High blood pressure plagues many Black Americans. Combined with COVID, it's catastrophic
Charles Thomas was unwell but he had no time for rest.
He was on the cusp of a management promotion and a move to Florida to begin a new chapter that would alter his family’s financial future and break the cycle of generational poverty.
Yet, as his family’s prospects improved, concerns about his health grew.
A severe bout of COVID-19 left the 52-year-old weak and in recovery for weeks. His wife, Melanese Marr-Thomas, worried he was pushing himself too hard to get back in the swing of things. Charles was a big man at 6 feet tall and 300 pounds. He struggled for years to get his weight under control.
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Later in life, that struggle gave way to high blood pressure and a medley of medications.
In a nation plagued by high blood pressure, Black people are more likely to suffer from it — and so, in the time of COVID-19, they are more likely than white people to die. It’s a stark reality. And it has played out in thousands of Black households that have lost mothers and fathers over the past three years, a distinct calamity within the many tragedies of the pandemic.
It has devastated families like the Thomases of District Heights, Maryland.
Charles had an intense fear of hospitals, needles and doctors, partially because they had, in the past, brushed aside his concerns. He felt doctors were quick to blame any ailments solely on his weight, but slow to listen to his symptoms or examine other causes. He eventually gave up on seeking medical care for a long time because he was tired of feeling judged.
His family had recently found a Black doctor who, for the first time in his life, made Charles feel comfortable —- and most importantly, heard.
“He knew he needed to take better care of himself so we were trying to change his diet and be more active,” Melanese said. “His blood pressure was beginning to come down.”
But then, COVID intervened.
This story is part of an AP series examining the health disparities experienced by Black Americans across a lifetime.
About 56 percent of Black adults have high blood pressure, compared to 48 percent of white people. Three in four African Americans are likely to develop the disorder by age 55.
When the force of your blood pushing against the walls of your blood vessels is consistently too high, it makes the heart and blood vessels work harder and less efficiently, which can lead to significant health issues.
While only 32 percent of white adults with high blood pressure have their condition under control with medication, the figure for Black Americans is even lower — 25 percent.
And it’s likely to get worse: By 2060, the number of Americans battling cardiovascular disease is expected to drastically increase. High blood pressure rates alone are projected to rise 27.2 percent, or from roughly 127.8 million to 162.5 million Americans.
Among white people, the prevalence of cardiovascular risk factors and disease is projected to decrease over time. Yet significant increases are projected among people of color, especially Black and Latino Americans.
It is clear that high blood pressure has played a major role in COVID deaths, and especially in the COVID deaths of Black people. Together, high blood pressure and COVID have created a deadly combination: While high blood pressure is listed as a contributing factor in 15.5 percent of the deaths of white COVID sufferers, the figure for Black victims is 21.4 percent — the highest of any racial group.
Like many conditions, genetics do play a part. Experts also blame poor diets, high cholesterol, obesity and smoking — risk factors that often exist at higher rates in Black communities. In recent years, more academics and doctors have called attention to structural inequities.
The nation’s health disparities have had a tragic impact: Over the past two decades, the higher mortality rate among Black Americans resulted in 1.6 million excess deaths compared to white Americans. That higher mortality rate resulted in a cumulative loss of more than 80 million years of life due to people dying young and billions of dollars in health care and lost opportunity.
“Until we reach health equity, these disparities are going to be a scar on the health care landscape in the United States,” said Dr. Keith C. Ferdinand, the Gerald S. Berenson Endowed Chair in Preventive Cardiology at Tulane University’s School of Medicine. He emphasized the importance of equal access to primary and specialty care and medications.
“If we don’t do that, then we don’t have a just society,” Ferdinand said.
Charles Thomas’ infectious laugh could fill any room he entered. He also was a great storyteller. It’s what made his wife, Melanese Marr-Thomas, fall in love with him decades ago when she was still a college student at Howard University in the late ’90s.
When they met, the two quickly hit it off and could spend hours just talking. But they were in vastly different places in life: While Melanese was focused on her studies, Charles was trying to survive in a particularly tough Maryland neighborhood.
He eventually cut off all ties from her with little explanation.
“‘You deserve so much more than what I can give,’” Melanese recalled Charles saying to her. “I was so hurt.”
Years later, she found out it was because he was struggling to find his way out of a life of selling drugs.
Charles eventually had a son, Charles Thomas III, with another woman — a child whom Charles tried to be heavily involved in raising. But his street life eventually caught up with him.
Charles was incarcerated off and on for much of his son’s childhood and teenage years.
“He was heavy in the streets,” Charles Thomas III, 33, recalled. “But he made his presence known even when he was in jail. He would still find a way to send me gifts for Christmas. I’ll never forget the little toy car he sent me and I said ‘My daddy sent me this present,’ not putting two and two together that he was in jail.”
It took years for Charles to eventually begin the hard journey of changing his life. Years later, he acknowledged the vicious cycle he found himself in. As a young Black man, he grew up poor and bounced around various communities that all suffered from the simmering effects of racism and segregation-era policies, with little hope and few pathways to escape poverty.
Eating healthy was hardly at the top of his mind, and largely out of reach. His neighborhoods were filled with fast food options, yet few grocery stores. And he was inundated with the toxic stress of living in a dangerous environment.
While in prison, Charles’ health suffered, too. Healthy foods weren’t readily available and routine health care was sporadic. His wife believes his high blood pressure and other ailments could have begun while he was incarcerated.
It wasn’t until his mother died while he was in prison that Charles felt a true spark to change.
“She was his backbone,” Melanese said. “But after his mother passed, he had no sense of home and he said, ‘I have to create my home and find my purpose and meaning.’”
Charles and Melanese reconnected in late 2009 and rekindled their romance. The couple eventually married and blended their families. He never shied away from talking about his earlier struggles in life. He acknowledged his mistakes and instead used it as a powerful way to teach his children to avoid the pitfalls he fell prey to.
“My dad, he was a great father to me and my best friend,” said Charles Thomas III, who is now a teacher. “He taught me what I needed to know. He taught me how to be self-sufficient and stand on my own two feet. When he did things that were wrong, he never made excuses for it. He always told me the truth, so I never held anything against him.”
Charles’ family is what mattered most to him. And Black fatherhood was something that he cherished. He often spent long nights staying up with his kids and wife, reminiscing and sharing fatherly wisdom — sage advice they cling to today.
He worked his way up at his job as a concrete truck driver and became well respected in the company — and within his community, as a known father figure to other Black boys at his youngest son’s football games. He launched a food truck and catering business, Sol Familia Mobile Kitchen, with his wife. Everything was looking up, finally.
But Charles Thomas began to feel sick around Thanksgiving in 2020. He thought it was a passing cold, but his wife was worried; the number of COVID cases was climbing, both nationally and locally, and the vaccine wasn’t yet widely available.
Melanese was right. The entire family — parents and six children — would be diagnosed with COVID. But as the others got better, Charles’ condition worsened.
His wife convinced him to go to the hospital, where his oxygen levels dropped severely and he spent eight days in the intensive care unit, where he was nearly placed on a ventilator. But he recovered, and went home in time for Christmas.
The family thought the worst was over.
Then Charles began having trouble breathing. The smallest tasks left him breathless and taking a few steps left him tired and struggling for air. Still, in late January 2021, he decided to go back to work.
“He was so enthusiastic about trying to make sure we got our food truck back up and running,” Melanese said. “But I told him he just came out of the ICU with double pneumonia. I asked, ‘Why are you going back so quickly?’”
She suspects Charles felt he still had to “make up” for time lost and his past mistakes.
The stress of it was toxic, and taxing on his health, and Melanese worried it exacerbated his high blood pressure — and also his COVID complications.
“I think that also killed him,” Melanese said.
More and more, researchers acknowledge that high blood pressure and other ailments that strike Black Americans disproportionately can, in great measure, be traced to the inequities of Black life in America.
Black Americans are more likely to live in communities that lack access to fruits and vegetables and other healthy foods. They’re also more likely to live in communities inundated with fast food options that are often cheaper and easier to access but less healthy.
The same Black communities that experienced discriminatory housing policies more than 60 years ago are at a greater risk of heart disease and other related risk factors today, according to a July study in the Journal of the American College of Cardiology.
Residents of those neighborhoods also have less access to public transportation and health insurance. They also see lower life expectancies and higher incidence of chronic diseases that are risk factors for poor outcomes from COVID-19 — including high blood pressure.
Research is examining the effect of stress on high blood pressure rates in Black communities, according to Dr. Anika L. Hines, director of the Equity in Cardiovascular Health Outcomes Lab at Virginia Commonwealth University School of Medicine.
For Black Americans in particular, psychological stress — including discrimination or navigating racism — and its ensuing effects could be a precursor to high blood pressure, Hines said.
Historically, medicine has overlooked the role of structural barriers to good health among Black Americans. Instead, genetics, individual choice and even race have been blamed.
“As more people begin to embrace antiracism and accept race as a social construct and not as a biological construct, more attention will be paid to these social factors, psychosocial factors, cultural context, and history,” Hines said.
Delmonte Jefferson, executive director of the Center for Black Health and Equity, said it’s important to understand how health inequities that date back generations created today’s conditions.
“This country has not, did not, does not at this point in time, value the health and well-being of people of color and so we keep having challenges with health and health disparities,” Jefferson said.
Near the end of February 2021, Charles Thomas’ 16-year-old ran into the room one evening and shook Melanese awake. Something was wrong with Dad.
She rushed into the bedroom and found her husband on the floor on his hands and knees.
“It looked like he had fallen and was trying to get himself back up,” Melanese said. “I said, ‘What’s wrong?’ He couldn’t speak. He couldn’t say anything to me.”
He struggled to get up, but collapsed on the floor and stopped breathing.
Emergency responders performed CPR, but it was too late. Charles died Feb. 28, 2021, of COVID-19 related complications. He was 52.
So much was lost that night. The family was getting ready to move to Jacksonville, Florida. Charles had just been offered a job he spent 10 years working toward. He was slated to be a plant manager. The family was in the midst of planning a trip to look at homes there.
“I still relive that night,” Melanese said. “I was so numb and in disbelief that someone that was just talking to me is no longer here. He was the pillar of our family, the foundation, our protector. He was everything and it is an immeasurable loss.”
Since Charles’ death, the family has worked hard together — and in their own ways individually — to keep his memory alive.
For his stepdaughter, Serena Marr, that means getting treatment for her own mental health in the wake of his death, and finishing college.
For Melanese, his beloved wife, that means cherishing his memory and their love.
“I’m spending my life reminding others that he was a husband, a father, a brother, an uncle, a nephew, a granddad, a co-worker and a friend to so many,” Melanese said. "He was not a COVID number. He was a person who had hopes and dreams, aspirations.”
For his namesake, Charles Thomas III, that means imparting love and wisdom to his own 5-year-old daughter, who his father adored. It also means supporting Melanese and helping her with his younger siblings.
“I can’t look in the mirror without seeing my dad,” he said. “When I go to school as teacher and I’m correcting my students, I see my dad. When I’m talking to my daughter and my girlfriend, I hear my father. Everything I say. I can hear him. He’s going to live on through me.”
Kat Stafford, based in Detroit, is a national investigative race writer for the AP’s Race and Ethnicity team. She is a 2022 Knight-Wallace Reporting Fellow at the University of Michigan. Follow her on Twitter: https://twitter.com/kat__stafford.