In less than two weeks, a single ZIP code representing some of Chattanooga's most at-risk neighborhoods went from several COVID-19 cases to being approximately one of every six local cases.
The 37407 area, containing the Clifton Hills and East Lake neighborhoods, represents less than 3% of Hamilton County's population and is now home to between 10% and 18% of the county's COVID-19 cases, according to data from the Hamilton County Health Department.
For months, Chattanooga looked like a national outlier in the coronavirus pandemic. Local case count data mirrored the area's racial demographics, while communities of color across the country faced heightened risk of COVID-19 infection, hospitalization and death.
As Chattanooga's numbers continue to rise and racial disparities become more pronounced, advocates and community members say the county health department and local leaders took months to take seriously the threat of the coronavirus to communities of color - using the right buzzwords but not taking appropriate, timely action to protect the most vulnerable.
"There were so many people at the table who were patting themselves on the back for doing a good job, but they were ignoring the minority voice on the table that was saying, 'You're missing an entire group of people in Chattanooga,'" said Esai Navarro, a community organizer with TN United.
COVID-19 thrust health departments across the country into the spotlight. The government agencies are often underfunded and not used to responding to a global pandemic of this scale.
Testing as a whole in Hamilton County lagged behind other major Tennessee metros, especially in hard-to-reach communities, as supplies were sent to harder-hit areas. In recent weeks, community partners have stepped in to fill the void of testing in such communities.
Hamilton County is now seeing the results, with the number of Hispanic residents with COVID-19 in the county surging in the past two weeks. The total, 126 cases as of Wednesday, is seven times what it was on May 1.
Hispanics represent about 6% of the Hamilton County population, according to the U.S. Census Bureau, and now represent more than 40% of all confirmed COVID-19 cases in the county.
The spike in cases shows the local government was not paying attention to the Latino community, said Sarah Marquez Berestecky, an East Lake resident and vice chair of Chattanoogans in Action for Love, Equality and Benevolence.
"It's staggering," Berestecky said. "It's concerning that there's not more effort being put into this community."
'The increase is concerning to us'
The 37407 area is more racially diverse than the rest of the county, with nearly 40% of residents being black or African American and more than 25% Hispanic, according to U.S. Census Bureau data.
The East Lake and Clifton Hills area is home to many immigrant families, many of whom live in close contact with one another for cultural reasons and because of the limitations of poverty. The 37407 area has a poverty rate nearly four times higher than the county, with 45% of the population living below the federal poverty line, according to the census.
On Wednesday, Hamilton County saw its largest one-day surge in COVID-19 cases to date - growing from 269 to 310. Despite the jump, only 13 people were currently hospitalized and Hamilton County has not had a death from COVID-19 in more than three weeks.
The previous largest single-day increase occurred last week, when 21 new cases were reported on May 6. The county reported an additional 21-case increase on May 7.
Hamilton County Health Department Administrator Becky Barnes said the spike in cases was not attributed to recent easing of social restrictions imposed in an effort to slow the spread of the pandemic.
She attributed the increase to infections spreading among essential workers - including construction, manufacturing, food industry, landscapers and daycare workers - who continued to work throughout the stay-at-home orders. There was also a link to large, multi-family and multigenerational homes, she said.
The health department said it does not consider 37407 a hotspot but acknowledged at a Thursday press conference that cases are rising there.
"This does not mean people in 37407 should be in fear," Barnes said. "It means that they should wear a mask and practice social disancting when they go out, as we've asked everyone to do.
The health department said focusing on ZIP codes is not necessarily the best approach.
"Individuals travel about in the county to work, shop, attend school and/or other functions," the statement said. "We feel focus on following the basic prevention practices (social distancing; wearing of masks when out in public or in places where distance; not going to work when sick; and covering your cough) would be more helpful than focusing on specific ZIP codes."
'Hasn't been effort to build that trust'
Navarro had a realization near the end of March. While thousands of residents were working from home or waiting in line before sunrise for supplies at Walmart, she walked into a local Spanish store to find no shortage of food. The shelves were stocked full of toilet paper.
Organizers with TN United began calling residents to see what they knew, Navarro said.
"We realized they had no idea that COVID-19 was in Chattanooga," she said. "And we already had eight cases."
The information about the coronavirus, about the risks and the safety precautions, about the resources were being broadcast by politicians and the health department, but it was not reaching a critical portion of the population.
"The Latinx community always seems to be an afterthought until it becomes an issue," Navarro said.
Ideas from advocates to reach the Latino community, such as canvassing in areas known to lack internet access, were presented in mid-March to the various working groups that were forming across the city and county.
Many of those ideas were ignored or tabled for discussion at a later meeting, advocates said. Chattanooga's most vulnerable community was not given the resources to stay safe, they said.
Public notes from meetings of Chattanooga's COVID-19 Joint Task Force, formed in late March, make no mention of efforts to reach Chattanooga's African-American or Latino communities until May 5. Gov. Bill Lee's administration announced last week it would shift its efforts toward testing low-income communities after first focusing on testing in senior living facilities and prisons.
Outreach efforts by the local government have included translating press conferences, partnering with La Paz Chattanooga to share information online, putting weekly radio advertisements on Radio Que Buena and staffing the hotline with bilingual receptionists.
Spanish versions of Hamilton County Government press conferences discussing the latest coronavirus updates appear on the organization's YouTube page between three and 10 days after the briefing. The first and only video in Spanish on the Hamilton County Health Department's page, explaining how to make a face covering, was posted May 8, 56 days after the first reported case in the county.
"This is a thing where it's a lot of organization, where they use a lot of buzzwords, where they talk about working with vulnerable communities and doing outreach," Navarro said. "But are you really doing the work?"
Dr. Kelly Arnold, medical director at Clinica Medicos, said information is shared primarily through word of mouth with the patients her clinic serves.
Digital efforts are not the most effective way to reach the 37407, residents said. Lack of English proficiency or lack of internet access is one of the reasons they are vulnerable, Navarro said.
Nearly 40% of households in the 37407 do not have access to internet, compared to 15% in the county as a whole.
On April 14, one month after the first case, the county announced Clinica Medicos as a testing site in a focused effort to reach people without health insurance, a primary care provider or a personal vehicle. This week Cempa Community Care began offering mobile testing in Alton Park. The health department has said its Riverfront Parkway testing site is an effort to reach low-income residents.
Organizers with TN United have also initiated outreach efforts themselves, largely without the funding and resources of larger charities or governing bodies.
The coronavirus puts particular strain on unauthorized immigrants in the community. They are not eligible for relief money from the government, despite paying taxes and working jobs without an option to work from home.
The announcement Thursday of 11 COVID-19 cases linked to the Koch Foods meat processing plant, as well as confirmed cases at a construction site and a separate downtown poultry processing plant, underscore community fears. Workers must be able to isolate if they are sick, Arnold said. Employers should pay employees who are isolated to lessen the burden of following public health guidelines, she said.
Fear or ineligibility for government assistance programs keep many Latino community members from having health insurance and interacting with most medical systems. The coronavirus only amplified this fear, putting at families at risk regardless of whether they have COVID-19, Navarro said.
"They are frightened to go into a hospital in the first place, because they think someone is going to call [Immigration and Customs Enforcement] ... Why would I risk being separated from my family even if I do have it and there isn't even a vaccine?" she said.
Now the same systems - local government, health care and law enforcement - that unauthorized immigrants avoided for decades because of the fear of being detained and deported are asking them to get tested. They are asking for trust after years of eroding it, Berestecky said.
Last month, managers of an Ooltewah mobile home community of mostly immigrants were arrested for hoarding items donated for tornado relief efforts. Residents told the Times Free Press the managers threatened deportation to get them to pay certain fees and sign questionable leases.
In the past week, confusion swirled across the state after news broke that local police forces would have access to otherwise protected health information, such as names and addresses of people who test positive for COVID-19. The Chattanooga Housing Authority Police was part of the agreement for several days before leaving. The East Ridge and Collegedale police forces are still involved.
"This community very much goes to work, raises their children and very much tries to stay out of the way," Berestecky said. "There hasn't been effort to build that trust and that's a really big part of it."
Contact Elizabeth Fite at firstname.lastname@example.org.