The Color of Covid: The Underlying Conditions of “Underlying Conditions”

The COVID-19 pandemic has reshaped our personal and professional lives in ways few of us imagined mere months ago. We now work remotely as university instruction has gone online and travel has been indefinitely postponed. Graduate students, too, have been impacted by these unprecedented global events—degree milestones are conducted online, archival and library access is curtailed, and networking events are limited to the virtual realm.

In response to COVID-19, the Southern Historical Association's Graduate Student Council is launching a new series of blog posts about research, teaching, and living under the shadow of the pandemic. Graduate school can be lonely and isolating under the best of circumstances and, for many, the pandemic has exacerbated these feelings. While we are sheltering in place, this new blog series provides a forum for graduate students to discuss a diverse array of personal and professional experiences, reminding us that we are not alone and our community endures.

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Underlying. It’s a commonly used word during this pandemic, albeit disingenuously and selectively. Underlying. A simple vocabulary search online reveals important insights. “To lie under or beneath; be situated under.” That’s what says, but elaborates: “While it’s true that when something underlies something else, it is beneath it, this does not necessarily mean subservience – it can also indicate a strong foundation or bedrock that underlies, or supports, an idea or decision.”

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I have been riding out this pandemic in my hometown, Vicksburg, Mississippi, the southernmost tip of the Mississippi Delta. For the last four years, I have been a PhD candidate at Harvard, writing a dissertation on Mississippi’s Black literary tradition. Though I have greatly missed home, being away has deepened my love for Mississippi. I am quick to defend it when people from other regions of the country – and world – speak out of pocket about it. In fact, when I applied to Harvard, I had no intentions of writing about Mississippi. It’s only when I realized how little those outside my state cared about what was happening within it that I switched dissertation topics.

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Over Christmas Break, I flew to Vicksburg and stayed six weeks. It was my longest visit since leaving in 2014. My last living grandparent, Dorothy Mayfield, was on her deathbed.

I called her regularly while at Harvard. She would always ask about the weather – “I bet it’s still snowing up there, huh?” – even in the summertime. She would then continue: “I don’t know how you live up there in all that cold! When you done, boy, I declare, you won’t be making that chicken money! They’re gonna pay you real nice.”

I would joke and say, “you should fly up here and visit me, Grandma!” It’s a joke because anybody that knew my grandmother knew she didn’t fly. But she and her husband, Reverend Henry Mayfield, did take a train to Milwaukee to make more money in the 1950s.

They hated it in Milwaukee.

They returned to Vicksburg sooner than expected – after only a year. The pace of life, combined with the harsh weather, was too much. Hearing that story repeatedly after moving up North is another reason I changed my dissertation topic. I want to honor her generation of Black Mississippians.

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My grandma lived 90 years. She died while I was still home on Christmas break. On January 14, 2020, with most of her 13 children, +40 grand and great-grandchildren, and other relatives in her home loving on her, she breathed her last with the utmost dignity – and agency. A few days before, she mustered up all the energy she could and continually whispered, “Everybody. Come.” And everybody did come. Not just the ones in Vicksburg, but those who had migrated to Atlanta, Dallas, D.C., New York, and elsewhere.

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My grandma had already beaten the odds long before the doctors told us she would not see Christmas – or the year of 2020. She lived 90 years in Mississippi. That is not common for any Mississippian, especially Blacks. Mississippi ranks last, 51st, in national life expectancy, averaging 71.8 years – the same as Bangladesh.

There is one very obvious reason for this, and it is not because Mississippi is more racist than other states. It is because Mississippi is the Blackest state, and no state in America cares about Black people. Of the 50 U.S. counties with the shortest life expectancy, 18 have a Black-American population that exceeds 50 percent, and 8 have an indigenous population that exceeds 50 percent.

8 of those 50 counties are in Mississippi.

According to the CDC, Black-Americans die 4 years earlier than White-Americans “due to higher death rates … for heart disease, cancer, homicide, diabetes, and perinatal conditions.”

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When Governor Reeves and State Epidemiologist Paul Byers answer questions about the disproportionate number of Black COVID-19-related deaths, they always say the same thing: “underlying conditions.” Such an answer evades political responsibility. Some politicians and pundits even blame Black Mississippians by pointing to unhealthy lifestyles. They won’t point out, however, the source of Blacks’ underlying medical conditions, namely: the underlying racial resentment of Mississippi’s most powerful white politicians.

During slavery, slaveowners gave my ancestors chitterlings – the most undesirable and unhealthy part of the hog as “leftovers.” They ate it because it was their only option. Even now, poor Black people don’t have better options – for food or health care. After Reconstruction, white mobs drove black doctors out of Mississippi – and Blacks resorted to home remedies. One medical study notes:

Mississippi consistently has the most unfavorable ratio of physicians to patients. In 1940, there was 1 black physician for 18,000 black patients, and in Sunflower County in the Delta, there was 1 black physician for every 46,646 patients. Only 13 black physicians practiced in the entire Mississippi Delta in 1951.

The infamous Tuskegee syphilis experiment occurred just one state over (Alabama); up until the 1980s, involuntarily sterilizing Black women deemed unfit to produce was so common in Mississippi that the practice became known as the “Mississippi appendectomies.” It should thus come as no surprise: Mississippians are the least likely state population to seek “primary care for chronic conditions and more likely to turn to hospitals when those ailments become more serious and expensive.”

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States with low life expectancies, high infant mortality rates, and high rates of preventable hospitalizations all have one commonality: high percentages of residents without health insurance. When President Obama signed the Affordable Care Act, Mississippi’s conservative white politicians resisted Medicaid expansion with the passion of the Confederate army. Two years later, when the Supreme Court ruled states do not have to opt-in to Medicaid expansion, then Governor Phil Bryant seceded quicker than Jefferson Davis. Even though the federal government reimburses each state for the added cost of covering more people, because many beneficiaries would be poor and Black, newly appointed Governor Reeves has recently stated, unequivocally, under no circumstances, will he ever expand Medicaid.

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2020 has been quite the year. The U.S. Department of Justice recently decided to investigate four of Mississippi’s six largest prisons due to unsanitary conditions, outbreaks of violence, and a persistent outburst of prisoner deaths – all of which has only exacerbated since the pandemic. Easter weekend, Mississippi was hit with the widest tornado in state history, killing 14. And Mississippi’s State Auditor is currently investigating the Department of Human Services’ welfare scandal – the largest in state history. $94M are in question, money “meant to help poor residents was used to buy luxury cars, sponsor a college baseball tournament and hire family members of a top state official.”

All of this on top of Gov. Reeves’s response to COVID-19. In March, he set up a COVID-19 task force, and then left the country for Spring Break with his family. Upon return, he visited Vicksburg to proclaim and celebrate Confederate Heritage Month with the Sons of Confederate Veterans – while Black Mississippians were dying at alarming rates. It makes you wonder: was this his plan all along? To watch us die like flies?

Mississippi’s demographics, and our politicians’ response to it, magnifies problems that exists in every state, which is why it is extremely important to study Mississippi. As Richard Wright once told a French journal, Mississippi is “only an immense ghetto, a vast prison where the whites are jailers and the Negroes are the prisoners.” Or Kiese Laymon: “Mississippi is known for a lot of things, but I think we’re known primarily for being a state that sanctions the disappearance of black bodies.” Or Jesmyn Ward, in Men We Reaped, states Black Mississippians die so young so often because of political decisions made at the expense of Black flourishing: “These are the numbers that bear fruit in reality. By the numbers, by all the official records, here at the confluence of history, of racism, of poverty, and economic power, this is what our lives are worth: nothing.”

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My grandmother – and her husband, who lived 84 years – could have died in countless ways before 90. For one, they were local civil rights activists, thus in danger of being lynched, bombed at church, or killed by a white vigilante drive-by shooting one night at home while my mom and her siblings were asleep. But Grandma saw 90, thank God, and helped raise me.

Though many Blacks, past and present, have been lynched or shot to death by a cop, it is important to note most Black Mississippians don’t die this way. Despite what any doctor or politician in Mississippi tells anyone, underlying medical conditions are not the root cause of Black COVID-19-related deaths. The root cause is underlying racist conditions set in place in slavery, and vigorously maintained until the present in various forms. Black Americans have always been especially vulnerable to sickness and death – seen most clearly in Mississippi, the Blackest state – because this country does not have the political will to ensure Black Americans with adequate health care.

[Donald Brown is a fourth-year PhD Candidate at Harvard University who studies Black Southern Literature.]

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Works Cited

  • Deshazo, Richard D, et al. “Black Physicians and the Struggle for Civil Rights: Lessons from the Mississippi Experience.” The American Journal of Medicine, vol. 127, no. 10, 2014, pp. 920–925.
  • Kochanek, Kenneth D., et al. How Did Cause of Death Contribute to Racial Differences in Life Expectancy in the United States in 2010? U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2013. 
  • Ladd, Donna. “EDITOR'S NOTE: Gov. Tate Reeves Has Failed the COVID-19 Leadership Test.” Jackson Free Press, 15 April 2020. 
  • Murray, Bill. “We Compared Life Expectancy in All 50 States to Countries Around the World. The Results Are Truly Stunning.”, 11 June 2018.
  • NOLA Fugees. “Author KIESE LAYMON on Writing, Race, and More.” YouTube, 9 June 2014. 
  • Ramseth, Luke. “Mississippi welfare scandal: Luxury cars among $94M in questionable spending, audit shows.” Mississippi Clarion Ledger, 4 May 2020.



  • Varney, Sarah. “Mississippi, Burned.” Politico, November/December 2014.



  • Ward, Jesmyn. Men We Reaped: A Memoir. New York: Bloomsbury, 2013.



  • Watkins, Lorie. A Literary History of Mississippi. Edited by Lorie Watkins. Jackson, MS: University Press of Mississippi, 2017.



  • Wright, Richard. Conversations with Richard Wright. Jackson: University Press of Mississippi, 1993.



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