By Michael Ollove and Christine Vestal
As states begin to ease quarantine restrictions, epidemiologists caution that success in conquering the next wave of the pandemic largely will depend on taking extra precautions to protect the most vulnerable — the elderly and people of color.
African Americans are at much higher risk of contracting COVID-19 than the rest of the population, and they are much more likely than white people to die from the virus.
That means that unless state and local governments redouble COVID-19 prevention campaigns in predominantly black counties and neighborhoods, the disease will continue to spread, straining the health care system and increasing the risk of contagion for all Americans, warned Dr. Lisa Cooper, a professor of medicine and public health at Johns Hopkins University and international expert on health disparities.
To find out whether any states were taking concrete actions to stem COVID-19 cases and deaths in black communities, Stateline contacted the 16 states where black residents make up a larger percentage of the population than the national rate of 13%.
Most responded that they are assembling task forces and conducting studies of health disparities.
But among those states, all of which were contacted by email and phone, Maryland, Michigan, Mississippi, New York, South Carolina and Virginia provided the greatest detail on what they are doing to concentrate special medical resources and social services in predominantly low-income and black neighborhoods.
They are targeting black communities for additional testing and contact tracing. They are distributing personal protective equipment, such as masks and hand sanitizers, door to door in hard-hit, predominately African American communities.
They are engaging trusted local community organizations, including black churches and historically black colleges and universities, to help with outreach. They are providing temporary housing where those infected with the virus can quarantine to avoid spreading it to the people with whom they live. And they are providing cash to compensate for lost wages when people quarantine and need food and other social services for their families.
In all but one of the 16 states, black victims made up a higher percentage of COVID-19 deaths than their percentage of the overall population, according to a Stateline analysis of data available on state public health websites.
In Delaware, African Americans accounted for one-quarter of the state’s population and the same share of its COVID-19 deaths.
South Carolina and Michigan had the largest gaps — 25 points — between the percentage of blacks in the population and the percentage of COVID-19 victims who were African American. Virginia and North Carolina had the smallest gaps: 3 points.
In Illinois and Michigan, black residents were nearly three times as likely to die of COVID-19 as the rest of the population. In South Carolina and Tennessee, they are nearly twice as likely to die of the virus, according to the Stateline analysis.
It is too early to tell whether state and local initiatives will temper the appalling toll COVID-19 is extracting from black communities. But state officials’ focus on the issue in both red and blue states signals an awareness that immediate action is required to make a difference.
“I’m not saying Virginia is getting it right in every area or that we are where we want to be,” said Janice Underwood, the state’s first Cabinet-level director of diversity, equity and inclusion. “But we’re certainly not where we used to be.”
The reasons for the disproportionate number of cases and deaths in black communities are well known. Blacks have a higher rate of underlying conditions such as diabetes, asthma and high blood pressure that make COVID-19 more dangerous. They also are more likely to work in frontline jobs, live in crowded housing and use public transportation, increasing their exposure to the virus.
“These problems have been going on for a long time,” Cooper said. “A lot of folks are acting surprised by this. It’s not because of their race that this is happening. The virus isn’t going after black people. It’s because of structural inequities that have led to poor health and greater exposure to the virus.”
Forty-one states are collecting race data on COVID-19 cases and deaths, but the lack of detail leaves many questions unanswered.
“We’ve got to address the specific underlying problems in these urban neighborhoods and rural communities as quickly as possible,” Cooper said. “Is it because there’s not enough testing? Not enough doctors or ventilators in the hospitals? Overcrowded housing and not enough access to food?”
Better demographic data would help state and local governments tailor their responses to the needs of the community. And better data on testing and hospitalizations would inform policymakers on whether those responses are working, she said.
“But waiting for the data is not a reason to not do something. We know there’s a problem. Even if we don’t know their race, we know certain groups in certain geographical areas are being hit especially hard.”
Eliminating the underlying causes of racial health disparities will require sustained commitment at all levels of government and health care for years. But long-term solutions won’t help in the middle of a pandemic, when African Americans are dying by the tens of thousands.
What needs to happen now, public officials, scholars and advocates insist, is for state and local governments to partner with trusted leaders in black communities to distribute accurate information about how to protect themselves from the virus and what to do if they show symptoms.
The coronavirus-related racial disparities are not surprising to Dora Muhammad, the congregation engagement director of the Virginia Interfaith Center for Public Policy in Richmond. “Outcomes for blacks have always been at the bottom,” she said. “Black lives have never been valued enough or prioritized.”
Nonetheless, Muhammad said, Virginia’s initiatives to help black communities now are encouraging. “The state’s response has been very real,” she said, referring in part to extra testing and the distribution of personal protective equipment in vulnerable, minority communities.
It has long been established that blacks have higher rates of diabetes, high blood pressure and heart disease than other groups. African Americans also die at higher rates than whites from cancer, kidney disease, diabetes, heart disease and stroke.
Poverty alone doesn’t account for the racial differences in health. Studies have found that an implicit bias on the part of health care providers often results in poorer treatment of black patients. Many medical schools now incorporate the concept of implicit bias in their curricula to help new practitioners guard against allowing unconscious biases affect their treatment of patients.
In recent years, there also has been increasing acceptance in medicine of a concept called weathering, which holds that the stress of living as a member of a minority in itself takes a toll on the body, weakening one’s cardiovascular, neuroendocrine and immune systems.
“Over time, those systems get dysregulated, cells biologically age faster and lead to early onset of hypertension, diabetes and other chronic conditions,” said Arline Geronimus, a public health scholar at the University of Michigan whose research introduced the notion of weathering. “It makes you much more vulnerable in a pandemic to infectious disease.”
Narrowing the gap
States responding to Stateline said they were conducting more testing in areas with high concentrations of coronavirus infections, which often are low-income and predominately African American neighborhoods.
Virginia, Michigan, South Carolina and Tennessee have created a combination of walkup testing sites and mobile units to provide access to residents who don’t have cars.
North Carolina and South Carolina reported increased testing of non-symptomatic residents in predominantly black communities by working with community leaders, local physicians, retail stores and health clinics.
Both states also reported surging contact tracing capacity in under-served, predominantly black counties and communities. South Carolina reported increasing its contact tracing staff from 20 to 600, with the potential of adding another 800 workers as needed. Most will be deployed in predominantly minority counties and neighborhoods.
New York said it has established 24 temporary testing sites in churches in minority communities in the New York City region and is providing free testing to public housing residents in the city.
In an interview with Stateline, Michigan Lt. Gov. Garlin Gilchrist — who leads the task force on coronavirus racial disparities created by Gov. Gretchen Whitmer, a fellow Democrat — said the state’s mobile units will go to hot spots in southeastern Michigan, which includes Detroit. They will provide testing in nursing homes, homeless shelters and neighborhoods otherwise identified as having a high likelihood of mass infections.
Gilchrist said Michigan also has committed to test “every person incarcerated in Michigan, which is over-represented by blacks and Latinos.”
New York and North Carolina reported offering temporary housing to ensure a safe environment with the necessary supports (private room and bathroom, adequate food and water, and access to medication) for residents in low-income communities who are asked to quarantine.
Gilchrist said Michigan has provided such housing for frontline health workers and intends to provide such facilities in low-income communities in the Detroit area as well.
Starting this month, Maryland plans to repurpose its existing health care navigator network, originally created to help people sign up for Affordable Care Act health plans, by hiring 30 new social workers to serve 50,000 people in 24 minority communities across the state.
Working closely with COVID-19 testing centers, Maryland’s health navigators will help residents who test positive find emergency housing, temporary cash assistance to replace lost wages and social services for other family members while they quarantine.
Underwood, Virginia’s diversity and equity officer, who leads a coronavirus health equity working group, said along with the testing the state conducts in vulnerable communities, it is distributing personal protection equipment.
In Richmond, Chesapeake and Harrisonburg, she said the state delivered 20,000 masks and 20,000 bottles of hand sanitizer to doorsteps in hard-hit, heavily African American communities. The state was preparing to repeat those activities in Roanoke, Petersburg and parts of Northern Virginia, she said. The state also plans to supply every inmate with two masks.
New York said it had delivered a million cloth masks and 100,000 gallons of hand sanitizer to public housing in New York City.
Many of the states said they are reaching out to trusted institutions in minority communities, both to gather information about the needs of that community and for help in spreading accurate information about the virus, about safe practices and where to seek help if needed.
States said they have enlisted churches in minority communities, historically black colleges and universities, and elected officials from those areas.
Mississippi said it is using Head Start programs to help disseminate coronavirus-related information to its clients. Tennessee has enlisted the help of Meharry Medical College, a historically black medical school in Nashville, to run its testing in the city and help with COVID-19 outreach.
South Carolina has created public service video messages delivered by black state leaders, including Democratic U.S. Rep. James Clyburn, Columbia Mayor Steve Benjamin and the state’s chief epidemiologist, Dr. Linda Bell.
Patrick H. Johnson, a senior vice president at Meharry involved in the pandemic response, said one challenge health officials face in working in minority communities is gaining the trust of those who have historic reasons for being skeptical of outside authorities. He praised the state for turning to trusted partners like Meharry.
“There’s a pride in the African American community when they hear Meharry is running all the testing sites,” Johnson said. “And it makes a big difference when they see these people look like me, they talk like me and they’re not treating me any differently.”
Johnson mentioned a technological innovation that authorities are introducing as they ramp up contact tracing in minority communities. The telephone numbers respondents will see, he said, will be from trusted community organizations.
“Most of the people aren’t going to pick up the phone from an 800 number they don’t recognize,” he said. “We have the technology though, so the number they’ll see will be from an organization they’ll trust, like Meharry or a community-based clinic. They’re more likely to pick up when they see that.”
Stateline is an initiative of The Pew Charitable Trusts.