For a black family in Baltimore, daughter's death from COVID-19 feels like collision of two crises
By ARIANA EUNJUNG CHA | The Washington Post | Published: June 6, 2020
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BALTIMORE — Dar'Yana Dyson's memorial service was set up as a block party.
It stretched from the dilapidated yellow monkey bars where the 15-year-old high school sophomore played not too long ago, through the parking lot, all the way to the other end of the O'Donnell Heights public housing complex. Rap music played as relatives in face masks fired up barbecue grills for the crowd.
The gathering for the youngest victim of the coronavirus so far in Maryland, Virginia or D.C. took place this week just a few miles from where thousands were marching at that very moment to protest the killing of George Floyd — and where five years ago another black man, 25-year-old Freddie Gray, died while in police custody.
Floyd and Gray's deaths were police-related. Dyson was killed by a mysterious pediatric complication associated with COVID-19.
But to the three generations of family members, friends and supporters who came together on this afternoon to grieve, the depredations of the novel coronavirus, police brutality, economic inequality and institutional racism all blur together.
Dyson was a healthy teenager, which should have made her among the least vulnerable. But she had two things working against her that were out of her control. She was black, and she was poor, living in a community full of people considered essential workers who came and went to their jobs every day.
"We don't get justice," said Lebra Foster, a 64-year-old Postal Service employee and Dyson's great aunt. "They treat us like we are not worth anything. I work hard every day, and it's not fair."
John Comer, a 38-year-old community activist who has been involved in demonstrations against police violence in Ferguson, Mo., Baltimore and other cities said he chose to attend Dyson's service instead of the protests down the street because he sees the virus' impact as an urgent new front in the battle against racism. He said he has been surprised that so many people he has met could not afford masks or did not know where to get them.
For the time being, he said, he has put down his protest signs to hand out free masks. As a moment, he said, "this feels different."
"I know people that died," Comer said. "To me, the virus has joined forces with racism. It feels like another trap in a long list of issues we are fighting every day."
The Trump administration, which has been accused of failing to recognize the disproportionate effect of the virus on communities of color, on Thursday moved to address the growing anger. Robert R. Redfield, director of the Centers for Disease Control and Prevention, apologized "for the inadequacy of our response" and said new requirements for reporting coronavirus data based on race, ethnicity and other demographic factors would take effect Aug. 1.
The public health agency reported new data this week that showed the coronavirus was not the great equalizer some had anticipated. Instead, it was laying bare long-standing health disparities that have traditionally resulted in higher death rates for African Americans from a range of causes. With the coronavirus, 23 percent of deaths have been among black Americans, although they make up about 13 percent of the U.S. population.
The unequal burden of the disease is most acute in Washington, where nearly 76% of deaths have been among black Americans even though they make up only about 47% of the population.
The National Medical Association (NMA), which represents 50,000 African American physicians, has blamed the high death rate on an amplification of "years of discrimination, unequal treatment and injustices in health care, criminal justice and employment."
Four out of five black Americans' jobs require them to be outside of the home. They are more likely to live in multigenerational households, which increases the virus risk. And a disproportionate number have been furloughed or laid off during the pandemic, putting pressure on their ability to pay for housing and food. A large number also have health conditions such as diabetes, hypertension and obesity that make them more vulnerable to the disease.
Add to that the impact of pollution and other environmental factors that are more acute in poorer communities, and the chances of a bad outcome due to the virus increase.
Oliver T. Brooks, a physician and president of the NMA, said in an interview that the deaths of Floyd, Gray and Dyson are part of the same problem: People with the least power and least access to resources being left unprotected.
"They are all linked," he said. "African Americans are 2.5 times more likely to die of COVID-19 and three times more likely to die of police violence. The clear underlying cause is racism."
Brooks, who was part of a group of doctors who were consulted about the crisis early on by the White House, said officials have not done enough to address racial disparities. "I feel we have not yet seen true action from the federal government," he said.
Leana Wen, an emergency physician and Baltimore's public health commissioner during the Gray protests, ascribed the recent protests to "underlying, longtime systemic injustices that are boiling over in anger and frustration."
"All these issues are interrelated," Wen said. "And ultimately, we have to be honest that police brutality is a public health issue and racism is a public health issue, too."
Dyson, her family members said, had done everything right when it came to the coronavirus.
Despite her low risk, she came home one day early in the outbreak with a mask and insisted on wearing it despite her friends' good-natured teasing. She was the one who begged her mom to go to the store to pick up hand sanitizer and other supplies. The eldest of four sisters, she enforced social distancing for the little ones.
But her mother, Kandice Knight, 32, worked as a hairdresser, and as her clients dwindled during the shutdown, she could no longer afford her own place. So they had been staying with relatives — nearly all of whom work jobs that force them to be out in the community, potentially exposed to the pathogen. Dyson's grandfather is a truck driver, their neighbor works for Burger King, an uncle for the electric company, and so on. The shops nearby and other neighbors' homes were also probably full of people who are essential workers.
Jerome Patterson, who called Dyson a "hype cousin" as a sign of his adoration, said she rarely ventured out and took stay-at-home orders seriously. Instead, she passed the time making TikTok videos with her little sisters and posting on Instagram to her friends.
Patterson, 15, the same age as Dyson but in ninth grade while she was in 10th, said the two of them had been sitting around listening to music when suddenly her stomach began to hurt her.
"One minute was fine, and then she was not," he said. "I've been sad and angry and really very scared."
Things got so bad that on May 11 — after several days of fever and severe stomach pains that left her unable to eat — her mother rushed her to the nearest hospital.
Over the next few days, Dyson's condition deteriorated further, and she began to experience the telltale symptoms of a rare and mysterious pediatric syndrome related to COVID-19 that has killed several children in New York state and other parts of the world. It has been described as similar but distinct from Kawasaki disease, a condition whose cause is unknown but usually affects children under the age of 5. Some doctors have described the condition as the pediatric equivalent of the "cytokine storm" occurring in some adults with severe illness.
Health commissioners in New York and New Jersey released data this week that showed black or Hispanic children have been disproportionately affected by the pediatric syndrome — representing roughly two-thirds of all cases.
Similar findings have been reported in Europe. In Paris, doctors at one hospital wrote in the medical journal BMJ that 12 of 21 children seen there were of African or Caribbean heritage. In another outbreak in the southeastern United Kingdom, six of eight cases were children of color.
"These clinical findings should prompt high vigilance among primary care and emergency doctors ... in countries with a high proportion of children of African ancestry and high levels of community transmission," the French researchers wrote.
Like others with the condition, Dyson tested negative for active coronavirus but had antibodies showing she had been infected in the past. Dyson broke out in a rash on her face, back, hands and feet. Her blood pressure plummeted. And her heart began to fail.
Doctors desperate to save her put her on a heart bypass machine and ventilator. Six days after she was admitted to MedStar Union Memorial Hospital and then transferred to Johns Hopkins, and a month shy of her 16th birthday, she died.
In the weeks since Dyson's death, family members have struggled to make sense of what happened — why, in a state with more than 1.3 million children, was an African American child the one to perish? Why are black deaths from COVID-19 such a big share of the total? Gov. Larry Hogan (R) has tweeted alarm about the "troubling disparities," and the state was one of the first to start collecting racial data.
Memorialized in a poster-size picture with silver balloons blowing in the breeze on the day of her funeral, Dyson stared down at the gathering from a small patch of grass in the complex. Her mother and three little sisters — ages 13, 5 and 3 — ran around dressed in identical tulle skirts in blue, the teen's favorite color, and a custom T-shirt picturing her with wings.
Knight said she and Dar'Yana were so close in age that she felt as if she had lost her best friend as well as a daughter. She said she was still in a state of shock.
"The virus took my baby," Knight said. "A girl this young and healthy — she shouldn't have died."
Knight and other family members, while respectful of the doctors who treated Dyson, expressed confusion and suspicion about what she experienced in those six days at the hospital. Some wondered whether it was the ventilator that might have killed her, given she was so strong and healthy before she went to the hospital. Her heart stopped just as doctors were getting her onto the machine. She was resuscitated but died several hours later.
"It wasn't supposed to affect someone her age, but it did," said Manuel Henderson, 61, Dyson's grandfather. "I think it's because they put her on the ventilator that did it."
The reflections underscore an eroding public trust in the medical establishment — trust that some relatives, friends and neighbors said was already fragile because of months of flip-flops and conflicts about the virus between President Trump and state health officials, as well as a history of mistreatment.
Ahing Castro, 39, a home improvement contractor who lives in the housing complex, said he has not been surprised that so many black Americans are dying from COVID-19. He said this was happening for the same reason he felt underperforming schools festered in black neighborhoods and large numbers of liquor stores got licenses to open up.
"It's how it's set up," he said. "It's another way to keep us down."
He described how he was recently working on renovating a home and police saw him through the window and immediately assumed he had broken in. Even when he showed them he had the key and his tools, he said, they detained him until they could reach the owner.
Looking back, some family members say, it may have been almost inevitable that Dyson was exposed, given the community in which she lived. Everyone seemed to know someone who had been infected or died. But family members also said there has not been enough testing, and many neighbors do not have cars.
"We need to know who has it so we can protect ourselves better," said Dyson's aunt Rhonda, 42. She asked that her last name be withheld because she works for the government. "We are out here scared, and we don't know what to do."
Suncercy Smith, a 33-year-old single mother and family friend who is a cashier working during the pandemic, said she is angry at the government for not doing more to protect black communities when it should have been clear they would be affected so severely.
"They knew," Smith said. "They should have been prepared. It's not right."