Buzz
Certain communities have been disproportionately impacted since COVID-19 arrived in the United States. According to CDC data shared with The New York Times, Black and Latino Americans were three times more likely to contract the virus and twice as likely to die from it between March and May compared to white Americans. Many Native American tribes have also faced stark disparities, with the Navajo Nation experiencing some of the highest infection rates in the nation.
There is no single cause behind the racial disparities seen in COVID-19 outcomes. Instead, the trend results from various forms of systemic racism that increase the vulnerability of Black, Latino, and Indigenous populations to the virus and its effects. Mytour interviewed experts in bioethics and healthcare to explore how COVID-19 has disproportionately affected people of color in the U.S.
1. Existing health conditions play a significant role.
Patients with specific underlying health conditions are at higher risk of developing severe COVID-19 symptoms. These include chronic kidney disease, hypertension, obesity, asthma, and diabetes—conditions that disproportionately impact nonwhite Americans. Black women in the U.S. are 20 percent more likely to suffer from asthma compared to white women, while Black individuals are four times more likely to experience kidney failure.
2. These preexisting conditions are often a result of systemic racism.
It’s not that nonwhite Americans are inherently more prone to these health issues. The racial disparities arise from environmental factors, living conditions, economic challenges, and restricted access to healthcare. Centuries of systemic racism have compounded these disadvantages, particularly impacting communities of color. As Dr. Geno Tai, M.D., an infectious diseases resident at Mayo Clinic and coauthor of a study on the unequal impact of COVID-19 on racial and ethnic minorities, explains to Mytour, “The root of these disparities lies in social injustice and systemic racism.” He highlights that policies like redlining have deepened poverty among African American households and left their neighborhoods under-resourced long after these policies ended.
Dr. Utibe Essien, M.D., an assistant professor at the University of Pittsburgh School of Medicine and coauthor of a different study on COVID’s racial disparities, shares a similar perspective with Mytour. He points out, “The food insecurity, impoverished neighborhoods, and poverty are major contributors to many clinical diseases. Limited healthcare access—whether due to insurance issues or systemic biases—also exacerbates chronic health risks.”
3. People of color are at a higher risk of exposure to the virus.
Black and Latino Americans not only face a higher risk of severe COVID-19 symptoms but are also more likely to contract the virus in the first place. This is largely due to the fact that their jobs and living situations often make it difficult, if not impossible, to maintain safe social distancing.
While many have had the opportunity to work remotely in recent months, this hasn't been possible for those in frontline roles that can't be done from home. These essential jobs tend to offer lower wages and lack benefits like paid time off. For these workers, practicing social distancing often means making the tough decision between their health and their livelihood. Harriet A. Washington, a bioethics professor at Columbia University and author of A Terrible Thing to Waste and Medical Apartheid, tells Mytour, "Telling people not to go to work, avoid public transit, or interact with others simply doesn’t work for those with no other option. These essential workers—those who clean, serve food, or drive trains—have no choice but to go to work. If they didn't, they would lose their jobs."
4. Communities of color face significant barriers to accessing COVID-19 testing.
When people of color fall ill, they often face greater difficulties in accessing COVID-19 tests compared to white Americans. Testing centers are often located in predominantly white neighborhoods, and white individuals are more likely to have health insurance and consistent access to a physician.
Testing has been recognized as a crucial tool in combating COVID-19, and unequal access to testing severely undermines containment efforts. Dr. Essien explains, "Without testing, we lack accurate information on who is infected. Without testing, we can't carry out effective contact tracing to determine who was exposed and who caused the exposure. And without testing, we are hindered in allocating resources such as treatment, protective equipment for healthcare workers, and in considering vaccination efforts in these communities as well."
The racial disparities in COVID-19 may actually be more pronounced than official statistics suggest, due to unequal access to testing.
5. The racial disparities in COVID-19 outcomes are even more significant when adjusted for age.
Along with preexisting health conditions, age is another major factor influencing the severity of COVID-19. Older individuals are at greater risk of severe illness and death from the virus, but the racial disparity in older patients is not as stark as it is among younger age groups. This is because the senior population in the U.S. is predominantly white. Dr. Essien explains, "Unfortunately, white Americans tend to live longer, and thus, the older population in our country is more likely to be white."
For his study, Dr. Essien and his colleagues adjusted for age to provide a more accurate understanding of the racial disparities in COVID-19. The findings revealed an even greater disparity than the raw numbers indicated. “The younger individuals who were dying were coming from vulnerable and marginalized groups. This is deeply concerning,” he says. “By adjusting for age, we move beyond the idea that this is just a problem confined to nursing homes.”
6. People of color face a greater impact from COVID-19, regardless of where they live.
In the early months of the pandemic, the New York City metro area was hit hardest, leading some to speculate that dense urban centers were more vulnerable to the virus. Since cities tend to have larger nonwhite populations than rural areas, the virus’s racial disparities seemed amplified. However, the disproportionate impact of COVID-19 on communities of color cannot be solely attributed to the virus’s initial concentration in cities. An analysis by The New York Times shows that the disparity extends across the entire country, including suburban and rural areas. In fact, many current COVID-19 hotspots are located outside of cities, with rural counties facing their own unique vulnerabilities to the disease.
7. Native American reservations face significant challenges in combating the virus.
Native American reservations have been among the hardest-hit communities by COVID-19. In the Navajo Nation, with a population of nearly 174,000 in 2010, 8593 people have tested positive for the virus, and 422 have died as of July 19. Indigenous people living on reservations face the same risk factors as people of color in other parts of the U.S., including higher rates of preexisting conditions. Additionally, reservations often lack essential infrastructure for pandemic response. On the Navajo reservation, 30 to 40 percent of residents lack running water, making it impossible to properly wash hands. Furthermore, reservations do not have the tax base that state and local governments do, and when non-essential businesses closed, many of their regular revenue sources vanished. These challenges make providing healthcare and other resources even more difficult during a critical time.
8. The racial demographic data on COVID-19 is incomplete.
To effectively address the racial disparities in COVID-19, accurate demographic data is essential. While some reports are emerging, the data remains incomplete. The New York Times was only able to publish its recent report after suing the CDC, and the documents released by the CDC were missing race and ethnicity information for more than half of the cases. Dr. Essien shares that, in his research for a study released on May 11, only 28 states were reporting race and ethnicity data related to coronavirus testing. One reason for the early lack of data may have been privacy concerns, but as the pandemic becomes a national crisis, Dr. Essien hopes that these issues will no longer be an obstacle.
Some within the medical community argue that publishing more data on COVID-19’s racial disparities could exacerbate the issue. However, Essien disagrees with this view. He explains, 'There's also anecdotal concerns that releasing race and ethnicity data would racialize the disease. If we see that certain communities are being hit harder than others, especially if they are minority communities, then people are going to forget about the disease and not take it seriously. I think that is a really concerning mindset if it's had by policy-makers or public health officials. The data drives so much around how we respond to this disease, so the more we have, the more we are helping those communities that are being most influenced.'
9. COVID-19’s racial disparity mirrors historical patterns.
Although much remains unknown about the relationship between COVID-19 and race, this issue is not entirely unprecedented. Similar patterns were observed in previous viral outbreaks and pandemics.
As Washington points out, 'There's little about it that's truly novel. We saw the same thing with HIV infections in the 1990s. We discovered that people of color were being infected disproportionately. The same thing happened with Hepatitis C.'
Even as COVID-19’s demographic data becomes clearer, medical experts can look to historical patterns to help combat the current crisis. Essien reminds us, 'I always like to remind folks that back in 2009 with the H1N1 flu pandemic, we saw very similar disparities around access to testing, access to treatments, and death in Black and Hispanic communities compared to white Americans. So we have a lot of lessons to learn from just 10 years ago. We don’t even need to go all the way back to 1918 like many do.'
10. The medical community must foster trust with people of color.
While trust in the medical community is generally low among all racial groups in the U.S., it is particularly low among Black Americans. According to the Pew Research Center, only 35% of Black Americans trust medical scientists to act in the public interest, compared to 43% of white Americans. This disparity is rooted in racism within medicine. 'We have known for a very long time that African American reports of symptoms, especially pain, tend to be discounted,' says Washington. In a 2016 study, nearly half of the surveyed medical students believed that Black patients experience pain differently from white patients.
During a pandemic, distrust in the healthcare system can be life-threatening. The medical community must earn the trust of Black Americans and other marginalized groups to save lives. 'The question often evoked is, 'Why don't African Americans trust the healthcare system? Why are they so fearful?' Washington asks. 'These are all the wrong questions. The real question is: Why is the American healthcare system so untrustworthy that large swaths of people don't trust it, even when they're ill?'
Rebuilding trust can begin at the doctor-patient level. 'Medical professionals should focus on providing exceptional care to all patients while considering their social circumstances,' says Tai. 'Implicit bias among clinicians is a widespread issue, so clinicians must constantly reflect on this.'
However, addressing the racial disparities we are witnessing with COVID-19 requires large-scale efforts as well. According to Essien, one of the most important steps that policymakers and medical professionals can take in the short term is to listen to the communities most affected. 'A lot of how we are going to be able to get these communities to trust us, which I think trust plays a big role in all of this, is to actually talk to them, is to hear what the Black and Hispanic and Native American communities who are being hit the hardest need from us in this moment,' he says. 'We can't just assume that they want the vaccine first, for example. We can't just assume that they want the government coming into their communities, into their churches, or barbershops and offering testing. They might feel like that's not appropriate in their different spaces. So actual communication, strong, thoughtful communication, with those communities is really critical.'
