Race and COVID-19 in San Antonio
In the first few weeks of the pandemic, most COVID-19 cases were white people clustered around Alamo Heights. For those not in San Antonio, that’s a mostly white and affluent municipality within San Antonio. These first cases came just after Spring Break, following trips to ski in Utah or vacations in Europe. This is also a population likely to have health insurance and thereofre ready access to health care and testing. (edit: not all people are wealthy and white in 78209)
It wasn’t long after that we saw a big jump in the Black/African American population, reflecting nationwide trends.
San Antonio is home to the largest Martin Luther King, Jr Day March every January, with upwards of 300,000 people participating. But our local Black/African American community is small, making up only 7.2% of the overall population.
Yet early in the outbreak, almost 20% of the COVID-19 cases were in the Black/African American community. As of June 1, they account for 9% of cases, still higher than their percent in the population but closer, at least. However, 23% of COVID-19 deaths in Bexar County have been in Black/African-Americans. That’s more than three times their numbers in the population.
The Hispanic community makes up 60% of the population and is over-represented in COVID-19 cases (66%) as well. However, given our representation in the population, fewer Hispanics are dying of COVID-19 (51%).
Put another way, the case-fatality rate (CFR: the number of people who die over the number of people infected), varies by location and age, but overall is 2–3%. In San Antonio, the CFR for Black/African Americans infected is 7%. If you’re white it’s 3% and if you’re Hispanic it’s 2%.
Not surprisingly, if you’re white and non-Hispanic, despite the initial outbreak in travelers, you’re less likely to get COVID-19 and less likely to die from it.
The Bexar County Jail has recently had an outbreak of COVID-19, with 403 cases, most in May. As of June 3, 2020, 12.3% of the 3,280 cases are in jail inmates.
A disproportionate percentage of the Black community is in jail. Of the inmates who were in the jail in May, 17% were Black, 38% were white, and 44% were Latino. Most of the inmates are between the ages of 35–64 (63%). However, most of the COVID-19 cases in the jail were identified in May, and by then the percent of overall cases in the Black community was decreasing. None of the inmates have died, and most (79%) were asymptomatic at the time of testing. So the higher proportion of deaths in the Black population is not related to to outbreak in the jail.
Race is not a risk factor for COVID-19. Racism is.
From the City of San Antonio Public Health Transition Team Report:
“In Bexar County, 15% of Latinx/Hispanic community members do not have health insurance. In the Black/African American community, more than 30% do not have health insurance. In the past 12 months, 24% of Latinx/Hispanic adults and almost 18% of Blacks/African Americans (non-Hispanics) did not see a doctor due to cost.”
Health disparities are very very real. They’re no secret. We’ve known about them for years. Poverty, lack of health insurance, lack of access to care, discrimination, food deserts all play roles in underlying health and health outcomes nationwide. San Antonio is no different.
A population that’s been a little more difficult to assess in COVID-19 is the LGBTQIA+ community. It’s not a standard question asked when identifying a new case, so data are not available. But we know that in the LGBTQIA+ community, the lack of culturally competent care layered on racial and economic inequities has led to even greater health inequities. In the past year, 46% of LGBTQIA+ people surveyed said they have avoided seeing a healthcare provider in the past year and 30.8% said they had been refused health care. (Study to be released this month: Amy L. Stone, R.S., Jr., Charlotte Georgiou, Ryann Williams. State of Our Community: San AntonioLGBTQ+ 2020 Survey. Strengthening Colors of Pride — Pride Center San Antonio, Trinity University, 2020.)
From the Public Health Transition Team Report: “The challenges our marginalized residents face in accessing health care discourage them from visiting a doctor when sick. As a result, individuals in this situation will not seek health care until severely ill, which is worse for their health and worse for the healthcare system.”
Racism is absolutely a public health issue. Some cities have begun to tackle it. The American Public Health Association has highlighted it. We still have so, so far to go.
