As vaccination efforts continue, COVID-19 isn’t the most serious threat facing some Philadelphians. Consider gun violence.

In the neighborhood around Jerome Brown Playground, most people know at least one person who died of COVID-19 — a friend, relative, neighbor, or coworker.

The virus, though, isn’t the only mortal danger infecting this North Philadelphia neighborhood, and for some it’s not even the most frightening.

“You hear shootings around here all the time,” said Al Harris, who lives near 22nd and Ontario Streets. “It’s continuously. A couple of my buddies got murdered.”

Throughout the community, people described gun violence as the greatest threat to their lives. Clem Outlaw, 33, said he lost an aunt, an uncle, and a coworker at a local hospital to COVID-19. But in the last 10 years, shootings claimed his brother and, recently, a nephew his age.

“It’s not like you have to be a part of something to be involved in the violence around here,” he said. “You got to watch who you’re walking to the store behind and everything.”

For the overall population, COVID-19 remains a greater killer throughout Philadelphia than guns. But depending on who you are and where you live, it may not be the only danger, and the relative risk can vary dramatically. In the eight Philadelphia zip codes where the most people have been shot since the start of the pandemic, people of all ages are twice as likely to die from COVID-19 than from gun violence. Those are tighter odds than in the rest of the city, where people are 11 times more likely to die from the virus than from bullets.

The risk shifts dramatically for younger people, who have lower risk of hospitalization and death from the virus and are disproportionately targeted by gun violence. In those hard-hit zip codes, more than 130 people under the age of 45 have been shot and killed since March 1, roughly when vaccinations began becoming more widely available, and Sept. 17, the latest data available from the Philadelphia Department of Public Health. Fewer than 15 people in that age group died of COVID-19.

Many residents take the coronavirus seriously and understand the importance of vaccination to combat it. A challenge remains, though, when people have to constantly negotiate multiple serious concerns, such as gun violence or housing insecurity. That reality sheds light on the complicated efforts to inoculate as many people as possible: While some Philadelphians worked from home and anxiously awaited the opportunity to get vaccinated, others wanting vaccination struggled to pay rent and feed their families.

“We’ve heard this anecdotally for a while now,” said James Garrow, a spokesperson for the Health Department. “Especially in the last nine months, with so many people being unemployed and struggling just to get enough to eat, we see how difficult it can be to prioritize something that is still relatively unlikely to happen to you.”

As the gun violence crisis has raged, concentrated in neighborhoods facing the deepest poverty and other structural barriers, the fear of being shot is acute and constant. Just last month, 15-year-old Simone-Monea Rogers died after being shot while playing basketball with friends in the playground.

» READ MORE: Philly blocks besieged by shootings have long endured poverty, blight, and systemic racism

“Whenever we’ve gone to the community, the number one thing for the last 10 years, the biggest barrier to the overall health for the community, is violence,” said Kathleen Reeves, director of Temple University’s Center for Urban Bioethics and a professor of clinical pediatrics. “Number two is opportunities for their kids. That doesn’t change.”

Dashay Bailey, 21, has no doubt about COVID-19′s hazards. Her mother lost friends to the virus, she said. Yet she put off getting her first shot until Sept. 15, and then only because her job as a home health aide required it. She didn’t doubt the vaccine’s effectiveness, she said, though she was nervous about side effects. Mostly, though, she just hadn’t gotten around to it.

“It was something I was saying, ‘get done, get done,’ but it never got done,” Bailey said. “I guess it was just cause I got other stuff to do.”

By contrast, she said, she has lost two friends in shootings and just a few weeks ago had to rush inside her house after hearing gunshots.

“I get scared,” she said, “worried about who done got hit, who done got shot.”

She is eager to move out of the neighborhood, ideally to King of Prussia. She has friends there, and, she said, “it’s quiet.”

» READ MORE: In Philly’s least-vaccinated zip codes, fighting the delta variant is a game of catch-up

The toll of gun violence also goes far beyond those who die. In the eight hardest-hit zip codes, more people have been shot, most not fatally, than have died from COVID-19. And while most people who are shot do survive, the terror created by gunshots can be more psychologically impactful — and wider spread — than that of a coronavirus infection, while physical disabilities some shooting survivors experience can be devastating.

“The community impact of the shooting, I think, is significantly different than the community impact of someone being hospitalized for COVID,” said Stephanie Reid, executive director of Philly Counts.

Of course, the pandemic has itself taken a disproportionate toll on already marginalized communities. About 46% of Philadelphia’s more than 3,800 COVID-19 deaths have been Black residents, though they make up 38% of the city’s population.

“It’s a hell of a weapon,” said Ontario Street resident Leon King of COVID-19. “You can’t see it. You don’t know where it’s coming from. You don’t know who has it. You don’t know if you have it.”

King, 69, was “all for it” when the vaccine became available.

Racism and disinvestment have meant a long history of less access to health care and greater distrust of health-care providers, setting the stage for the virus’ outsized impact on communities of color.

“People may suffer from diabetes and heart failure and high blood pressure, but other areas of their life make it so that they can’t pay attention to [managing their health] in the same way” as a more privileged person, said Reeves, who also participates in the North Philadelphia Collective, a Temple University-initiated group aimed at responding to community concerns. “That isn’t dissimilar from what’s happening with COVID.”

The poorest Philadelphians also are more likely to suffer consequences of the pandemic in their employment, finances, and mental health.

“When we think about COVID generally in the pandemic,” said Jaya Aysola, executive director of Penn Medicine’s Center for Health Equity Advancement, “oftentimes we only get fixated on the infectious crisis and not on the socioeconomic crisis associated alongside it.”

Citywide, about 66% have received at least one vaccine dose, but in 19 zip codes, fewer than half have received a dose. In those majority-unvaccinated zip codes, the shooting rate is more than three times higher than in majority-vaccinated zip codes.

Paying rent and utilities often is a bigger priority than getting a vaccine, said Charles Lanier, executive director of Hunting Park Community Revitalization Corporation and a member of the North Philadelphia Collective.

“Right now, that seems to be the focus because people are getting shutoff notices, people are in fear of getting evicted,” Lanier said. “The people need their utilities on. They need to have a roof over their head.”

In West Philadelphia, City Councilmember Jamie Gauthier said, efforts to get people vaccinated have to acknowledge the fears most acute in people’s lives.

“We can’t tell people what they should fear the most,” she said. “What they fear and what they prioritize is dictated by their everyday experiences in their neighborhoods. In certain neighborhoods, Black and brown people are just not safe in this moment.”

Navigating those challenges and risks requires a constant process of evaluating and prioritizing. The stakes are basic survival. Facing hard choices and trauma regularly can eventually have a numbing effect, said Lily Brown, of University of Pennsylvania’s Center for the Treatment and Study of Anxiety.

“When you think about the compiling effects of food insecurity and housing insecurity and sleeping in really hot environments where they don’t have temperature control,” she said, “it’s harder to make a decision when you’re faced with these other stressors that are either physically uncomfortable or biologically affecting your brain.”

Plenty of people in the city’s most violent communities take COVID-19 seriously.

“I’m not anti-vaxxer,” said Outlaw, who is vaccinated. “I think a lot of people would take it if they had more trust.”

Harris, 56, knows which of his neighbors on 22nd Street are vaccinated and said he got his first shot in April, as soon as he was eligible. His 16-year-old daughter, though, has asthma and eczema, and the shots she takes to treat those have forced her to push back her vaccination until this week. Now she is going to school in-person.

“I wanted her to be fully vaccinated before she walked into this bombshell,” said Harris, a maintenance supervisor at 10 Penn Center. “I’m vaccinated and she’s not and I’m more worried about her.”

She was finally able to receive her first dose, Harris later said.

Harris noted that a neighbor died recently of COVID-19. It is striking, though, he said, how much of his time off is spent attending funerals for murder victims.

Brown, the anxiety expert from Penn, explained that personal experience is often more influential in risk evaluation than more abstract threats such as COVID-19 death statistics, another reason gun violence looms large.

“When someone is shot on my street, it might be something that neighbors come out of the house and actually see, or it’s on the news — it’s in the conscious awareness of a lot of people in the community,” Brown said. “In context, having a death from COVID-19, by all accounts it can be a horrific experience, but it’s not documented in the same way.”

Penn has a social needs response team, Aysola said, that can refer anyone who interacts with Penn for vaccination, testing, or contact tracing to primary health care, as well as financial resources such as unemployment. Philly Counts, Reid said, also connects people with social services.

“We have to understand these are whole people,” she said. “We have to be prepared to listen and to be available in a supportive, authentic way.”