Public health officials in cities around the country have identified a disturbing trend: Black COVID-19 patients are being hospitalized and dying at a rate disproportionate to their share of the population.
But it shouldn’t come as a surprise.
“It should not be a surprise to anyone in the United States of America that poor folks and African Americans and even whites who live in certain ZIP codes would have a much more severe disease burden with COVID-19,” said Meharry Medical College President James Hildreth, himself an infectious disease expert, on Tuesday.
It’s not that vulnerable populations are more likely to catch the disease — the fact is that, when they do, their disproportionate instances of underlying health conditions and other political and cultural circumstances seem to result in worse outcomes. Still, Nashville and state authorities have so far refrained from reporting (and in some cases, collecting) racial and ethnic data related to the virus’s spread.
That could change as soon as today, state Health Commissioner Lisa Piercey said. She added that the delay was due to the risk of reidentification (the ability for the public to identify individual instances of a disease, which could conflict with medical privacy laws). But with the numbers of cases rising, it will be easier to report racial and ethnic data and still keep individuals anonymous.
“It’s important to make sure we’re maintaining access across all ethnicities and to eliminate or mitigate any disparities that we might identify,” Piercey said Monday.
She had not yet reviewed the data, and so she could not point to any trends or disparities. Nashville Mayor John Cooper, however, suggested Tuesday that the city was not experiencing the same health disparities seen in cities including Chicago and Milwaukee.
The hospitalization rate “seems to reflect the demographics as a whole,” the mayor said. But Dr. Alex Jahangir, chair of the Metro Board of Health, said the city still did not know the race of nearly half of the city’s patients who ended up in hospitals. He directed city officials to begin collecting race and ethnicity data with hopes of reporting it publicly “as soon as possible.”
“The people this virus impacts the most are those individuals who are most vulnerable medically,” Jahangir said. “This happens to be disproportionately minorities and those that have limited access to health care.”
Dr. Consuelo Wilkins, vice president for health equity at Vanderbilt University Medical Center, agrees that it should come as no surprise that black people would see worse outcomes from the disease. She suggested that worse water quality could decrease the efficacy of hand washing and that more crowded housing situations make social distancing more difficult. Medical conditions like hypertension, asthma and diabetes — conditions that are more prevalent in African American communities — make fighting COVID-19 more difficult, too.
“There are structural, political, social and cultural disparities that have existed for a long time that make these populations more vulnerable,” Wilkins said. “In a pandemic, we're going to see those disparities perhaps even more pronounced.”
The issue has drawn the attention of some in the federal government, too. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said this week that the spread of coronavirus was “shining a bright light” on pre-existing health disparities in minority neighborhoods.
“When all this is over — and as we said, it will end, we will get over coronavirus — but there will still be health disparities which we really need to address in the African-American community,” Fauci said.
