A lack of preparedness, testing, and leadership has led the United States to become the new epicenter of the largest public health crisis since the Spanish Flu of 1918. As this pandemic is stretching the capacity limits of the US health care system, there is potential for exacerbation of another critical issue: racial disparities.
Marginalized communities will be hit the hardest as a result of this pandemic.
Black and other minority populations are probably having more difficulty getting tested for COVID-19. Physicians in Virginia have begun to raise the alarm on this issue. Why would racial minorities have more trouble getting tested? It comes down to access to care. According to the 2017 US Census report, while about 94 percent of the US white population had insurance coverage, this rate was lower among racial minorities — with 89 percent for Blacks, 84 percent for Hispanics, and about 93 percent for Asians. It doesn’t matter that insurance companies are waiving COVID-19 testing fees — you still need access to the system through a primary care physician or an in-network health care facility. Inadequate access is also driven by distrust of the health care system, language barriers, and financial toxicities associated with missing work to receive care. The consequences of which, in the context of a pandemic, is that they may not get tested or checked at the appropriate time, waiting until some may have advanced symptoms — which will also contribute in spreading the disease further in their communities.
Racial minorities are also at higher risk for developing severe forms of COVID-19 than white populations. This is because the prevalence of conditions that have a higher morbidity and mortality in COVID-19 cases — high blood pressure, diabetes, heart disease, lung diseases, asthma and chronic bronchitis, and autoimmune diseases like lupus — are disproportionately found in Blacks, Latinos, and Native Americans. Early data from Michigan show that Black people represent a whopping 40 percent of deaths from COVID-19 in that state though they represent only 14 percent of the state’s population. As of Tuesday, the data from the Chicago Department of Public Health reveal that approximately 69 percent of the 118 COVID-19 deaths occurred in the Black community, even though it makes only 29 percent of the city’s population.
In the aftermath of COVID-19, other issues will affect individuals of color unequally. While some insurers have opted to waive copayments for testing and treatment related to COVID-19, there is uncertainty around cost-sharing even for people with insurance. Some individuals may require long-term post-acute care, especially after being on a ventilator for several weeks in the ICU. It’s unclear who will pay for that. Assuming that further legislative action is not taken to address these issues, financial devastation will likely be much more prevalent among minorities post COVID-19. Even if some found a way to remain financially solvent, mounting routine expenses could make them less likely to get medical care when needed after COVID-19. Cancer and cardiovascular deaths among minorities could rise post-pandemic, leading to the exaggeration of false perceptions that minorities have a genetic predisposition for such trends.
However, there are some immediate steps that can be taken to mitigate the impact of COVID-19 on racial minorities. What policymakers need to remember is that if we do not measure the impact, we cannot contain the fallout. Recently, members of Congress sent a letter urging the Department of Health and Human Services t(HHS) o document racial and ethnic demographic data on COVID-19 testing and treatment. This effort should be supported. It will enable identification and mitigation of potential racial disparities ensuing from this pandemic. According to the Centers for Disease Control and Prevention, in the 2009 H1N1 pandemic, racial minorities were more likely to report to health authorities and underwent higher hospitalizations. The CDC also reported that the mortality rate among Hispanics was also higher than whites. Interpreting such data are crucial to build health system protections and provide equitable structural and financial support for marginalized communities.
To be sure, there are provisions for low-wage workers in the recent economic stimulus bill — however, it does not go far enough. COVID-19 does not discriminate on the basis of race or income or national origin, but given the inherent limitations of the US health care system for these communities, the impact of this disease could be more severe for some. Without comprehensive data collection and legislative action by federal agencies, it will be difficult, if not impossible, to interpret and prevent the damage that this pandemic will cause to people of color in the United States.
Junaid Nabi is a public health researcher at Brigham and Women’s Hospital and Harvard Medical School. He is also a senior fellow at The Aspen Institute. Dr. Quoc-Dien Trinh is an associate professor of Surgery at Harvard Medical School, codirector of the Dana-Farber/Brigham and Women’s Prostate Cancer Program, and director of Clinical Operations at the Division of Urological Surgery at Brigham and Women’s Hospital.