By: Pooja Dasgupta and Sonya Wadhawan, PharmD Candidates c/o 2025
The coronavirus, also known as SARS CoV-2 or COVID-19, has widely affected various people globally. The study of SARS CoV-2 has shifted from studying individuals and their unique symptoms during their disease duration to studying different populations and their backgrounds that increase the risk of getting and surviving the disease. There were a multitude of reasons as to why public health officials widened their scope, including the fact that they did not learn much from simply knowing one’s age and preexisting health conditions. Researchers have discovered that factors such as race, gender, occupation, education, and even one’s housing are just as crucial as age when gauging an individual’s likelihood of surviving the disease. 1
There has been staggering evidence indicating that some racial and ethnic minority groups have suffered disproportionately from COVID-19. 1 In a new study conducted by researchers at the MIT Sloan School of Management, it has been shown that the higher percentage of Black residents in a county, the higher its death rate from COVID-19. 1 Statistically, the average county-level death rate is 12 deaths per every 100,000 people. However, this number is proven to be 85% higher in Black communities. In turn, there is an increased hospitalization of Black people due to more severe disease states. As Malika Fair, an emergency medicine physician in Washington D.C. and senior director of health equity programs at the Association of American Medical Colleges said, “Black people are dying of COVID-19 at a rate more than twice our share of the population”. 1 In addition, more recent studies have found that life expectancy for minorities have been reduced significantly compared to Whites as the life expectancy for Blacks decreased by 2.10 years and for Latinos by 3.05 years. 4 This decrease in life expectancy for Black and Latino population is 3 to 4 times larger than for Whites and could be explained by the underlying social disparities. These minorities are more likely than Whites to hold low paying jobs, which are often in industries that could not work remotely and have suffered great job losses during the pandemic. Not only did this create significant high unemployment rates for both Blacks and Latinos but as well as a higher rate of health insurance loss. 4
This concerning increase in death rates among the Black community is not only due to factors such as poverty, age, sex, or chronic health conditions, but results from deeper rooted issues such as systemic racism. When trying to determine the factors that contributed to such an increase of Black deaths, factors that are impacted by racism such as the quality of insurance African Americans have and the quality of health care received have shown to be significant factors. People with Medicaid or high-deductible plans are more likely to not have a primary care physician. In the United States, 34% of African Americans and 15% of white people are covered by Medicaid. 1 As a result, people that do not have a relationship with a primary care doctor are much less likely to go and get tested. According to George Benjamin, a physician and the executive director of American Public Health Association, when Black people do go to see their doctors, they are less likely to receive a COVID-19 test even though they presented with the cornerstone symptoms of the disease because they do not have a proper relationship with their primary care provider to begin with. Benjamin states that, “someone without a primary care doctor doesn’t get into the ER as fast as someone whose doctor calls ahead. At what point were your symptoms severe enough that you got into the health care system?” 1 For people of color, it was likely later, he suggests. This is one reason Black people may not bother going to see a doctor at all. Additionally, it has been historically proven that a lack of trust exists between doctors and the Black community. This can be seen through The Tuskegee trials, which consisted of experiments conducted on 600 Black men, of whom 399 had syphilis and 201 who did not have syphilis. The purpose of the experiments was to try to find a cure for syphilis, however, was deemed “ethically unjustified” as the experiments were done without informed consent. The trials were highly inappropriate as the men who participated were misled and never given all the facts about the study which were needed in order to provide informed consent. They were told they were being treated for their ailments, but in reality, never received the proper treatment needed to cure their illness. Even after 1947, when penicillin became the drug of choice for syphilis the researchers did not offer it to the participants of the study. 3 As a result of the unethical Tuskegee trials, the lack of trust between doctors and the Black community, which was already present from past discriminatory events, became further reinforced and still holds today.
Also, due to the embedded systemic racism in our society, when Black people do reach out for help through the system, the quality of care they receive is significantly poorer. Research has shown that this has been prevalent for Black people getting treatment for several different health ailments such as cardiovascular heart disease.1 As a result of receiving improper care for underlying medical conditions, the risk for COVID-19 in Black people is higher. Evidence has suggested that people with pre-existing cardiovascular disease, diabetes, or hypertension are at higher risk of severe illness from COVID-19. 1 In a control study conducted in China, it was found that the estimated mortality risk for COVID-19 in patients with coronary heart disease was three times greater than patients without coronary heart disease. 2 Unfortunately, racism is apparent in the health care system and because there are differences in the quality of care amongst races, minorities continue to suffer.
A multitude of people are being affected by COVID-19, however Black communities have been hit the hardest. A prominent factor for this is systemic racism in our society that affects the type of insurance, treatment, and quality of healthcare people of color have received. There needs to be a change in the system itself so that everyone can receive the best opportunity for appropriate healthcare. In such strenuous times, it is imperative that we connect and support each other. To prevent the spread of COVID-19, we must all work together to ensure that all communities have equal access to resources such as healthcare information, affordable testing, and medical care to manage their health.
References:
- Begley S. To understand who’s dying of Covid-19, look to social factors like race more than preexisting diseases. Stat. https://www.statnews.com/2020/06/15/whos-dying-of- covid19-look-to-social-factors-like-race/. Published 06/15/2020.
- Gu T, Chu Q, Yu Z, et al. History of coronary heart disease increased the mortality rate of patients with COVID-19: a nested case-control study. BMJ Open. 2020;10(9):e038976. doi: 10.1136/bmjopen-2020-038976
- Tuskegee Study – Timeline – CDC – NCHHSTP. Centers for Disease Control and Prevention. https://www.cdc.gov/tuskegee/timeline.htm. Published March 2, 2020. Accessed November 1, 2020.
- Andrasfay T, Goldman N. Reductions in 2020 US life expectancy due to COVID-19 and the disproportionate impact on the Black and Latino populations. Proceedings of the National Academy of Sciences of the United States of America. https://www.pnas.org/content/118/5/e2014746118. Published 02/02/2021.
