Thread by @EpgntxEinstein

While the other four boroughs take a welcome slight rightward turn, the #Bronx continues its trajectory of increased deaths in #NYC from #Covid19.

Now one person in 1,262 in the Bronx has lost their life to the pandemic

Data from www1.nyc.gov/site/doh/covid…

Deaths are a lagging indicator, colleagues at @MontefioreNYC are seeing fewer new cases presenting, so hopefully the curve will decelerate in the #Bronx.

Now one in 1,154 in the borough has died from #COVID19.

@MontefioreNYC Turning the corner, literally. A long road ahead, but #NYC is getting on top of the #COVID19 pandemic.

Now one in 1,095 in the #Bronx has died from #COVID19.

Data from www1.nyc.gov/site/doh/covid…

@MontefioreNYC Declared victory prematurely. Manhattan on a good slope, but the outer boroughs still climbing. A tale of two cities.

Now one in 1,023 in the #Bronx has died from #COVID19.

More work to do.

@MontefioreNYC The #Bronx death rate *still* not flattening. Queens also distancing from other boroughs.

Grim milestone, we’ve passed 1/1,000:
the Bronx has now lost 1/947 people from #COVID19.

This
Pandemic
Is
Disproportionately
Killing
People
Of
Colour

(Data www1.nyc.gov/site/doh/covid…)

Yesterday's update. Let's see if the curving continues.

#Bronx death rate: 1/904

New data presentation format includes additional 'Probable' cases, which would bring #COVID19 death rate in #Bronx to 1/733. Devastating.

www1.nyc.gov/site/doh/covid…
@MontefioreNYC @EinsteinMed

Deaths by borough April 15. Despite the discharges>admissions now at @MontefioreNYC, deaths still climbing in the #Bronx (1/819 mortality) and #NYC as a whole.

#COVID19 doesn't let go its grip without a fight. Dropping our guard now would be immensely stupid.

Something odd is happening with these numbers from www1.nyc.gov/site/doh/covid…

My guess is that they are now recategorising some cases that were not initially attributed to #COVID19. I don't trust the curves.

Now one in 725 in the #Bronx has died from this virus.

Data from April 19. The death rate in the #Bronx is almost double that in Manhattan.

1/703 people in the Bronx has died from #COVID19.

The daily percent increase in deaths now <4% in all #NYC boroughs for the first time.

Wave #1 coming under control. Let's not screw this up.

#COVID19 deaths, April 20 in #NYC.

1/668 #Bronx residents dead of #COVID19. 1/1,294 in Manhattan. 1/792 in Queens.

#COVID19 deaths as of April 21 in #NYC.

1/649 #Bronx residents dead of #COVID19.

Data www1.nyc.gov/site/doh/covid…

Something different today, helps to illustrate why health disparities exist.

Bottom line: poor communities don't get studied like rich communities. A lesson from SARS-CoV-2 genotyping, and data from the excellent @GISAID resource.
1/

2/ Here is a breakdown of deaths per 10,000 residents in each borough of #NYC. The #Bronx and Queens especially hard hit. Fits with the realisation that #COVID19 is a disease disproportionately killing people of colour and disadvantaged people. Nothing new here.

3/ Wonderful colleagues in #NYC are to be commended for their viral genotyping and making data available through @GISAID.

Take a look at this fascinating preprint from Matt Maurano, @AdrianaHeguy and colleagues:
medrxiv.org/content/10.110…

4/ If you download the 639 viral genomes from New York on @GISAID today, 511 are from the five boroughs of #NYC.

Of these, 415 are from Manhattan and Brooklyn.

5/ Now if you calculate the amount of genotyping as a function of the death rate (number of deaths per 10,000 population in borough), you see the problem.

We test who we can. We aren't testing who is most at risk in this pandemic, in the the Bronx and Queens.

6/ Thanks to @chandranlab, @EinsteinPath and generous support from @gingko, we'll try to boost these numbers at @MontefioreNYC @EinsteinMed.

But the problem is structural.

7/ The health care systems serving poorer communities do not have the income to support research. Nor a donor base from the patients served, who are struggling to get by. And donors generally don't favour unglamourous projects asking why poor people are less healthy.

8/ The @NIH (even the @NIMHD) do not fund infrastructure to collect specimens.

Health disparities can't be researched if we can't even get samples, let alone do sexy NIH-worthy research on them.

This is just one of the vicious cycles into which poor people are locked.

9/ My colleagues at @MontefioreNYC and @EinsteinMed have been doing outstanding work for decades serving the #Bronx community in spite of these structural problems.

But there is so much more we could and should be doing.

10/ We are now seeing the broader effects when the poorer people in an insanely wealthy city have health disparities.

We can fix this. We need #NYC to be the city that shows how health care disparities can be studied and fixed, as a model for the world.

Clap for that at 7 pm.

As health care disparities go, so do research disparities. Rich health care systems are the ones testing local populations. Poor health care systems, which care for the disadvantaged, barely scrape by. Research is very secondary #ResearchDisparities

nytimes.com/2020/04/26/nyr…

The #COVID19 death data in #NYC for April 24.

One person in 598 in the #Bronx has now succumbed.

I'm concerned that the @NIH doesn't recognise #ResearchDisparities.

This issue of @AMJPublicHealth describes the 'scientific visioning' behind setting up the @NIMHD.

No mention of biorepositories, very little on infrastructure.

A swing and a miss.

ajph.aphapublications.org/toc/ajph/109/S1

#NYC data as of 25 April 2020, from www1.nyc.gov/site/doh/covid…

A bit of a jump in mortality across all boroughs, may be reclassification of some deaths as being due to the pandemic. Still climbing.

Now one person in 577 in the #Bronx is dead of #COVID19.

The three biggest disasters causing loss of life in the history of #NYC:

1904 The General Slocum disaster (~1,021 deaths)

2001 The World Trade Center terrorist attack (2,606 deaths)

2020 #COVID19 (11,454 deaths as of yesterday)

#NYC will rise again. But this is a tough one.

The General Slocum disaster, for those not familiar with it:
nypl.org/blog/2011/06/1…

Devastated the German community of the East Village. Avenue B used to be called German Broadway. The traumatised families abandoned the neighbourhood.

I left out probably the most relevant comparison, the Spanish (Kansas) flu of 1918, which was estimated to have killed 30,000 people.

Eerie to read this paper about how #NYC responded >100 years ago to that pandemic, similarities to today, from @CescoAim1
ncbi.nlm.nih.gov/pmc/articles/P…

26 April 2020 update. Percent increase in #COVID19 death rate now pretty consistently ≤3% over last few days across all boroughs.

Deaths in the #Bronx: 1/566 people (0.18%)
Queens 1/636 (0.16%)
Manhattan 1/1,063 (0.09%)

The Harlem River separates a 2-fold risk of dying.

27 April 2020. Good news: only small increase in deaths (<2%), although
@MontefioreNYC
internal numbers show an odd admissions>discharges current blip, hope that goes away.

Deaths in the #Bronx: 1/557 people in a two month period.

28 April 2020. Not flattening yet.

Deaths in the #Bronx: 1/538 people.