KAI WRIGHT: A few episodes back. Right about as COVID-19 was hitting the US. I introduced you to Dr. Gail Christopher. We talked about the racial disparities that were likely to emerge in the course of this epidemic. And at the time there wasn't a lot of data on this question. She and many others who pay attention to racial justice. They were clamoring for more information. Well, the data's in.

NEWS CLIP 1: Now to that growing and disturbing trend. The disproportionate impact COVID-19 is having on communities of color.

NEWS CLIP 2: An Associated Press analysis of nearly thirty three hundred Corona virus patients who died found 42 percent of them were African-American.

NEWS CLIP 3: Every place that's reporting racial data is reporting racial disparities in terms of African-Americans in particular, having a higher infection rate and having a higher death rate.

KAI: Listen. I'll admit it. It feels good to think about viruses and diseases as these great equalizers, but they're just not and as COVID-19's, awful demographic path has become visible. It has just confirmed everything we already knew about race and health care.

GOV CUOMO: You know, it always seems that the poorest people pay the highest price. Why is that?

KAI: And this episode, we are going to answer Governor Cuomo's question, but I'll tell you now, the answer isn't poverty, at least not poverty alone. Nor is it the personal choices black people make or even really the high incidence of conditions like diabetes and heart disease, at least not those things alone. There's actually decades worth of research explaining why black people in particular, are dying from COVID-19. How we could stop it.

ARLINE GERONIMUS: Part of what structural racism is, is the extent to which you have to persevere and fight and kind of bang your head against a wall. And that then causes biological weathering.

KAI: I'm Kai Wright and this is the United States of Anxiety, a show about the unfinished business of our history and its grip on our future.

[Theme music] 

VERALYN WILLIAMS: Hey. Hi. How are you?

KAI: I'm good. I'm good. You know…

KAI: Veralyn Williams is a producer on our show. I reached her at her apartment in the Bronx.

KAI: What about you? What you got going on over there?

VERALYN: I mean, for the most part, I am sheltering at home alone. The other day, my dad came over.

DAD: Okay Vera.

VERALYN: He parked in front of my house because I wanted to talk to him.

VERALYN (w/ dad): Here.

VERALYN: But I also wanted to keep my distance from my dad.

DAD: What am I suppose to do?

VERALYN (w/ dad): So you hold that... you just hold it.

VERALYN: And so we end up having this like really convoluted way where.

VERALYN (w/ dad): Let me untangle...

VERALYN: I hand him the recorder and then I jump into the backseat and I'm trying to like make sure that he stays on mic.

DAD: Testing, testing 1, 2, 3...

VERALYN (w/ dad): So dad you see how you moving it away from your mouth... perfect.

DAD: OK.

VERALYN: I talked to him from what? Isn't six feet away, but it was a comfortable enough distance with both of us trying to have our masks. But our master really like on our chin because we also want to speak into microphones.

VERALYN (w/ dad): Tell me what you had for lunch.

DAD: I didn't have any lunch.

KAI: Was this the first time you saw him? I mean, you guys you guys are pretty close.

VERALYN: I mean, I have seen him. He's come over to, like, drop off food. More or less. But what hasn't happened is that he hasn't been upstairs my apartment because my dad is one of these people that are still going to work because he's an essential worker.

KAI: What kind of work does he do?

VERALYN: He works at FedEx.

DAD: I basically run the store and I have more into the graphics section. But because of the Corona virus, all the companies around us, they all closed now. So we don't do any of that's right. As we speak. Shipping is what we're doing now.

VERALYN: He takes a lot of pride in being able to do this in this moment where everyone is trying to connect in this way.

DAD: We're doing a great service to the public because a lot of people come in. Their mom is in another state. They're worried that they don't have enough supplies of food, mask. You know, they come and we can get it done the next day.

KAI: We still need things delivered. And so that is an essential service.

VERALYN: It's true. But here's the thing. My dad is black. He's 62 years old and he's diabetic. So these are all factors. That means that if he were to get COVID-19, he would probably not do too well with it.

KAI: And he's in the Bronx. That's one of the places where we see there's so much both infection and death in New York City.

VERALYN (w/ dad): When you leave your house, like, how do you prepare for being outside?

DAD: I leave my house around 7:00 and I walk to the train station just about a 10 minutes walk. And there's hardly anybody in the streets. Everyone is quiet. There's nobody there. But then when you go down to the subway, then there's a whole bunch of people and will have to jump on the same car and go to work. And we're all sitting there looking at each other. We're trying to stay away from each other. It's almost impossible.

VERALYN: And so you would think that that means that he will be taking every precaution, but until the recent mandate for people to be wear masks. My dad wasn't one of the people with masks on.

DAD: No, I wasn't.

VERALYN (w/ dad): Even though I tell you every day. So wear a mask.

DAD: But I wasn't wearing the mask.

VERALYN (w/ dad): Why?

DAD: Because, I didn't think I needed it in my mind. I believe that's the core of virus is something that's if you get it's if your immune system is in perfect condition, you can overcome it. Every day I drink a glass or two of the ginger, I drink my apple cider vinegar. I take my immune medication. I take vitamin C. I take my ginseng. I mean, I'm right on top of it. That's why I'm not worried. No, I'm not worried at all.

KAI: So he's not scared of it at all?

VERALYN: Not even in the slightest.

KAI: Why do you think that is? Why would he?

VERALYN: I mean, my theory is that that's just the way he's learned to cope with things where Sierra Leonean. So in Sierra Leone, you know, we've had a civil war. There's economic issues. So there's all this, you know, national expectations of disaster. Right. And then, you know, in our personal lives, you know, my dad has had personal trauma. And so I like look at my dad and I realize that a lot of his ability to compartmentalize what's actually happening with the way that he's moving in the world, has to do with his-- the ways he's how. Always had to deal with trauma. Right. The ways he's always had to, kind of push things to the side in order to be able to move forward in life. But listen, I'm not here to psychoanalyze my dad. The reality is he does proactively take care of himself.

DAD: I did my physical two weeks ago and my my doctor was like, wow, you're doing great. I used to go to the gym three, four times a week. Well, because of all of this, that's why I stopped going. So I'm really fit.

VERALYN: So this is literally my. And when I was talking to him, you know, he's like,

DAD: I know that I'm a very strong guy. I can overcome anything. That's my belief.

VERALYN: And I'm like, I know, dad, because you say that's me every day.

KAI: But it might be true, too, you know. I mean, that's the thing. You talk about all this stuff he's been through and a lot of black families have these conversations about just the resiliency of people in our families to be able to go through things physical, emotional, mental, financial and-- make it through. There is some real strength there.

VERALYN: It's true. But there is like facts. And the fact is anyone that lives at the intersection of all these things, the way he does it means that you're probably not going to do well. And I think what's frustrating to me is that he is dealing with the public every day.

KAI: I mean, it's a hard conversation to have. Right. Because on one hand, you know, we're hearing all of this stuff about how black and Latino people are so much more likely to get infected and so much more likely to die. It's also true he has to go to work.

VERALYN: Yeah. He does say, like, if I was to stay home, like, what would I do? So I do get that. And I also sometimes envy his ability to choose an existence. That doesn't mean being afraid of COVID-19. Right. He called me paranoid.

DAD: Yes, you are. I think differently from you, Vera. You know that.

VERALYN: And so his ability to see what I see as a very healthy fear of the facts. He can just put that to the side and say, that is not my reality. In my world-- I out here boosting my immune system since 1990. And so I'll be fine.

KAI: He's taking his gender. You know.

VERALYN: Here's the thing. My dad's ability to do what needs to be done for his family. Since the day I was born, which included, you know, leaving the only home he's known and move around the world to America. That type of resiliency and commitment to taking care of your family and the people around you and and really taking it day by day. Right. Like not knowing necessarily what tomorrow will being, but just knowing that knowing that today this is what I'm that one needs to be done. Like, I can only admire that. I am a product of that. Right. And s--.

KAI: Grit. Like actual grit.

VERALYN: Absolutely. He puts his mind to something and he works to make it happen. Love that about my dad. I aspire to be that. But I do think that when I sit and think about that, that means not paying attention to what the CDC is saying, what the recommendations are in this moment of crisis. For me, I'm just I'm, I'm scared. And I just feel like I wish that I could do more then, talk to him from the backseat of his car.

KAI: I've always thought one of the more ironic things about racism is the way some people fantasize about black victimhood. This notion that we walk around thinking of ourselves as at risk and marginalized and all this other stuff, I have personally met very few actual black people of any class who think that way. But the attitude of Veralyn's dad that I know. And like Veralyn, I don't always know what to feel about it, because in public health there is a long and growing body of work that shows how this resilience, this learned ability to get through it, whatever it is. How that both saves our lives and literally tears down our bodies. Coming up, a conversation with one researcher who has spent decades documenting this tension.

[PROMO]

KAI: When Veralyn told me about her dad and how he's still going out to work every day, confident in his body strength against COVID-19, it made me want to talk to Arline Geronimus, who is a researcher at the University of Michigan.

KAI: How you doing? 

ARLINE GERONIMUS: I'm doing OK, all things taken into consideration.  

KAI: I am also doing, doing well. Things taken into consideration. I think I'm pretty blessed, actually, in terms of my ability to safely isolate and still have an income and all of the above.

KAI: Arline has spent the past 30 years trying to explain the exact kind of disparity we are seeing right now in terms of who lives and who dies from COVID-19 and not just rhetorically. She wanted to describe what happens to black people's bodies on the cellular level, over time when we live in a racist society. She calls it weathering.

KAI: What does that word mean for you? Why weathering?

ARLINE GERONIMUS: I call it weathering because of the two different meanings that that word has. You can talk about weathering as being exposed to things that erode you, like the rock was weathered by the storm. And you can also talk about weathering as in coming through a storm as in the business weathered the recession.

KAI: Erosion and resilience. You know that cliché you hear where an exasperated black person says something like, I am tired, sick and tired of-- fill in the racist thing? Well, Arline's one of a number of scientists who have spent decades proving that that statement is literally true. Proving that this sentiment. It involves an actual physiological process.

ARLINE GERONIMUS: Because of the multiple chronic and often toxic stressors across your life course, you would experience kind of a stress mediated wear and tear on your organs and body systems in cells that in effect leaves you more vulnerable to poor health. It causes a kind of accelerated biological, aging and premature death.

KAI: She began her research trying to explain why black women and their babies die so much more often in childbirth. The conventional wisdom held that childbirth was dangerous at certain ages. When you're really young and as you get much older. 

ARLINE GERONIMUS: I was finding that that does not always pertain. And in particular, for Black Americans, the risk of poor birth outcomes increase with age from about the mid teens just straight on up. So that the ages we sort of assumed were perfectly healthy. Prime childbearing ages were already higher risk for black moms. And it led me to wonder, is there something happening in the lives of black women that leads them to poor health earlier than white women?

KAI: The answer was yes, and it was chronic, intense stress.

ARLINE GERONIMUS: People will be familiar with fight or flight. That part of what I'm talking about.

KAI: Think about our ancestors, you know, fighting off predators. There's a physiology to that systems that kick in to give us strength. But it turns out it doesn't have to be a rampaging lion to kick that system into gear. It can be all kinds of threats that feel mortal. Looming eviction, the threat of violence, the realization that you're defenseless if your boss or a cop or even your doctor decides to treat you like dirt. The moms Arline studied were constantly facing these kinds of stressors. And it's that that made their bodies different from other women.

KAI: So the point is that it's not so much. Oh, I had a stressful day today. It's that ongoing nature of it. That's what's distinguishing here in terms of the kinds of stress we're talking about, something that is repetitive and constant...

ARLINE GERONIMUS: Repetitive and constant and arouses automatically this physiological stress reaction to that, what's happening is your having a physiological reaction that you're not supposed to be having for more than maybe three minutes, every once in a while. You're instead having it constantly. And we're just not built to withstand constant stress, arousal.

KAI: And then all of this leads to stuff like diabetes and heart disease because. Why? Why those things?

ARLINE GERONIMUS: Will you indulge me to say the long form and then you can cut out whatever you want to take out?

KAI: Absolutely.

ARLINE GERONIMUS: Okay. So mechanistically, what the physiological stress response does is it increases your breathing, your heart rate, your blood pressure....

KAI: This process is describing gets complicated fast, but basically you start pumping out hormones that are meant to make you strong, quick, to fight off that lion.

ARLINE GERONIMUS: And then those released stress hormones sort of activate a breakdown of triglycerides in your fat cells.

KAI: All kinds of stuff rushes into your bloodstream. And once it's there, your body can't really put the toothpaste back in the tube easily. And over time, when this happens repeatedly, it damages your veins and arteries.

ARLINE GERONIMUS: Many people understand this in the context of eating high fat or high cholesterol foods or high sugar foods. But all these processes also happen from this physiological stress response. And so if you're chronically exposed to that stress response, you're going to get quite a buildup of plaque. You're going to get heart and arteries, you're going to get high blood pressure. The dysregulation of your glucose and insulin makes it more likely become diabetic.

KAI: Sort of all the things that are similarly associated with eating a bad diet with too much fat and too much sugar. A lot of the sort of physiological things that kick into your blood system from that kick in, from this constant unremitting stress as well.

ARLINE GERONIMUS: Right. And for populations who have this constant, unmitigated stress, it's probably a much bigger factor in the weathering of their health and then diet. Now, when you add to it that they may have poor diets in part, by the way, because having these unleashed stress hormones kind of induce cravings for high fat and high sugar food and for alcohol and nicotine and other drugs.

KAI: I certainly eat and drink my emotions. So. 

ARLINE GERONIMUS: Right. Anyone who's heard of comfort food or stress eating knows this concept. But people have underestimated the extent to which chronic active effort for coping with just omnipresent stressors, over years and decades is much harder on your health than simply eating too much fat in your diet or too much sugar.

KAI: So I ask you all of this and I try to wrap my head around all of this complicated medical ideas because I'm also trying to understand this striking disparity we're seeing racially in COVID-19, both in terms of infection and then how deadly it is when you become infected.

ARLINE GERONIMUS: I think there's several reasons for that. But certainly weathering is a very important one. And not only because you're more likely to have those diseases we've identified as risk factors for more severe COVID-19 like diabetes or asthma or heart disease, but also because even if you don't have a diagnosable condition, if you have been weathering what you have is across your body systems, you've been weakened and are more vulnerable.

KAI: And that includes your immune system. Arline argues that the effects of weathering taken altogether, they make you essentially older biologically than the age on your driver's license, which is crucial when talking about something like COVID-19.

ARLINE GERONIMUS: When you talk about population subject to weathering, using an age like saying your high risk if you're over 65, is probably way too conservative because people will be biologically aged by 55 or 45. They're aging has been accelerated biologically speaking. And so at the same chronological age, they will be biologically older and less able to withstand or mount a healthy immune response to COVID-19.

KAI: I asked Arline about the conversation Veralyn had with her dad and how we should all think about the people who have been deemed essential workers in this moment. 

ARLINE GERONIMUS: It's interesting because we're having narratives narrow about COVID-19 that these people are heroes, are risking their lives or deserve hazard pay, which they do. But part of the point about weathering is they are paying with their life not in such an obvious way as if they get COVID-19 and don't survive it, but every day there is a toll taken on their health that will eventually reduce their chances of a long, healthy life.

KAI: It's almost a stark demonstration of weathering in progress right now.

ARLINE GERONIMUS: People who do those jobs are in a more incremental way, harming their health through weathering every day. And they should be getting hazard pay for that. They should be being valued more. And I think it also really, you know, makes starker concepts. What privilege means.

KAI: I have never had my privilege is laid more bare for me, I think, than the course of this past few weeks. It's kind of funny because you're talking about how resiliency can wear a person down. And yet, for those of us who experience it, we kind of think of it as the opposite, right. That we're stronger as a consequence and that we can make it through something like COVID-19. So I just wonder how you make sense of those two opposing ways of thinking.  

ARLINE GERONIMUS: That's why I like the word weathering. Resiliency has two meanings. There can be the personal or cultural or collective resiliency where even in the face of adversity you're able to carry on, to keep engaging, to overcome. But then there's just the biological idea of your cells and your tissues and your organs and your body systems being resilient. And not only are those two separate things, but what I'm saying is part of what weathering does is it's because you have the first kind of resilience, that contributes in part to wearing down your biological resistance.

KAI: Ironically, because you're working so hard at beating the social conditions. That process is hurting yourself physically.

ARLINE GERONIMUS: Physically. Now it's helping you in other ways. I'm not trying to say people would be better off in every dimension if they just stayed home and watch TV on the couch. Rather than fighting and persevering. But part of what structural racism is, is the extent to which you have to persevere and fight and kind of bang your head against a wall and do that constantly. And that then causes biological weathering.

KAI: What do I do with that personally?

ARLINE GERONIMUS: OK, there's a question for one does and there's a question about what society does. But primary prevention, which is what most people think prevention is, would mean changing these structures that, that make you have to bang your head against the wall.

KAI: And that's bigger than any individual.

ARLINE GERONIMUS: It is, though, it can be done. You know, you don't have to have a revolution to make progress towards that. But it is something that has to be done at a community and society and political level.

KAI: I wonder if you're seeing anything in that regard right now. I mean, we keep hearing these kind of notes of optimism that COVID-19 has somehow revealed these inequities in our society and in our health system. You know Tony Fauci even made a reference to it at a recent White House press briefing.

TONY FAUCI: About sometimes when you're in the middle of a crisis like we are now with the Corona virus. It really does have ultimately shine a very bright light on some of the real weaknesses and foibles in our society.

KAI: And so the implication in that is that, you know, maybe now people will be ready to make the kind of primary prevention changes you're talking about. I personally am skeptical of that. 

ARLINE GERONIMUS: Well, I'm also skeptical of that. People said the same thing after Hurricane Katrina. People said they had no idea there was so much poverty and racism, you know, and then we saw what happened in Puerto Rico just last year with their hurricane, but not a lot really changed. And so one reason I wanted to spell out weathering is I think as long as we just think, well, people are higher risk because they're black and there have hypertension or heart disease, most people just think that means there's something in African-Americans genes or their bad behaviors or diets that's causing that. And that's not going to propel people to participate in social change. But if people come to understand better this entire process of weathering and all that it's doing. I would hope maybe then there would be at least some people more predisposed to make some structural changes.

KAI: But I wonder, I mean, has anyone turned to you as anyone said, hey, you know, I. I get it now. And here's something I could do different.

ARLINE GERONIMUS: I've heard that a lot. I'm currently being an expert consultant to some immigration attorneys discussing, weathering with them to get early release for for some people in immigration detention centers.  

KAI: How so? Can you tell me about that?

ARLINE GERONIMUS: I can try. Since I'm not a lawyer, I may not get this right. But obviously, jails, prisons, detention centers are places where COVID-19 would be very quickly rampant. They're just like a tinder box to set off a COVID-19 explosion in any of these kinds of centers.

KAI: We talked about this a few episodes back. When this outbreak started. There were just under 40 thousand people in immigration detention. They were being held mostly in local jails and prisons as they waited for a judge to decide if they could remain in the United States. And has COVID-19 spread immigration lawyers and advocates began arguing that, you know, at minimum, people who are sick or who are over the age of 65 should be released immediately because they already have an elevated risk from the virus.

ARLINE GERONIMUS: But now, but weathering has added to that mix is the idea that if you're a member of a racial minority group, which pretty much everybody in immigration detention is that you're at high risk because of weathering and you don't have to be 65 yet.

KAI: Because you're actually older than your biological age.

ARLINE GERONIMUS: Exactly. And this argument has been used successfully to release just yesterday one person, and that has set a precedent. And now this is going to be applied to literally thousands of cases.

KAI: Wow. The precedent now exists for other judges.

ARLINE GERONIMUS: Right.

KAI: This is a potential revolution early. You say we don't have to have a revolution, but that sounds revolutionary.

ARLINE GERONIMUS: What I meant is we don't have something we call a revolution and actively storm the gates. But you can leverage these kinds of ways that racism has pinned people literally in immigration detention, pin people in and made their lives harder and made them more subject to weathering. And if you change a lever here or there, it can do a revolutionary act.

KAI: That's going to be pretty satisfied in three decades. You've been studying this and to see it in action in that way now in this moment. That might be the first hopeful thing I've heard in this whole COVID-19 outbreak business.

ARLINE GERONIMUS: Yeah. When I got the communiqué yesterday that based on that argument, this particular person was released. I was humbled and I had to keep tears back. I mean, it was it was a very powerful feeling I had. And it did make me have this feeling. But maybe I'm not only talking to people who read, you know, scientific journal articles. My goal has always been to actually-- we call it a public health of consequence-- to actually having a positive impact. And this was such a concrete example of at least for this one man and hopefully for up to thousands of other men and women that, yes, it was a very powerful moment for me. 

KAI: Revolution through science.

ARLINE GERONIMUS: Well, but it's too bad I don't want to be Debbie Downer, but it took COVID-19 to get people listening in. But I guess you know, better late than never.

KAI: Thank you for your work, Arline.

ARLINE GERONIMUS: Oh, you're very welcome.  

KAI: United States of Anxiety is a production of WNYC Studios. This episode was produced by myself and Veralyn Williams. It was edited by Christopher Werth and mixed by Isaac Jones. Our executive producer is Karen Frillmann.

Our team also includes Emily between, Jenny Casas and Marianne McCune. With help this week from Carolina Hidalgo and Kim Nowaki, our theme music was written by Hanna's Brown and performed by the Outer Burro Brass Band. Keep in touch.

You can follow me on Twitter at Kai_Wright.

Thanks for listening. Take care of yourself.