America set up black communities to be harder hit by COVID-19

The COVID-19 pandemic is piling on top of a litany of health inequalities in America to kill a disproportionate number of African Americans. In Chicago alone, black residents make up more than half of all cases and about 70 percent of those who’ve died of the disease. That’s despite African Americans only making up about 30 percent of the city’s population.

“Those numbers take your breath away, they really do,” Chicago mayor Lori Lightfoot said in response at a press conference on April 6th. “This is a call-to-action moment for all of us.”

Experts who have long grappled with higher rates of chronic conditions like diabetes, heart disease, and asthma in black communities aren’t surprised. The barriers and biases that laid the groundwork for African Americans to be potentially harder hit in this crisis have been in place for generations, they say. Ensuring better health outcomes in this pandemic or any future public health crisis means addressing those underlying injustices.  

“When you look at [COVID-19] that particularly is virulent for persons who have higher rates of disease, that’s exactly the picture of African Americans. But it’s not their genes. It’s the social conditions that we have created,” says, David Williams, a professor of public health at Harvard whose research has examined how race and class affect health. “I hope this is a wake up call for America.”

It’s hard to get a grasp on how discriminating the spread of the disease in the US really is; limited testing nationwide means we don’t even have a good baseline for how many Americans have contracted COVID-19. Many states aren’t reporting the breakdown of their cases by race, and many localities disclosing the race of COVID-19 patients don’t have demographic data for every single case. The data that we do have, however, is beginning to show a stark divide across the nation. 

In Michigan, African Americans make up a third of all cases and 40 percent of deaths, while making up just 14 percent of the state’s population. And 70 percent of people who’ve died of COVID-19 in Louisiana as of April 6th were African American; less than one-third of the state’s population is black. In Alabama, an equal number of black and white residents have died, but 69 percent of the population is white while roughly 27 percent is black.

“I have seen in my waiting room mostly black and brown patients who are essential workers and service workers who can’t afford to stay home. These are the ones that I see presenting to the clinic with COVID-19 symptoms,” said Uché Blackstock, a physician in Brooklyn and CEO of the company Advancing Health Equity, in an April 6th press call. 

On April 8th, New York — the state that has more than a third of all the cases in the US — released data on race for the first time, backing up Blackstock’s earlier observations. Black New Yorkers made up 18 percent of deaths to COVID-19 in the state (outside of New York City), although they’re just 9 percent of the population. In the Big Apple, Hispanic and black people have died at rates 5 to 6 percent higher than the percentage of the population they make up. 

“The disparities that have plagued this city, this nation, that are all about fundamental inequality are once again causing such pain and causing innocent people to lose their lives,” New York City Mayor Bill de Blasio said in a press conference today. “It’s sick. It’s troubling. It’s wrong.”

Improving the odds for neighborhoods of color, Williams says, will mean addressing the cascade of disparities when it comes to housing, air quality, education, and job opportunities. “Your zip code is a better predictor of how long and how well you will live than your genetic code,” Williams says. 

Chicago has the biggest differences in life expectancies based on ZIP code in the US, according to data from NYU Langone Health. There, the neighborhood with the lowest life expectancy — 60 years — has a population that’s almost 95 percent black. Meanwhile, the neighborhood with the highest life expectancy — 90 years — is predominantly white. 

Without closing those neighborhood-to-neighborhood gaps, Williams fears that the economic fallout from COVID-19 could make health disparities even worse in the future. “Without that investment, I shudder to think of what the long term effects are going to be,” he says. 

COVID-19 is deadlier in people who have preexisting health conditions that weaken their lungs and immune systems. Black Americans were already three times more likely to die from asthma-related causes in 2014, according to the US Department of Health and Human Services. Living in neighborhoods with more air pollution is likely a contributing factor: African Americans were 75 percent more likely to live in places bordering a polluting facility like a factory or refinery compared to other Americans, according to a 2017 report by the NAACP and Clean Air Task Force. They’re also exposed to air that’s 38 percent more polluted in comparison to white Americans, the report found. 

Heightened risks for African Americans are paired with lower rates of being insured and lower median household incomes in comparison to whites, which can limit access to health care. Williams also points out that black households are less likely to have an economic cushion to help them get through the pandemic and its aftermath since they have 10 cents in wealth for every dollar that white households have accumulated. 

While anyone struggling to make ends meet is especially vulnerable right now, Williams points out that people of color face the added burdens of racism and discrimination when trying to get medical care. Racial and ethnic minorities tend to get worse care compared to whites, regardless of insurance status, income, age, or severity of conditions, a comprehensive 2003 report from the National Academies’ Institute of Medicine found. “Across virtually every therapeutic intervention, from the most simple medical procedure to the most complicated, blacks and other minorities receive poorer quality care and less intensive care than whites,” Williams says. He fears the same could be playing out now.

There’s already some early evidence that testing for COVID-19 might have been out of reach for many African Americans, which could lead to a “silent spread” of the disease among black communities, says Syracuse University associate professor Shannon Monnat. States with more black residents and higher poverty rates had lower rates of testing for COVID-19, according to preliminary data published by Syracuse University last week. Those early figures similarly suffer from a poor baseline since testing has been low across the board for all Americans. But Monnat says that places that have large concentrations of vulnerable populations, including racial and ethnic minorities and poorer residents, tend to have poorer health care infrastructure, which could lead to less access to COVID-19 tests.

In response to New York’s newly released numbers, Gov. Andrew Cuomo said that the state would increase its testing in minority communities and conduct research on why the state is seeing those gaps. That’s a late start considering the state has seen an exponential growth in cases for weeks, but it could serve as a lesson for other big cities bracing for a surge of infections. 

“You can almost predict with certainty that already marginalized and vulnerable populations will be getting tested less frequently and less easily than other populations,” says Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University. “They are always at risk for not getting what’s needed, especially and including in times of disaster.”