Racism and coronavirus in America: A tale of two pandemics
COVID-19 has dealt major damage to every part of the U.S., but minorities are feeling its effects far more than their white counterparts.
COVID-19 has killed more Americans in two months than were killed in the 20-year Vietnam War, with death tolls rising above 67,000.
As dark as this reality may seem, there’s an even uglier one simmering below the surface: The virus is disproportionately affecting a higher percentage of minorities throughout the country, exposing decades of deep-rooted, institutionalized racial and ethnic disparities spread across health and socioeconomic differences.
Health and societal factors
The Centers for Disease Control and Prevention lists four primary factors to explain why racial and ethnic minorities have become more vulnerable to COVID-19 than whites: Living and work circumstances, underlying health conditions and lower access to health care.
People of color are more likely to live in highly dense population areas because of institutional racism manifested in residential housing segregation, which makes it more difficult to practice effective social distancing measures. Many racial minority members live farther away from medical facilities and grocery stores than white people, which makes stocking up on supplies and receiving medical care during a pandemic harder to accomplish. Black Americans were almost 70% more likely to live in a zip code with a shortage of doctors than their non-black counterparts, according to the National Institutes of Health.
Multi-generational households tend to be more common in minority families, which can put older family members at a higher risk of infection and death in crowded spaces. Incarceration rates among racial minority groups are profoundly overrepresented in the U.S. prison population, putting individuals at an exponentially higher risk of contracting the virus due to cramped and unsanitary living conditions.
Pre-existing health conditions also have a huge effect on coronavirus cases; 90% of the most serious COVID-19 cases involve patients with a history of health complications such as hypertension, cardiovascular disease, diabetes, obesity, chronic lung disease, congestive heart failure and asthma. Since data shows that people of color more frequently live in congested, high-density areas with higher levels of pollution than white people, this increases the risk they have of suffering from other respiratory illnesses as well.
Critical workers in essential industries, who are at a higher risk of being infected compared to many people who can work from home, are also overrepresented by minorities. Jobs in the service sector employ nearly a quarter of all Latinx and African American workers compared to 16% for non-Hispanic whites — and many of these individuals face economic circumstances that cause them to feel the need to keep showing up to work despite coronavirus outbreaks in their community. People of color are also more likely to rely on public transportation to get to work, which further increases the risk of virus exposure.
Latinx Americans are almost three times as likely as whites to not have health insurance, and blacks are nearly twice as likely as whites to not have health insurance. The C.D.C. lists financial implications, language barriers and long-standing distrust of the health systems as a few of the reasons why so many minorities have inadequate access to health care.
“We need to understand that people’s health is not a direct result of their behaviors and actions,” said Dr. Lisa Cooper, distinguished professor at the John Hopkins Bloomberg School of Public Health and John Hopkins School of Medicine and director of the John Hopkins Center for Health Equity. “People’s individual actions and behaviors do play a role in health. But the environments in which they exist and the policies that we put in place that shape people’s opportunities actually determine what choices they have to make.”
‘Weathering’ onset by unequal access adds to risk
Medical experts have come to understand that the accumulated effects of these physical, psychological and environmental factors over long periods of time lead to higher rates of poor health for people of color at earlier ages. Dr. Arline Geronimus from the University Of Michigan School Of Public Health coined the term “weathering” to describe the conclusion that “racial inequalities in health exist across a range of biological systems among adults and are not explained by racial differences in poverty.”
Former president of the American Public Health Association Dr. Camara Phyllis Jones uses “accelerated aging” to describe the same process. “We have evidence that the wear and tear of racism, the stress of it, is responsible for the differences in health outcomes in the black population compared to the white population,” she said, which can be applied to all minorities currently affected disproportionately by the coronavirus.
COVID-19 by the numbers: N.Y.C. case study
The most comprehensive evidence of coronavirus racial disparities can be seen in the world’s deadliest hotspot, New York City. 659.9 out of 100,000 African Americans contracted cases that did not require hospitalization, compared to 475.8 out of 100,000 Latinx Americans, 494.3 out of 100,000 white Americans and 231.9 out of 100,000 for Asian Americans as of April 27, according to New York City’s Department of Health and Mental Hygiene.
Racial disparities run deeper in the Big Apple when examining both non-fatal cases that required hospitalization and cases that led to death. For non-fatal hospitalized cases, 379.9 cases out of 100,000 for black patients, 298.6 out of 100,000 for Latinx patients, 162.5 out of 100,000 for white patients and 132.6 out of 100,000 for Asian patients. And for cases where patients were confirmed to have died from COVID-19-related complications, the rates stood at 209.4 out of 100,000 for black, 195.3 out of 100,000 for Latinx, 107.7 out of 100,000 for white and 90.8 for Asian Americans.
African Americans, Latinx Americans, non-Hispanic Caucasians and Asians make up 24.3%, 29.1%, 42.7% and 13.9% of New York City’s population, respectively. But out of 17,682 total deaths (confirmed and probable), black people make up 30.5% of deaths, Latinx people 29.7%, white people 28.6% and Asian people 7.9%.
And across the U.S.
In St. Louis, black people make up 45% of the city’s population but account for 66.4% of confirmed cases and 75.4% of deaths. Black Chicagoans total 30% of the city’s population but account for 38.4% of cases and 53% of deaths. San Antonio has a black population of just 6.9%, yet they account for 9.6% of cases and 25% of deaths. And in Washington D.C., black people account for 48% of cases and 79% of deaths, despite making up 46.9% of the U.S. capital’s population.
Michigan currently has the third most deaths of any state at more than 4,000, with African Americans accounting for 32% of cases and 41% of deaths despite making up only 14% of the population. This comes during the midst of multiple standoffs at the Michigan State Capitol initiated by armed gunmen and protestors intent on pressuring state lawmakers to reopen the state.
Michigan’s Lieutenant Governor Garlin Gilchrist told the Guardian that the virus makes it harder for people of color to come together for support the way they could in past crises. “This is something that’s very real for communities,” said Gilchrist. “I live in Detroit and part of the reason that communities of color are so anxious is because typically, when something so frightening is happening we come together to cope with it as a community. And this virus has made the act of coming together, dangerous and deadly.”
Overrepresentation of COVID-19 infections and fatalities among black populations can be seen in many other states that have supplied some demographic data on race for cases and deaths. In Louisiana, black people make up 32% of the population but almost 59% of deaths. Black people make up 27% of South Carolina’s population, but account for 44% of cases and 53% of deaths.
The Georgia Department of Public Health and eight hospitals in Georgia looked at characteristics and clinical outcomes of adults hospitalized by COVID-19 in March under a recent C.D.C. study. Out of 297 hospitalized patients in which information on race was available, 83.2% of them were black compared to 10.8% white, 3.4% Hispanic and 2.7% Asian or Pacific Islander.
Some states with smaller populations of minorities that have released race data on COVID-19 patients do not fare any better when it comes to existing racial health disparities. North Dakota has one of the smallest percentages of black people living within the state at 3.4%, yet they account for 19% of cases, whereas white people only account for 32% of cases while making up 84.4% of the state’s population. And in Wisconsin, coronavirus death rates are more than five times greater than what the state’s population indicates; black people make up 6% of the population but account for 23% of cases and 32% of deaths.
In some places where African Americans are not the largest minority group, others are disproportionately affected
For example, a few miles west of D.C. in Fairfax County, Latinx people account for 16.8% of the population, but make up 53% of the 4,101 coronavirus cases there. Meanwhile, the black population is 10.6% of Fairfax’s makeup, but current data shows they account for 10% of cases within the county. Racial data for the county’s 157 deaths are not currently provided.
And in New Mexico, Native Americans make up 10.9% of the state’s population, which is a far higher amount than the country’s total Native American composition of 1.7%. But data from New Mexico’s Department of Health indicates that Native Americans make up 53.41% of coronavirus cases, while it does not provide details on the fatality count.
Many states have incomplete data or are choosing not to share
With the U.S. now at over one million confirmed infections and growing, there are still many states that have not yet released racial and ethnic breakdowns of their coronavirus statistics on cases and deaths. Information compiled by John Hopkins University’s Coronavirus Resource Center breaks down which states have released COVID-19 data by race along three factors: confirmed cases, deaths and testing. Nine states still have not released data on confirmed cases by race, 12 states have not released data on deaths by race and 48 states have not released data on testing by race, as of publication.
Senators Elizabeth Warren of Massachusetts, Cory Booker of New Jersey and Kamala Harris of California alongside House Representatives Robin Kelly of Illinois and Ayanna Presley of Massachusetts — all from states hit hard by COVID-19 — urged the Department of Health and Human Services to reveal racial data on testing and treatment for the virus in a letter sent to H.H.S. Secretary Alex Azar on March 27.
“Although COVID-19 does not discriminate along racial or ethnic lines, existing racial disparities and inequities in health outcomes and health care access may mean that the nation’s response to preventing and mitigating its harms will not be felt equally in every community,” the Congress members wrote. “Lack of information will exacerbate existing health disparities and result in the loss of lives in vulnerable communities.”
More than a month later, the facts on the ground support their claim: Although black Americans represent just 13% of the population of states that have so far reported racial and ethnic information, they account for almost 34% of all COVID-19 deaths in those states, according to the John Hopkins Coronavirus Resource Center. And even in states which have made some data available, a lot remains missing — or withheld.
Georgia only has data on race for 40% of its cases; Georgia Health Department communications director Nancy Nydam said that part of the problem is because the information was left out on many reporting forms by doctors, health care providers and testing facilities.
Pennsylvania and Massachusetts — which combined currently have more than 110,000 cases and 6,000 fatalities — are missing data on race for 50% to 70% of their cases because many health care providers never submitted completed reports that included ethnicity. In Arizona, where 31% of the population is Latinx, and Native Americans, blacks and Asians make up 5.3%, 5.1% and 3.7% of the population, race and ethnicity are unknown for 36% of the state’s coronavirus cases.
Meanwhile, Los Angeles County, California, has 23,142 confirmed cases, but its health department lists 10,174 (44%) as “under investigation” beneath the race and ethnicity demographic column.
Some public health officials claim that much of the blame for incomplete information on the country’s COVID-19 race data can be placed on the federal government, as it never declared standard requirements for what state health departments should include within their data. The federal government’s severely retroactive response has led some experts in the field to believe this has created an atmosphere in which states can avoid accountability by choosing what information to divulge to the public.
In a rare glimpse of good news, many states increasingly seem to be making race data on coronavirus deaths more available to the public. More than two weeks ago, only a third of COVID-19 deaths made mention of a known ethnicity — but by April 30, racial data on the deceased became available for 82% of deaths from the states that have provided data.
Coronavirus highlighting systemic issues
Coronavirus cases overloading hospitals, doctors and nurses — coupled with a questionable push to end social distancing protocols across states — highlights the larger issue of resolving health and socioeconomic disparities along racial and ethnic lines ingrained by generational, institutionalized racism.
“These disparities are real, they are deep and they are exacting a terrible price,” Dr. Clyde W. Yancy told the New York Times. Dr. Yancy, who is chief of cardiology in the medicine department at Northwestern’s Feinberg School of Medicine, published an article online in The Journal of American Medical Association about the unfortunate connection between black people and COVID-19. He grew up during segregation in Baton Rouge and has studied race health inequalities for much of his life.
“If there ever was a moment to have a rallying cry, to have a call to action, to have a wake-up call, there should be a moment of epiphany right now” Yancy said. “And that epiphany should be: This is not the way a civil society allows its population to exist.”
Versión en español, traducida por Carlos Alfaro Rodriguez
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