Racial Disparities in COVID-19

Though some media coverage has (rightfully) focused on the increase in racism against Asian-Americans in the context of the pandemic, the virus has broader impacts on racial inequality.

Racial and socioeconomic disparities in health care access and outcomes for a variety of diseases have been well-documented and studied by those working in public health. Unfortunately, COVID-19 has proved to be no exception.

There are many different ways to see this statistic. In Michigan, over 40% of COVID deaths are Black Americans, though they comprise only 14% of the population; similar disparities have been seen in California, Illinois, Louisiana, and Minnesota among other places. Preliminary CDC findings from March of this year show that across a sample of counties in 14 states (selected to be nationally representative), Black residents accounted for 18% of the population but 33% of all COVID-related hospitalizations. A JAMA article from early May also notes that both Black and Latinx populations both have an increased susceptibility to COVID-related mortality. A recent study from Yale conducted across 28 states finds that after accounting for age, Black people are 3.57 times more likely to die from COVID-19 than their white counterparts. This project from The Atlantic is another comprehensive resource.

It’s important to note that this isn’t the only way in which the pandemic has had differential impacts on communities of color: data from the Brooklyn District Attorney’s office show a disproportionate number of arrests for violating social distancing measures occurring in black communities. Further, some Black Americans have reported apprehension about wearing masks in public due to fears that wearing masks may increase their risk of being racially profiled and seen as threatening.

But what is causing these disparities? So far, the unequivocal consensus is that poverty, household crowding, and racialized economic segregation in addition to underlying systemic inequities in health insurance coverage, labor policies, and geographic distance to medical facilities are the main culprits. An additional potential factor is advanced aging caused by persistent external stressors (e.g. racial descrimination) which, in turn, has been linked to co-morbidities (namely cardiovascular disease and diabetes) that have been shown to increase risk of severe Sars-CoV-2 infection. It’s easy to imagine why certain factors (e.g. a more crowded household, a longer distance to the hospital) might increase the prevalence of the virus in a given community and these sorts of racial disparities have been well documentedin the public healthliterature. Data from Europe and Africa corroborates these mechanisms.

Understanding the factors driving these trends is critical here. A recent New England Journal of Medicine (NEJM) article explains why. First, these findings out of context have the potential to perpetuate incorrect ideas about inherent biological differences between races, in particular the long-debunked-but-still-widely-believed myth that there are fundamental physiological differences between the respiratory organs of Black people and people of other races. This has translated into the belief that Black people are getting infected at higher rates due to an inherently higher biological susceptibility to the disease. Inversely, some people have come to believe that comparatively low rates of COVID-19 infection in Africa indicate that people of African descent have some baseline level of immunity to the virus. Let’s be clear: none of these theories have been backed by any sort of evidence.

The article further notes that a lack of context and understanding about the real causes of these racial disparities can lead people to assume that racial minorities engage in irresponsible or unhygienic behavior that increases their odds of contracting the disease. This explanation has also historically been applied to other racial groups, namely Latinx and Asian populations. Again, this is unequivocally false.

Third: though there is certainly value in the geographic disaggregation of COVID-19 data, this should be done (and reported about) cautiously. Discussing elevated prevalence of the virus in marginalized communities without nuance has the dangerous potential to further stigmatize these places and cause even lower rates of investment and engagement in neighborhoods that are already underfunded.

And lastly, the erroneous assumption that the virus is only a problem of marginalized communities is likely to increase the probability that people dismiss this disease as only being a problem for certain groups of people (this kind of rhetoric can make it easy to dismiss COVID-19 as a “Black disease” just as AIDS had at one point become a “gay disease” though obviously, all people have the potential susceptible to both infections). The authors of the paper note that COVID-19 is currently affecting so many people across the US that this is unlikely to be an issue in the immediate future, but this may become more concerning as wealthier communities are better able to shelter themselves from the virus going forward.

In writing about these problems, the authors of the NEJM article offer a number of suggestions on responsible data collection and reporting practices. With respect to the immediate problem of accurately monitoring trends in COVID-related mortality and morbidity, the authors of the article recommend collecting both socioeconomic and racial information whenever data about the virus is collected. This is especially important given that many municipalities are not even collecting relevant data (e.g. on the total number of people in the ICU or on ventilators) systematically, let alone broken down by race or income.

Better data of this type will help provide insight on when race and class contribute (and help parse out the relative contributions of each) to the prevalence of the virus in certain areas or among certain populations. The authors further suggest highlighting the connections (whenever these disparities are discussed) between COVID-related health disparities and upstream forces such as persistent underinvestment in minority communities, a lack of access to medical resources in minority communities, and racialized economic inequality.