It has been said that a chain is only as strong as its weakest link. In the time of COVID-19, the more apt analogy is that we are only as safe from the virus as those most vulnerable in our society.
Since the outbreak began in the US, the speculation that COVID-19 would have an inequitable impact on our population has been well documented. As we descend further into the crisis, however, we are realizing just how profoundly our nation’s history of systemic racism is compounding the impact of the virus as it ravages communities of color, not just across the country, but also closer to home.
For example, with 92 per 10,000 cases, Chelsea, Massachusetts has one of the highest per capita infection rates in the country. This town of 40,000 mostly Latinx people just east of Logan airport has infection rates just behind several boroughs in New York City. Other communities of color in the Commonwealth–including Lawrence, Everett, and Mattipan–are reporting similarly high rates of infection. Multiple Native American reservation communities across the country–including the Zia and San Felipe Pueblos, as well as the Navajo Nation–have also reported a staggering number of confirmed cases per capita. And that is just confirmed cases. Due to a lack of available testing, and in particular community-based testing, it is certain that the magnitude of infection is significantly higher than what has been reported.
There are many reasons for these ethnic and racial disparities, including high population density; poverty; intergenerational living situations; a preponderance of essential workers, some of whom may be working shifts in two or three high-risk locations with little to no paid time off; and significant disease comorbidity in these populations–particularly asthma and heart disease–which appear to play a disastrous role with COVID-19. Nearly all of these factors are related to the social determinants of health, which in turn are linked to the history of systemic racism in this country.
Exacerbating the crisis in minority communities is the lack of quality healthcare systems and the means to access them via reliable transportation, time off, and the ability or means to participate in telemedicine, not to mention that many members of underserved communities may lack health insurance or remain unaware of their eligibility for health benefits (Medicaid). Accordingly to Mbole Nku, an Integrated Care Contract Manager at MassHealth, this compounds the lack of testing and rampant spread of this disease in minority communities, something which will also leave many of these individuals and families with potentially massive medical bills which may affect their finances and livelihoods moving forward.
At last count there were 29 states collecting data on COVID-19 related racial disparities. However, these data are not collected systematically, nor have they been collected since the onset of the outbreak. According to Ibram X Kendi, Executive Director of the Antiracist Research and Policy Center, only a handful of any “states, counties, hospitals, or private labs had released the racial demographics of the people who had been tested for, infected with, hospitalized with, or killed by COVID-19.”
Complete and transparent data collection, including racial and ethnic data, is important for a number of reasons. Most immediately, it will allow public health professionals to predict rates of viral spread, and identify emerging “hotspots” or areas of increased transmission. This, in turn, will allow for the creation of mitigation strategies for those areas, according to Dr. Joseph Betancourt, Vice President and Chief Equity and Inclusion Officer at Massachusetts General Hospital.
There is also another reason for the need to track ethnic and racial data connected to the longer term impact of the unfolding COVID-19 crisis. The story of the crisis is still being written, but better collection of, and reporting on, racial data, will highlight the underlying problems with our current national health care system. This will enable us to better understand how the virus doesn’t just disproportionately impact communities of color, but is historically compounding existing inequities. As CNN’s Van Jones put it, COVID-19 has become “an epidemic jumping on top of a number of other epidemics [asthma, diabetes and heart disease] in the black community.” Documenting this trend, we can better work to address these disparities in health care systems across the country, thinking more critically about barriers to equitable medical access, testing (including minority enrollment in clinical trials) and treatment, and ensuring that the lessons learned from this crisis facilitate the reform of our healthcare system moving forward.
The COVID Racial Data Tracker, a collaboration between The Atlantic’s COVID Tracking Project and the Antiracist Research and Policy Center, will assist in the tracking and analysis of racial data vis a vis the pandemic in the US. However, it will be incumbent on antiracist allies of communities of color to demand that our policy makers and elected leaders view the disparities we see emerging from this crisis as directly attributable to systemic racism.
On April 14th, Democratic lawmakers in both chambers of Congress introduced the Equitable Data Collection and Disclosure on COVID-19 Act of 2020, legislation which would compel federal health officials to collect data on race, ethnicity, sex, age and socioeconomic status, among other demographic information on those tested and treated for COVID-19, and to post this data daily. If passed, the legislation also requires HHS to provide a summary of final COVID-19 statistics in a report to Congress, no more than 60 days after the public health emergency has ended. Massachusetts lawmakers Ayanna Pressley and Elizabeth Warren introduced the bill, and it currently has more than 80 sponsors. Contact your representative to voice your support for this important and potentially life-saving legislation.