Researchers face hurdles in examining COVID-19 racial disparities

As the country reels from days of unrest in major U.S. cities as Americans protest police brutality and racial inequality, researchers are working toward quantifying the disproportionate impact the coronavirus pandemic has had on minority communities. 

What they are finding is that preexisting racial disparities in the United States contribute to more coronavirus-related deaths among minority groups while also making it difficult to quantify the differences. 

Though most U.S. states report some coronavirus data broken up by race, much of it is incomplete, primarily due to the fact that some private labs don’t collect racial data. 

An April analysis from the Kaiser Family Foundation found that in the majority of states reporting data that include race and ethnicity, black people and Latinos account for a higher share of confirmed cases and deaths compared to their share of the total population. 

But the numbers that exist alone don’t tell the full story. 

Researchers at Yale found that, when adjusted for age, preliminary data analysis suggests that Latinos, who are collectively younger than white Americans, face a significantly higher risk of death than is reflective in raw data. 

In Wisconsin, data suggests black COVID-19 patients are 18 times more likely to die of COVID-19 than white patients, while in Pennsylvania data suggests they are only slightly less likely to die from COVID-19 than whites, Yale found. 

Knowledge remains limited in part because, according to information collected by Johns Hopkins University, only four states track testing by race.

Havidan Rodriguez, president of the State University of New York at Albany, was appointed by Gov. Andrew Cuomo (D) to study the impact of COVID-19 in minority communities and work toward increasing testing in those communities.

His team of researchers are exploring the following factors: Housing and food security; an individual’s ability to work remotely; how individuals learned about the danger of COVID-19; their level of risk and what options for testing were available to them; the availability of health insurance coverage and access to health care; and existing mental and behavioral health diagnoses.

“These are situations and issues that have existed long before COVID-19 and they are broad,” Rodriguez said, adding that disproportionate impacts are visible in nearly every crisis America has faced.

“Every time we have an emergency or disaster — would be Hurricane Maria, Hurricane Katrina … all of a sudden these issues, once again, are at the forefront,” Rodriguez said. “They were not created by COVID-19, but they are indeed exacerbated by it.”

According to the Centers for Disease Control and Prevention (CDC), minority Americans tend to live in multigenerational housing in densely populated areas. They are also more likely to be further from grocery stores and medical facilities.

Minority populations are also overrepresented in jails, prisons and detention centers — where outbreaks have been common — and are more likely to work in essential industries without paid sick leave, the CDC found.

Carlos Rodriguez-Diaz, an associate professor at the George Washington School of Public Health, noted that undocumented people also tend to lack labor and health protections guaranteed to U.S. citizens. 

“[Latinos] are also often challenged by the fact that it’s very hard to get a job. So once they have one, they want to keep it, even when the conditions are not necessarily conducive to staying healthy,” he said. 

Health literacy is typically lower in communities of color, partly because health information is tailored for an English-speaking audience before it is translated to other languages. 

In Latino communities, particularly those of relatively recent immigrants, misinformation spread on the online messaging app WhatsApp and Facebook is rampant.  

“I think one solution that we have is to make sure that we respond with strategies that are culturally congruent with the Latino communities in the United States,” Rodriguez-Diaz said.

Stephen B. Thomas, director of the Maryland Center for Health Equity, said black Americans tend to distrust government institutions, including public health agencies, because of a “cultural memory of when people in white coats came and said ‘I’m here to help you,’ and instead they were there to abuse them.”

“You cannot disconnect what’s happening in Minneapolis from what’s going on with COVID-19,” Thomas said, referring to the death of George Floyd, a 46-year-old black man who died in police custody last week.  

A video of former Minneapolis police officer Derek Chauvin kneeling on Floyd’s neck for about eight minutes as he indicated he could not breathe and pleaded for his mother went viral last week, leading to massive unrest in Minneapolis and dozens of major U.S. cities. 

“[The message] that that sends to many black people and other people of color is: We don’t matter. And if COVID-19 is taking us out at greater proportions, the government doesn’t care,” Thomas added. 

Most scholars agreed that focusing resources on disproportionately impacted communities is likely to have a positive impact on the population as a whole. 

For example, the Department of Health and Human Services has begun focusing anti-HIV resources in the 48 U.S. counties, Washington, D.C., and San Juan, Puerto Rico, where 50 percent of new HIV diagnoses in 2016 and 2017 occurred. 

“And the approach that has been taken for the HIV epidemic globally is precisely investing more in the communities that are disproportionately affected,” Rodriguez-Diaz said.