The Washington Post - USA (2020-11-22)

A16 EZ RE THEWASHINGTONPOST.SUNDAY,NOVEMBER 22 , 2020

zonesmatchedup.

Numerousstudieshavesince

borne out the relationship be-

tween these health conditions

and high covid-19 death rates.

When lookingat the role of race,

smallerstudies —based on data

from singlehospital systems or

regions—found thatdifferences

inmortalitynarrowedwhencon-

trollingforailmentssuchashigh

blood pressure, diabetes, lung

conditionsandobesity.

In the CDC data, however,the

differencein death rates grows

even larger when controlled for

those other health conditions—

althoughinformation is missing

formanypatients.

Fos, amember of Louisiana’s

task force on race and covid-19,

argues the initial observation

thathigh covid-19 death rates

coincidedwithhotspotsforother

health problemsled some public

health officials to concludethe

unequal burdenwas somehow

inevitable.Afewwentsofarasto

suggest thatthose mostaffected

weresomehowtoblamefortheir

illnesses.

Rep. Maxine Waters (D-Calif.)

called out U.S. Surgeon General

Jerome Adamsin April, for in-

stance, for singlingout African

Americanswithadvice to avoid

alcohol,tobacco, and drugs to

lowertheirriskforseveredisease

from the virus. AlthoughAdams

had noted his own health strug-

gles as partof“that legacyof

growingup poor and Blackin

America,”Waters described the

commentsas “a backhandedat-

tack on AfricanAmericans and

communities of color.” Adams

subsequently apologized,saying

he“usedthelanguagethatisused

in my family”and thatthe com-

ments were not meant to be

offensive.

Fosand other experts argue

theclusteringofcovid-19casesis

more of asocial and economic

phenomenon.

He notedthe high proportion

of peoplein such communities

whointeractdailywiththepublic

as essentialworkers, who often

live in more densely packed

neighborhoodsandmultigenera-

tionalhouseholds, and who

might not have regulardoctors

becausetheylack health insur-

ance.

In addition,minoritiesface a

long historyofunequal access to

medicalcare —which mayhave

impacted treatment decisions

andoutcomes.Astudyusingdata

fromtheSocietyforCriticalCare

Medicine, posted this month be-

forepeerreview, foundthatAfri-

canAmericanpatientsweremore

likely than Whitesto receivean

older,less-expensive and riskier

blood thinner linked to higher

mortalityfromcovid-19. Blood

thinnershave becomeacritical

weaponin the arsenalused by

doctors againstthe diseasebe-

cause manypatients with severe

diseasedevelopclots.

It was notclearwhether the

administration of thatmedicine

related to insurance coverage,

physicianpreference, or some-

thing else. One of the study’s

authors, VenkySoundararajan,

chiefscience officer of data firm

Nference, wondered whether

some doctors chose the older,

moreestablishedproductformi-

noritypatients becausethe new-

er drugs were overwhelmingly

testedonWhites.

higher share of Black and His-

panicresidents.

In thespring,scholarspuz-

zling over such disparities over-

laid maps of covid-19 deaths

with maps of communities

where heartdisease,diabetes,

obesityand other conditions

were highestinthe United

States. Theyfound thatthe hot

Boston-baseddatafirmsaidAfri-

can Americans with symptoms

such as coughing maybeless

likely to getaccess to scarce

coronavirus tests. An academic

analysisof testing in NewYork

Cityfound thatmore testing ex-

isted in White neighborhoods

althoughthe highestpositivity

rateswereincommunitieswitha

significantly higher death rates

forBlacks, Hispanics, Native

Americansand Asians than for

Whites.

While minoritiestend to get

infected at higher rates, some

studies have suggested thatde-

laysindiagnosisandtheirexperi-

ences in hospitals appear to con-

tribute to pooreroutcomes. A

anainthespring,herecallsbeing

baffled.Respiratorydiseases,like

the flu, tend to move randomly

throughapopulation. “Rich,

poor,male,female,”hesaid.“Usu-

ally,everyoneisatrisktogether.”

Coronaviruscases,however,he

noticed,seemedto be clustered

in mostly poor Black neighbor-

hoods.He called up friendsin

Mississippifor thatstate’s data

and found similarpatterns.The

samethingwastrueinMichigan.

“Wedon’t thinkofinfectious

diseasesasbeingahealthdispar-

ity,”herecalled,“but here it was

infrontofme.”

Comparable data for many

otherstates simply did not exist.

Then and now,testing and data

collection came under the aegis

of the White House —which

congressionalDemocrats, public

health experts and civil rights

leadershave criticizedas being

slowtorespondtothedisparities.

Public health experts saythat

gooddataisthecornerstoneofan

effective pandemic response.

Withoutit, health officials and

others fly blind. But U.S. data on

the pandemic,especiallyabout

race and ethnicity, hasbeen in-

complete, or lackingaltogether,

in partbecause of the different

waysstateandlocaljurisdictions

reportit, and the federal govern-

ment’s delayinmandatingit.

NativeAmerican advocacy

groups, for instance, have ex-

pressedconcernabout the exclu-

sion of some of their communi-

ties from analyses, and inconsis-

tenciesin data from tribes, as

comparedwith whatstates and

localjurisdictionsarecollecting.

TheCDC said in astatement

thatitis“workinghard to ad-

dressthe threatofcovid-

amongracialandethnicminority

groups”by expanding testing for

at-risk groups, increasing en-

gagement with “trusted racial

andethnicminorityservicingor-

ganizations” includingBlack col-

leges anduniversitiesand

churches,and working to get

betterdata.

Yetsome early efforts to ad-

dress inequities were quashed:

TheCDC had internaldiscus-

sions for example, about ways to

increasetestinginAfricanAmer-

ican and other hard-hitcommu-

nities. On May3,adocument

posted on its website recom-

mendedthatpeople from “racial

and ethnic minoritygroupsdis-

proportionately affected by ad-

verse covid-19 outcomes” getpri-

orityfortesting.Threedayslater,

thelanguagewasremoved.

In responseto questions from

ThePost, the CDC’s press office

said the document was “a draft

posted without proper vetting

throughall CDC channels.”An

officialspeakingonthecondition

of anonymitybecause theywere

not authorized to discuss the

issue said it was actually higher-

ups at the Department of Health

and Human Services and the

White House who had asked for

its removal. No follow-upguid-

ancewaseverissued.

LeonMcDougle,afamilymed-

icinespecialistatOhioStateUni-

versitywho heads the National

Medical Association, the coun-

try’soldestBlack physicians

group, said he had been optimis-

ticthe Trump administration

wouldtakesteps to addressthe

disparities. But after thatdocu-

ment disappearedwithoutany

public explanation, he began to

havedoubts.

“Ihaverealconcernsaboutthe

... political influencethatap-

pears to playafactor in deci-

sions,”hesaid.

In early June, CDC Director

RobertRedfield apologized to

lawmakersfor“theinadequacyof

our response”indocumenting

the nation’s high rates of infec-

tionanddeathsamongBlackand

Hispanic Americans. That same

day, Adm. Brett Giroir,anHHS

assistant secretaryrunningthe

government’scoronavirustesting

response,said thatasofAug.1,

the federal governmentwould

begin requiringlaboratories to

reportracialandethnicinforma-

tion for people who were tested

forthevirus.

Thenationalcoronavirusdata-

base available todayismuch

more robust, but holes remain.

Some recordsare missingrace,

gender or age, while others lack

information on the patient’s oth-

er medicalconditions,or even

whetherthepersonlivedordied.

Information is more likely to be

blank for non-Whites. Among

hospitalized patients,for in-

stance,therewasnoinformation

on whether the patient survived

for36percent of Hispanics,

29 percentofBlacks, 26 percent

of Asians and 24 percent of

Whites.

ThePostanalyzedthe data in

numerousways: with and with-

outthe missing information,

withall infected patients, and

with only patients whohad been

hospitalized. No matter which

modelitused,theresultsshowed

the pandemic’s peak in the
spring,when refrigerator trucks
were parked outsideNew York
Cityhospitalsand ice rinks were
converted into morgues,accord-
ing to an analysisof anonymized
data collected by the Centers
for DiseaseControland Preven-
tion.
But as anotherwave of infec-
tions sweepsacross the country
this fall, losses among racial and
ethnic minoritiesremaindispro-
portionately large. Black Ameri-
cans were 37 percentmore likely
to die than Whites,after control-
ling for age, sexand mortality
rates over time. Asians were
53 percentmore likely to die;
Native Americansand Alaskan
Natives,26percentmorelikelyto
die; Hispanics,16 percent more
likely to die. Those higher case
fatalityrates for diagnosedpeo-
ple of color are on top of the
increasedinfection rates for
those unableto isolate at home
becausetheyare essentialwork-
ers.
These patterns have devastat-
ed communitiesof color across
the country: multigenerational
Latino householdsin Texas, Pa-
cific Islander familiesin Wash-
ington state, AfricanAmerican
familiesinSouthCarolina.
Advocacygroups, researchers
and other experts saymanyof
thesedeathsarepreventable,and
theyblame federal, stateand
local leadersfor failing to take
thedisparitiesseriouslyandtake
stepstoaddressthem.
Theshortageoftestingincom-
munitiesof color,which made
headlinesinthe beginning,per-
sists to this day. Despitetheir
symptoms,for instance, neither
Demi Bannister,nor hermother,
Shirley, weretested for the virus
until theywere close to death in
lateAugustandSeptember.
Criticsalsopointtospottyrace
data, which has made disparities
harder to identifyand solve;
weak enforcementofprotocols
likemask-wearingandsocialdis-
tancingat essentialworkplaces;
delays in translatingcritical
health alerts into other languag-
es; conflictingguidance from
health agencies thatdeepened
distrustinsome communities;
economic and cultural factors
thatlead more families to live in
multigenerational homes; and
immigrationpoliciesthatexacer-
bate crowdedhousingand dis-
couragepeople from seeking
medicalcare.
“Itisaperfectstormthathas
been created thatled to the
deaths of groups of people,”said
Elena Rios, head of the National
HispanicMedicalAssociation.
JulietChoi, chiefexecutive of
theAsian &Pacific Islander
American Health Forum, said
manyofthe measuressought by
minoritygroupstomitigate the
effects of the virus on their com-
munitiesare easy to implement
and inexpensive,but theyhave
beenmostlyignored.
“Itcomesdowntopoliticalwill
andcommitment,”Choi said.
“We’renotaskingthatdecadesof
systemic barriers geteliminated
overnight, but thereare many
simplethingsweshouldbedoing
thatwearenotdoing.”
Thereisgrowingevidencethat
such changes do makeadiffer-
ence.Facedwithextremedispari-
ties in covid-19 deaths, Michigan
officials undertook aseries of
steps, from boosting testing to
connecting people of color with
primarycare doctors. Thestate’s
rapid progressproves the issues
are neitherintractable, nor root-
edsomehowinbiology.
Garlin GilchristII, aDetroit
native as well as the state’slieu-
tenant governor,formed one of
the nation’s firststate racial dis-
paritiestask forces on covid-
backinApril.
Made up of 23 community
organizers,doctorsandotherex-
perts,thegroupfocusednotonly
on boosting testing and contact
tracing,but also tailoringmes-
sagesonmask-wearingandother
publichealthprecautionstoAfri-
can Americancommunities. It
also addressed broadersystemic
issues, such as access to primary
care, and helpingthose in rural
areasaccesstelemedicine.
When stateepidemiologists
ranthe numbers again in Sep-
tember, they found ahuge
change: Black residents who in
April accounted for 29.4percent
of cases and 40.7percent of
deaths now made up only 8per-
cent of cases and 10 percentof
deaths —verysimilartotheir
percentageinthepopulation.
Gilchristemphasized the
state’s effortshavenotbeencom-
plicated. “I thinkthe reason we
have been able to makeprogress
iswechosetofocusonit,”hesaid.

Holes in the data

When epidemiologist Peter J.
Fosfirstsawthecoronaviruscase
datafromhisownstateofLouisi-

VIRUSFROMA

Racial, ethnic minorities

still hit hardest by virus

Source:Centersfor DiseaseControland Prevention THE WASHINGTON POST

Highercovid-19death ratesamongcommunitiesof color

Black,Asian,Native American and Hispanicpatientsstill die far morefrequentlythan White patients,evenas

deathrateshave plummetedfor all racesand age groups,accordingtoaWashington Post analysisof records

from5.8 millionpeoplewho testedpositivefor the virusfromearlyMarchthroughmid-October.

FebruaryOctober

0

2%

1

FebruaryOctober FebruaryOctober

Death rate for womenages 0to

Blacks

Hispanics

Asians

June June June

Whites Whites Whites

Within the sameage group,Hispanic

men die moreoftenthan Whites.

Overall,the Hispanicdeathrate is

16 percenthigher.

FebruaryJune October

Whites

Hispanics

Thereare fewer Asianmen dyingof

covid-19.Asianmen in their 60s are

still dyingatarate higherthan Whites.

FebruaryJune October

Whites

Asians

Blackmen in their 60s arestill dyingata

higherrate than White men in the same

age group.

0

10

20%

FebruaryJune October

Whites

Blacks

Death rate amongmen ages 60 to 69

February June October

0

20

40%

70s

60s

80s

Ages 0to4950s

Death rate by age:Ninemonthsinto the pandemic,older

patientsconsistentlysuffer far higherdeathrates,evenas

ratesfor all ageshave declined.

0

4

8

12%

February June October

Women

ages60to

Men

ages 60 to 69

Genderdisparities:Amongcovid-19patientsin their

60s, men die at ahigherrate than women.The pattern

persists acrossall ages:men are64% morelikely to die

than women.

June June June

Whites Whites Whites

0

5%

2

Blacks

Hispanics

Asians

Death rateamongmen ages 0to

FebruaryOctober FebruaryOctober FebruaryOctober

PHOTOSBY BRENDABAZÁNFOR THE WASHINGTONPOST

Raquel Chavez losther father,

Ángel Chavez,and abrother,

Juan Francisco Chavez, to the

coronavirus. Other relatives

have fallen ill, too. “Mymother

cannotovercome what

happened,”she said. “Itwas so

quick.” Thefamily lives in

Texas’sRio Grande Valley, hit

especially hard by the virus.