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Published: January, 2021; Vol 17, Num 9

 

COVID-19 Risk Differs Widely Across Racial and Ethnic Lines

Last July, we covered how COVID-19 infections and deaths were disproportionately affecting racial and ethnic minorities. Black and Hispanic communities were seeing far higher rates of positive cases, hospitalizations and deaths than their share of the population.

Since then, more studies have confirmed this disparity. A recent CDC report found that people identifying as Hispanic or Latino in the Denver area made up 55 percent of COVID-19 cases, 62 percent of hospitalizations and 51 percent of deaths, despite this group making up only 25 percent of the Denver community.

Image courtesy of LIUNA Local 42

Across the U.S., it’s a similar story. A nationwide study of COVID-19 cases found that the Hispanic population had infection rates 158 percent higher than their share of the population. The Asian and American Indian/Alaska Native populations each had infection rates at least 100 percent higher. The Black population’s infection rate was 50 percent higher. And while the White population across the U.S. has also been greatly affected by COVID-19, there wasn’t a single state where Whites were being impacted at a level disproportionate to their share of the population.

Given these numbers, researchers are now focusing on better understanding the causes behind these health disparities. We know that many of the root causes stem from structural racism and discrimination. The challenge is identifying the specific factors driving these outcomes in day-to-day life so we can begin to change them.

Factors Driving Increased COVID-19 Risk in Racial/Ethnic Groups

While there are many possible reasons for the disparities in COVID-19 infection and death rates, early research is pointing to the following:

Larger Households/High-Density Housing

In the Denver study mentioned above, Hispanic adults with COVID-19 were more likely to live in larger, multi-generational households. Almost 40 percent of Hispanic adults with COVID-19 reported five or more people in their household, compared to 13 percent for non-Hispanics.

COVID-19 is more easily transmitted indoors during prolonged exposures, so living with more people automatically increases a person’s number of close contacts. Having more people in a household also makes it more difficult for someone with COVID-19 to self-isolate. Multi-generational households also increase exposure for older adults, who are at increased risk for severe illness from COVID-19.

Fewer Distancing Options Due to Socioeconomic Status

An analysis of COVID-19 cases in New York City identified socioeconomic status as a driving factor for COVID-19 risk. Households in wealthier neighborhoods had a much easier time following social distancing orders. This included less reliance on public transportation, the ability to have essentials like groceries delivered instead of shopping in person and being able to shelter outside New York City during the worst of the pandemic.

Access to Healthcare/Timely Testing

We already know that Hispanic/Latino and Black workers are more likely to work in frontline and essential jobs. In these industries, many workers face the difficult decision of whether to continue working while sick due to financial needs or a lack of paid sick leave.

In addition to these existing obstacles, data shows Hispanic adults were more likely to have COVID-19 symptoms for longer before seeking testing. This delay could help contribute to additional spread among household members before a COVID-19 positive is confirmed. Reasons for waiting to get a test are varied, but could include a lack of healthcare access, lower overall health literacy, a language barrier or concerns about immigration status.

Finding a Path Forward

The COVID-19 pandemic has exposed long-standing health inequities at the community level, leaving racial and ethnic minorities to bear the brunt of COVID-19. The complex social factors involved, including the root cause of systemic discrimination, means fixing these health disparities won’t happen overnight.

And yet we do have a clear opportunity as the U.S. and Canada move closer to wide distribution of a COVID-19 vaccine. There’s already been discussion on who should get the vaccine first. The first doses are going to nursing home residents and healthcare workers, both of whom have been hit hard by COVID-19. The CDC notes that mitigating health inequities is one of its goals in distributing the vaccine if supply is limited. Making sure racial and ethnic minorities in vulnerable communities are also high on the list could save lives and protect thousands of essential workers at the same time.

[Nick Fox]