Mighty Blog

Equity in the Time of Coronavirus – Part 2

From the desk of Dr. Marc Gorelick, Children’s Minnesota president and CEO

A tiny bit of RNA (ribonucleic acid) enclosed in a protein coat. The entire package is small enough that 8 billion of them would fit in a grain of sand. The novel coronavirus (COVID-19) doesn’t seem nearly large or sentient enough to be a vehicle for racism. And yet….

While statistics are spotty, it appears that at least in the US, the COVID-19 pandemic is disproportionately affecting people of color, and especially African Americans. In most places reporting data by race, the toll of this disease is far higher among blacks than others. In Louisiana, for example, blacks make up 32 percent of the population but 70 percent of the COVID-19-related deaths. Of course, the disease is not evenly distributed within states, but even at the county and city level the disparities are stark. In Milwaukee County, blacks are 26 percent of the population but account for 73 percent of deaths. And it isn’t just deaths; blacks get the disease at a higher rate than others. The disease rate per 1000 population is 3.5-4 times higher in black majority counties than white or Latino majority counties, and the death rate is 6-10 times higher.

Why is this? Surely, it’s not malign intent on the part of the tiny virus. No, the virus is not racist. But these disparities are simply the latest manifestation of the kind of structural racism that has affected the health and well-being of blacks for decades if not centuries. Here are a few of the leading hypotheses for the disparities in COVID-19:

Marc Gorelick, MD, president and CEO
  1. Blacks are more likely to suffer from other conditions, especially obesity and hypertension, that put them at higher risk of severe disease or death if they develop COVID-19. While some have been tempted to blame the victim for these disparities, these are the result largely of socioeconomic and health care system factors that have systematically disadvantaged blacks.
  2. Blacks and those who are poor are less likely to have jobs that enable them to work from home. They are overrepresented in the kinds of service industries that require closer in-person contact that spreads diseases. As a report from the Economic Policy Institute pointed out, only 9.2 percent of workers in the lowest quartile of the wage distribution can telework, compared with 61.5 percent of workers in the highest quartile.
  3. Blacks and the poor have a harder time complying with social distancing It’s great that child care is considered an essential service, but what if you cannot afford child care and you rely on a network of family members to care for your children while you go to work? In many places, including Minnesota, blacks are more likely to have no or limited internet access, further limiting the ability to work or conduct other necessary activities remotely. And the idea of wearing a mask in public sounds wonderful – if you’re white. Some black men have expressed a reluctance to do so for fear of racial profiling, and episodes of harassment show this fear is not unfounded.

And here is the human face of this inequity: I grew up in New York, my colleague grew up in Detroit.  These are both disease hot spots. But my colleague, who is black, knows a heck of a lot more victims than I do. The point is, these are not statistics. They are people.

The COVID-19 pandemic has upended almost every aspect of our world.  It has brought out the best in many of us as individuals. But it has also placed in stark relief some of the less pleasant truths about our society and about our healthcare system. I only hope that this virus, when it is done wreaking its havoc on us, by making plain the inequities in front of our eyes, can compel us to begin to correct them.

This is part two of a previous blog from Dr. Marc Gorelick.

Alexandra Rothstein