For a decade, Stephen B. Thomas has studied racial inequality from a research center at the University of Maryland. It happens to be located in one of the wealthiest Black enclaves in the nation, Prince George’s County.

The location wasn’t necessarily relevant to his work — until now. Thomas and his team at the university’s Center for Health Equity are in the midst of a real-time case study asking a disconcerting question:

Why has affluent Prince George’s been hit harder by the coronavirus than any other place in Maryland?

“You would expect Prince George’s to be the healthiest county in the country,” Thomas said. “It’s not even the healthiest county in Maryland.”

The virus has cut a swath through the sprawling county of 900,000. Cases surged this spring, overwhelming hospitals and prompting some to erect tents outside their buildings to house extra beds.

Churches, funeral homes and community organizations scrambled to provide food and comfort as the losses mounted — of loved ones to the virus and jobs and income to the shutdown.

More than 19,000 Prince George’s residents have tested positive for the coronavirus, more than 27 percent of Maryland’s total cases. The county accounts for just 15 percent of the state’s population.

More than 680 residents have died of COVID-19, a fifth of the state’s total deaths and second only to more populous Montgomery County.

“The virus is a terrorist, it is a monster in the village,” said Curlee Raven Holton, an artist who in April lost his mentor and close friend, the distinguished professor David C. Driskell, to the coronavirus.

An artist and leading authority on African American art, Driskell, 88, lived in Hyattsville, a hot spot for COVID-19.

Then, on Memorial Day, the death of George Floyd under the knee of a police officer in Minnesota triggered nationwide protests that had particular resonance in Prince George’s, where more than 64 percent of the residents are Black. By mid-June, after a scathing court filing alleging the Prince George’s County Police Department discriminated against Black and Hispanic officers, the white police chief resigned.

The twin stressors, overlapping on the issue of race, cut to the bone, residents say.

Researchers have long documented how racial disparities in income, housing, access to medical care, and exposure to violence and trauma lead to poorer health among African Americans.

But increasingly, they’re also finding that even for those in higher income and educational brackets, simply the stress of navigating a discriminatory world — where doctors don’t take your symptoms as seriously, or seeing a police car on your street can be frightening rather than reassuring — takes a toll on health.

“We still see stark racial disparities even at the highest income levels,” said Tanjala Purnell, associate director of the Johns Hopkins Center for Health Equity. “People say, ‘Oh, minorities are dying because they’re poor.’ We know that’s not the case.”

To be sure, more affluent Black areas of the county generally have seen lower rates of COVID-19 than poorer ones. Areas with higher concentrations of Hispanic residents, who constitute about 20 percent of the population, tend to have more cases.

Taken as a whole, experts say, the county’s experience reflects the persistence of racial inequities that have left African Americans and other minorities more vulnerable to the virus.

“Look at all of the inequities that African Americans face in jobs, in housing, in education, in the criminal justice system as well as in health care,” said Deneen Richmond, an administrator at Luminis Health, which operates Doctors Community Hospital in Lanham.

“COVID is really exposing these underlying health disparities,” she said. “Racism in and of itself is a public health crisis.”

Societal forces at work

Experts say the higher rate of COVID among minorities is not an issue of biology, but rather of societal and historical forces in a nation where race plays a role in everything from generational wealth to the criminal justice system to health outcomes.

“The coronavirus doesn’t know your race,” County Executive Angela Alsobrooks said.

But it does prey on preexistingmedical conditions such as diabetes, hypertension, heart disease, and the lack of full access to healthy foods and medical care — all of which beset many county residents of color, she said.

Alsobrooks points to how the county has long needed more physicians and hospitals.

Its ratio of one primary care doctor for every 1,860 residents is well below that of neighboring Howard and Montgomery counties, as well as the state average of one per 1,140, according to data compiled by the University of Wisconsin.

The relative dearth of physicians, along with similar deficits in the number of mental health professionals and dentists, contributed to Wisconsin researchers ranking Prince George’s last in Maryland for clinical care.

Some two-thirds of residents get their health care outside the county, which has long awaited the opening of a new regional University of Maryland Medical System hospital. The $543 million facility is scheduled to open in Largo next year.

As with Maryland as a whole, the numbers of coronavirus cases, hospitalizations and deaths in Prince George’s generally have been trending downward. Alsobrooks attributes that to residents heeding the stay-at-home restrictions that she has lifted more slowly than some other jurisdictions.

In late June, she moved the county into a full phase two of reopening, allowing gyms, malls, casinos, churches and other gathering spots to operate at 50 percent capacity.

The return to even limited communal life could help ease some of the burden residents have felt as they coped with the pandemic’s fallout isolated from friends and family.

Tom Zizos, who owns Beall Funeral Home in Bowie, said families have had to delay services or limit the number of mourners attending, adding an extra layer of sadness to what should be a time of consolation.

“They can’t have their friends around them. They can’t have their family around them,” he said. “They can’t do what they traditionally would like to do for their loved one.”

Also reopening were barbershops. Michael Brown had been eager to get behind his chair at The Shop Spa in Hyattsville to cut hair and start recouping lost income, but also to rejoin what he calls “the front line.”

Brown, 48, considers health education and advocacy part of his work at the shop, which serves as a comfortable social center where men might be more open to talking about medical issues.

Brown was recruited by the University of Maryland’s Thomas to join a program he created to reach Black men who otherwise may not seek out regular care or screenings and provide information on colorectal and prostate cancer and occasional visits by medical professionals. Similar programs operate elsewhere, including in Baltimore.

“The relationship we have with customers, they take heed,” said Brown, who has been cutting hair for 30 years.

The shop is located in the ZIP code 20783, which has the most cases in the state.

“We’ve been waiting to get the chance to respond to it,” Brown said of the shop’s reopening. He took an online course on how to prevent the virus’ spread and placed his certificate of completion on the mirror of his station.

Thomas said the reluctance of African Americans to seek medical care stems in part from a history of maltreatment, most notoriously in the Tuskegee Study of 1932-1972, in which hundreds of Black men with syphilis were left untreated for government scientists to observe the effects of the disease.

The mistrust lingers, hampering efforts through the years and up to the current pandemic, he said.

Black residents understandably think, he said, “before you come in here to prick for my blood or ask for my DNA, I need to trust you.”

Constantly making the case

Civic leaders say Prince George’s residents often lack the kinds of amenities that would allow them to lead healthier lives and that neighboring counties have in greater abundance.

Take that signifier of middle-class well-being, Whole Foods: The county got its first store just three years ago, in Riverdale Park south of College Park.

“We’re constantly having to make the case for investment in Prince George’s County,” said David Harrington, who heads the county’s Chamber of Commerce.

Harrington, a former Bladensburg mayor, county councilman and state senator, said there are pockets of poverty and aging, distressed areas that don’t get the kind of attention and development that more affluent areas attract.

“You still have no grocery stores in some areas. The parks are dilapidated,” he said. “You have a deficit of clinics. There are few walkable assets; you have to drive everywhere. It’s another barrier we have to overcome.”

As businesses shut down and residents lost jobs amid the pandemic, access to food became even more critical.

“What we saw is a thriving community that brakes were slammed on, and people had to come up with solutions,” said the Rev. Esther Gordon of the First Baptist Church of Glenarden.

The church has seen demand for its food donations jump — it provided 9,300 residents with bagged groceries in March, and almost four times that many in May.

That the county should have struggles with food is ironic, given the amount that flows through it every day: The Giant chain is headquartered in Landover and other grocers have warehouses and distribution centers in the county.

Many residents work in the food industry. Giant is the county’s seventh-largest employer — after the University of Maryland, Andrews Air Force Base and several government agencies — and Shoppers Warehouse and Safeway are in the top 20, according to state data. Among those workers are store and warehouse personnel, at greater risk of contracting the coronavirus because their workplaces remained open as essential businesses during the pandemic.

In Maryland, 167 of the 10,090 workers represented by United Food and Commercial Workers Union Local 400 have contracted the virus, said its spokesman, Jonathan Williams

“Generally speaking, who are the workers that are still going to work?” he said. “They are disproportionately people of color. You can put two and two together. It’s no surprise that the number of cases in Prince George’s would be high.”

Williams said the union has pressed for more protections and on-site testing for workers because some lack the time or transportation to get screened at another location.

“They’re essential workers,” he said. “They can’t take off.”

Hopkins’ Purnell said the pandemic served to identify a range of underlying issues that left entire groups more vulnerable to the virus because of the kinds of jobs they have or the housing or neighborhoods they live in.

But these are fixable, she said.

“Let’s put more protections in place for essential workers,” Purnell said. “Let’s make housing more affordable. Let’s think about food security. Let’s pay people a livable wage.

“These are clear things we can be doing,” she said, “while trying to dismantle the whole system of racism.”

Mourning and recovery

Natalie Burke heads a Washington-based nonprofit, CommonHealth Action, that works toward health equity. But at night, she goes home to Fairwood, a subdivision in Bowie whose history speaks to the issues she addresses on a daily basis.

A onetime slave plantation owned by a former governor of Maryland, Oden Bowie, it was developed into an upscale neighborhood with houses selling for as much as $1 million, with most of those homeowners being Black. But it was hit hard by the Great Recession of 2008, when many houses went into foreclosure.

“Half the houses on my street had signs,” Burke recalled.

To her, the foreclosure crisis and the coronavirus pandemic are two sides of the same coin, reflecting the shaky ground that even more affluent Black people can find themselves on, whether it’s economics or health.

“There are people in Prince George’s who are doing well, but they may be first-generation doing well,” Burke said. “They don’t necessarily have the backing of generational wealth to protect them.”

The lack of a safety net that more long-standing wealth might provide has contributed to what Burke calls “this perfect storm” of African Americans bearing more than their share of the pandemic’s ravages.

“It was set in motion,” she said, “generations ago.”

Now, as the county seeks to stabilize and prevent a second uptick, residents and leaders alike are trying to recoup what has been lost.

“I want to make sure we remain on the path we were on before COVID,” Alsobrooks said.

Prince George’s was on an “upward trajectory,” with multiple developments underway, particularly around transit centers, and only one has been delayed so far, the county executive said.

Still, the underlying conditions that left Prince George’s residents more vulnerable to the coronavirus remain. And, as with all jurisdictions, it now faces the economic fallout of the pandemic: massive job losses, the likelihood some businesses may not reopen even when restrictions are further lifted, a possible eviction crisis.

But, Alsobrooks said, Prince George’s is used to facing adversity, having to attract investment by “telling its story over and over again.”

Now that story includes the coronavirus, and it is one that is both personal and public.

“I was born and raised here. I know so many people who have become sick, and died,” Alsobrooks said. “It’s not like I’m talking about something I don’t know about.”

Throughout the county, the mourning continues.

“This was heartbreaking to lose someone like that,” said Holton, the artist and protege of Driskell. “He was a national treasure.”

At Northwestern High School in Hyattsville, faculty and students plan to plant trees in memory of the staff they lost, including Terrance Burke, a guidance counselor and basketball coach, then two weeks later, Annis Creese, a Spanish teacher.

“It shook us to our core,” said Northwestern’s principal, Carlene Murray.

Their grief could only be shared remotely, with schools still closed. Rudy Outlaw, a business education teacher, said one of his students, a basketball player, was in particular despair.

“‘What is the purpose of doing anything else in my life, my coach is gone,‘” Outlaw said the student told him. “I had to encourage him that your coach would want you to move on.”

Outlaw said his friend Burke, with whom he shared New York roots and a love of basketball, handled adversity both on and off the court in the same way.

“When life puts you down, what do you do?” he said. “You got to get back up.”