Coronavirus infection rates are all worse for people of color: more of them are getting sick, they get sicker, and they are more likely to die.
There’s an old African American aphorism: “When white America catches a cold, black America gets pneumonia.” Now we can add: if it’s COVID-19-related pneumonia, black Americans die.
The numbers are impossible to miss: people of color have been having a harder time with COVID-19.
Around the nation, at the beginning of the pandemic, Latino and African-Americans were three times more likely to become infected as their white neighbors, and nearly twice were as likely to die from the coronavirus, according to Centers for Disease Control and Prevention (CDC) data reported by The New York Times. One study found that as of early May in Chicago, blacks had more than three times a greater risk than whites of dying from the coronavirus.
The racial divide showed up in suburbs, small towns, and rural areas, as well as in big cities. In California, where around 40 percent of adults under the age of 50 are Latino, they represented 70 percent of all COVID-19 deaths in that group. Native Americans were suffering more, too.
There are many reasons why these communities are suffering more in the pandemic, most of them traceable to low incomes and fewer choices. When you tally the forces that affect our health, up to half are related to income and where you live, according to research from the National Academies of Science. The average net worth (including the value of a home) of a white family was $171,000 in 2016, nearly 10 times more than that of a black family: $17,150.
Poorer people tend to have poorer health overall, and the COVID-19 pandemic and shutdowns added pressures specific to this moment.
How the shutdowns affected minorities
People of color are more likely to hold jobs that you can’t do from home. Some of those jobs were considered essential during city-wide shut-downs — you came to work if you were a hospital technician, police officer, supermarket clerk, or bus driver. You were more likely to be exposed to the coronavirus than people who sat at their computers at home.
Or you might have held one of the many low-paying jobs in industries that stopped doing business — washing dishes in a restaurant now doing only take out, or cutting hair in a salon that closed. You were more likely to be unemployed. That could affect your health, for instance, if you moved in with family, exposing everyone to more crowded conditions.
The more people in your home, the more people who could bring COVID-19 home. If you can’t keep a sick person in her own bedroom or bathroom, you’re all at risk.
Why minorities were more exposed to COVID-19
Say you live in an area that didn’t shut down — or an area reopening now. People of color may be more likely to work when they’re ill. One reason is that low-income jobs are less likely to have paid sick days, the CDC notes. The CDC told Americans to stay home for two weeks if they had been exposed to someone with COVID-19 and to stay home whenever they felt they might be ill. But what if you don’t get paid and can’t cover your bills? How many people pay a cleaning lady or nanny more than once or twice if she says she’s not coming in? Many businesses think the same way. You’ll need savings — which many don’t have — or unemployment benefits, which you may not have.
Since poorer people are less likely to be able to afford to skip work, if you’re washing dishes the chances are greater that other people in the kitchen are sick and infecting you. The same goes for everyone traveling to work on a crowded bus. Staying home is a luxury. Being quarantined is a greater luxury still.
People of color are also more likely to live in prisons, jails, and shelters — they can’t safely shelter in place either.
These same groups have been more vulnerable to conditions that raise the risk of a serious COVID-19 case — obesity, diabetes, and liver problems, and heart disease. In the United States, African-Americans are 60 percent more likely to have diabetes than whites. Black women are 60 percent more likely to suffer from high blood pressure, a form of mild heart disease, than white women.
Minorities are also more likely to live near highways or toxic landfills, exposing them to noise and other pollution, one reason black children are four times more likely to be admitted to the hospital for asthma than white children.
For all these reasons, it would make sense to provide and promote free testing in poorer neighborhoods — at least to let people know when they should stay home (if they can afford to) and try to avoid their elders (if there’s a bed somewhere else). Yet, the opposite happened. In Philadelphia, for example, a scientist at Drexel University in Philadelphia reported in April that testing in the city’s wealthier zip codes was six times higher than in poorer zip codes with more unemployed, uninsured, and minority residents. As you’d expect, the percentage of positive tests was higher in the poorer neighborhoods.
The burden of history
Please don’t misunderstand — not every person with darker skin has a low-income job. There are black CE0s of major companies — but only four of them, as of this summer. A black man can be elected president — witness President Obama.
To land in top positions, however, people of color have to overcome a history of low economic and social status. The CDC starts its list of problems affecting minority health with discrimination. When employers are less comfortable with you because of your skin color, you end up in less desirable jobs, unless you can manage to be extra smart, personable, dedicated, and prepared.
To even get considered for work in demand, you need the right education. Among working adults in the United States, only 21 percent of Hispanics and 31 percent of blacks had a college degree or higher, compared to 41 percent of whites. (Asians as a group don’t share the same problems. They’re better off — 63 percent of Asians in the U.S. have a college degree or better.)
What does a college degree have to do with catching a virus? The college degree gives you more options, and you’re likely to have more savings and benefits, including health insurance. You live in a wealthier neighborhood and have more space for each person.
Lack of insurance
Millions of Americans of all groups, including whites, lack adequate insurance. Some have jobs that don’t provide health insurance or plans that don’t cover much. You might buy an Affordable Care Act (aka Obamacare) plan but with a high deductible. Millions also don’t qualify for Medicaid, especially in states like Texas that refused to take ACA funds to expand the program. As of 2018 in Texas, 13 percent of white residents were uninsured — compared to 16 percent of blacks and 29 percent of Latinos. Those numbers got worse when people lost their jobs.
When you need to pay for medical care yourself, you’re less likely to see doctors and more likely to develop and neglect those sadly common illnesses that make COVID-19 more dangerous.
If you live in a poor minority neighborhood, you also might distrust the local public hospitals, which have become especially overwhelmed during outbreaks. Or you might fear that hospitals will treat you less generously because of your race or language.
Money and status make a difference in our health system. President Trump has received cutting- edge care that has not been available to ordinary citizens of any origin. Your insurance — if you have insurance — may not cover care at the most prestigious hospital in your area.
It’s also true that American medical workers, many of whom are minorities themselves, have a commitment not to discriminate among their patients. In one study of more than 11,000 COVID-19 patients at 92 hospitals across 12 states, researchers tried to analyze whether hospitals weren’t treating black patients as well. They found that there was zero difference in how many white and black patients died — once you took into account factors like whether the patients had insurance or other health problems or lived in a poor neighborhood. It also didn’t matter which hospital you went to.
In the end, medical care is important, but it’s not the main factor in your health — it contributes perhaps 10 to 20 percent when we look at large groups. There are plenty of other reasons why people of color have suffered more during the COVID-19 pandemic.
March 31, 2021
Janet O’Dell, RN