This is the first story in our reporting series, “Year One: COVID-19’s Death Toll.” See all the stories and interactive features here.
Gregory Denny didn’t get his bachelor’s degree until he was 48 years old — and not until after his death from COVID-19.
Denny, a veteran, was a security specialist at Taylor Guitars in El Cajon. He’d been doing private security work since coming home from the Gulf War in the early ‘90s. He got married and raised two children.
But when he hit his 40s, Denny was struck with a burst of middle-aged aspiration. He decided to get a bachelor’s degree and by June 2020 was only a few weeks away from completion. That’s when he caught the novel coronavirus, which took his life on July 24, 2020.
In honor of his work and life, American Military University in Virginia posthumously awarded him with a bachelor’s degree, making him a member of the graduating class of 2021.
Denny’s story exemplifies a cruel truth about the pandemic: That having a bachelor’s degree and the elevated job status that comes with it often marked the distance between life and death.
Income and education levels have already been linked with increased risk of death among COVID-19 patients. But a new Voice of San Diego analysis shows, in disturbing detail, how the pandemic disproportionately killed San Diegans with lower levels of education and income.
Voice of San Diego reviewed 4,046 death certificates, one for each COVID-related death in San Diego County beginning with the first on March 22, 2020, and ending a year later.
Only 17 percent of people who died in San Diego County had a bachelor’s degree or higher. But 40 percent of people 25 and older have that same level of education countywide, according to U.S. Census Bureau data. Another 31 percent of victims didn’t have a high school diploma, which is also significantly out of line with countywide figures.
“In many ways, the presence of having a bachelor’s degree for individuals during the pandemic was really an insurance policy,” said Audrey Dow, senior vice president of the Campaign for College Opportunity, a public advocacy and research group. “It was really a prevention asset.”
Having a bachelor’s degree is often the distinguishing factor between essential workers and those who worked from home during the pandemic.
Denny, for instance, was still working in-person at Taylor Guitars when he contracted COVID-19. That’s where his wife, Kimberly, thinks he got it, though she doesn’t blame the company.
People like Denny had to be physically present at their place of employment, while many with a college education were at home, designing personal office spaces and learning how to use Zoom.
After Denny’s death, Kimberly didn’t leave their house in Jamul for a long time. Her life was thrown off its course. But it was Denny’s memory that forced her back outside.
“Greg wouldn’t want me sitting in my house,” she said. “He wouldn’t want us to be crying for sure.”
She sold the house and moved to Arizona.
***
The American Dream cannot reconcile itself to the idea that outcomes of any kind — like the job a person has or the age at which they die — are determined by a person’s ZIP code and not their character. But the analysis of local death certificates makes clear that COVID-19 traveled along the socioeconomic fault lines of San Diego and made them even wider.
Pandemic deaths by ZIP code, class or education level all tell the same story: San Diegans with less died more.
“Those factors are significantly more influential in terms of our health status than things like our inherent biology or even healthcare,” said Tyan Parker Dominguez, University of Southern California clinical professor and chair of the School of Social Work.
Where you live and the job you do, in other words, has more impact on your health than your own DNA or access to healthcare. As a logical proposition, it hardly seems to make sense. The reasons are many, and may seem small on their own, but together create a wall that is nearly impossible for poverty to pass through.
Take, for instance, food deserts. It’s well documented that poorer neighborhoods have few or no grocery stores. They are much more likely to have a Family Dollar and a drive-thru window.
“It’s very costly to eat healthy food. It costs less to eat off the McDonald’s menu,” said Maria Rosario Araneta, a professor of public health at UC San Diego.
But eating off the fast food menu clogs arteries and elevates sugars. It leads to chronic health conditions like diabetes and heart disease, which make you far more likely to die from COVID. Out of the 4,000-plus deaths analyzed by Voice of San Diego, approximately 80 percent of people were suffering from a chronic health condition. Of those, 25 percent had diabetes.
ZIP code 92113, which stretches from Barrio Logan to Lincoln Park, had one of the highest death rates in the entire county. And it has some of the fewest options for buying healthy food and produce, said Araneta.
“There’s no Vons, no Sprouts, no Trader Joe’s and there’s definitely not a Whole Foods,” she said.
It’s not just food deserts that make working-class people more susceptible to chronic disease, though. Poorer adolescents literally have higher blood pressure than their peers. Blood pressure above a certain point is considered hypertension, which is also more common among people with lower incomes. Hypertension increases the likelihood of strokes and heart attacks and was also a common condition listed on the COVID death certificates.
The stress that comes with poverty, in other words, increases a person’s health risks.
And consider the many risks the many incidental hazards. Poor people were more likely to need public transportation during COVID, making them more exposed. They were more likely to live in cramped or precarious housing — with people who were more likely to be going out into the world everyday as essential workers, in grocery stores, retail stores and old people’s homes.
The lower someone slides on society’s ladder, the more these risks close in around them.
As part of the analysis, Voice logged nearly all the information contained on each death certificate into a database. An occupation was listed for each individual, as well as educational attainment and other data points. Voice then grouped each job into categories that align with U.S. Census Bureau definitions.
The analysis suggests COVID disproportionately killed working-class San Diegans.
The most frequently listed occupation was “homemaker.” Those made up 15 percent of all deaths.
The median age of death was 76 — which may explain why homemakers made up such a large percentage of those who died. Women of older generations were more likely to stay out of the workforce.
Out of the 10 most frequently listed job categories, excluding homemakers, only two have a median income of more than $50,000 a year.
The largest category is somewhat all-encompassing for entry-level jobs. It includes administration, support services and waste management. Secretaries, custodians, security guards and landscapers all fit into this category.
Construction workers, who remained “essential” throughout the pandemic and even experienced an increase in demand in 2020, made up the second largest class of occupations.
“Those who don’t have a bachelor’s degree or a high school degree are more likely to work in manual activities, customer service, agriculture, manufacturing and other economic activities that don’t allow them to stay safely at home,” said Arturo Bustamante, a UCLA public health associate professor.
Three out of every four people who died during the first year of the pandemic were older than 65. Most of them were likely retired, even if they had an occupation listed on their death certificate. In that sense, the occupations listed are a more accurate reflection of a person’s class than whether they performed essential work during the pandemic.
Even still, more than 1,000 working age people died — and many of them performed essential labor.
Francisco Rubio, like Denny, worked in private security.
Francisco, like many of those who died, had a health condition that made him more vulnerable to the novel coronavirus. He struggled with obesity and was in and out of the hospital due to infections and blood clots. When he was younger, his family moved from unincorporated East County to San Diego so he could be closer to medical professionals.
Jackie Rubio remembered her son as a funny and lovable guy who did impressions and might have been a comedian. He also loved cars — “that was his joy,” she said — and before testing positive for COVID-19 in December 2020 he’d been making plans to study automotive repair.
The family was on the way to the hospital on New Year’s Day to say their goodbyes when Francisco passed away. He was 21.
Though obesity put Francisco at risk and made it harder for his body to fight back, COVID-19 was considered the primary cause of death. COVID-19, however, was not listed as the primary cause in each of the death certificates Voice examined. In 7 percent of cases it was listed as a contributing cause, rather than a primary cause.
***
A comparison of median household income and death rates shows a clear statistical relationship between the two. Higher income ZIP codes had lower death rates, and vice-versa.
In fact, for every $6,600 increase in household income, the rate of death went down by 10 percent, said David Meyer, a mathematics professor at UCSD, who reviewed Voice’s data.
A Carmel Valley ZIP code, 92130, ranked first in household income and also had the lowest death rate, at 0.3 deaths per every 1,000 residents. A San Ysidro ZIP code, 92173, had one of the lowest median incomes and the highest death rate, at 3.4 deaths per every 1,000 residents.
Race and ethnicity are also inextricably linked with income in the United States. Roughly 55 percent of the residents who live in the Carmel Valley ZIP code identify as White-only, for instance. More than 90 percent of the people living in the San Ysidro ZIP code identify as Latino.
On the whole, Whites and Latinos experienced opposite effects during the pandemic. San Diego County residents who identify as White-only accounted for 33 percent of deaths during the first year of the pandemic, while accounting for 43 percent of residents. Latinos represent roughly 34 percent of county residents, but 47 percent of deaths in the first year of the pandemic.
“People with less income, and Black and brown folks, are the folks who are going to be at higher risk, historically, for adverse health outcomes,” Dominguez said.
The facts of COVID are indisputable: Latinos died more often; the less educated died more often; and poor people died more often. What’s up for debate is why.
Some believe, with research to support them, that vulnerable citizens face death by a thousand cuts. The public and private institutions of the country — everything from grocery stores to governments — are contaminated with racial and class inequality, the thinking goes.
But a whole other swath of people don’t believe that at all. They believe the United States gives you back whatever you deserve.
It’s a colossal disagreement. But focusing on the facts we know could still empower better decision-making in the future, according to public health experts.
“Knowing this information about who are the high-risk groups could have certainly guided policies, decisions around resource allocation and around thinking about targeted strategies for ameliorating risk and the spread of disease,” said Dominguez.
One of those early strategies was COVID-19 testing. And testing centers were not located in the most vulnerable areas of San Diego in the earliest days, said Araneta, the public health professor at UCSD.
In other words, officials put more testing centers in places where they were needed less.
Vaccination sites were also not clustered in places with the highest infection rates early on, Araneta said.
Many people would assume the United States has the greatest health care system in the world, that it is more prepared to weather disaster than any other nation and the standard of living is unequaled. Some San Diegans do live in the safety of that America. But the massively unequal results brought about by the pandemic challenge those assumptions.
“It’s another example of a disease that affects a broad swath of the population disproportionately,” said Robert Schooley, an infectious disease specialist at UC San Diego Health, “one of the things that perpetuates our caste system of people who have means.”
This reporting project is made possible with support from the Fund for Investigative Journalism.