The devastating impact of COVID-19 is apparent, with nearly three million confirmed cases and more than 131,000 deaths in the US. Among those affected, communities of color bear the brunt of the pandemic. Health disparities in the COVID-19 crisis call attention to long-standing inequities that pervade the health care system and society at large.
The pattern of disparities during the COVID-19 crisis is analogous to the medical concept of “acute on chronic.” This refers to a long-standing medical condition that is exacerbated by an acute illness, often leading to worse outcomes than would have resulted from the acute illness alone. This is the case for COVID-19: It is a novel disease and global pandemic that has unmasked long-standing underlying health disparities.
New federal data reveals that African Americans and Latinxs in the US have been three times more likely to contract COVID-19 than white residents and nearly twice as likely to die from it. Some counties with a majority of African American residents have almost six times the death rate compared to counties that are predominantly white. In some states such as Illinois, Latinxs have nearly seven times the rate of COVID-19 cases compared to white people, while African Americans have the highest death rate. In California, Pacific Islanders face a death rate from COVID-19 that is 2.6 times higher than the rest of the state, while in South Dakota, the rate of COVID-19 among Asian Americans is six times what would be predicted based on their share of the population. Other minority communities are also disproportionately affected, including in New Mexico, where Native American people comprise about 11 percent of the population yet account for more than half of COVID-19 cases.
Health disparities during COVID-19 reflect two important patterns of inequity. First, minority communities have a high likelihood of contracting the virus by living in urban areas and disproportionately working in higher-risk environments. According to data from the Bureau of Labor Statistics, a greater number of African American workers are unable to work from home, compared to white workers. A study of the “Mission District” community in California showed that Latinxs accounted for more than 95 percent of positive COVID-19 cases and 90 percent of individuals with positive tests were unable to work from home. Certain industries that have workers that are predominantly minorities face higher rates of COVID-19: At meatpacking plants, where the rate of COVID-19 infections is higher than the rate in 75 percent of US counties, nearly half of workers are Hispanic and a quarter are African American.
Second, racial minorities also experience higher rates of chronic medical conditions, including obesity, diabetes, and kidney disease, which are risk factors for severe illness from COVID-19. These statistics occur on a backdrop of existing disparities in outcomes: For example, African Americans have higher rates of maternal mortality and death from cancer and heart disease than any other racial and ethnic group. Individuals from underserved communities are also more likely to have undiagnosed chronic disease, compounding the acute impact of COVID-19. These inequities are tied to long-standing barriers to accessing essential resources such as food, transportation, and housing, as well as a long history of unequal treatment, discriminatory policies, and systemic racism.
COVID-19 has resulted in stopping key social programs that are community lifelines, such as schools and senior centers. Home visitation programs that have been instrumental in reducing infant mortality and lead poisoning have been put on hold. Many who have chronic conditions face additional problems of accessing care. The acute impacts of COVID-19 worsen underlying conditions in individuals and communities. Solutions must therefore focus on both aspects.
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