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Data and COVID-19: It Didn’t Take A Pandemic to See the Disparities

It has been said, ignorance perpetuates ignorance. We are three months into the COVID-19 pandemic and there is still a lot we don’t know about the virus. Testing is hard to come by in communities of color, there is no FDA approved treatment and we’re 18 months away from a vaccine to prevent the spread. But one thing we do know is that the rates of infection and death rates among Blacks and Latinos are significantly higher than their White counterparts, especially in densely populated cities, such as New York, New Orleans, Detroit, Washington, DC, Milwaukee and across the South. 

According to Black Demographics, the numbers are dire. In Detroit, 40 percent of deaths have occurred among Blacks. In Chicago where 30% of the city’s population is Black,  70 percent of COVID-19 related deaths are among Blacks and a shocking 81 percent of deaths were among Blacks in Milwaukee which has a Black population of less than 27%. Black Americans get COVID-19 at 2-3 times the rate of white Americans.

While local and state health departments may collect data on the novel COVID-19 virus by gender and race, the US Centers for Disease Control and Prevention (CDC) does not collect all of that data.  As of April 8, the CDC had collected data from only 14 states on 1,482 patients 580 of whom were hospitalized. Even with limited data, disparities were clear. Of the 1,482 patients, 59% were white and 18% were black. However, of those hospitalized, 45% were white and 33% were Black.  Note: as of April 8, over 430,000 cases in the US had been confirmed.

As recently as last week, the public was told by the President that any person could be tested at any time. Not so. The available data shows that a shortage of tests has made universal testing impossible and people across the US report needing authorization from a healthcare provider in order to receive a test even at drive-thru sites. And now that there are more tests available, there are few testing sites that serve the needs of the Black community. Sites in major cities tend to be located in suburbs or in wealthier sections of town, in or closer to major hospitals.  Many community-based organizations are offering testing to the general public…for a price. In Atlanta, several churches offered drive-thru testing for as much as $150. The small print on flyers stated that individuals could be reimbursed by their insurer – assuming they had health insurance. What the flyers didn’t say is that Medicare reimbursement for COVID-19 tests will be about $36 for the CDC -approved test and $51 for those created in house or by other entities. And, by the way, the reimbursement is to the laboratory conducting the test. Testing for COVID-19 is free for the public.

The COVID-19 crisis is revealing what public health professionals have known for more than 30 years: there are serious structural barriers to accessing healthcare for Black and Brown populations and for low income people. 

In a recent Democracy Now broadcast,  Camara Jones, M.D., a family physician, and leading expert on racial disparities and health equity said, “COVID-19 is just unmasking the deep disinvestment in our communities, the historical injustices and the impact of residential segregation.” Dr. Jones added, “the outbreak reflects similar outcomes for African-Americans in terms of disproportionately high rates of maternal death, low levels of access to medical care and higher rates of asthma.” But without complete and accurate data by race, any efforts to address the disparities are undermined. This is why we need a national COVID-19 disease registry. As with other databases, such as cancer registries, we would have a much better understanding of who is getting infected, where, under what circumstances and what treatment outcomes are occurring.  

While the federal government is not collecting this kind of data, others are finding ways to tease out the impact on Black communities.  The biotech data firm Rubix Life Science reviewed recent billing information in several states and found that a Black person who comes to a provider with symptoms like cough and fever was less likely to be given a diagnostic test than her White counterpart. And as resources such as hospital beds and ventilators are increasingly scarce, it also begs the question as to who has access when black and patients may not live near better equipped hospitals. 

It is estimated that there may be as much as a 40% undercount of COVID-19 deaths in New York because those who die at home, never having been diagnosed or seen by a provider, will never be tested.  

We know that much of the mortality we see in black COVID-19 patients is due to underlying chronic disease conditions. Of course, one must ask, why there are such high rates of underlying chronic disease conditions?  Lack of access to quality care, lack of health insurance, low-wage or inadequate employment, lack of affordable, healthy food and provider bias are just a few of the structural inequities borne out of historical racism black and brown people face every day. This explains the high rates of chronic disease and COVID-19 infections and deaths. And who is still working during this pandemic?  A disproportionate number of black and brown people. Physical distancing is not an option for them.

The data we have does not support this statement by Director of the NIH Institute of Allergy and Infectious Diseases, Anthony Fauci,: “African Americans aren’t necessarily being infected more, underlying health conditions like diabetes, her tension, obesity, and asthma are leading to a higher rate of deaths among those in the Black community.”  

They are, in fact, being infected more. 

Without a registry that contains comprehensive surveillance and population-based testing and diagnostic data coupled with the failure to report this data by race/ethnicity and gender, we will never know the true extent of COVID-19 among Black Americans and Latinos.  Let’s not let ignorance perpetuate death.

Linda Goler Blount, MPH, is President of the Black Women’s Health Imperative, an epidemiologist and a Public Voices Fellow of The OpEd Project.

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