COVID-19’s disparate impact on Americans of color: Experts identify 10 key takeaways

COVID-19 has killed Americans of color out of proportion to their numbers in the general population, but that disparity can only be corrected in the context of the larger racial and economic inequalities in American society. 

That was the central message to emerge from the recent webinar and “Color and COVID-19: The Virus’s Disproportionate Impact” hosted by the MJH Life Sciences COVID-19 Coalition. The findings were also collected into a whitepaper.

Participants included:

• Taison Bell, MD, a critical care and infectious disease physician at the University of Virginia and director of the medical ICU;
• Nwamaka Eneanya, MD, MPH, FASN, a nephrologist at the University of Pennsylvania and director of health equity, antiracism, and community engagement;
• Ebony Hilton, MD, associate professor of anesthesiology and critical care medicine at the University of Virginia and medical director of Goodstock Consulting

The webinar was moderated by Utibe Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh School of Medicine.

According to data from APM Research Lab, as of early January 2021, Indigenous Americans had experienced the highest death rate from COVID, at 168.4 deaths per 100,000 population. That was followed by Black Americans (136.5), Pacific Islanders (112.0), Latinos (99.7), Whites (97,2), and Asian-Americans (59.9).

“These numbers representing the really painful disproportionate toll that the virus is taking is just a sub-set of the discussion,” Bell said, adding that the pandemic’s effects have been made worse by ineffective leadership and poor communication.

The webinar focused on three broad COVID-related challenges confronting non-White Americans: the disproportionate impact of the virus itself, overcoming reluctance to getting vaccinated, and the future of health equity. 

Addressing the first of these, Eneanya said that Black Americans and others of color face challenges such as the belief that biological differences may make them more vulnerable to the coronavirus than Whites. She cited studies controlling for social determinants, such as housing and food insecurity, that have shown no differences in mortality rates between racial groups. 

“When we’re seeing differences in outcomes, we should stop trying to prove biology,” she said. “Of course there are downstream effects of biology, but we’re not inherently different in between racial groups.”

Hilton said the tendency of health care providers to take complaints from patients of color less seriously than those of White patients adds to the disparate impact of the virus. She pointed to Virginia Department of Health data showing that while Latino and Black patients come to emergency departments with COVID-like symptoms at higher rates than Whites, Whites are hospitalized for such symptoms at higher rates than the other two groups.

Regarding vaccination reluctance, Hilton said she finds it primarily among people of color who distrust the public health system due to prior mistreatment, undocumented Hispanic Americans who fear deportation, anti-vaxxers, and those who believe COVID-19 is a hoax. Identifying which of these groups a person falls into is important, she added, “because in order to communicate effectively the language will be different for each of those.

“It’s up to the medical community….to have those difficult conversations, and to ask how we can start to bridge this gap and heal those generational wounds,” she added.

The panelists noted that the impact of vaccine reluctance is compounded by lack of vaccination sites in Black and Latino communities and by prioritizing guidelines. Hilton pointed out that although Black, Hispanic, and native American people are dying at the highest rates, most of those receiving the first vaccines are White.

“If we’re basing our plan on a flawed system, then the entire plan moving forward is also flawed,” she said.

Looking ahead, Eneanya called for health systems to take steps to reduce the pandemic’s impact on people of color, such as funding educational programs about the vaccine targeted at underserved communities, or allowing employees to miss a day of work after getting vaccinated.

Hilton suggested creating a Cabinet-level Department of Equity as a way to combat systemic racism and ensure that public policies at all levels are created with equity in mind.

“I think we need to restructure everything that we’re doing on the policy level, because we know the social determinants of health are the feeders into why we have disparities.” she said, citing factors such as education, housing, and transportation. “You cannot have a race-neutral policy on a race-targeted disease process.”

LEARN MORE:

View the webinar
Read the whitepaper 
Visit the MJH Life Sciences COVID Coalition website