Beyond the Curve: Dr. Peter Lurie's COVID-19 Blog

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By now, most of us are well aware that Americans do not face equal risks of becoming infected and dying from COVID-19. Not by a long shot.

Thanks to the pandemic, Americans’ average life expectancy at birth will be lowered by two years in Black people, three years in Hispanic people (greatly narrowing their mortality advantage), but by a less than one year in White people, thus widening the existing gap between the races, according to a recent estimate.

In the United States, Hispanic people are 70 percent more likely than White people to become infected with the coronavirus; Black people are 50 percent more likely and Native American people 80 percent more likely. And all three groups are dying from COVID-19 at nearly three times the rate of White people.

Why is this? How can a virus, that has no way of discerning skin color, appear to discriminate among its victims?

Some early commentators blamed high rates of obesity and bad diets among minority groups for the disparities, as these contribute to comorbidities that increase risk of severe COVID-19 and death. But it’s all far more complex and deep-rooted than what people eat. As sociologist Sabrina Strings of the University of California Irvine pointed out last spring, while 42 percent of White Americans and 50 percent of African Americans have obesity, which is associated with hospitalization and more severe COVID-19 illness, this 8-point difference does not even begin to account for the massive disparity in COVID-19 fatalities.

Inequities in who gets infected, who gets sick and what kind of care they receive are all patterned by structural racism, which has gotten so much attention this year. Structural racism refers to the way racism goes beyond individual prejudices and is baked into our policies, laws, and practices. Rooted in historical practices such as slavery and segregation, racial discrimination (intentional and unintentional) continues into the present, exerting its destructive effects.

And to fully comprehend how COVID-19 selectively infects and kills Americans, one must consider disparities across the entire spectrum of the pandemic experience, beginning with exposure, continuing with the disease, and ending all-too-often with death.

It all starts with where people live and work and consequently in differences in exposure to the virus. People of color are more likely to live in multi-generational households in crowded neighborhoods. They’re also more likely to be incarcerated in crowded prisons and jails. And they’re more likely to be residents of under-staffed nursing homes that have fewer resources to combat the virus.

People of color are also less likely to have jobs that can be done safely at home or to have paid sick leave if they become infected. Their work is more likely to be in industries like food service, retail, transportation, and other occupations, dealing up close with people who might be infected with the coronavirus, often without being provided adequate personal protective equipment (PPE). Their chances of avoiding COVID-19 infections are far less than others who can afford to stay at home, who have reliable Internet for work or socializing, and who can pay someone else to deliver food to their door. Census data from 2018 show that 40 percent of Black and Latino workers in the United States are employed in service or production jobs that for the most part cannot be done remotely, while only about one in four White workers held such jobs.

The disparity in COVID-19 victims “really is about who still has to leave their home to work, who has to leave a crowded apartment, get on crowded transport, and go to a crowded workplace, and we just haven’t acknowledged that those of us who have the privilege of continuing to work from our homes aren’t facing those risks,” Dr. Mary Bassett told the New York Times. Bassett is the Director of the FXB Center for Health and Human Rights at Harvard University and a member of the Board of Directors of the Center for Science in the Public Interest.

What happens after one is infected with the virus depends on what care one can afford and what medical resources are available in one’s community. Long before the pandemic, it was clear that inequality existed at virtually every point in our healthcare system, from trying to make an appointment with a physician, to having health care coverage and access to medical care, to getting timely preventive care, and receiving appropriate treatment.  Obamacare and the expansion of Medicaid in some states has helped address these inequities, despite unrelenting efforts to dismantle it by the Trump administration.

Unequal access to health care can mean unnecessary suffering or death, while timely access can be life-saving. For example, when military veterans are diagnosed and treated for prostate cancer in the Veterans Affairs health system, everyone receives the same quality of treatment and Black men are not more likely than White men to die from the cancer. In the civilian world, on the other hand, Black men with prostate cancer die more often.

We’re seeing the same phenomenon with COVID-19. Black and Hispanic Americans are hospitalized more frequently than White Americans with severe COVID-19 infections, in part because they’re more likely to have obesity. But once they receive the same hospital care as White Americans, they’re just as likely to survive the infection.

This pandemic, together with the Black Lives Matter movement, has focused overdue attention on our nation’s structural racism and the health disparities that causes. As of August, more than one-third of the states had launched task forces to examine health disparities in their communities. Corporations are also stepping up. Drug manufacturer Johnson & Johnson, for example, recently pledged $100 million to help eliminate health inequities in communities of color in the United States.

Our nation is now facing the challenge of distributing COVID-19 vaccines initially to those who need protection the most, frontline health workers and the residents and staff in nursing homes, where more than 100,000 have died so far and where the death toll is rising again. But early signs are not promising. Not only have we struggled to vaccinate in general, but, in most states with available data, we are vaccinating Blacks at about the rates of Whites – or even less.

What happens next?  Perhaps, before we choose middle-age and older citizens who are safe at home Zooming and ordering what they need delivered, it should be the front-line workers helping to keep us fed and safe. Those who harvest crops, process meat and poultry, manage warehouses, stock shelves, deliver food to households, run public transportation, and do all the other essential tasks to keep our country moving. Frontline workers are disproportionately people of color, and giving essential workers priority will help address the unequal impact of COVID-19, even if doing so doesn’t address the root causes of the inequity. That disparity will likely continue to plague our nation long after the pandemic recedes.

This post was written in collaboration with Eva Greenthal and David Schardt.

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