CHARLOTTE, N.C. \u2014 As covid-19 devastated communities across the nation in spring 2020, a group of Black ministers in this racially divided city made an urgent plea for more testing in their neighborhoods.<\/p>\n

Testing at the time \u201cwas outside of communities of color,\u201d said the Rev. Jordan Boyd, pastor of Rockwell AME Zion Church in Charlotte. For Boyd, pandemic losses were personal: Covid-related complications killed a brother-in-law who worked as a truck driver. \u201cWe saw what was happening with our folks.\u201d<\/p>\n

Mandy Cohen, who led the state\u2019s pandemic response as secretary of North Carolina\u2019s health department, had said widespread testing was one of \u201cour best tools to keep our community safe and to protect our frontline workers.\u201d But the state was failing to get tests to its most vulnerable people, with grim consequences: Black people in North Carolina were getting sick and dying<\/a> from covid-related causes at far higher rates than white people, data show.<\/p>\n

KFF Health News analyzed and confirmed publicly available data<\/a>, including the location of testing sites that Cohen\u2019s office directed the public to in mid-May 2020 in Mecklenburg County, home to Charlotte, the state\u2019s largest city. Just 1 in 4 fixed sites stood in more disadvantaged areas with significant Black populations, including what is known as the Crescent, neighborhoods reaching west, north, and east of downtown that for generations have had elevated rates of diabetes, high blood pressure, lung disease, and other conditions that can cause life-threatening complications from covid. Far more testing was available in south Charlotte and suburban areas \u2014 the whiter, wealthier neighborhoods.<\/p>\n

Life in the Crescent is marked by higher rates of poverty, crowded housing, and less access to health care, transportation, and internet service \u2014 factors that fueled transmission of the virus and created barriers to testing.<\/p>\n

\u201cThere were a lot of hurdles that you had to go through,\u201d said Boyd, who helped spearhead the effort to bring testing to Black churches.<\/p>\n

President Joe Biden and others in political and health policy circles have praised Cohen\u2019s pandemic leadership in North Carolina. Biden in June cited her \u201cproven track-record protecting Americans\u2019 health and safety\u201d when elevating Cohen to run the Centers for Disease Control and Prevention, the nation\u2019s top public health agency.<\/p>\n

Those on the ground in North Carolina\u2019s most vulnerable communities, including Cohen\u2019s admirers, tell another story \u2014 about living with the downsides of the state\u2019s emergency response. These include advocates for groups that were disproportionately harmed during the public health crisis, including minority and immigrant communities, people with disabilities, and families of nursing home residents.<\/p>\n

The Rev. Jordan Boyd stands in the sanctuary of Rockwell AME Zion Church in Charlotte, North Carolina. Boyd and fellow clergy members spearheaded the effort to bring covid testing to Black residents early in the pandemic. In the first months, he says, testing was mostly \u201coutside of communities of color.\u201d(Fred Clasen-Kelly\/KFF Health News)<\/span><\/figcaption><\/figure>\n
Corine Mack, president of the Charlotte-Mecklenburg NAACP, recalled that in late 2020 she and others complained to Cohen about public money going to white-led organizations instead of Black-led ones working in minority neighborhoods.<\/p>\n
\u201cI said we had to send resources tomorrow, not next month,\u201d Mack said. \u201cShe started crying. I was so passionate about our people dying. Once she understood the severity of the situation, she did what she had to do.\u201d<\/p>\n
The challenges Cohen faced in North Carolina were exacerbated by structural inequities in and outside the health care system, problems that are too large for any one person to fix. Still, Cohen now faces the same challenges on a national scale, as she\u2019s charged with fixing the CDC after its pandemic missteps.<\/p>\n
Cohen, through her spokesperson at the CDC, declined multiple requests for an interview.<\/p>\n
A report in January<\/a> called \u201cBuilding the CDC the Country Needs,\u201d which was signed by dozens of health policy experts, urged an agency overhaul. Among the priorities cited: more quickly collecting data on racial, ethnic, economic, and geographic factors that is \u201cfoundational to improving equity of access to services.\u201d<\/p>\n
For most of the pandemic, Black, Hispanic, and Native Americans fared worse than whites<\/a> across the country.<\/p>\n
In North Carolina, critics and allies alike say Cohen heeded concerns. She relied heavily on data and followed federal guidance closely, they said. And Cohen showed vigilance when she interpreted rules, like those on nursing home visitation and mask mandates, even in the face of criticism.<\/p>\n
She also repeatedly urged personal responsibility to contain the spread of the virus, underscoring how public health messaging often focuses on choice rather than societal constraints, said Anne Sosin, a researcher at Dartmouth College who focuses on health equity.<\/p>\n
\u201cMany of the people and communities hardest-hit by the pandemic had little choice in their exposure\u201d because they got covid where they lived or worked, Sosin said. \u201cLimiting our focus on the choices that people make \u2014 rather than on the broader structural and social forces that shape risk \u2014 really will set us up for the same failures in the future.\u201d<\/p>\n
With more than 1 million residents, Mecklenburg County has become a symbol both of North Carolina\u2019s economic rise and of its struggles to overcome a long history of racial discrimination and disparities. A short drive from the headquarters of Fortune 500 companies, such as Bank of America and Honeywell, sit minority neighborhoods plagued by poverty. A national study on social mobility found that, among the 50 largest cities, Charlotte was the hardest place<\/a> for a child to move from poverty to the upper class.<\/p>\n
Researchers from North Carolina\u2019s health agency and the University of North Carolina found that access to tests during the first three months of the pandemic \u2014 between March and June 2020 \u2014 was not evenly distributed<\/a> across racial and ethnic groups, with inadequate access for Black and Latino residents.<\/p>\n
On May 14, 2020 \u2014 two months after the national emergency was declared \u2014 Cohen\u2019s agency directed clinicians<\/a> to prioritize testing for people from \u201cracial and ethnic minority groups disproportionately affected by adverse COVID-19 outcomes,\u201d and officials recommended<\/a> using mobile testing for \u201cvulnerable populations,\u201d documents show.<\/p>\n
The disparities persisted. In Charlotte, the difference in testing sites underscored the inequity people of color often face in health care, as they were left to depend on a few mobile units whose routes and hours varied by the day. Meanwhile, wealthier areas had an abundance of well-resourced, fixed sites with regular hours.<\/p>\n
Critics say the state was slow to address glaring and predictable problems. Mecklenburg County Commissioner Pat Cotham, a Democrat, said it took authorities precious time to shift testing to the hardest-hit neighborhoods. Cotham said officials should have more quickly enlisted Black ministers and others who had established trust with residents. Instead, she said, even elected representatives of those areas were often locked out. \u201cI remember getting information from press releases or TV,\u201d she said.<\/p>\n
North Carolina initially failed to prioritize testing for people who were exposed to covid because of where they live or work, said Jeanne Milliken Bonds, a professor of social impact investing at the University of North Carolina. She co-authored a white paper that criticized the national pandemic response<\/a>, saying, \u201cWe are ignoring the critical impact of systemic racism in vulnerabilities to the deadly virus.\u201d<\/p>\n
Black people, immigrants, and ethnic minorities disproportionately hold jobs that governments deemed essential \u2014 in food processing plants, retail stores, and nursing homes \u2014 and they were unable to isolate and work from home, Milliken Bonds said.<\/p>\n
Charlotte had one of the biggest disparities in access to testing in the nation, according to a study of 30 large cities<\/a> by researchers at Drexel and Temple universities. Only Austin and Houston in Texas fared worse.<\/p>\n
In 2020, Black people in North Carolina died from covid at a higher rate than white people, although the disparity was slightly less pronounced than in the U.S. overall. A KFF Health News analysis of CDC data shows<\/a> that 112 of every 100,000 non-Hispanic Black residents in the state died, compared with 89 per 100,000 non-Hispanic white residents. North Carolina\u2019s death rates for all racial and ethnic groups that year were lower than those nationally.<\/p>\n
\u201cThe driving factor for testing and vaccination was, \u2018Let\u2019s get older people and let\u2019s protect our health care workers,\u2019\u201d Milliken Bonds said. \u201cYou end up losing the health equity lens. There was a course correction later in 2020. They looked at the data and said, \u2018Oh my God!\u2019 They were missing people of color.\u201d<\/p>\n
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**Tensions Rose<\/strong><\/p>\n**
**In April 2020, when covid tests were scarce nationally and states had little federal support, Cohen\u2019s Department of Health and Human Services** convened a work group<\/a> to increase testing. The initiative began as Democratic Gov. Roy Cooper indicated he would ease the restrictions he\u2019d put in place in March to limit covid\u2019s spread.<\/p>\n
The group included state employees, consultants, local officials, and representatives from major hospital systems, community health centers, and commercial labs, North Carolina HHS news releases and state documents show. Officials set priority groups for testing, including hospitalized patients, health care workers and first responders, and people in long-term care or correctional facilities, according to meeting minutes from April 24<\/a>. The last item: \u201cadditional emphasis on equity and ensuring communities of color have access to testing.\u201d<\/p>\n
**The state also received guidance from experts focused on equity<\/a>.<\/p>\n**
\u201cWe know that there\u2019s more covid-19 out in our communities than gets captured by what\u2019s in our lab data,\u201d Cohen said April 30, during one of Cooper\u2019s pandemic briefings.<\/p>\n
Of the covid test results reported to North Carolina\u2019s health department at that time, a smaller share were coming back positive relative to prior weeks, and covid hospitalizations were level \u2014 developments Cohen hailed as progress. But tensions were brewing.<\/p>\n
By May 5, Disability Rights North Carolina filed a civil rights complaint<\/a> with the U.S. Department of Health and Human Services about a proposed state emergency plan. The advocacy group said the plan \u2014 which determined who would get lifesaving treatments in hospitals if supplies were scarce \u2014 would put people with disabilities in the \u201cback of the line\u201d and lead to a disproportionate death toll among people of color or with low incomes.<\/p>\n
As the state began reopening businesses in early May, officials knew testing levels were not adequate, according to a review of public documents, interviews, and Cohen\u2019s public remarks. Hundreds of sites were up and running, \u201cbut there\u2019s more to do,\u201d Cohen said May 20.<\/p>\n
In a letter in the North Carolina Medical Journal<\/a>, North Carolina HHS employees and a consultant with Accenture said \u201ctesting was difficult to access outside of a hospital\u201d that month. \u201cOf the tests being performed early in the pandemic, the majority were in White populations even though we could already see differences in poor outcomes in Black\/African American, American Indian\/Alaskan Native, and Latinx populations infected with the virus around the country,\u201d they wrote.<\/p>\n
Kody Kinsley, who worked for Cohen and succeeded her as health secretary, said the state\u2019s response was stymied by factors beyond its control, including supply chain shortages. \u201cWe were essentially riding the backbone of the existing health care network with inadequate supplies,\u201d Kinsley said. The department tried to contract with outside firms to boost testing access in historically marginalized communities, but \u201cresources weren\u2019t available.\u201d<\/p>\n
Boyd, the pastor, said it was \u201cdifficult times.\u201d To reach hard-hit communities across the state, \u201cyou have to be able to do that through connections on the ground,\u201d he said. \u201cOtherwise it\u2019s not going to happen. But that takes time.\u201d<\/p>\n
In Charlotte, he said, fixed testing sites at hospitals and elsewhere, which required appointments, weren\u2019t as accessible for those in the city\u2019s poorest neighborhoods. \u201cYou had to go online and sign up,\u201d he said.<\/p>\n
$\"A$
Mecklenburg County Commissioner Vilma Leake, a Democrat, says she never received a satisfactory answer when she asked why people of color were not prioritized for testing given the South\u2019s long history of racial exclusion and wide disparities in well-being. \u201cHistory is repeating itself. It is always a fight for some people,\u201d she says.(Mecklenburg County)<\/span><\/figcaption><\/figure>\n
Black residents were desperate for testing: When a mobile van run by Atrium Health, the dominant hospital system in Charlotte, arrived at Boyd\u2019s church in early May, \u201cCars were lined up around the block at 4 or 5 o\u2019clock in the morning,\u201d he said.<\/p>\n
Atrium\u2019s mobile testing started in April, circulating in minority communities where data showed emerging hot spots. While people could walk up to get a test, locations shifted daily, according to internet archives, social media posts, and other announcements. Between mid-April and early July, the units stopped at many Black churches only once.<\/p>\n
\u201cWe were last on the list. We lost a lot of people,\u201d said Vilma Leake, a Democratic member of the Mecklenburg Board of County Commissioners. Leake said she never received a satisfactory answer when she asked why people of color were not prioritized for testing given the South\u2019s long history of racial exclusion and wide disparities in health, education, and income. \u201cHistory is repeating itself. It is always a fight for some people,\u201d she added.<\/p>\n
Kinsley said the state\u2019s response \u201cwas intentionally designed to be conscious of class and race and ethnicity,\u201d which he said informed its guidance for essential workers and efforts to push businesses to provide paid leave and on-the-job covid tests.<\/p>\n
By late spring, the state\u2019s testing data, which captured only a fraction of infections, painted a troubling picture. As of May 26, Black residents made up 31% of cases and 35% of deaths<\/a> despite being 22% of the state\u2019s population. Latinos made up 9.6% of the state\u2019s population and 35% of covid cases.<\/p>\n
That same day, Cohen stood at Cooper\u2019s pandemic briefing. While she described the state\u2019s efforts to improve safety for workers at meat processing plants, she again called for personal responsibility.<\/p>\n
\u201cOur ability to continue to ease restrictions and get back to work as safely as possible hinges on all of us working together to protect each other,\u201d Cohen said, adding, \u201cWe want to save lives. And we can do that with simple individual actions.\u201d By that time, North Carolina had allowed restaurants, pools, and personal care businesses such as barbers to open at 50% capacity.<\/p>\n
$\"A$
North Carolina\u2019s response \u201cwas not adequate for protecting essential workers,\u201d says the Rev. Rodney Sadler, the director of the Center for Social Justice and Reconciliation at Union Presbyterian Seminary. \u201cIt was targeted toward those who had resources, who had a knowledge base, who had greater freedoms, who had the ability to work from home.\u201d(Britten Nicole)<\/span><\/figcaption><\/figure>\n
The state\u2019s response \u201cwas not adequate for protecting essential workers,\u201d said the Rev. Rodney Sadler, the director of the Center for Social Justice and Reconciliation at Union Presbyterian Seminary.<\/p>\n
\u201cIt was targeted toward those who had resources, who had a knowledge base, who had greater freedoms, who had the ability to work from home,\u201d he said, adding that it\u2019s important to \u201cthink about how this hits differently for poor Black and brown people in inner-city communities than it does for wealthier, white communities in the suburbs.\u201d<\/p>\n
The Rev. Greg Jarrell helps lead QC Family Tree, a social justice organization in Enderly Park, a Black neighborhood near downtown Charlotte that is gentrifying. He said people often waited hours for testing at a site near his neighborhood, even with appointments.<\/p>\n
\u201cWe saw the severe limitations of the whole system,\u201d he said. \u201cWho has got time to sit in line for three hours? Not an hourly employee.\u201d<\/p>\n
If you don\u2019t set up \u201crace-conscious and class-conscious policy,\u201d Jarrell said, \u201cthe system is always going to serve people who have more resources.\u201d<\/p>\n
Throughout June, as North Carolina\u2019s covid infections and hospitalizations climbed, the state focused more intensely on Black, Latino, and Native American residents. It took until July 7 for officials to announce they would deploy 300 free temporary testing sites in underserved communities across the state.<\/p>\n
The state\u2019s covid death toll had reached 1,420 people<\/a>, and 989 more were hospitalized. The trajectory, Cohen said, was \u201cmoving in the wrong direction.\u201d<\/p>\n
**A Bigger Challenge at the CDC<\/strong><\/p>\n**
**Political leaders, public health experts, and advocacy groups say Cohen is well suited to run the CDC.<\/p>\n**
She has navigated vast government agencies \u2014 experience her predecessor, Rochelle Walensky, lacked. Cohen has political acumen, having worked effectively in a politically divided state \u201cwith a range of views about public health,\u201d said Tom Inglesby, director of the Johns Hopkins Center for Health Security and a former senior White House adviser on covid response. \u201cShe is super bright and a very clear communicator about the issues on the table.\u201d<\/p>\n
During the Obama administration, Cohen, a physician, climbed the ranks to become chief operating officer and chief of staff at the Centers for Medicare & Medicaid Services, which has more than 6,000 employees and oversees government programs like Medicare and Medicaid that insure millions of Americans. In 2017 Cooper appointed her North Carolina health secretary. She stepped down at the end of 2021.<\/p>\n
Cohen\u2019s time \u201cin North Carolina will inform the practical, on-the-ground work that will make a big difference at the CDC,\u201d Kinsley said, citing efforts to minimize racial and ethnic disparities in covid vaccination.<\/p>\n
According to CDC data comparing covid mortality rates by state, North Carolina had the 12th lowest age-adjusted death rate in 2020. But the state\u2019s fortunes changed in 2021, when it dropped to 30th place. North Carolinians said Cohen listened to their perspectives, but their calls for help were punctuated by a drumbeat of deaths.<\/p>\n
**$\"A$** Mecklenburg County Commissioner Mark Jerrell, a Democrat, says the pandemic exposed how North Carolina is still reeling from centuries of racial discrimination.(Mecklenburg County)<\/span><\/figcaption><\/figure>\n
Mecklenburg County Commissioner Mark Jerrell, a Democrat, said the pandemic exposed how North Carolina is still reeling from centuries of racial discrimination. Even as Cohen \u201cbecame a trusted community voice,\u201d he said, \u201cthere was a disconnect between the discussion of equity and the application of equity.\u201d<\/p>\n
He worries that painful lessons of those early pandemic months seem forgotten, saying, \u201cWe don\u2019t even hear this conversation now.\u201d<\/p>\n
*Data reporter Hannah Recht contributed to this story.<\/em><\/p>\n*
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The Rev. Jordan Boyd stands in the sanctuary of Rockwell AME Zion Church in Charlotte, North Carolina. Boyd and fellow clergy members spearheaded the effort to bring covid testing to Black residents early in the pandemic. In the first months, he says, testing was mostly \u201coutside of communities of color.\u201d(Fred Clasen-Kelly\/KFF Health News)<\/span><\/figcaption><\/figure>\n
Corine Mack, president of the Charlotte-Mecklenburg NAACP, recalled that in late 2020 she and others complained to Cohen about public money going to white-led organizations instead of Black-led ones working in minority neighborhoods.<\/p>\n
\u201cI said we had to send resources tomorrow, not next month,\u201d Mack said. \u201cShe started crying. I was so passionate about our people dying. Once she understood the severity of the situation, she did what she had to do.\u201d<\/p>\n
The challenges Cohen faced in North Carolina were exacerbated by structural inequities in and outside the health care system, problems that are too large for any one person to fix. Still, Cohen now faces the same challenges on a national scale, as she\u2019s charged with fixing the CDC after its pandemic missteps.<\/p>\n
Cohen, through her spokesperson at the CDC, declined multiple requests for an interview.<\/p>\n
A report in January<\/a> called \u201cBuilding the CDC the Country Needs,\u201d which was signed by dozens of health policy experts, urged an agency overhaul. Among the priorities cited: more quickly collecting data on racial, ethnic, economic, and geographic factors that is \u201cfoundational to improving equity of access to services.\u201d<\/p>\n
For most of the pandemic, Black, Hispanic, and Native Americans fared worse than whites<\/a> across the country.<\/p>\n
In North Carolina, critics and allies alike say Cohen heeded concerns. She relied heavily on data and followed federal guidance closely, they said. And Cohen showed vigilance when she interpreted rules, like those on nursing home visitation and mask mandates, even in the face of criticism.<\/p>\n
She also repeatedly urged personal responsibility to contain the spread of the virus, underscoring how public health messaging often focuses on choice rather than societal constraints, said Anne Sosin, a researcher at Dartmouth College who focuses on health equity.<\/p>\n
\u201cMany of the people and communities hardest-hit by the pandemic had little choice in their exposure\u201d because they got covid where they lived or worked, Sosin said. \u201cLimiting our focus on the choices that people make \u2014 rather than on the broader structural and social forces that shape risk \u2014 really will set us up for the same failures in the future.\u201d<\/p>\n
With more than 1 million residents, Mecklenburg County has become a symbol both of North Carolina\u2019s economic rise and of its struggles to overcome a long history of racial discrimination and disparities. A short drive from the headquarters of Fortune 500 companies, such as Bank of America and Honeywell, sit minority neighborhoods plagued by poverty. A national study on social mobility found that, among the 50 largest cities, Charlotte was the hardest place<\/a> for a child to move from poverty to the upper class.<\/p>\n
Researchers from North Carolina\u2019s health agency and the University of North Carolina found that access to tests during the first three months of the pandemic \u2014 between March and June 2020 \u2014 was not evenly distributed<\/a> across racial and ethnic groups, with inadequate access for Black and Latino residents.<\/p>\n
On May 14, 2020 \u2014 two months after the national emergency was declared \u2014 Cohen\u2019s agency directed clinicians<\/a> to prioritize testing for people from \u201cracial and ethnic minority groups disproportionately affected by adverse COVID-19 outcomes,\u201d and officials recommended<\/a> using mobile testing for \u201cvulnerable populations,\u201d documents show.<\/p>\n
The disparities persisted. In Charlotte, the difference in testing sites underscored the inequity people of color often face in health care, as they were left to depend on a few mobile units whose routes and hours varied by the day. Meanwhile, wealthier areas had an abundance of well-resourced, fixed sites with regular hours.<\/p>\n
Critics say the state was slow to address glaring and predictable problems. Mecklenburg County Commissioner Pat Cotham, a Democrat, said it took authorities precious time to shift testing to the hardest-hit neighborhoods. Cotham said officials should have more quickly enlisted Black ministers and others who had established trust with residents. Instead, she said, even elected representatives of those areas were often locked out. \u201cI remember getting information from press releases or TV,\u201d she said.<\/p>\n
North Carolina initially failed to prioritize testing for people who were exposed to covid because of where they live or work, said Jeanne Milliken Bonds, a professor of social impact investing at the University of North Carolina. She co-authored a white paper that criticized the national pandemic response<\/a>, saying, \u201cWe are ignoring the critical impact of systemic racism in vulnerabilities to the deadly virus.\u201d<\/p>\n
Black people, immigrants, and ethnic minorities disproportionately hold jobs that governments deemed essential \u2014 in food processing plants, retail stores, and nursing homes \u2014 and they were unable to isolate and work from home, Milliken Bonds said.<\/p>\n
Charlotte had one of the biggest disparities in access to testing in the nation, according to a study of 30 large cities<\/a> by researchers at Drexel and Temple universities. Only Austin and Houston in Texas fared worse.<\/p>\n
In 2020, Black people in North Carolina died from covid at a higher rate than white people, although the disparity was slightly less pronounced than in the U.S. overall. A KFF Health News analysis of CDC data shows<\/a> that 112 of every 100,000 non-Hispanic Black residents in the state died, compared with 89 per 100,000 non-Hispanic white residents. North Carolina\u2019s death rates for all racial and ethnic groups that year were lower than those nationally.<\/p>\n
\u201cThe driving factor for testing and vaccination was, \u2018Let\u2019s get older people and let\u2019s protect our health care workers,\u2019\u201d Milliken Bonds said. \u201cYou end up losing the health equity lens. There was a course correction later in 2020. They looked at the data and said, \u2018Oh my God!\u2019 They were missing people of color.\u201d<\/p>\n
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**Tensions Rose<\/strong><\/p>\n**
**In April 2020, when covid tests were scarce nationally and states had little federal support, Cohen\u2019s Department of Health and Human Services** convened a work group<\/a> to increase testing. The initiative began as Democratic Gov. Roy Cooper indicated he would ease the restrictions he\u2019d put in place in March to limit covid\u2019s spread.<\/p>\n
The group included state employees, consultants, local officials, and representatives from major hospital systems, community health centers, and commercial labs, North Carolina HHS news releases and state documents show. Officials set priority groups for testing, including hospitalized patients, health care workers and first responders, and people in long-term care or correctional facilities, according to meeting minutes from April 24<\/a>. The last item: \u201cadditional emphasis on equity and ensuring communities of color have access to testing.\u201d<\/p>\n
**The state also received guidance from experts focused on equity<\/a>.<\/p>\n**
\u201cWe know that there\u2019s more covid-19 out in our communities than gets captured by what\u2019s in our lab data,\u201d Cohen said April 30, during one of Cooper\u2019s pandemic briefings.<\/p>\n
Of the covid test results reported to North Carolina\u2019s health department at that time, a smaller share were coming back positive relative to prior weeks, and covid hospitalizations were level \u2014 developments Cohen hailed as progress. But tensions were brewing.<\/p>\n
By May 5, Disability Rights North Carolina filed a civil rights complaint<\/a> with the U.S. Department of Health and Human Services about a proposed state emergency plan. The advocacy group said the plan \u2014 which determined who would get lifesaving treatments in hospitals if supplies were scarce \u2014 would put people with disabilities in the \u201cback of the line\u201d and lead to a disproportionate death toll among people of color or with low incomes.<\/p>\n
As the state began reopening businesses in early May, officials knew testing levels were not adequate, according to a review of public documents, interviews, and Cohen\u2019s public remarks. Hundreds of sites were up and running, \u201cbut there\u2019s more to do,\u201d Cohen said May 20.<\/p>\n
In a letter in the North Carolina Medical Journal<\/a>, North Carolina HHS employees and a consultant with Accenture said \u201ctesting was difficult to access outside of a hospital\u201d that month. \u201cOf the tests being performed early in the pandemic, the majority were in White populations even though we could already see differences in poor outcomes in Black\/African American, American Indian\/Alaskan Native, and Latinx populations infected with the virus around the country,\u201d they wrote.<\/p>\n
Kody Kinsley, who worked for Cohen and succeeded her as health secretary, said the state\u2019s response was stymied by factors beyond its control, including supply chain shortages. \u201cWe were essentially riding the backbone of the existing health care network with inadequate supplies,\u201d Kinsley said. The department tried to contract with outside firms to boost testing access in historically marginalized communities, but \u201cresources weren\u2019t available.\u201d<\/p>\n
Boyd, the pastor, said it was \u201cdifficult times.\u201d To reach hard-hit communities across the state, \u201cyou have to be able to do that through connections on the ground,\u201d he said. \u201cOtherwise it\u2019s not going to happen. But that takes time.\u201d<\/p>\n
In Charlotte, he said, fixed testing sites at hospitals and elsewhere, which required appointments, weren\u2019t as accessible for those in the city\u2019s poorest neighborhoods. \u201cYou had to go online and sign up,\u201d he said.<\/p>\n
$\"A$
Mecklenburg County Commissioner Vilma Leake, a Democrat, says she never received a satisfactory answer when she asked why people of color were not prioritized for testing given the South\u2019s long history of racial exclusion and wide disparities in well-being. \u201cHistory is repeating itself. It is always a fight for some people,\u201d she says.(Mecklenburg County)<\/span><\/figcaption><\/figure>\n
Black residents were desperate for testing: When a mobile van run by Atrium Health, the dominant hospital system in Charlotte, arrived at Boyd\u2019s church in early May, \u201cCars were lined up around the block at 4 or 5 o\u2019clock in the morning,\u201d he said.<\/p>\n
Atrium\u2019s mobile testing started in April, circulating in minority communities where data showed emerging hot spots. While people could walk up to get a test, locations shifted daily, according to internet archives, social media posts, and other announcements. Between mid-April and early July, the units stopped at many Black churches only once.<\/p>\n
\u201cWe were last on the list. We lost a lot of people,\u201d said Vilma Leake, a Democratic member of the Mecklenburg Board of County Commissioners. Leake said she never received a satisfactory answer when she asked why people of color were not prioritized for testing given the South\u2019s long history of racial exclusion and wide disparities in health, education, and income. \u201cHistory is repeating itself. It is always a fight for some people,\u201d she added.<\/p>\n
Kinsley said the state\u2019s response \u201cwas intentionally designed to be conscious of class and race and ethnicity,\u201d which he said informed its guidance for essential workers and efforts to push businesses to provide paid leave and on-the-job covid tests.<\/p>\n
By late spring, the state\u2019s testing data, which captured only a fraction of infections, painted a troubling picture. As of May 26, Black residents made up 31% of cases and 35% of deaths<\/a> despite being 22% of the state\u2019s population. Latinos made up 9.6% of the state\u2019s population and 35% of covid cases.<\/p>\n
That same day, Cohen stood at Cooper\u2019s pandemic briefing. While she described the state\u2019s efforts to improve safety for workers at meat processing plants, she again called for personal responsibility.<\/p>\n
\u201cOur ability to continue to ease restrictions and get back to work as safely as possible hinges on all of us working together to protect each other,\u201d Cohen said, adding, \u201cWe want to save lives. And we can do that with simple individual actions.\u201d By that time, North Carolina had allowed restaurants, pools, and personal care businesses such as barbers to open at 50% capacity.<\/p>\n
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North Carolina\u2019s response \u201cwas not adequate for protecting essential workers,\u201d says the Rev. Rodney Sadler, the director of the Center for Social Justice and Reconciliation at Union Presbyterian Seminary. \u201cIt was targeted toward those who had resources, who had a knowledge base, who had greater freedoms, who had the ability to work from home.\u201d(Britten Nicole)<\/span><\/figcaption><\/figure>\n
The state\u2019s response \u201cwas not adequate for protecting essential workers,\u201d said the Rev. Rodney Sadler, the director of the Center for Social Justice and Reconciliation at Union Presbyterian Seminary.<\/p>\n
\u201cIt was targeted toward those who had resources, who had a knowledge base, who had greater freedoms, who had the ability to work from home,\u201d he said, adding that it\u2019s important to \u201cthink about how this hits differently for poor Black and brown people in inner-city communities than it does for wealthier, white communities in the suburbs.\u201d<\/p>\n
The Rev. Greg Jarrell helps lead QC Family Tree, a social justice organization in Enderly Park, a Black neighborhood near downtown Charlotte that is gentrifying. He said people often waited hours for testing at a site near his neighborhood, even with appointments.<\/p>\n
\u201cWe saw the severe limitations of the whole system,\u201d he said. \u201cWho has got time to sit in line for three hours? Not an hourly employee.\u201d<\/p>\n
If you don\u2019t set up \u201crace-conscious and class-conscious policy,\u201d Jarrell said, \u201cthe system is always going to serve people who have more resources.\u201d<\/p>\n
Throughout June, as North Carolina\u2019s covid infections and hospitalizations climbed, the state focused more intensely on Black, Latino, and Native American residents. It took until July 7 for officials to announce they would deploy 300 free temporary testing sites in underserved communities across the state.<\/p>\n
The state\u2019s covid death toll had reached 1,420 people<\/a>, and 989 more were hospitalized. The trajectory, Cohen said, was \u201cmoving in the wrong direction.\u201d<\/p>\n
**A Bigger Challenge at the CDC<\/strong><\/p>\n**
**Political leaders, public health experts, and advocacy groups say Cohen is well suited to run the CDC.<\/p>\n**
She has navigated vast government agencies \u2014 experience her predecessor, Rochelle Walensky, lacked. Cohen has political acumen, having worked effectively in a politically divided state \u201cwith a range of views about public health,\u201d said Tom Inglesby, director of the Johns Hopkins Center for Health Security and a former senior White House adviser on covid response. \u201cShe is super bright and a very clear communicator about the issues on the table.\u201d<\/p>\n
During the Obama administration, Cohen, a physician, climbed the ranks to become chief operating officer and chief of staff at the Centers for Medicare & Medicaid Services, which has more than 6,000 employees and oversees government programs like Medicare and Medicaid that insure millions of Americans. In 2017 Cooper appointed her North Carolina health secretary. She stepped down at the end of 2021.<\/p>\n
Cohen\u2019s time \u201cin North Carolina will inform the practical, on-the-ground work that will make a big difference at the CDC,\u201d Kinsley said, citing efforts to minimize racial and ethnic disparities in covid vaccination.<\/p>\n
According to CDC data comparing covid mortality rates by state, North Carolina had the 12th lowest age-adjusted death rate in 2020. But the state\u2019s fortunes changed in 2021, when it dropped to 30th place. North Carolinians said Cohen listened to their perspectives, but their calls for help were punctuated by a drumbeat of deaths.<\/p>\n
**$\"A$** Mecklenburg County Commissioner Mark Jerrell, a Democrat, says the pandemic exposed how North Carolina is still reeling from centuries of racial discrimination.(Mecklenburg County)<\/span><\/figcaption><\/figure>\n
Mecklenburg County Commissioner Mark Jerrell, a Democrat, said the pandemic exposed how North Carolina is still reeling from centuries of racial discrimination. Even as Cohen \u201cbecame a trusted community voice,\u201d he said, \u201cthere was a disconnect between the discussion of equity and the application of equity.\u201d<\/p>\n
He worries that painful lessons of those early pandemic months seem forgotten, saying, \u201cWe don\u2019t even hear this conversation now.\u201d<\/p>\n
*Data reporter Hannah Recht contributed to this story.<\/em><\/p>\n*
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