For my special project, I completed an analysis on the current COVID-19 pandemic and how it affects the field of social work.
Introduction
There are three different levels of social work which are the micro, mezzo, and the macro level. Micro level social work involves working with clients at an individual level which includes therapy sessions or case management. Mezzo level social work involves working with groups and families which may therapy groups and group homes. Finally, macro social work involves solving issues that affect people at the community level and globally. Recently, there has been a virus that has been spreading across the world called the COVID-19 virus. This virus is very fatal and has spread from China and across the world into the United States.
The issue of COVID-19 would be considered a macro level issue because it is in the realm of public health and has community and global impact. In this paper, I will use the nine social work competencies to address and analyze the severe impact of this fatal virus and how it has affected the practice of many social work agencies, including my own field placement, which is Signal Centers, Inc. This agency serves children and adults with developmental disabilities in the Chattanooga, Tennessee area. At its’ core, it is a day care center for both children and adults to spend time at during the day to give assistance to their caretakers. The specific interventions that is used at Signal Centers, Inc. is art therapy and Person-Centered Care. My specific internship is at the Adult Center where I interact with the adults from ages 21-90. Some of the specific disabilities that they have include cerebral palsy, Down syndrome, aphasia, and autism.
According to the CDC, the population that is the most vulnerable to the virus are those over the age of 60 which involves at least half of the participants that come to the Adult Center. As a result, my task supervisor sent out an e-mail saying that they were suspended all of the services for the Adult Center until further notice. This analysis will discuss how social work practice is and can be implemented when dealing with a public health pandemic within the nine social work competencies.
What is the COVID-19 or the Coronavirus?
Coronaviruses are a large family of viruses and COVID-19 is one of those viruses COVID-19, or the coronavirus, is a type of illness that can be spread from person to person. The symptoms for the virus can range from mild symptoms (or no symptoms) to severe illness (CDC 2020). COVID-19 specifically comes from the severe acute respiratory syndrome coronavirus (SARS-CoV 2) which is also a part of the same family of coronaviruses as COVID-19 (Elflein 2020). Some of the specific symptoms of the virus include coughing, shortness of breath, fever, chills, loss of taste or smell, sore throat, and muscle pain (CDC 2020). Some other symptoms that have been reported but not as common as the other symptoms that were mentioned are gastrointestinal such as vomiting, nausea, or diarrhea (CDC 2020).
The number of COVID-19 cases within the United States is beginning to rise due to recent everyday testing. Everyone regardless of age, ethnicity, race, or nationality can contract the virus. As stated earlier, those are who are at the highest risk for contracting the virus are older adults or people who may have serious medical conditions regardless of age. Some of the medical conditions include heart conditions, diabetes, severe obesity, chronic lung disease, asthma, liver disease, and those who are immuno-compromised, or in other words may have an impaired immune system (CDC 2020). Adults who have disabilities are not at a higher risk of contracting the virus, unless they have any of the serious medical conditions.
In the United States, some of the cases of those who have contracted the virus were either infected while traveling across the world to different countries infected. For some others, they were interacting with someone who had contracted the virus. Also, they were in a specific community where the people were infected by the virus in some way, shape, or form, but didn’t have any knowledge of how or where the community had contracted the virus (CDC 2020). As of right now, there is no vaccine to help fight the virus.
Recommendations to Help Prevent the Spread of the Virus
One of the basic overall recommendations from the Center of Disease Control is that everyone wears a face mask while going out in public. This was put in place especially during the national quarantine for those who needed to go outside of their home and purchase any necessities that such as food to help them get through the pandemic. This has also been recommended for all of the essential workers who work in hospitals such as doctors, nurses, CNAs, LPNs, and social workers. Wearing the face mask helps to prevent the spread of COVID-19 onto other people in the environment.
Along with wearing the face masks, it has also been recommended that everyone stay at least six feet apart from each other. This is another simple method to help stop the spread of the virus. One of the most complicated aspects about this virus is that it can be it can be contracted by someone who doesn’t even show any of the symptoms of COVID-19 (CDC 2020). Another recommendation made by the CDC to help prevent the spread of the virus is for everyone to avoid huge crowds and gathering in groups. The term that has been used for this is called “social distancing”. This “social distancing” is important because it also helps to protect those who are more vulnerable and at are at higher risk of contracting the virus (CDC 2020).
Finally, people are also encouraged to begin sanitizing and cleaning surfaces that are being used and touched very often. Many times, surfaces such as doorknobs, tables, kitchen counters, desks, phones, computer keyboards, toilets, and sinks contain many viruses that are being passed around. It has been recommended that people should be using sanitizers and surfaced cleaners approved by the EPA to clean the surfaces. It also goes without saying that people should also continue to wash their hands (CDC 2020).
Competency 1: Demonstrate Ethical and Professional Behavior
At the individual level, I began hearing about the COVID-19 virus from the news and I had begun some research about the dangers of the virus. Here, I was trying to find how it would affect my specific field placement and possibly pose a threat to the adult participants who attend Signal Centers on a daily basis. I would consider this action to be ethical because as a future social worker, it is crucial that I always consider the well-being of the clients that I serve first. This is also important considering that half of the adult participants who normally attend Signal Centers are also a part of the vulnerable population. In other words, half of the participants who attend Signal Centers, Inc. are in the age range of 60 and above.
Because the information about the virus was just getting out and beginning to surface on the internet and through the media, I wasn’t exactly sure which actions to take outside of making sure specific surfaces were clean and that I wore gloves while handling the food during the scheduled lunch and snack times for the participants so that germs wouldn’t spread and put any of the participants at risk.
While I was on my Spring Break, I was being notified by my task supervisor in the Adult Services department that Signal Centers was going to be suspending face-to-face daycare services until further notice. Although it caused an inconvenience for someone as myself who is a graduate student that was in need of hours in order to finish my field requirements for the program, it was the wisest and ethical decision because it was made with the participants in mind who are also at the most risk. As stated earlier, just about anyone can contract the virus even though they may not be in the age range of 60 and above. One of the major adjustments made by my supervisor from my agency was hosting virtual meetings and events with the participants and having them complete some of the activities that they would normally be working on at the agency. Even when using technology, the ethical usage is still in place concerning the confidentiality of the participants.
At the community level, the mayor of Chattanooga, Andy Berke, had signed an executive order that everyone find shelter within their homes to stay in during the national quarantine at the beginning of April. This included that everyone had to stay at home unless they were working at a business that was considered essential, getting food and groceries, or receiving any type of medical attention at a hospital. Part of this executive order also included that all parks and public spaces, including the Walnut Street Bridge that is most often frequented by many of the citizens of Chattanooga. Many childcare and day care centers were also closed as a result of the executive order that was signed by the mayor.
At the state level, the governor of Tennessee, Bill Lee, had established the Economic Recovery Group (ERG), which is a group to help rebuild the economy within the state of Tennessee due to many people within the state being on unemployment because of COVID-19. This group is a joint effort between state departments and different industries across the state to create responsible strategies to help the citizens of Tennessee to be able to safely return to their work lives after being impacted by unemployment.
All of the decisions made by the agency and at the local, community, and state level were all decisions that were made at the according to all of the social work values created by the National Association of Social Workers. These specific values are those that help to protect people at the micro, mezzo, and macro levels which is most definite important especially in a time where many people’s lives are at risk not only at the local, community, or state level, but also across the country of the United States and the rest of the world. The social work values that are being implemented with all of these are service, social justice, dignity and worth of the individual, importance and centrality of human relationships, integrity, and competence.
Implementing all of these policies to preserve the safety of the citizens of the community also aligns with the NASW Code of Ethics. The specific Code of Ethics that were being applied at the local, community, and state levels are 6.01 which is Social Welfare, 6.02 which is Public Participation, 6.03 which is Public Emergencies, and 6.04 which is Social and Political Action (National Association of Social Workers, 2017) . All of these ethical standards were being implemented by Andy Berke and Bill Lee because they involve keeping the public safe from COVID-19 and having all of the citizens of Chattanooga and across the state of Tennessee.
Competency 2: Engage Diversity and Difference in Practice
One of the issues that has been discussed across many social media platforms is the effect of COVID-19 and how it may impact the African American community. There have been many instances of racism concerning the healthcare system and its treatment towards African Americans. During this pandemic, there has been plenty of concern in terms of the ability of how people within this population will be able to gain access to proper testing and healthcare if they have already contracted the virus.
According to an article from Jama Network, it was shown that some of the major health factors that put the African American community at risk for contracting the COVID-19 virus are obesity, diabetes, hypertension, cardiovascular diseases such as heart failure and coronary artery disease (Yancy 2020). In the city of Chicago, there are about 70% of cases of COVID-19 which mainly comprise of African Americans that ended in death event though this population only makes up about 30% of the population within the city (Yancy 2020). In the state of Louisiana, just about 70.5% of the deaths of COVID-19 were also African Americans even though the African American population (Yancy 2020). Also, Yancy explains:
“The consequent infection and death rates due to COVID-19 complications are no longer surprising; they should have been expected. These observations are rooted in the recalcitrant reality of the deeply entrenched history of health care disparities and may settle as the most painful example yet of the regressive tax of poor health. COVID-19 has become the herald event that now fully exposes the deep and chronic social wounds in US communities. What makes this particularly egregious is that unlike the known risk factors for which physicians and others can stridently offer clear advice regarding prevention, these concerns—the burden of ill health, limited access to healthy food, housing density, the need to work or else, the inability to practice social distancing—cannot be well-articulated as clear, pithy, and easily actionable items. What is the action plan? It is less an action plan and more of a commitment. A 6-fold increase in the rate of death for African Americans due to a now ubiquitous virus should be deemed unconscionable. This is a moment of ethical reckoning. The scourge of COVID-19 will end, but health care disparities will persist. Does the US chronicle these poor outcomes due to COVID-19 complications with the higher burden of cardiovascular disease, poorer outcomes for breast cancer, higher amputation rates for peripheral vascular disease, lower kidney transplant rates, and worse rates for maternal mortality, then safely park everything in the health care disparity domain and go back to “normal”? Or will the nation finally hear this familiar refrain, think differently, and as has been done in response to other major diseases, declare that a civil society will no longer accept disproportionate suffering? (Yancy 2020)”
The other minority population that has also been affected by the COVID-19 crisis are the Asian-American community. Ever since the breakout was reported in the United States, there have been many instances of racism towards Asian-Americans across the country. Last month, there was an incident where two children, one being two years old while the other was six, were stabbed because the perpetrator had believed that they were which they were not (Liu, 2020). There was also another incident where an Asian man was walking his son to the bus stop and a 44-year old man had pushed him (Liu, 2020).
Combating racism in terms of the healthcare system for African Americans and the xenophobia towards Asian-Americans will require that people, especially social workers and other healthcare professionals, to help advocate for better healthcare policies that protect the rights of African Americans. Also, this pandemic is a crucial time for social workers to build the cultural competency necessary to fight against the racism that Asian-Americans are currently facing. This involves speaking with politicians and also school administrators about the current discrimination that is taking place towards this specific demographic. It is important to note the difference between Asian Americans and the Chinese government while discussing the overall impact of the virus (Liu, 2020).
Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice
Globally, there has been many cases across the world involving COVID-19 starting from Wuhan, China. Currently, the United States has the largest number of COVID-19 deaths in the world. Many government officials, including the president of the United States, have placed travel restrictions in light of the COVID-19 crisis as well. Implementing this type of policy helps to protect the citizens of each country from contracting the virus which also helps to decrease the number of COVID-19 cases. Within the United States, there also have been many restrictions on state travel across the country.
According to an article from The Washington Post, there are about at least 20.5 million people in America that are unemployed due to the current pandemic. About a month ago, there was a stimulus check sent to each family which had an income of at least no more that $75,000. However, it has been debated that this amount of money would not suffice and that there would probably need to be more stimulus checks until there is a vaccine that could help fight against the COVID-19 virus. This pandemic so far has exposed some of the weaknesses of capitalism and in times of crisis when many Americans are struggling to find employment.
One strategy that would help to eliminate structural barriers to ensure equity would be to advocate for middle- and lower-class Americans to be able to receive a specific stimulus check that would meet the needs for each specific household. How this strategy would be carried out would be that every family would need to apply for the specific check, and on the application, they would have to give information about the amount of people in each household and what their specific needs and circumstances are. One of the differences between this specific strategy and the past stimulus check that was recently sent around the country is that college students who are dependents of their parents will also qualify.
Another strategy to help eliminate structural barriers would be to advocate for healthcare of low-income citizens. This includes those who may be employed while working a minimum wage job but do not have any benefits of healthcare insurance that comes with the job. No being able to gain access to testing also puts those who are unable to afford healthcare insurance at risk. There has been struggles for many Americans to gain better access to testing for COVID-19. The solution for this specific issue would be for community health clinics to provide applications for low-income citizens who are unable to afford health insurance. This would also allow for them to visit the doctor and be able to afford any medicines that they may need to help preserve their health, including during the COVID-19 pandemic. Also, as addressed in the previous competency, there needs better healthcare services for the African American community due to the history of discrimination and racism within the healthcare system in America.
Lastly, the third strategy to help eliminate structural barriers to ensure equity would be to host virtual workshops for both clinical and non-clinical social workers about advocacy for the Asian-American community. These workshops will involve teaching cultural competency and how to advocate and fight against racism and discrimination towards the Asian-American community. These workshops will address different biases and how to make sure that Asian-Americans and other minorities are safe during this pandemic.
Competency 4: Engage in Practice-Informed Research and Research-Informed Practice
Teletherapy has shown to be one of the best evidence-based practices when it comes to delivering mental health services to clients who are need of therapy. It has been one of the greatest developments within the field of social services which can most definitely be used to reach those who may not have transportation to a mental health agency. This type of therapy of course, involves the use of technology with the client.
During this current COVID-19 crisis, there are many social workers from mental health agencies who are using this evidence-based approach to therapy. This type of approach can be provided by using a telephone, or via Zoom, FaceTime, Skype, Facebook Video Chat, or other online platforms for communication. Using this approach allows social workers and other therapists to continue delivering therapeutic services while at the same time, maintaining the safety of the staff at the agency (Haider, Tiwana, Tahir 2020). Even though there is teletherapy being provided over technological platforms, the NASW Code of Ethics would still apply. One of the major ways that the Code of Ethics still would apply is that the licensed clinical social worker or the therapist is that informed consent must be gained before providing teletherapy to the client.
Another evidence-based approach that informs practice that is relevant in this situation is psychological first aid. Psychological first aid is generally being given to survivors of disasters and disease outbreaks. It focuses on compassion for the survivors, providing informational care, and listening to their stories about the specific impact of the crisis (Haider, Tiwana, Tahir 2020).
This approach is built on the foundation of five principles which supposedly helps to reduce the rate of distress from traumatic events which are connectedness, installation of hope, safety, calmness, sense of self-and community-efficacy (Lanza, Roysircar, Rodgers, 2018).
Competency 5: Engage in Policy Practice
During the month of March, when the COVID-19 virus broke out across the country, at local level within the city of Chattanooga, Andy Berke ordered that all of the nonessential businesses were to be closed while the essential businesses were to be opened. The main businesses that were considered to be “essential” are hospitals and grocery stores. All of the parks, including the Walnut Street Bridge were being closed due the national quarantine order. The people who benefited from this local policy were mostly grocery store owners and those who didn’t benefit as well from the local policy were those that were running small businesses that weren’t considered to be essential in order to be open during the quarantine. For Signal Centers, since it is not a traditional social work agency that is not considered to be essential, the administration of the agency was required to close down the agency until further notice.
According to the Center for Disease Control & Prevention, businesses and employers have also been encouraged to coordinate with both of the state and local public health officials about a timeline for re-opening their businesses (CDC 2020). Employers have also been encouraged to complete a hazard check of the physical work environment and to assess how some of their employers may have either contracted or been exposed to the COVID-19 virus. It has also been recommended by the CDC that employers ensure that their sick leave policy is flexible and that they continue to do virtual checks on their sick employees (CDC 2020).
For Signal Centers, Inc., including at the Adult Services, sanitation is a very important process and is not taken lightly. While doing my internship at Signal Centers, cleaning around the facility was most definitely a very important task that was not taken very lightly. It was already an action that was done with the concern of the participants and making sure that the environment of the agency was healthy enough for the participants to enjoy until their caretakers come to pick them up towards the end of the day. Earlier in the semester, for Martin Luther King Jr. Day, many high schools across Chattanooga were using this day as a holiday for community service. Therefore, at Signal Centers, the staff and administration had decided to also close for the day so that the high school students come to the agency and assist in cleaning and sanitizing all of the surfaces.
Competency 6: Engage with Individuals, Families, Groups, Organizations, and Communities
One theory that definitely applies in the current COVID-19 pandemic is systems theory. Systems theory involves analyzing the human behavior and how it is being impacted by different systems. “Systems” could involve families, community, governments, or organizations. Therefore, when it comes to completing assessments on clients, using systems theory can be a very effective approach. For instance, a social worker maybe delivering teletherapy to a client who is suffering a traumatic loss of a family member who died because they had contacted the COVID-19 virus and is also suffering a lot of stress due to not be being able to pay their bills since their job had closed down due to social distancing regulations. In this instance, the social worker would look at different ways each of the “systems” affects the client’s livelihood. In this situation, the specific systems that affect the client’s life would be the politicians within the government, the healthcare system, and the organization that they were working for before the COVID-19 pandemic.
One other theory that could also be applied within the context of the current COVID-19 pandemic is conflict theory. The concept behind this theory is that power structures or power disparities have a huge impact on people’s lives. In just about every society, power is being divided unequally which causes different forms of oppression based on race, economic status, class, gender, and sexuality. This is especially true when discussing the struggles of African Americans and Asian-Americans during this current pandemic. Based on this theory, it seems as though the effects that the pandemic has had on the economy will force many politicians currently in power to re-analyze policies at the national, state, and local level that affect underprivileged communities.
Competency 7: Assess Individuals, Families, Groups, Organizations and Communities
Assessment is an important aspect of social work practice. It is also continuous and ongoing which can consistently help to improve the delivery of social services within an agency. Assessments often times involve looking at the specific strengths, weaknesses, or challenges within the agency or program and the specific effect that it has on services being given by the agency. One specific theory that is applicable when it comes to completing assessments as a social worker is social learning theory. This specific theory is also known as behaviorism or behavior theory.
Social learning theory has been the main theory that I have implemented in my field placement at Signal Centers within this past semester. Using this theory has allowed for me to learn about how the participants who have developmental disabilities function on a day-to-day basis. Throughout the day, I would take at least ten to fifteen minutes to read a case file for one of the participants. In these case files, I was able to learn more about the participants in terms of their family history, medical history, and their current diagnosis. I was also able to learn more about the participant’s eating habits during lunch time, so I knew which food to serve to them. Also, at the end of the day, part of one my duties as an intern was to complete paperwork that involved manual assessments of the participants. I was required to record if there were any improvements in the participant’s behavior or demeanor.
As far as assessing the strengths and needs of my agency, I would say that the current model being used, which is a combination of Person-Centered Care, art therapy, and social interaction, meets the overall needs of both the agency and the participants so far. At Signal Centers Inc., it is prohibited for a social worker or any other professional working there to provide any types of other therapeutic services to the participants. However, one suggestion that I believe would be very useful that wouldn’t be completely invasive to the participants would be something such as using Mindfulness exercises. Mindfulness exercises can help bring around relaxation and help the client to be able to clear their mind. However, this would be something that would have to be approved by the administration at Signal Centers Inc.
The other theory that I believe would be very useful to assess the strengths and needs of my agency would be Bronfenbrenner’s Ecological Systems Theory which suggests that people are settled within different layers of society starting from their families to society at large. The four systems would be the micro-system, meso-system, exo-system, and the macro-system. I would use this theory to assess Signal Centers from more of a macro perspective. Analyzing my agency from macro perspective would involve investigating how is the agency using gaining funding and maintaining their ability to function within the Chattanooga community and provide services to children and adults with developmental disabilities. Using these theories for the assessments would be most helpful in response to making sure that the agency is able to continue delivering services even within pandemics such as COVID-19.
Competency 8: Intervene with Individuals, Families, Groups, Organizations, and Communities
One of the interventions which evidence-based that I would use with my agency is would be Mindfulness-Based Stress Reduction. I believe that this would be a very effective intervention concerning the caretakers of the participants that attend Signal Centers. One of the main reasons why I suggest this intervention is that it could help to prevent caretaker burnout. Often times, this burnout leads to the abuse of the elderly and those who have developmental disabilities. The way that I would collaborate with my supervisor and other colleagues about this specific intervention would be to discuss a specific time for the caretakers who are experiencing stress or burnout to come to the agency which would be about once or twice a month. This intervention would also be useful during the current COVID-19 pandemic which is bringing about a lot of stress and panic considering that Signal Centers is closed until further notice.
The other intervention that would be most useful at Signal Centers which is already an intervention that is being implemented would be art therapy. Art therapy is major part of the program at the agency and there have been many art contributions from Signal Centers to the community of Chattanooga. From my personal experience and research, using art therapy is one of the best strategies to interact with individuals who have developmental disabilities. Instead of using a therapeutic intervention such as Cognitive-Behavior Therapy, using art therapy is a straightforward method which allows the social worker to be able to interact with the participant or client with a developmental disability in a more creative fashion. This past semester, I have been able to take leadership in the art therapy activities along with the activities coordinator that plans them.
Competency 9: Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities
One of the approaches that I implement to evaluate the effectiveness of my interventions that were stated previously would be to use a survey. Surveys are very effective in terms of evaluating the effectiveness of a program or an intervention. The reason that they are effective is that they help to improve and inform social work practice. By using surveys, it will allow for me to gather data to see the overall results of using the specific intervention. Therefore, within about every four months, I would send the caretakers a survey which evaluates the behaviors of all of the participants. The questions will specifically ask the participants if there has been improvements or changes in the participant’s behavior. In other words, this would be called tracking change.
The other evaluation approach that I would implement would be impact evaluation. This type of evaluation involves accounting for both the positive and the negative effects of a specific intervention being implemented. How I would implement this specific evaluation would be to measure the history of using these interventions in the field of social work and what the long-term benefits and consequences would be in terms of using the interventions with the participants at Signal Centers.
Summary
Completing this assignment really has expanded my knowledge on the current COVID-19 pandemic and how it is affecting social workers. It has also forced me to research deeper about the best practices with the participants and how I can build a therapeutic collaboration with their caretakers as well. I have also learned about how the pandemic is affecting other business within the community of Chattanooga and the rest of the state of Tennessee. While doing my research and reading recommendations from the Center for Disease Control and Prevention, I have been able to see how the pandemic is not only affecting people within the United States but also worldwide.
I also believe that the current pandemic has also shown why social workers are necessary and also why it is important that social workers should be flexible in how they deliver social and therapeutic services to their clients. From doing research and expanding on concepts for the competencies, I have been able to find some interventions that I will be able to use in the future for my own practice. Once I gain my LCSW license and open my own practice in the future, I plan to begin delivering teletherapy to clients who may not have transportation or do an in-person appointment.
References
Cleaning And Disinfecting Your Home. (2020, April 2). Retrieved May 12, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html
Code of Ethics. (2017). Retrieved May 12, 2020, from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
Haider, I. I., Tiwana, F., & Tahir, S. M. (2020). Impact of the COVID-19 Pandemic on Adult Mental Health. Pakistan Journal of Medical Sciences, 36, S-1-S-5. https://doi-org.ezproxy.southern.edu/10.12669/pjms.36.COVID19-S4.2756
Heather Long, A. V. D. (2020, May 8). U.S. unemployment rate soars to 14.7 percent, the worst since the Depression era. Retrieved May 14, 2020, from https://www.washingtonpost.com/business/2020/05/08/april-2020-jobs-report/
Interim Guidance for Businesses and Employers Responding to Coronavirus Disease 2019 (COVID-19), May 2020. (2020, May 5). Retrieved May 11, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/community
Lanza, A., Roysircar, G., & Rodgers, S. (2018). First responder mental healthcare: Evidence-based prevention, postvention, and treatment. Professional Psychology: Research and Practice, 49(3), 193–204. https://doi-org.ezproxy.southern.edu/10.1037/pro0000192
Liu, O. by E. (2020, April 11). Covid-19 has inflamed racism against Asian-Americans. Here’s how to fight back. Retrieved May 12, 2020, from https://www.cnn.com/2020/04/10/opinions/how-to-fight-bias-against-asian-americans-covid-19-liu/index.html
Situation Summary. (2020, April 19). Retrieved May 12, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html#emergence
Tennessee Pledge. (n.d.). Retrieved May 12, 2020, from https://www.tn.gov/governor/covid-19/economic-recovery/tennessee-pledge.html
Yancy CW. COVID-19 and African Americans. JAMA. Published online April 15, 2020. doi:10.1001/jama.2020.6548