The COVID-19 pandemic is affecting everyone. Initially it was thought that this pandemic would be considered “the great equalizer” as it was believed that every individual would be equally susceptible to the virus (Krouse, 2020). As the pandemic goes on we’re seeing that this is increasingly not the case. In fact, the pandemic is seemingly aggravating the already present health inequalities that people of color face on a daily basis.It should be noted that these inequalities leading to health discrepancies are not linked to genetic differences between black and white individuals (Gravlee, 2009).
To understand the effects the pandemic is having on people of color it’s important to understand what circumstances already surround these individuals. For one, people of color already tend to have worse health outcomes (Hicken et al, 2018) and have some of the higher rates of prevalence of chronic disease (CDC, 2020). This is often aggravated by higher levels of stress people of color endure (Sternthal et al., 2011). Furthermore, there are many social factors that contribute to poor health outcomes among people of color (Gravlee, 2009). So, how do these factors work together to cause negative health outcomes associated with COVID-19 among people of color?
The Virus
Before I get into the question, understanding more about the virus may be beneficial. What is COVID-19? COVID-19, or coronavirus disease 2019, is a respiratory illness caused by the pathogen SARS-CoV-2 and which through a series of steps and mutations jumped from bats to humans (CDC, 2020). This virus is easily transmissible and in turn dangerous because individuals can spread it before the onset of symptoms. The time it takes for an individual to get sick from the virus ranges anywhere from two to 14 days (Lauer et al., 2020). This is known as the incubation period. The infectious period, or the time when you can infect other people with the virus, begins two days before your onset of symptoms and can last up to three days after your last fever. This is why it’s so easily transmissible. Individuals can spread the disease before they realize they have it and after they think they’re cured. This poses a necessity for education and proper monitoring of who may have the virus.
In terms of symptoms, the virus does not cause the same effects on every person. There are individuals who are completely asymptomatic or have no symptoms. These individuals could be carriers, often spreading the virus without knowing. Other individuals have mild flu-like symptoms where they feel fatigued or tired but may still choose to go out and do things because they don’t feel bad enough to stay in bed. There is also a group of people that become severely ill. This group often requires mechanical ventilation or other extreme measures to keep them healthy (Zhai et al., 2020). This last group is often composed of individuals over the age of 65 or individuals with preexisting conditions, however there have been cases of perfectly young and healthy individuals dying due to the virus.That’s why proper education becomes important. To teach individuals to isolate regardless of the gravity of their illness.
Social Factors
There are many social factors that may put individuals at risk of experiencing complications and having negative outcomes upon infection with the virus. There is an increasing body of evidence that shows that socioeconomic status (SES) plays a role in predicting the outcome one might have as a result of exposure to the disease (Mirowski and Ross, 2015), including COVID-19. In fact, people with lower SES seem to be admitted to the hospital at higher rates than their higher SES counterparts (Figure 1) (Azar et al., 2020). This is likely due to the fact that individuals with lower SES are less likely to be able to take time off from work and, in turn, are more likely to present to the hospital with more advanced symptoms (Azar et al., 2020). In the case of African Americans, they’re even more likely to prolong the time it takes them to seek medical attention due to having lower SES and the inability to take time off from work (Azar et al, 2020) as well as an inherent mistrust in the healthcare system (Marmot, 2003).
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Adjusted odds of hospital admission
Figure 1: This graph illustrates the odds of hospitalization by income bracket. There is statistical evidence to demonstrate that individuals who have lower incomes are hospitalized at higher rates. (Azar et al., 2020)
Another factor people of color are likely to be more negatively affected by the pandemic is the inability to isolate from each other. Culturally, people of color are more likely to live in households with multiple generations, grandparents, parents, children, and even grandchildren (Abuelgasim et al, 2020). This poses an increased risk for these communities. Because young healthy individuals are in the workforce in order to pay the bills, they are putting people over the age of 65 at greater risks of exposure when they get home from work. In terms of employment, it should also be noted that a large proportion of people of color are working essential jobs and in fact, 30% of LPNs are African American (CDC, 2020). To make matters worse, many of these essential workers don’t have paid sick leave so staying home becomes a very difficult option.
Biological Factors
Among the factors why people of color are more susceptible to the virus there are biological factors. Black Americans are significantly more likely to suffer from chronic diseases (CDC, 2020). There is an increasing body of evidence that shows that individuals who have conditions like type 2 diabetes, heart disease, asthma, and obesity, just to name a few, are 1.5 times more likely to be admitted to the intensive care unit and die from complications associated with COVID-19 (Azar et al., 2020). This could explain why African Americans make up 33% of hospitalizations (Kirby, 2020). If an individual is already experiencing difficulty breathing due to a preexisting condition they may have then an decrease in lung function could lead to deadly hypoxia.
So if black populations are more likely to suffer from chronic disease but they’re also less likely to have the privilege to stay home from work due to financial constraints, it is inherent that the virus is targeting these individuals at higher rates. This is unfortunately not the only truth. In fact, the mortality rate among blacks is significantly higher than the mortality rate among whites (Figure 2).
Figure 2: This chart illustrates the Case and Death rates by ethnicity in colorado.
People of color in the state of Colorado are getting sick, and often dying, at greater rates than their white counterparts. (CDPHE, 2020)
Conclusion
Between the social factors and biological factors we clearly see that there are inequalities in how COVID-19 is affecting different groups. African Americans tend to have some of the highest rates of chronic illness such as diabetes and heart problems. These factors pose great risks to individuals diagnosed with the virus as they can lead to life threatening complications. The social factors, such as the inability to take time off from work, the mistrust in the healthcare system, and the type of living conditions people of color often face could lead to increased incidence and increased rates of detrimental outcomes across the community.
The next steps become more complicated. I’m not going to tackle the large changes that need to be made in order to lower the incidence of chronic illness across black populations. That’s a complicated topic that requires a conscious change in the culture of this country and a change in the perspective of every American. Although, in order to keep these communities safe, as well as keeping everyone safe some social changes need to be made. Primarily, incentivising employers to give employees paid sick leave would be an important first step. This would allow individuals to isolate without feeling like they’re going to go into financial struggle if they seek medical attention. Furthermore, comprehensive and culturally conscious outreach and education programs should be offered in order to help individuals understand what puts them at risk, who is at risk, and how to take preventative measures in order to mitigate the spread of COVID-19 and reduce the effect of the virus.
References
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