In American epidemics, race is a preexisting condition.

Whether it’s the influenza pandemic of 1918 or COVID-19 over a century later, race and ethnicity have been, and continue to be, enormous factors in determining whether people will receive medical attention when they become ill, and the sort of attention they will receive.

In “The 1919 Influenza Blues,” Essie Jenkins documented the toll the flu took on the country, noting that viruses don’t discriminate when it comes to their victims. She sang:

“People died everywhere
death went creepin’ through the air
and the groans of the rich
sure were sad

But it was God’s own mighty plan
He’s judging this old land
North and South, East and West
can be seen

He killed rich and poor
and he’s going to
kill some more …”

According to the Centers for Disease Control and Prevention estimates, the 1918 flu infected 500 million people worldwide and resulted in 50 million deaths around the globe, 675,000 of which were American. But while viruses don’t discriminate, people do. In cities across the nation, black people struck by the flu were often left to fend for themselves. They received substandard care in segregated hospitals, where they could be relegated to close quarters in basements, or they were only allowed admittance to black-only hospitals. Even in death, black bodies were neglected by white public infrastructure. In Baltimore that year, white sanitation department employees refused to dig graves for black flu victims after the city’s only black cemetery, Mount Auburn, could not accommodate any more graves.

“The mayor then had to appeal to the War Department, which is now called the Defense Department,” said Marian Moser Jones, a social historian and ethicist of public health at the University of Maryland. “The War Department sent 342 black soldiers, black American soldiers to do the task, which is very much in keeping with the way black soldiers were treated by the Army in the war. They were detailed to the worst duties, the most grueling labor details were the ones who were most often sent out to clean out the trenches after a battle and even exhume and rebury dead soldiers’ remains.

“It’s sort of a continuity from the war. The resources that were there, that were limited, the resources to address African American health and even death were overwhelmed in cities like Baltimore.”