Coronavirus disproportionately impacts black America
Photo: KAMIL KRZACZYNSKI (Getty Images)
By now the world knows coronavirus disproportionately affects black and brown communities in the US. Starting with a news story from Chicago where 70% of all COVID-19 deaths were among black people, over the next 24 hours a wave of attention focused on death disparities in black America wafted across the airwaves as news in other states highlighted similar disparities in Louisiana, Michigan, Wisconsin and New York, where the death rate is similar for blacks and Hispanics. The disparities discussed in numerous news stories and op-eds like this one by Dr. Uche’ Blackstock, a New York-based physician on the frontlines, leave no doubt about systemic neglect of the health of black America. Blackstock says, “This pandemic will likely magnify and further reinforce racialized health inequities, which have been both persistent and profound over the last five decades, and Black Americans have experienced the worst health outcomes of any racial group.”
But why is the COVID-19 death rate so high among blacks? The disparity doesn’t come as a surprise to health policymakers like Dr. Patrice Harris, President of the American Medical Association and Dr. Oliver T. Brooks, President of National Medical Association and Chief Medical Officer at Watts Healthcare Corporation in South Los Angeles. Both agree the background rates of chronic diseases like diabetes, heart disease and high blood pressure in black people contribute to higher COVID-19 death rates. However, Harris says other contributors include inequities in testing access, widespread misinformation about coronavirus infection and the disproportionate rate of black people in lower wage jobs placing them at risk for infection. She says, “Many workers on the front lines working in [transportation], food and delivery services may not have the privilege of working from home.” Dr. Brooks believes the disparity also arises from lack of consistent data collection on race and ethnicity. Without this information, it is difficult to understand how to target prevention efforts and messaging. He says, “We must create a data repository overseen by a credible organization to ensure data are consistently accessible to everyone.”
Now that everyone is aware of the problem, what’s next? At the White House press conference yesterday, Dr. Tony Fauci offered a rare public acknowledgment of persistent health disparities in black America saying the COVID-19 death disparities are inextricably linked to disproportionate rates of chronic diseases. He closed these remarks by saying “there’s nothing we can do right now other than try to give them the best possible care to avoid complications.” But this isn’t quite true. Waiting for cases to manifest is too passive an approach for an aggressive pandemic like this one. States must be more proactive and acquire tools to test widely and find cases of infection starting with vulnerable populations and those at greatest risk of death from COVID-19. The fates of New York and Louisiana don’t necessarily foreshadow things to come in many other states where the situation isn’t as dire. In these places it’s not too late. There is still time for basic public health intervention and outbreak response that prioritizes case finding by testing, isolation of people with infection and contact tracing to find positives among these contacts. If testing resources in the volumes needed are not available in the United States, what prevents States from procuring these tools outside the US?
There are other things we can do now. Dr. Harris suggests, implementing housing policies to protect and shelter blue collar and hourly employees working on the front lines, ensuring they also have access to masks and any protective equipment needed on the job. She also highlights a dire need to ensure culturally-appropriate health and prevention information is reaching people in underserved communities who may be disconnected from main stream health communication. Dr. Booker suggests other short-term interventions are feasible such as expanding access to health technology including wider deployment of remote monitoring tools for chronic diseases and ensuring resources are available to address the mental health needs exacerbated by the pandemic.
I wondered how members of the community were reacting to the COVID-19 death data and sought a firsthand perspective from the community. Ms. Lynette Roney, Southeast DC resident, recently lost a family member to COVID-19. Roney says she studies the pandemic and learns everything she can. She is aware of high rates of chronic diseases in the black community but believes it’s not the only reason for the high death rates. She believes people don’t go to the hospital because they are afraid they won’t get help. I asked why she believes she couldn’t get the care she needs during this crisis and was stunned by her sobering response. “I haven’t left my house in 38 days and I am not leaving even if I get sick. I’m black, I’m a woman, I’m 72 years old and I figure if I go to the hospital they will put me in a corner and let me die so I’d rather die right here in my house.”
Vanessa Gamble, a professor and researcher at George Washington School of Public Health studies race, equity and bias in healthcare, understands Roney’s perspective. Gamble says our public health messaging in this pandemic is alienating to underserved black communities and this reinforces distrust like Roney’s. “I heard an advertisement for drive up testing. But what if you don’t have a car? That makes you believe it doesn’t include you,” she said. She suggests public health messaging must be nuanced to include proactive actions for all populations. For example, she says more appropriate messaging might be, “If you can’t stay home, here are some things you can do.” As a scholar of history and injustice, Gamble believes this is a unique moment. It’s a moment that positions us to have a much different response than those of previous social tragedies like Katrina or the economic downturn in 2009. She says it’s different because the COVID-19 death disparities manifesting across the country have laid bare the breadth and depth of the social injustice and persistent health neglect in black America.
It is indeed a unique moment. During Dr. Fauci’s second round at the mic yesterday he said the pandemic is “shining a very bright light on some of the weaknesses and foibles in our society” and that “health disparities have always existed for the black community”. Further, he acknowledged this pandemic illustrates how unacceptable this is because black people are suffering disproportionately. He said, “When all this is over there will still be health disparities which we need to address in the [black] community.”
As for what now, Ms. Roney agrees with Fauci. She adds, “We need an investigation. A protocol to review all the people who died and figure out what happened to them and how they were treated.” That’s great advice. Maybe some of the states should call her up and put her in charge of the response.