By Jeph Ajobaju, Chief Copy Editor
Blacks are bearing the brunt of coronavirus deaths in the United States, recording high rates in communities with low African American residents, even though the disease itself does not discriminate.
Experts say pre-existing conditions of low paid jobs, poverty, and structural racism in public health delivery explain why more blacks are dying of COVID-19, despite blacks accounting for 13 per cent of the 327 million population.
There are 1,448,123 cases and 83,416 deaths globally as of 13.17 GMT on April 8, according to live figures compiled by worldometers.info
In the number of deaths, Italy ranks highest with 17,127 but has the third highest cases of 135,586.
Spain is second in both death rates (14,555) and cases (146,690).
The US is third in death figures (12,857) but highest in cases (400,549).
New York is the epicentre of the disease in the US, recording 731 deaths on April 7, the highest daily rise, bringing its total to 5,489 deaths and 138,836 infections.
Overall, the 24-hour death toll surpassed 1,850 across the US on April 7, a record for any country in a single day, The Washington Post reports.
Disproportionate impact
Experts say the African American community is disproportionately impacted by underlying conditions linked to poverty, and often faces challenges in accessing testing and health care.
“We know that blacks are more likely to have diabetes, heart disease, lung disease,” US top doctor, Surgeon General Jerome Adams, told CBS News on April 7.
These chronic illnesses can lead to more serious forms of the COVID-19 disease.
“I represent that legacy of growing up poor and black in America. And I, and many black Americans, are at higher risk for COVID,” explained Adams, who is himself black and has high blood pressure and asthma.
There is no nationwide data available on COVID-19 cases by race, but a familiar pattern of over-representation by black Americans has emerged in states or jurisdictions that are sharing the information, reports AFP.
Up to 68 per cent of coronavirus deaths in Chicago have been among African Americans, who make up just 30 per cent of the city’s population.
“Those numbers take your breath away,” the city’s mayor Lori Lightfoot said on April 6 at a coronavirus briefing. “This is a call to action for all of us.”
The trend is repeated in North Carolina, Louisiana, Michigan, Wisconsin, and the capital, Washington.
Georges Benjamin, executive director of the American Public Health Association, told AFP the issue was also linked to social class, with black people more likely to work jobs deemed essential that expose them to potential infection.
“That population is more public facing,” he said. “More bus drivers, more people taking public transportation to work, more people providing services in nursing homes, more folks working in grocery stores.”
Lack of access to health care
The issue is also likely exacerbated by pre-existing prejudice that black people face in the medical system.
“Like with any illness or pain, African Americans are less likely to have their symptoms believed by those in health care due to implicit bias,” said Brandon Brown, an epidemiologist at the University of California, Riverside.
That is borne out by several studies that have found black people’s pain is less likely to be investigated or treated than their white counterparts.
There are already fears that, as historically underserved communities, black people and other groups like Latinos will have less access to testing, which in turn is vital in getting early treatment.
A civil rights group has written to Health Secretary Alex Azar, calling on him to “release daily racial and ethnic demographic data related to COVID-19 testing, disease burden and patient outcomes.”
This, said Lawyers’ Committee for Civil Rights Under Law, was necessary to ensure a robust public health response, and to ensure care and testing was not being administered in a discriminatory manner.
The group said the Centers for Disease Control and Prevention (CDC) was already collecting the information but deliberately withholding it.
Writing in Slate, an online magazine, Uche Blackstock, an emergency medicine physician and founder of Advancing Health Equity, said high levels of diabetes, hypertension and asthma among black people were “directly linked to structural racism.”
“We’re already very vulnerable,” she said. “When you add this pandemic on top of us, we’re more likely to be sicker when we present.
“And then we have to worry about whether or not we’re going to receive unbiased care.”
Statistics in Chicago
Black Chicagoans account for half of all coronavirus cases in the city and more than 70 per cent of deaths, despite making up 30 per cent of the population.
Other cities with large black populations, including Detroit, Milwaukee, New Orleans and New York, have become coronavirus hotspots.
The US has recorded nearly 370,000 virus cases and almost 11,000 deaths.
Globally there have been nearly 75,000 deaths and more than 1.3 million cases total.
As of 5 April, 1,824 out of Chicago’s 4,680 confirmed Covid-19 cases were black residents, said city officials on April 6.
That compared with 847 white, 478 Hispanic and 126 Asian Chicagoans.
Chicago has seen a total of 98 deaths as of April 5, with 72 per cent of them black residents.
The disparity is reflected across Illinois, of which Chicago is capital, where black people account for 41 per cent of Covid-19 deaths, despite making up 14 per cent of the population of the state, reports the BBC.
Chicago public health commissioner, Allison Arwady, told reporters that black city residents already lived on average about 8.8 years less than their white counterparts.
Lightfoot, the Chicago mayor, said the coronavirus was “devastating black Chicago”.
She said city inspectors would be sent into shops to ensure everyone was adhering to social distancing guidelines.
She also raised the possibility of curfews in areas where people gathered outside liquor stores, reports the Chicago Sun-Times.
Fault lines along race, health care
USNews also reports that experts who study the fault lines along race and health care sounded an urgent alarm that the highly contagious and fatal virus could ravage African American communities.
Early data from multiple jurisdictions shows blacks accounting for disproportionate and, in some cases, shockingly high shares of coronavirus cases or deaths.
Apart from Chicago, statistics showed that roughly 70 per cent of COVID-19 deaths occurred among blacks in Louisiana, even though they are a minority in both areas.
In North Carolina’s Mecklenburg County – home of Charlotte, the state’s largest city – black people make up 32.9 per cent of residents, but accounted for 43.7 per cent of reported coronavirus cases as of April 4.
In Milwaukee County, Wisconsin, blacks make up about 27 per cent of the population but comprised almost half of all COVID-19 infections – and, as of data early April 7 afternoon, 71 per cent of all fatalities.
Next door in Michigan, state health officials report that 33 per cent of COVID-19 cases have occurred among blacks or African Americans – 10 percentage points higher than whites, and more than twice the state’s percentage of black residents.
Blacks or African Americans also accounted for 41 per cent of deaths, compared with 28 per cent among whites and 26 per cent of cases for which race was not known.
Some experts were appalled but not surprised by the grim data, and anticipate the disparities will get worse as the pandemic grinds on.
Georges Benjamin, executive director of the American Public Health Association, says the pandemic has pulled back the curtain on social inequities and health care disparities – problems that usually are not revealed in real time, or under such a harsh national spotlight.
“We have always known that we’ve had these enormous social determinants that impact health and create an unequal society,” he says.
“I’m not surprised that we have had these enormous disparities in illness and deaths from COVID-19. They exist for everything else.”
“We don’t know for sure” the true extent of illness and death disparities between blacks and whites, Benjamin adds, because many states and cities have lagged on including race when compiling and releasing data on the coronavirus pandemic.
As of April 7, the information site of the CDC also did not include a racial breakdown.
A coalition of congressional lawmakers on the same day asked the CDC to make racial data on coronavirus testing, cases, hospitalisations, and fatalities publicly available.
“As COVID-19 spreads into more American communities, government agencies and academic and industry researchers are working hard to understand the depth and breadth of the pandemic and its impact on the health and well-being of Americans,” the lawmakers wrote in a letter to CDC Director Robert Redfield.
“To this end, it is important to document if particular groups in the United States are at greater risk for the virus and why.”
Request for more data
The letter echoes a request in March from a group of doctors who urged the CDC and the World Health Organisation (WHO) to release data that could show whether blacks are being tested for coronavirus at the same rate as whites.
Experts have warned that long-standing health disparities between racial groups in the US – such as higher rates of conditions like asthma, obesity and diabetes, along with lower access to health care among blacks compared with whites – place some blacks directly in the sights of COVID-19.
According to USNews, hidden biases white doctors have toward black patients, and black Americans’ historical mistrust of the medical system, could exacerbate the situation, speeding the spread of the virus in struggling communities.
Many black Americans also hold low-wage jobs in which it may not be possible to work from home, potentially increasing their chances of infection.
Mara Youdelman, staff attorney for the National Health Law Program – which seeks more access to quality health care for the underserved – says the US has “a long history of both overt and structural racism in society and in health care.”
Structural racism range from unequal access to physicians to complicated, confusing messaging for immigrants who are not proficient in English.
“The pandemic is a perfect storm for revealing these cracks,” Youdelman says.
And she warns that this may be just the end of the beginning. Southern states that have turned their backs on the Affordable Care Act, she says, likely represent the next surge of new COVID-19 cases among blacks and Latinos.
“The states that haven’t expanded Medicaid have huge numbers of people of colour residing in them, and therefore efforts to expand health insurance and therefore access to care has continued to leave people behind.”
Overhauling health care system
Both Benjamin and Youdelman say the high death totals among African Americans send a clear signal that the health care system must be overhauled and recalibrated to reduce disparities that the coronavirus pandemic has revealed.
“For decades there have been downward pressures on spending in public health and spending on health care infrastructure, including everything from helping clinicians come out of medical school without debt, expanding coverage to the uninsured and underinsured,” Youdelman says.
“The warning signs have been there for years and years. It’s no surprise we’re seeing the direct impacts” and the likelihood of more COVID-19 deaths in communities of colour.
Benjamin has vowed to hold lawmakers’ feet to the fire once the pandemic subsides.
“I’m hoping that the next (presidential) administration and Congress forces the argument” to reduce health care disparities, he says.
“When we get a window at the other end of this, my association will be raising hell about a new social compact on health.”