Coronavirus doesn’t discriminate. So why is it causing more harm in black communities?
To answer that, Romona Brazile, Deputy Director of Prevention and Wellness for the Cuyahoga County Board of Health, asks folks to take a few steps back. It’s the only way she knows to get below the surface conversation happening around COVID-19 and race.
The simple thing to do is to talk about chronic disease, said Brazile, a registered nurse. Americans who are black and brown have higher rates of asthma, diabetes and high blood pressure. Some of these chronic health conditions, along with lung disease, are “underlying conditions” seem to put people at higher risk for complications, hospitalization and death from COVID-19, according to preliminary information from the U.S. Center for Disease Control and Prevention.
But why are there higher rates of those chronic diseases in many black communities?
The question takes Brazile to a Desmond Tutu quote she recited at a recent county press conference: “There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”
Brazile, and other public health colleagues, have spent several years trying to do just that — draw attention to the environmental, social, economic and systemic reasons.
In 2019, a Cuyahoga County Community Health Assessment determined that eliminating structural racism was among the top “health needs.”
Read the report here: https://hipcuyahoga.org/2019cha/
“When I say asthma, I want you to think about housing conditions,” Brazile said. “Why do so many people of color live in housing that isn’t healthy?” The same goes for diabetes and other conditions often directly related to access to healthy, affordable food. Is it available in the neighborhood? Is it affordable?
Also consider exercise. The public health advice is to exercise often, but that message can fall flat in some communities. “What if there is no place for you to exercise? What if you don’t feel safe in a park.” Brazile asked.
COVID-19 for African Americans is one problem, layered on top of many other problems, she said. Of course it has caused more harm. “It’s not surprising,” Brazile said. “but it also isn’t acceptable.”
At the state level, Gov. Mike DeWine, and Health Department Director, Dr. Amy Acton, recently formed a Minority Health Strike Force to study the higher numbers of black Ohioans affected by the disease and to make recommendations.
The picture is still murky because of limited testing statewide and incomplete reporting of race and ethnicity data for reported infections and deaths. (Race information is missing in between 10% and 12% of cases statewide.)
Ohioians who identify as black make up about 13% of the state’s population but, according to state health data as of April 24 are:
- 22 % of confirmed COVID-19 infections
- 16 % of deaths
- 29 % of hospitalizations
The numbers in Cuyahoga County are less clear. Cleveland, which has its own health department, has not yet shared racial demographics for its cases. About 30% of the county population is estimated as black and as of last week 29 % of COVID-19 patients were black, with race data missing for about 15% of cases.
Cases that required hospitalization and intensive care included a disproportionate number of patients who were black: 42% of intensive care patients were black and 49% of ICU patients were white.
DeWine called the disproportionate number of COVID-19 cases “very, very concerning.”
In other states like Illinois, Michigan, and Missouri, disproportionate cases and deaths appear to be even more stark:
In Illinois, where 14% percent of the population identifies as black, 41% of the confirmed deaths due to complications from COVID-19 as of April 20 were black residents, according to the state health department.
In some cases, distrust in the medical system and the government might influence how the disease impacts minority communities. Some of that likely grows out of the experiences of black community members that have taught them not to trust those systems.
There are legitimate reasons, Brazile said, like the Tuskegee Experiment, where black men were enrolled without proper consent in a medical study about syphilis. There was also the more recently publicized case of Henrietta Lacks, who had cells taken from her body without her consent while she was being treated for cancer, replicated and used in experiments. Or the attention tennis star Serena Williams’ birthing complications drew to the issue of black maternal health complications and deaths.
Influenced by those experiences and stories, some black patients may be reluctant to get tested for COVID-19 or to be vaccinated should one become available.
The pandemic has affected everyone, Brazile said but for many who already had a toxic level of stress or were in crisis, this is another layer — with worries about jobs and kids not being in school — that will increase stress hormones and compound diabetes or hypertension.
A lot of the work that the county is doing now, is about addressing barriers: How are we going to make sure that people have access to testing? How can we make sure that people who are quarantined or isolated have the food they need?
But in the bigger picture, Brazile said, she hopes that the COVID-19 pandemic will bring a wave of attention to health disparities and inequities — enough to garner the political will to address them.