Covid-19 exposes America’s racial disparities


COVID-19 rarely assaults children with the force it uses against adults, especially older people.

But some kids who have been infected with the coronavirus develop a potentially fatal condition that brings fever, shock and organ failure. For some reasons, this rare “multisystem inflammatory syndrome” afflicts Black children at significantly higher rates than White children.

The disparity is not confined to children. Across the US, Covid-19 poses a broader threat to people of African ancestry.

Studies and data from several states show that Black Americans contract coronavirus at rates much higher than their share of the population. Their death rates are higher, too, especially in middle age; adjusted for age, Black death rates are 3.6 times those of Whites.

Medicare data suggest that, among elderly Americans, being Black is a Covid-19 risk factor almost as great as being over the age of 85.

Why? The precise reasons are unknown. The link seems to be less about any inherent vulnerability than about where Black Americans live, where they work, the kind of healthcare they receive and the unique stresses they face.

Sorting out the specific causes will require more research, and this work should be prioritised as the Covid-19 pandemic continues. Finding the answer might lower the death rate from Covid-19 and help bring the pandemic to heel. It could also shed light on other racial health disparities.

Black people’s higher susceptibility to Covid-19 could be connected to underlying health conditions. Doctors have observed that people with hypertension, diabetes, asthma and heart disease are more likely to be hospitalised with Covid-19 and to suffer severe consequences, including death.

Black Americans suffer from these conditions in relatively high numbers. But scientists don’t know whether the correlation between chronic conditions and Covid-19 is causal, or whether it reflects deeper vulnerabilities to all illness.

A recent Massachusetts Institute of Technology (MIT) study found that race predicts susceptibility to Covid-19 in the US more than obesity and smoking do, and also more than poverty does. So, other aspects of life shared by Black Americans could be at work — perhaps having to do with quality of healthcare or health insurance or chronic stress, as Christopher Knittel, the senior author of the MIT study, suggests.

Perhaps, long commutes, especially using public transportation, make a difference. Maybe, living in places with more air pollution, as Black Americans tend to do, increases susceptibility to Covid-19, as it does for other conditions, including poor childbirth outcomes.

One recent study of pregnant women found that the odds of their contracting Covid-19 were higher if they lived in neighbourhoods where unemployment was high and households were crowded — an experience more common for people of colour than for White Americans.

There is also the possibility, supported by research, that Black Americans receive inferior healthcare, in part because of unconscious bias by doctors and other providers.

Evidence suggests that Black patients do better when they see Black doctors, but in a population that is more than 13% Black, only 5% of doctors are.

What’s certain is that African American vulnerability to Covid-19 is complicated. Researchers, including epidemiologists, infectiousdisease experts and social scientists, need to dig into all the complications and possible factors in order to learn what can be done to keep all Americans healthy. The National Institutes of Health should prioritise such studies.

It would help to have better data on Covid-19 by race, as scientists and members of Congress have been demanding. To date, more than 40% of Covid-19 cases in the Centres for Disease Control database lack basic race and ethnicity data — in part because states and private laboratories have not reported the information. The Centres for Medicare and Medicaid Services has promised to mandate the reporting of more detailed demographic data, but not until Aug 1.

States and cities, for their part, should target testing and tracing efforts to neighbourhoods and regions, especially affected by the pandemic, as Dr Anthony Fauci of the Trump administration’s coronavirus task force has recommended.

Thus far, communities of colour have had less access to Covid-19 testing than White communities have had. Increasing testing in underserved areas will work best to the extent that the public health workforce includes people of colour.

Biomedical researchers and pharmaceutical companies must ensure that Black subjects are included in trials of vaccines and treatments for Covid-19.

America’s health disparities by race and income are among the greatest in the world. Consider just a few examples. Black American women contract breast cancer at about the same rate as White women — but they are more likely to die of it. Infant mortality rates are more than twice as high for Blacks as for Whites. Black men have the lowest life expectancy of any demographic group in the US. America has tolerated these differences for far too long.

The country is now engaged in a far-reaching racial reckoning. A new resolve to confront injustice is taking hold. It needs to make health disparities a core concern. — Bloomberg

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.