How racism, rural living and COVID-19 created deadly conditions for a chicken plant worker
This article by Alissa Zhu was produced as a project for the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg Center for Health Journalism’s 2020 National Fellowship.
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Clara Ann Kincaid’s life was her family.
She raised four sons, mostly on her own, in a three-bedroom mobile home in a rural corner of Holmes County. The names she chose for each of them started with the letter “K” because they were her kings, she liked to say. Every year, she was on the planning committee for her family reunion. While her sons were growing up, she organized softball teams for children in the neighborhood, hosted barbecues and rented bounce houses. She pushed her sons to maintain their spots on school honor rolls, so they could have opportunities she didn’t.
“She was a super mom,” her oldest son Kelvin Wade, 34, said.
If family was the most important thing in Kincaid’s life, the second was work.
Work was a 35-minute commute to the Peco Foods chicken processing plant in Canton, Mississippi. Kincaid was a supervisor on the debone line and had dedicated more than 20 years to the job. She had worked there so long and was so close with some of her coworkers that her sons called them “aunties.”
Notwithstanding the warmth and kinship among her colleagues, her family believes it was in the crowded, cold environment of the poultry processing floor that Kincaid contracted COVID-19 — a deadly virus that would later claim her life.
Kincaid’s story is one of an essential worker, exposed to COVID-19 at a company that remained open but was slow to react to a global pandemic. Her story is about the challenges many residents of rural and isolated areas face when it comes to healthcare access, a pervasive problem that is more pronounced for Black Americans living in the South than any other racial group. It’s also about the roles racism and discrimination can play in health and healthcare across the country and in particular in Mississippi, one of the nation’s poorest, and by several measures, most vulnerable state.
“These inequalities were ingrained in our society before COVID-19,” said Jamila Taylor, director of health care reform and senior fellow at the Century Foundation. “What COVID-19 has done is blown it up in a way; it’s magnified them.”
Despite Black residents making up only 38% of the state’s population, nearly half of all Mississippians who have died from complications due to COVID-19 were Black, according to data from the Mississippi State Department of Health. Nationwide, COVID-19 deaths are higher among communities of color.
That disparity is entrenched in areas where essential workers, like those who staff chicken processing plants, are more susceptible to exposure because companies remained open during stay-at-home measures that shuttered other industries.
Of the more than 1,200 poultry plant workers who tested positive for COVID-19 in Mississippi from February through September, 63% are Black and 21% are Latino, according to the state health department. At least eight chicken plant workers have died of the disease. No less than 312 workers contracted COVID-19 at Peco Foods plants across the state, the highest number of any of the nine poultry companies that reported coronavirus cases in Mississippi, according to state health officials.
‘Another box of damn chicken’
In April, President Donald Trump ordered meatpacking and poultry plants to stay open as large parts of the country remained locked down. Kincaid and thousands of other Mississippi chicken plant employees — who are majority Black or Latino — continued to go to work while many parts of Mississippi’s economy ground to a halt.
Kincaid was worried about COVID-19 in her workplace, according to her sister-in-law, 54- year-old Francine Jefferson. Peco Foods wasn’t communicating with workers about the pandemic, Jefferson recalled Kincaid saying. At that time, no one received any personal protective equipment or were advised of pandemic-related safety measures.
“People ain’t here and folks sick and I just don’t know what we’re going to do,” Jefferson remembered Kincaid telling her. “....They haven’t told us anything. We’re just at work and it’s just like business like usual here.”
In early April, Kincaid attributed her symptoms — shortness of breath and wheezing — to a sinus problem. One of her sons began to feel sick after she started showing symptoms and he tested positive for COVID-19. This finally prompted Kincaid to get tested for coronavirus herself. By the time she went to the clinic, it was so hard for her to breathe that she could hardly talk. Her results didn't come back until days after her death.
On April 16, Kincaid fell unconscious on the floor of her bedroom. Her two youngest children, who were home at the time, shook her and poured water on her face in unsuccessful attempts to wake her. When the EMT’s arrived, they declared Kincaid dead, her son 22-year-old Kenny Kincaid said. She was 50 years old.
“All of this came down to putting chicken (on the table), another box of damn chicken,” Jefferson said. “Her death was senseless in my opinion. Because if you're going to tell me she’s essential, why didn’t you take the precautions to protect her? And they didn’t do that.”
Peco Foods has said that the health and safety of their employees “has and always will be (their) top priority, especially as we continue to navigate these challenging times.” The company said in a statement that working conditions meet or exceed federal guidelines and it has taken safety measures including installing partitions at work stations and break areas, requiring masks, screening temperatures of everyone on site, relaxing attendance policies and increased disinfecting of common areas. However, the company did not respond to a question about when those measures were implemented.
Jefferson said it’s a good thing that Peco Foods implemented safety measures for their workers later, but for Kincaid’s family “it’s a slap in the face…. because it should have had it in the first place.”
Kincaid was tested for COVID-19 the week of April 14 at a MEA clinic in Jackson, her son Kenny said.
It’s protocol for medical professionals to tell people to quarantine at home while waiting for their coronavirus test results.
However, Kincaid’s symptoms were so severe at that point that Jefferson believes the medical professionals at the clinic should have recognized that she needed further treatment.
“I am convinced that had she been a white woman they would have put her in the hospital. I believe that with everything in me,” Jefferson said. “...You just couldn’t understand her with all that coughing and all that gasping for air. So it’s just unconscionable to me that they would send her back home.”
St. Dominics, the health system that runs MEA clinics in Jackson, said that it cannot comment on a specific patient’s care due to privacy laws.
A spokeswoman for St. Dominics wrote in an email, “Without discrimination, MEA has provided the same exceptional care to all of its patients in the Jackson community for more than 41 years.”
“COVID-19 is a terrible illness that unpredictably impacts each person differently, including some who can rapidly decline in a matter of hours,” the spokeswoman said via e-mail. The health system’s providers all follow a strict protocol for assessing, treating and educating patients about the symptoms of COVID-19 and how to seek follow-up care immediately if their condition worsens, according to the e-mailed statement.
While no one incident points to outright discrimination in Kincaids’ experience with the clinic, health advocates who study healthcare disparities have pointed to fissures in trust among Black patients and medical care professionals as a contributor to inequity in medical treatment. Historical injustices, such as the forced sterilization of Black women and the Tuskegee Syphilis experiments, have resulted in a deep distrust of government and doctors, experts say.
One way racism and bias shows up in healthcare is when Black patients “express pain or discomfort and that is ignored or not listened to,” said Taylor, an expert in health care reform.
That can be traced back to stereotypes dating back to slavery, she said, with perceptions that Black people have thicker skin and higher thresholds for pain. This racist belief was infamously used by J. Marion Sims, known as the “father of modern gynecology,” to justify performing experiments on enslaved Black women without the use of anesthesia.
Even in modern times, Black patients tend to get worse medical treatment and have worse health outcomes than white patients, a jarring trend that has been observed across the U.S.
Research by the National Academy of Medicine shows that Black patients are given lower quality health care than white patients, even when other factors such as insurance status, income, age and severity of conditions are similar.
The very act of facing discrimination day in and day out creates toxic stress responses in the body, Taylor said. This unabated stress causes inflammation, which is linked to a wide array of chronic illnesses — including high blood pressure, heart disease, obesity and diabetes — found in higher rates among Black people. “Racism makes us sick,” she said.
Many of those same chronic illnesses are also more common among people who live far away from grocery stores that sell fresh fruits, vegetables and meat. Many low-income and rural Mississippians live in food deserts, where their closest options are convenience stores, gas stations and fast food restaurants that sell food high in oil, salt and sugar and low in nutrition, according to the University of Mississippi Medical Center.
To Jefferson, it’s no coincidence that her county’s been one of the hardest hit by COVID-19. Even before the pandemic, Holmes County was ranked as the second worst county for health factors in Mississippi. Nearly 15% of residents don’t have health insurance. There are high rates of chronic diseases, such as diabetes. More than one in three people are food insecure.
There are fewer primary care physicians per person in Holmes County, compared to the rest of the state and the country.
“Our pandemic in Holmes County was poverty long before COVID came along,” Jefferson said. “It’s just the pattern …. We’re not crying the race card game or anything like that, it’s just freaking reality. We’re the food desert in the Delta, welcome to Holmes County, the least of these among us.”
Kincaid death reveals fracture in rural health care system
In the days before her death, Kincaid had been eating little, sleeping a lot and coughing, said her third oldest son Kenny Kincaid, who returned home from his junior year at the University of Mississippi when the pandemic hit. The morning of April 16, his mother decided to rest on the floor of her bedroom. She never got up.
After Kenny called 911, it took 45 minutes to an hour for the ambulance to arrive at their house, he said. When the EMTs arrived, they were not able to revive his mother.
Kincaid and her sons lived in Ebenezer, an unincorporated town in rural Holmes County made up of little more than green pastures, churches and the Ebenezer “Big Store,” a local eatery known for its burgers. The community has no gas station, drug store, clinic, post offices or grocery stores, Jefferson said.
Holmes County — a largely rural county where nearly half of the population lives below the poverty line and 83% of residents are Black— has one of the highest per capita rates of coronavirus cases in Mississippi. One in every 14 Holmes County residents has tested positive for COVID-19. One of every 284 residents have died of complications from the disease, according to a New York Times analysis of coronavirus cases.
With a COVID-19 death rate of about 30%, Holmes County has the ninth highest death rate in the country based on demographics, shows a USA TODAY analysis of Johns Hopkins University data.
The nearest hospitals to Kincaid that day were in Lexington and Yazoo City, 15 and 30 minutes away, respectively, but the ambulance that arrived at Kincaid’s front door had traveled from Jackson, according to Kenny.
Global Medical Response, the ambulance company that owns MedStat EMS which contracts with Holmes County for emergency transportation declined to comment on Kincaid’s case, citing patient privacy laws.
Ryan Kelly, executive director of the Mississippi Rural Health Association, said in some rural parts of the state a 45-minute wait for an ambulance could be common. Response times can vary depending on resources available to the emergency transportation companies.
In general, one of the drawbacks in rural living is limited access to healthcare. In impoverished areas where people are spread far apart, it’s hard to sustain healthcare infrastructure from a business standpoint, Ryan said. Lack of high speed internet in those areas also makes accessing telemedicine a challenge.
Kincaid is one of more than 3,600 Mississippians who have died of COVID-19 as of mid November.
Every time Jefferson checks the latest death count on her phone, each digit represents more than just a number. In the tally, she sees her sweet and hardworking sister-in-law and three other close friends she’s lost to COVID-19.
Wade, Kincaid’s oldest son, still struggles to talk about his mother’s death. He and the rest of the family are helping to raise Kincaid’s youngest child, now 11 years old.
His brother Kenny Kincaid faces the prospect of finishing his last year of college without his mother, who valued education so much.
Kincaid’s 2-year-old granddaughter Kennedy closely resembles her grandmother and hardly spent a day apart from her when she was alive. When she visited the cemetery at the family’s church in Ebenezer, she ran up to her grandmother’s gravesite and spread her arms out for an embrace.
Jefferson checks her phone sometimes, still expecting to see the uplifting messages Kincaid used to love to send — Love you, smile, be blessed, be safe.
At the chicken processing plants it was “profit over people,” Jefferson said.
“You can substitute a chicken sandwich for a peanut butter and jelly sandwich if you have to, but you can’t replace her,” Jefferson said. “There’s no substitute for Clara Ann Kincaid. No amount of money, nothing.”
Maria Clark who reports for The American South, contributed to this piece. Email her at firstname.lastname@example.org or follow her on Twitter @MariaPClark1. Alissa Zhu formerly reported for The Clarion-Ledger in Mississippi. You can follow her on Twitter @AlissaZhu.
This article was produced as a project for the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg Center for Health Journalism’s 2020 National Fellowship.
[This story was originally published by the Clarion Ledger.]