior to the pandemic, equitable housing was not a main priority for Mobile but this has shifted somewhat over the past year, given new investments and efforts to build new affordable housing in the city as well as provide support for those who may be facing eviction or homelessness.

There are broader concerns about children of all ages, particularly children of color, disengaging with the school and social systems and what this might mean for their futures. On a positive note, new collaborations formed to fill critical gaps in health care services and to support the safe reopening of schools.

Findings on Mobile County’s COVID-19 response:

• The pandemic’s early days (released July 2020)
• Cross-sector collaborations in recovery efforts (released October 2020)
• Impacts on children and families (released March 2021)
• COVID-19 one year later (released July 2021)

Much of San Juan County overlaps with the Navajo Nation. Some places in this New Mexico county face deep challenges, like lack of running water or Internet service. Roughly 30 percent of children live below the poverty level and only two-thirds of households have Internet access. These factors impact health, especially during a pandemic.

The county has also experienced uncontrolled spread of COVID-19 for much of the pandemic, particularly among members of the Navajo Nation. An acknowledged but unaddressed disconnect between the Navajo Nation and the rest of San Juan County reveals minimal county-level response to high numbers of cases within the Navajo Nation.

However, the state of New Mexico has been lauded for its COVID-19 response efforts that prioritized protecting public health. Vaccinations rolled out quickly and generally equitably within the state, with a focus on communities already experiencing vulnerability due to underlying health disparities and economic conditions. In fact, frontline workers and residents of color in New Mexico were vaccinated more efficiently than in many other states, due to the state’s vaccine prioritization plan and allocation strategy.

In San Juan County, opinions about the success of COVID-19 response were mixed. Local nonprofit stakeholders perceived that leaders across sectors did the best they could given the circumstances, connecting businesses to federal supports, advocating for additional federal relief funding for food and housing security efforts, and working together to meet the needs of communities they served. A lack of coordinated philanthropic relief effort, few existing formal coalitions, and significant pre-pandemic need meant that scarce resources had to be cobbled together. Funding from the oil and gas industry had long supported local nonprofits and was drying up as the industry shrank. Technological barriers hindered remote schooling efforts, and schools faced outbreaks of the virus when they attempted to re-open in person. Additionally, disconnects between the Navajo Nation and the rest of the county challenged efforts on behalf of agencies to support members of the Navajo Nation when the pandemic was especially serious.

Although different sectors have mobilized to basic needs and address mental health challenges, the county still lacks a comprehensive response to persistent inequities.

Findings on San Juan County’s COVID-19 response:

• The pandemic’s early days (released July 2020)
• Cross-sector collaborations in recovery efforts (released October 2020)
• Impacts on children and families (released March 2021)
• COVID-19 one year later (released July 2021)

In this small Michigan community with relatively little diversity, health was never a communitywide focus.

Sanilac’s trajectory of response and response is an interesting one in that state level policies to mitigate the spread of COVID-19 have not aligned with the pattern of COVID infections occurring in the region. At the beginning of the pandemic, very few cases were recorded, yet state-wide closures and business and travel restrictions resulted in the community mainly feeling the economic impacts of the pandemic. Schools were also able to open to in-person schooling as a result of the low number of cases in the region. This disconnect between state-level policies and the experiences of the region have led to pandemic fatigue and a belief that the state-level policies have been too heavy-handed. However, as state-wide restrictions are being released, people are returning to work, and schools elsewhere in the state have reopened to in-person learning, the case rate of COVID-19 in Sanilac County has continued to rise. In the spring of 2021, Sanilac County had one of the highest rates of new COVID-19 infections in the state and country, with schools moving back to remote instruction, and hospitals at full capacity. Given that Sanilac is a popular summer destination for many in Michigan, it remains to be seen whether trends in COVID-19 infection will affect the County’s health and economic response, and what this may mean for the further spread of COVID within the region and across the state.

As a more rural, homogeneous community, there has not been a heavy emphasis on equity and this did not change much during the pandemic. One community leader described Sanilac as a community where everyone knows everyone else and their approach to responding to the pandemic has largely followed suit, working to support each other with basic needs, and finding ways to support local businesses during the pandemic. Existing emergency management operations were leveraged, but they did not significantly modify their approach and Sanilac followed or adopted many of the policy decisions coming from the state. As a result, there is little evidence that the pandemic altered the course of how the community will address health and well-being moving forward.

Findings on Sanilac County’s COVID-19 response:

• The pandemic’s early days (released July 2020)
• Cross-sector collaborations in recovery efforts (released October 2020)
• Impacts on children and families (released March 2021)
• COVID-19 one year later (released July 2021)

COVID-19 arrived in Tacoma relatively early, with the first U.S. case of the virus identified in March 2020, about 100 miles north of this small city. Supported by state-level policies, the community took a cautious approach to economic reopening during the pandemic. Response activities prioritized mitigation while also attending to emerging issues like food insecurity, economic support for small businesses, housing stability, and safely reopening schools.

Having established strategic plans, tools, and processes prior to the pandemic that encouraged consideration of equity impacts meant that a range of stakeholders were poised to mount a response to COVID-19 that kept equity top-of-mind. For example, the TPCHD had identified geographic “communities of focus” for their health promotion efforts, which they used to center their pandemic response activities, and the city of Tacoma’s Equity Index and departmental Racial Equity Action Plans helped the city to prioritize efforts in a way that was rooted in data and accountability metrics. Elected officials in Tacoma were consistently focused on the disproportionate impact of COVID-19 on communities already experiencing vulnerability, which city staff noted allowed them to experiment with innovative approaches to reach these groups.

Nonprofit and health care stakeholders cited a collaborative and engaged approach on the part of TPCHD as a critical factor in the community’s success. Decision makers across sectors sought a diverse set of voices to weigh-in on response and response priorities, including experts and high-profile organizations and national networks, as well as smaller community-based organizations and residents.

These approaches helped to guide COVID-19 mitigation, testing, and vaccination strategies in the community; to target communications about small business relief programs; and informed the ways in which the community spent federal and philanthropic response funds.

Findings on Tacoma’s COVID-19 response:

• The pandemic’s early days (released July 2020) 
• Cross-sector collaborations in recovery efforts (released October 2020)
• Impacts on children and families (released March 2021)
• COVID-19 one year later (released July 2021)
  

Tampa has been hit by severe hurricanes in the past and, as a result, sectors are accustomed to working together for emergency response. The pandemic, however, has catalyzed deeper collaborations within and across sectors, including new partnerships to address issues of health and equity.

Despite having a county Office of Health Equity as well as many community-based organizations that focus on providing services to communities of color, communities of color still lag behind in vaccinations because of state-level policies. Proposed cuts to Medicaid and to affordable housing dollars at the state level also made, and continue to make it difficult for Tampa leadership to fully support low-income and otherwise disadvantaged communities. This tension between local and state government played out in policies at both levels—where state leaders pushed for a full reopening sooner, while local leaders opted for a more cautious path that aligned more closely to CDC recommendations.

Tampa has a strong focus on economic response and the city is currently working to implement facets of a strategic plan that was developed by a diverse workgroup. The strategy explicitly calls out inclusive economic growth, racial equity, reducing poverty and educational opportunity to help ensure that all residents in Tampa have an opportunity towards economic response and growth moving forward.

Continuing challenges in Tampa include stable housing, long-standing problems in Tampa’s transportation infrastructure, as well as a dysfunctional unemployment system that one-year later still has not been able to process benefits for many residents.

Public schools in Florida have been open for most of the school year. Hillsborough County Public Schools is planning on using American Rescue Plan dollars to help address learning loss and to provide additional mental health supports for children in schools.

Despite the active support of community faith leaders and the mental health community, the longer-term trajectory of the health and well-being of Tampa residents, particularly with respect to vaccine uptake and mental and behavioral health, remains to be seen.

Findings on Tampa’s COVID-19 response:

• The pandemic’s early days (released July 2020)
• Cross-sector collaborations in recovery efforts (released October 2020)
• Impacts on children and families (released March 2021)
• COVID-19 one year later (released July 2021)

White Plains, a commuter community near New York City, was one of the hardest hit areas in the early days of the pandemic. Its response efforts are closely tied to county and state efforts. Locals, many of whom are immigrant or undocumented, benefitted from cross-sector and neighborly collaborations that were in place well before COVID-19.

While some of these efforts leverage existing coalitions and infrastructure, others started in summer 2020 and are supported by large donations from corporations headquartered in White Plains. The region’s COVID-19 response has also prioritized small business response and mitigating the cascading effects of lost income.

Children and families are facing a number of challenges as a result of the pandemic, with immigrant and undocumented families being hit hard. Older youth are taking on more responsibility to care for younger siblings or bring in supplemental income, but this can be detrimental to their own schooling. The school system has been proactive with the safe reopening of schools. Child-serving agencies, however, are concerned about children’s mental health and the inability to deliver in-person services, like face-to-face counseling.

Prior to COVID-19, White Plains’ capacity to promote health, equity, and well-being was grounded in the city’s efforts to support its most underserved residents, mainly children and youth, immigrants, and those who are struggling economically. As a result of these efforts, the government as well as other organizations were able to quickly mobilize to provide further support to community members during the pandemic. However, fear of seeking health care and other services was common particularly among undocumented residents prior to COVID-19, and this reluctance to seek services may have been compounded by additional concerns around contracting the virus.

Findings on White Plains' COVID-19 response:

• The pandemic’s early days (released July 2020) 
• Cross-sector collaborations in recovery efforts (released October 2020)
• Impacts on children and families (March 202)
• COVID-19 one year later (July 2021)