African-Americans represent 4 percent of the population in West Virginia and yet make up over 7 percent of the cases. The death rates show 5% of the deaths being African American.( https://dhhr.wv.gov/COVID-19/) Despite late testing and often incomplete racial data this is still probably an accurate picture. Challenges arise as we often do not have full demographic data of those tested and when local health departments investigate the positives, this is the data acquired. West Virginia is one of the best states in gathering racial data but holes still exist. Nationally almost half of cases and 9% of deaths still have no race tied to them. This can affect our awareness and response.
From the best data we have now nationally, African-American deaths from COVID-19 are nearly two times greater than would be expected based on their share of the population. In four states, the rate is three or more times greater. West Virginia has been fortunate in the pandemic reporting just over 2000 cases and only 88 deaths with over 2 million cases and over 100,000 deaths reported nationally. (https://covidtracking.com/race)
Our country is volatile now. Etched on the MLK Memorial are these words. “Out of a mountain of despair, a stone of hope.” For those who have visited, it is a place for reflection and contemplation. Sculptor Lei Yixin depicted a granite statue of King emerging as a “stone of hope” from a symbolic “mountain of despair.” The rough edges depict the difficult journey, while the entrance conjures the openness of democracy.
I (George) have been leading the local action and one result was a commitment from state leaders to increase testing and outreach to African-American communities throughout the state. Last month the state finally got moving on the issue after some pressure from the state’s NAACP chapters. We have tested over 1000 people in our minority communities over the last month and this is a start to help us see the picture. The NAACP negotiated for an amount of the $1.5 billion Federal dollars allocated to West Virginia to fight the coronavirus be specifically directed to communities of color.
Locally, I have found people more polite and kinder that usual, such as making and distributing free masks, keeping the six feet distance in stores and still striking up a conversation, increased concern about their neighbors and the elderly by phone calls, et cetera. People have been looking out for the needy as far as food is concerned. Maybe it takes a pandemic to make the world more loving and kinder.
Are Communities of Color Disease Hot Spots?
Coronavirus is exposing and exaggerating deep inequities in our society. The Covid-19 hot spots of disease burden and mortality also reflect different types of hot spots. Even though it is clear that viruses do not discriminate, data from across the US and UK demonstrate that the neighborhoods of color are impacted differently by Covid-19. Almost daily the news and medical journals report the disparities in test positivity, hospital admissions, ICU cases, and death. But why?
Something very unusual is happening on both sides of the Atlantic where the US has the world’s highest number of fatalities and the UK has now topped 30,000 deaths, the most in Europe. A recent UK (1) report found black women and men are over 4 times more likely to die with Covid-19 than whites. The most recent US CDC report (2) revealed that over 30 percent of COVID-19 patients are African American yet make up about 13 percent of the population.
More recently a large US pre-publication database from a team of epidemiologists and clinicians at four universities show counties with higher black populations account for more than half of all Covid-19 cases and almost 60% of deaths. (3,4)
But what about New Orleans where minorities are overrepresented in the hospitals, ICUs, and in mortality? Can we blame the Mardi Gras celebrations in late February? Similar stories are playing out in the neighborhoods and hospitals in Detroit, Chicago, New York. The New York Times shared a map reflecting the mortality by neighborhood. African American communities were the darkest shades(5).
Why are so many dying? Certainly Louisiana is a hot spot in obesity with a nearly 40% percent obesity rate, as well as a hot spot for the co-morbidities of diabetes, cardiovascular disease, hypertension, and kidney disease. The same is true for the hardest hit neighborhoods in the other cities. Many of the victims suffer more than one of these conditions. Vitamin D deficiency is also being connected to poor outcomes and tied closely to darker skin groups. (6)
Medical Model —
Social Hot Spots
Dr. Jerome Adams, US Surgeon General stated on CBS in April: “ Blacks are more likely to have diabetes, heart disease, lung disease …and many black Americans are at higher risk for Covid-19.”
On a later CNN podcast Adams then states: “My recommendation is to all of America that we’re really doing this [staying home/distancing] to protect not just ourselves but each other. Every single person who stays at home is a person who is not spreading Covid-19….”
But can the stay home rule and safe distancing apply equally to the communities of color where structural inequities exist? The virus hits communities differently and the hot spots of poor health and socioeconomic disparity are mirroring the Covid-19 hot spots.
Living spaces are overcrowded making distancing all but impossible. Working and schooling from home is often not an option. “Essential jobs” in the service sector are overrepresented by minorities creating more chances for exposure-jobs such as home health aides, grocery work, delivery, and services.
Economic hardship exacerbates stress as the pandemic is having devastating effects on jobs, future earnings, the immediate threat of lay off, and future health insurance coverage. There is a wage gap for minorities and often little to no savings to support financial gaps from distancing. It’s hard to get away from being poor.
We are aware of the importance of optimal nutrition on metabolic and immune function. Many minority neighborhoods are food deserts with little to no access for affordable nutrient dense foods and less likely to have the supports to lead a healthy lifestyle.
Cases might be under reported as there is often limited access and resistance to enter health care. Thus far testing been a clinical strategy of case identification of symptomatic people versus a public health approach. We need racial and ethnic data to help us identify current and future communities at risk. Greater disease rates are rooted in socioeconomic, physical and even psychological factors such as chronic stress.
It’s not all negative. Bright spots in education are happening with improved home computer and internet access. States are enacting task forces to address disparities. The US Air Force just became the first branch of the Armed Forces to select an African American Chief of Staff in General Charles Q. Brown(7). And the vote was a unanimous 98-0. We can build back stronger communities. Hurricanes Katrina and Sandy have hopefully taught us lessons. Knowledge leads to public policy change and public health preparedness to address the disparity hot spots as we learn to live with Covid-19. We can engage in non-violent demonstration for justice.
We may not get to the mountaintop with you but together we can try.
• Rutherford first demonstrated for civil rights and equality for African Americans in 1962 and is president of the Jefferson County National Association for the Advancement of Colored People (NAACP)
• Cucuzzella is a professor at WVU School of Medicine and retired from the US Air Force. He practices at Jefferson Medical Center and in Martinsburg WV at the Center of Diabetes and Metabolic Health.
(1) Coronavirus (COVID-19) related deaths by ethnic group, England and Wales: 2 March 2020 to 10 April 2020 accessed at https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronavirusrelateddeathsbyethnicgroupenglandandwales/2march2020to10april2020
current stats go to https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#Race_Hispanic
(3) Black communities account for disproportionate number of Covid-19 deaths in the US, study finds – CNN https://www.cnn.com/2020/05/05/health/coronavirus-african-americans-study/index.html
(4) Low-Income and Communities of Color at Higher Risk of Serious Illness if Infected with Coronavirus | The Henry J. Kaiser Family Foundation
(5) New York City Coronavirus Map and Case Count By The New York Times https://www.nytimes.com/interactive/2020/nyregion/new-york-city-coronavirus-cases.html
(6) Vitamin D Insufficiency is Prevalent in Severe COVID-19 prepub doi: https://doi.org/10.1101/2020.04.24.20075838
(7) First black service chief in US military history confirmed by Senate CNN https://edition.cnn.com/2020/06/09/politics/charles-brown-senate-confirmation-first-black-service-chief