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One of the U.S. states hit hardest by the pandemic has lifted its rules on physical distancing and mandatory masks, even as Black and low-income people continue to get sick. Where did it all go wrong?

Cassandra Rollins of Jackson, Miss., right, stands alongside her granddaughter Makalin Odie, middle, and her daughter Sherrie Rollins. Another of Cassandra's daughters, Shalondra, a 38-year-old elementary-school teacher, died of COVID-19 early last year.Photography by Rory Doyle/The Globe and Mail

In mid-March of 2020, Cassandra Rollins was out shopping with her 38-year-old daughter, Shalondra, when the younger Ms. Rollins complained of head pains and body aches. Despite the growing COVID-19 pandemic, Cassandra said, Shalondra’s doctor diagnosed her with the flu and sent her home with antibiotics. Only when a friend of Shalondra’s tested positive for the novel coronavirus was Shalondra herself able to get a test. She, too, had the infection.

On the morning of April 7, Shalondra had difficulty breathing and collapsed in the shower of her Jackson, Miss., apartment. Her 12-year-old daughter, who has asthma, used her own inhaler to try to help her mother breathe.

The responding ambulance was driving so slowly that Cassandra became stuck behind it and honked at it to speed up. When the paramedics drove Shalondra to hospital, the elder Ms. Rollins said, they did not turn on lights or sirens to make an emergency run.

Within the hour, the hospital called Cassandra. Her daughter had died on a gurney in the hallway.

Shalondra Rollins, an assistant teacher who worked with special needs children at an elementary school, was the first person in Jackson to die of COVID-19. Her case foreshadowed the trends that would soon come to define the pandemic in the United States: Black, diabetic, with a low-income childhood in public housing and, according to her family, difficulty with the health care system.

Over the past year, in addition to grieving, Cassandra has struggled with the pandemic’s effects. Herself a substitute teacher, she has been off work since Jackson’s schools closed last spring. Even when they were reopened in the autumn, Ms. Rollins felt it wasn’t safe to go back.

Earlier this month, Mississippi Governor Tate Reeves ended all physical-distancing restrictions and lifted the state’s mask mandate, making public places even more fraught.

Ms. Rollins also has diabetes and does not have health insurance coverage, meaning a brush with COVID-19 could be financially ruinous if not deadly.

So she has had to mostly stay home. She has avoided seeing friends and cut back on seeing family. She spends her time raising Shalondra’s teenaged daughters and setting up vaccination appointments for senior citizens who have trouble navigating the state’s sign-up portal.

“When they post the death toll, I know my daughter’s in it,” Ms. Rollins, 57, said. “It’s been really hard on me, being locked in my house, thinking about the two kids, thinking about the pandemic. I’ve dealt with a lot of bad days.”

Daily cases for select states
7 day rolling average

Mississippi has been one of the places hit hardest by COVID-19. Its 7,000 deaths in a population of three million gives it the fifth-highest death rate among U.S. states, ahead of pandemic hot spots such as Arizona and South Dakota, and behind only the densely populated U.S. Northeast. Despite this, it has received scant attention, often ignored by a national media hyperfocused on more populous locales.

But understanding what has gone so catastrophically wrong in the country’s poorest state helps explain why the U.S. as a whole has utterly failed to deal with the pandemic.

Racial and social inequality, a broken health care system and political divisions over the response to COVID-19 have all marked the past year in Mississippi.

In recent weeks, meanwhile, Jackson, the state’s capital and largest city, has also dealt with a debilitating water crisis. A winter storm wreaked havoc on an aging infrastructure, turning off the taps for almost all residents, and leaving them under a boil-water advisory for a full month. The disaster offered another abject lesson in how dysfunctional the world’s wealthiest country can still be at handling matters of basic public health.

“It’s being brought into focus just how inequitable our society is, how disparate the effect of these types of traumas are on our communities,” Jackson Mayor Chokwe Antar Lumumba told The Globe and Mail. “We’ve been fixing the bike while we’ve been riding it.”

Vaccination day in Mississippi: At top, vehicles line up at a vaccination site in Jackson's eastern suburb of Pearl, and at bottom, registered nurse Michelle Owens administers a shot to Billy Garner at a health centre across town. Mass vaccination sites in rural and suburban Mississippi have received more resources than at-risk communities in inner cities.

One recent Saturday morning, a steady stream of people lined up at the Central United Methodist Church in downtown Jackson for a pop-up COVID-19 vaccination clinic. Greeting them at the door was volunteer Robert Pugh, a 77-year-old retiree who used to run the association representing the state’s non-profit health care centres.

Mississippi’s inoculation rollout has primarily relied on mass, drive-through vaccination sites. The only two in the Jackson area are at suburban ballparks.

On many days, there are no open appointments at either of them, while vaccination sites in more distant, rural counties have thousands of available slots.

Mr. Pugh himself ran up against this problem in January. It took two weeks of refreshing Mississippi’s vaccine sign-up portal before he finally found an appointment. It was another week and a half before his first shot. Hence the need for the clinic at Central Methodist, where people could walk in off the street and get the one-shot Johnson & Johnson vaccine in a matter of minutes.

“We’re trying to get the sites closer to the communities most exposed, to the communities in need,” Mr. Pugh said.

“This has been one of the challenges of the distribution: getting sites set up in the inner city.”

It took weeks for Robert Pugh, 77, to get a vaccination appointment.

These sorts of inequities have marked the course of the pandemic, both in Mississippi and nationally.

This state is the poorest in the U.S., with a per capita income less than half that of Washington, D.C., the country’s wealthiest jurisdiction. It has some of the highest rates of heart disease, obesity and diabetes. All of these conditions track poverty and, in part, are related to the inability to afford to eat healthy. They also make it more likely that the sufferer, should he or she contract COVID-19, will get seriously ill.

Mississippi also has the highest proportion of Black residents of any state, at 38 per cent. Nationally, African-Americans are nearly twice as likely as white people to die from COVID-19. At one point last spring, Black Mississippians represented a staggering 72 per cent of the state’s death rate.

Experts have proffered a range of explanations for such discrepancies. Black people in the U.S. are more likely to face poverty and chronic health conditions. They are more likely to work in front-line jobs that don’t allow for physical distancing. And when they do encounter the health care system, Black Americans are less likely to receive the right treatment.

Chevalye Alexander, 26, said his grandfather was in and out of hospital in Canton, Miss., an industrial town near Jackson, with COVID-19 in October. His case was so severe that he couldn’t get up to tend his garden. “They said he was good to go back home. And later on that night, he ended up dying in the bed,” said Mr. Alexander, who is Black, as he sold paintings at a shopping centre in Jackson.

Nearly 13 per cent of Mississippians have no health insurance, according to data from the Kaiser Family Foundation, more than four times the rate in Massachusetts, which has the country’s most comprehensive coverage.

The Republican-run state has repeatedly refused to join a federal program under the Affordable Care Act to expand Medicaid, a government plan that provides health insurance to the lowest-income Americans. Signing on to the Medicaid expansion would cover up to 300,000 more Mississippians.

Robin Johnson, 34, can’t afford health insurance on the money she scrapes together from freelance jobs as a social-media manager, illustrator and art gallery guide. She estimates that her hourly pay works out to between US$10 and US$12. She worries about the enormous hospital bills she could be stuck with if she were to contract the virus.

“I try to stay in as much as possible and not get sick. Because I know if I were to fall ill, I don’t have any kind of backup plan,” she said.

Making matters worse, the state was hit in February by the same winter tempest that shut down the electricity grid in Texas. The subzero temperatures froze the pumps at Jackson’s water treatment plants and caused aging pipes to burst under city streets. The crisis made the city’s entire water supply unsafe to drink for the next month.

Greg Morgan, a 63-year-old mental-health worker, said he took to putting out five-gallon rain buckets and boiling water on the stove before every use. Ms. Johnson relied on bottled water to brush her teeth and make coffee. Mr. Pugh had to wash clothes by hand in his kitchen sink.

A billboard in Jackson advertises masks available at wholesale.

In a state that only removed the Confederate battle flag from its insignia earlier this year, pandemic politics have also broken down largely along racial lines.

By last fall, the disparity between Black and white COVID-19 death numbers in Mississippi had largely vanished. Asked to explain the reversal, State Health Officer Thomas Dobbs told reporters that Black Mississippians were more vigilant about following public-health precautions than their white counterparts.

In last year’s presidential election, 81 per cent of white Mississippians voted for Donald Trump, who took an often laissez-faire attitude toward the pandemic, while 94 per cent of Black voters cast ballots for Joe Biden, who campaigned on a nationwide mask mandate.

Representing this gulf locally are Mr. Reeves, the Governor, on one side and Mr. Lumumba, the Jackson mayor, on the other. The state as a whole is solidly Republican; Jackson, with a more than 80-per-cent Black population, is a Democratic stronghold.

Mr. Reeves, a white Republican who resembles a heavyset version of Bill Gates, has taken a light touch on physical distancing. In September, he allowed the state’s mask mandate to expire. Forced to reimpose it after cases spiked a few weeks later, he lifted the mandate again this month. At the same time, Mr. Reeves also allowed businesses to fully reopen. “The governor’s office is getting out of the business of telling people what they can and cannot do,” he declared.

Mr. Lumumba, by contrast, is a Black Democrat who endorsed Bernie Sanders’s presidential campaign. Holding press conferences in skinny jeans and slim-cut sport coats, he gives off a distinctly hipster vibe. And he has repeatedly tried to keep pandemic safety measures in place locally after the state has ended them, including by ordering his own mask mandate for the city.

Jackson Mayor Chokwe Antar Lumumba sits in his office beside a picture of his father, a former mayor.

The two levels of government have also fought over the water crisis. Mr. Lumumba contends that years of underinvestment in the system would cost US$2-billion to fix, money the city does not have. Mr. Reeves’s deputy, Delbert Hosemann, meanwhile, has argued Jackson did a better job maintaining water infrastructure when it was run by a white mayor.

In an interview, Mr. Lumumba framed both the pandemic and water crisis as expressions of the same problem.

“Whether it’s a failed infrastructure, whether it’s the disproportionate effect on Black and brown communities of the pandemic, these are things that have revealed the conditioning and the state that we have been in for quite some time,” he said as he walked to his office in Jackson’s neoclassical City Hall.

“We have to be able to shift our metrics of success, of government success, of national and local economies, from simply looking at GDP or the stock market or whether we’re building nice buildings, and move it toward sustainable development.”

Jackson’s struggle with poverty and urban decline is readily visible.

Around the state legislature, there are nearly as many surface parking lots as there are buildings. Many residential neighbourhoods are dotted with abandoned strip malls and burnt-out or demolished houses. On some blocks, dilapidated homes have been nearly swallowed by vegetation under towering elm and magnolia trees, giving the effect of the forest reclaiming the city. Along Farish Street, the inner-city thoroughfare that includes Central United, dozens of historic brick commercial buildings are boarded up.

As she stood outside the church after receiving her vaccine, Andrana Rankins, a university biology student, said COVID-19 never had to get this bad. Currently working on a school co-op program in a nursing home, she has seen the psychological toll on pensioners unable to see their families.

“The social distancing has not been as good as it could have been – we have a governor who is not requiring masks. Not expanding Medicaid was a very selfish decision,” Ms. Rankins, 20, said.

“We’ve been in this pandemic for a year now, and I feel like it should never have lasted this long.”

Downtown Jackson is framed through an opening in an abandoned building. Mississippi's winter storm in February, the same one that froze Texas, damaged Jackson's aging water infrastructure, leaving residents under a boil-water advisory for a month.

Trish Tidmore, like Cassandra Rollins, has been out of work for the past year. Ms. Tidmore, 36, had to quit her job as an administrator at a hospice last spring to stay home with her six-year-old son when his school closed. After the education system reopened in the fall, she couldn’t find work.

Her family, which also includes her husband, Curtis Linton, 39, and a teenaged daughter, has had to rely solely on Mr. Linton’s income as a pipe layer to get by.

They’ve cut back on groceries, starting a vegetable garden to supplement their meals. Where they used to visit their extended families, who live several hours away, two or three times a month, they now only make the trek every three or four months – the gas is just too expensive. On a couple of occasions, they said, they nearly had to give up their car because they could no longer afford it.

But unlike Ms. Rollins, Ms. Tidmore blames the situation not on COVID-19 itself but on the physical-distancing measures used to combat it. She believes in a Trump-fuelled conspiracy theory that government agencies are inflating the death toll.

“We don’t believe it’s a pandemic,” she said one overcast afternoon last week as she and Mr. Linton stood, unmasked, watching their son climb on a piece of play equipment at an outlet mall in Pearl, Miss., a suburb of Jackson. “We made the solution worse than the virus itself. The death numbers are not accurate.”

Ms. Tidmore and Mr. Linton also do not plan to get vaccinated because they believe it is ineffective. Instead, the couple said, they are relying on vitamins to keep them from contracting the virus. “Everybody needs to calm down and go on with life,” Mr. Linton said.

Rankin County, where Ms. Tidmore and Mr. Linton live, lies directly across the Pearl River from Jackson. Demographically, it is the city’s opposite. Its population is 74-per-cent white and it has a median household income of US$66,000, almost double Jackson’s. Solidly Republican, Rankin gave Mr. Trump 72 per cent of its vote. It’s the sort of place where even those who have seen the pandemic’s ravages firsthand support ending coronavirus containment measures.

Ron Johnson, a 37-year-old powerline technician, buried both his stepmother and her mother the week after Christmas. They contracted COVID-19 at a beauty salon. But he’s happy to see the mask mandate and other restrictions go.

“I think if you’re going to get it, you’re going to get it, it’s your time,” he said, tugging his blue surgical mask down under his nose, as he shopped with his grandmother at an outlet mall. “I can’t breathe with this on. I don’t like it.”

Mr. Johnson dismissed the notion that a lack of health care coverage is one of the reasons for the high death toll in Mississippi. “It’s just lazy people, people who don’t want to work, people who want free things in life,” he said. “You give them a car, they want a house.”

Despite Mr. Reeves’s efforts to fully reopen, many businesses around Jackson and its suburbs – including most of the shops in the outlet mall – still required masks. Others limited the number of people allowed inside at once.

But in some places, you could almost imagine there was no pandemic on at all. One recent Friday night in Fondren, a hip neighbourhood in north Jackson, the restaurants were full, with diners and drinkers sitting in close proximity and crowding around the bar.

It’s the sort of scene that fills Ms. Rollins with dread. Just last week her youngest daughter, 27-year-old Tabitha, also tested positive for COVID-19. It was another reminder that the pandemic is still not over. And Ms. Rollins wishes everyone would take it as seriously as she does, to avoid the toll it’s taken on her family.

“I see them in clubs, packed, no mask,” she said. “And nobody’s doing anything about it.”