Black & Brown Lives and COVID-19

“Black communities are bearing the brunt of COVID-19 throughout the United States… The data show that we are not all at equal risk during this pandemic, and this is a racialized disease.”  Yale Associate Dean for Global Health and Equity, LaRon E. Nelson, PhD, RN, FNP, FNAP, FAAN in a coauthored the paper “Understanding COVID-19 Risks and Vulnerabilities among Black Communities in America: The Lethal Force of Syndemics” for the journal Annals of Epidemiology

The United States is not a particularly good place to get sick if you are on the lower rungs of the American economic ladder. For residents of color, wellness and health are often elusive, and during a pandemic, when often fatal when “fatal” just isn’t a necessary outcome, it is especially bad. Beyond the desperation to earn money for those on the fringes of economic survival, there are the realities of crowded communities and extended families forced into substandard and very tight living conditions. Scarce and overcrowded hospitals, a proclivity of the system to accord second class treatments (if at all) to people of color and given the lack of universal healthcare present in most developed countries, and you get a cruel and highly racist system that simply continues to spread COVID-19 everywhere.

“[In the above-cited report, Yale University Global Health and Equity Associate Dean LaRon] Nelson and his colleagues show that  Black Americans make up 13 percent of the US population but 30 percent of COVID-19 cases in the 14 states for which racial data were available. The paper discusses how multiple historical and current factors are responsible for the Black community experiencing the lethal force of COVID-19. Conditions such as chattel slavery, mortgage redlining practices, political gerrymandering, employment discrimination, healthcare provider biases, and a lack of Medicaid expansion are manifestations of the structural racism that all contribute to this result. 

“Nelson added that because racism is structured into the American social system, the same inequitable distribution patterns will emerge regardless of the disease. For example, Black Americans experience higher rates of underlying chronic conditions, such as hypertension, diabetes, and obesity, which make those individuals more vulnerable to poorer clinical outcomes when exposed to COVID-19. To compound the issue further, Black Americans are 1.5 times likelier to be underinsured or lack insurance altogether than White Americans. This contributes to delayed access to healthcare, including lifesaving care.” Racial Disparities of COVID-19 are a Consequence of Racist Social Structures in Nursing.Yale.edu, June 8^th.

Black does badly; brown doesn’t do particularly well either. Los Angeles is a microcosm of the impact of COVID-19 on Latinos, for both legal residents/citizens as well as the sizeable undocumented population. The lower on the economic ladder, the more necessary is getting back to work. Government payroll and unemployment restrictions on aid combine with the lack of healthcare coverage to make this segment of the population also particularly vulnerable. “‘As Latinos, we have to work,’ [said one undocumented worker in Spanish]. ‘People have to risk their lives to put food on the table. I also support family in my country, so I have to work.’

“David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA's School of Medicine, projected this kind of spike would happen as those Angelenos who could self-isolate did so, while others — particularly low-wage workers of color and those living in dense housing — could not… ‘You have these people that were making it possible for the wealthier families to shelter in place,’ Hayes-Bautista said. ‘But in doing so, they had to expose themselves to the potential of coronavirus infection.’

“In California, Latinos are overrepresented in the service, production, construction and maintenance industries. They are the group least likely to be able to work at home, followed by African Americans, according to a May survey from UC Berkeley. White workers are the group most likely to be able to work at home.

“Many essential workers, like grocery store workers and farmworkers, weren't immediately given the right protective equipment, Hayes-Bautista said… Also, among Latinos and in other communities of color, there are risk factors associated with housing: Families living in tight spaces, densely populated neighborhoods, and multi-generational households, where infected people can more easily pass the virus onto their family members…

“Dr. Don Garcia, medical director of Clínica Romero, whose clinics in Pico-Union and Boyle Heights serve a predominantly Latino clientele, said the positive test rate for the patients his clinics are seeing is much higher than the county as whole… He said 34% of patients at Clinica Romero who have been tested for COVID-19 have tested positive… Countywide, according to health officials, only about 8% of people tested for coronavirus get a positive test result.

“‘I believe that the reason for this is that we are seeing...a very vulnerable population in the sense of their immigration status, their food insecurity, their transportation insecurity,’ Garcia said.” LAist.com, June 9^th. These trends apply to any concentration of Latinos anywhere in the United States. Indeed, outbreaks among Latinos in Midwest meatpacking plants/slaughterhouses, often hundreds of COVID-19 infections within a single facility, become the ignition point for the virus to migrate and explode in the surrounding communities and beyond. Thus, even for the most selfish and uncaring white workers, they are simply exposing themselves to serious risks under the mistaken belief that such lower income, particularly undocumented, workers don’t deserve taxpayer money or care. The virus doesn’t check passports.

Needless to say, in a racially insensitive federal administration, one hell-bent on denial to justify reopening the economy, the biggest missing pieces needed to drive proper decision-making have been the lack of accurate testing and tracking data. The federal leadership required to implement this national priority has been somewhere between woefully inadequate to completely empty, as confirmed even by a very conservative Trump HHS senior administrator:

“A top public health official [HHS Adm. Brett Giroir] in the Trump administration acknowledged Tuesday [6/9] that no national coronavirus response for underserved communities is possible until laboratories that perform diagnostic testing begin to collect race-specific data. Such data will provide insight into whether communities of color that have suffered inordinately in the last several months are receiving the services they need to beat back the disease. 

“‘We can’t develop a national strategy to reach the underserved, or know how well we’re doing, till we have the data that shows us whether we’re reaching them or not,’ … Giroir told lawmakers on Capitol Hill… ‘What I don’t have is the national data to say how many African-Americans have been tested, how many Hispanics have been tested,’ he said in his testimony, referring to two populations that have suffered disproportionately from the pandemic.

“As of late May, COVID-19, the lower-respiratory disease caused by the coronavirus, had killed more than 20,000 African-Americans. Similar statistics for Latinos do not appear to be available, but they, too, have suffered from the coronavirus more than other groups have. In all, about 113,000 Americans so far have died from COVID-19.

“The Department of Health and Human Services recently issued guidance mandating that laboratories must report not only diagnostic test results, as they have been doing, but precise data about each person tested, including age, gender, ZIP code, race and ethnicity. 

“After that guidance was released, the American Clinical Laboratory Association — a trade group that represents industry giants like Quest and LabCorp — issued a statement saying, in part, that improving ‘the current patchwork reporting system will require strong federal coordination and leadership.’ The association said it would work with HHS to ‘gather as much data as possible to respond to the COVID-19 pandemic effectively.’” Yahoo News, June  9^th. We haven’t cared, and this racist administration is scientifically tone deaf anyway.

There is an ugly irony that the throngs of protesters, maddened by the murder of George Floyd and determined to end systemic racism in all facets of American life, have most certainly exposed themselves to COVID-19 in significant numbers. And while many of those protesting represented all racial and ethnic groups, the fact that the largest turnout was by African Americans suggests that, once again, they will suffer new disproportionate COVID-19 infection rates, a sacrifice to make their voices heard, loud and strong. The entire nation should be listening and joining in that battle against racism accordingly. It’s about time!

            I’m Peter Dekom, and can America actually and finally decide to apply long-standing and basic constitutional and morally required values to a class of human beings in this country long denied these basic rights?