Impact of the COVID-19 pandemic on African-American communities

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The COVID-19 pandemic has revealed health care disparities with African-Americans experiencing the highest current COVID-19 mortality and morbidity rates in the US—more than twice as high as the rate for white people and Asians (outside Filipino Americans, who have higher infection and mortality rates than African Americans), who have the lowest current rates.^[1]

Many studies and socio-economic observations have demonstrated that the African-American community was more impacted disproportionately by the disease in multiple ways. In many cities like Chicago, although African Americans are only 30% of the population, they make up more than 50% of COVID-19 cases and about 70% of COVID-19 deaths.^[2]

Racial disparities between White-Americans and African-Americans have been growing since the beginning of the pandemic, whether it is related to health, jobs, prison, education, psychology, mental health and housing.

COVID-19 pandemic in the US[]

Background[]

The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was first identified in December 2019 in Wuhan, China. The World Health Organization declared a Public Health Emergency of International Concern regarding COVID-19 on 30 January 2020, and later declared a pandemic on 11 March 2020. As of 11 May 2021, more than 159 million cases have been confirmed, with more than 3.3 million deaths attributed to COVID-19, making it one of the deadliest pandemics in history.^[3]

In May 2020, the World Health Assembly in resolution WHA73.1 requested the Director-General of the World Health Organization (WHO) to realize a global study about the origins of the COVID-19 in Wuhan.^[4] The World Organization for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) tried to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts. The WHO-convened Global Study of Origins of SARS-CoV-2: China Part was launched in February 2021 and recognized the "impact of the epidemic on Wuhan, from affected individuals and communities to government officials, scientists and health workers" and called for "a continued scientific and collaborative approach to be taken towards tracing the origins of COVID-19". As a result, the origins of COVID-19 are still unknown today.

Symptoms of COVID-19 are highly variable, ranging from none to life-threatening illness. The virus spreads mainly through the air when people are near each other. It leaves an infected person as they breathe, cough, sneeze, or speak and enters another person via their mouth, nose, or eyes. It may also spread via contaminated surfaces. People remain contagious for up to two weeks, and can spread the virus even if they are asymptomatic.^[5]

Recommended preventive measures include social distancing, wearing face masks in public, ventilation and air-filtering, handwashing, covering one's mouth when sneezing or coughing, disinfecting surfaces, and monitoring and self-isolation for people exposed or symptomatic. Several vaccines have been developed and widely distributed since December 2020. Current treatments focus on addressing symptoms, but work is underway to develop therapeutic drugs that inhibit the virus. Authorities worldwide have responded by implementing travel restrictions, lockdowns/quarantines, workplace hazard controls, and business closures.^[6]

History of COVID-19 in the USA[]

First cases[]

The first cases of the COVID-19 pandemic of coronavirus disease 2019 in North America were reported in the United States in January 2020. Cases were reported in all North American countries after Saint Kitts and Nevis confirmed a case on 25 March, and in all North American territories after Bonaire confirmed a case on 16 April.^[7]

Deaths and other data[]

On 26 March 2020, the U.S. became the country with the highest number of confirmed COVID-19 infections, with over 82,000 cases. On 11 April 2020, the U.S. became the country with the highest official death toll for COVID-19, with over 20,000 deaths. As of 21 November 2020 the total cases of COVID-19 are over 13,942,964 with over 383,084 total deaths.

As of 18 February 2021, Canada has reported 834,182 cases and 21,435 deaths, while Mexico has reported 2,013,563 cases and 177,061 deaths. The most cases by state is California with 3,492,045 cases and 47,916 deaths as of 18 February 2021.

COVID-19 is killing people on a large scale. As of October 10, 2020, more than 7.7 million people across every state in the United States and its four territories had tested positive for COVID-19.

According to the New York Times database, at least 581, 669 people with the virus have died in the United States.^[8] However, these alarming numbers give us only half of the picture; a closer look at data by different social identities (such as class, gender, age, race, and medical history) shows that minorities have been disproportionally affected by the pandemic. These minorities in the United States are not having their right to health fulfilled.^[9]

The impact of COVID-19 on African-Americans[]

Sectors[]

According to Maritza Vasquez Reyes in Health and Human Rights Journal, given that the COVID-19 pandemic is more than just a health crisis—it is disrupting and affecting every aspect of life including family life, education, finances, and agricultural production—it requires a multi-sectoral approach.^[9]

According to the World Health Organization’s report Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health, “poor and unequal living conditions are the consequences of deeper structural conditions that together fashion the way societies are organized—poor social policies and programs, unfair economic arrangements, and bad politics”.^[10]

The combination of structural factors as they play out during this time of crisis is disproportionately affecting African American communities in the United States in many aspects of their life.

Pre-existing conditions[]

African-Americans are more likely to have diseases such as hypertension, heart disease, and diabetes, conditions that amplify the severity of COVID-19 than that of White Americans, which is lower, except for lymphoma.^[11] Research has shown that not only do black people develop these diseases at a greater rate than white people, they also tend to develop them at a younger age.^[12] Medical experts attribute the disproportionate rates of these diseases in black people to higher levels of stress and racial discrimination.^[12]

Additionally, many black people live with people who are at high risk for developing serious illness from the COVID-19 because of their age or underlying medical conditions.^[13]

Health[]

African-Americans experience the highest actual COVID-19 mortality rates nationwide since the beginning of the pandemic ; their mortality rate represents more than twice as high as the rate for white people and Asians.

This statistic varies from state to state, in Kansas, black people are seven times more likely to have died than white residents, while in Washington, D.C., the rate among black people is six times as high as it is for white people.^[14] In Missouri and Wisconsin, it is five times greater. Black people are 13% of the U.S. population that has released COVID-19 mortality data, but they account for 25% of the deaths. South Carolina and Michigan had the largest gaps — 25 points — between the percentage of black people in the population and the percentage of COVID-19 victims who were black, Virginia and North Carolina had the smallest gaps: three points.

This disproportionate impact can be explained by the racial inequalities in health insurance in the United States. For instance, according to the Kaiser Family Foundation, in 2018, 11.7% of African Americans in the United States had no health insurance, compared to 7.5% of whites.^[15] African-Americans communities have access to diminished health care and finances as the uninsured are far more likely than the insured to forgo needed medical visits, tests, treatments, and medications because of cost.

As the COVID-19 virus made its way throughout the United States, testing kits were distributed equally among labs across the 50 states, without consideration of population density or actual needs for testing in those states. Although there is a dearth of race-disaggregated data on the number of people tested, the data that are available highlight African Americans’ overall lack of access to testing. For example, in Kansas, as of June 27, according to the COVID Racial Data Tracker, out of 94,780 tests, only 4,854 were from black Americans and 50,070 were from whites. However, blacks make up almost a third of the state’s COVID-19 deaths (59 of 208). And while in Illinois the total numbers of confirmed cases among blacks and whites were almost even, the test numbers show a different picture: 220,968 whites were tested, compared to only 78,650 blacks.^[16]

Similarly, American Public Media reported on the COVID-19 mortality rate by race/ethnicity through July 21, 2020, including Washington, DC, and 45 states.^[1] These data, while showing an alarming death rate for all races, demonstrate how minorities in the US are impacted harder by the pandemic.

The overrepresentation of African Americans among confirmed COVID-19 cases and number of deaths underscores the fact that the coronavirus pandemic is amplifying and exacerbating existing social inequalities tied to race, class, and access to the health care system according to many statistical studies.

Prison[]

Nearly 2.2 million people are in US jails and prisons, the highest rate in the world. According to the US Bureau of Justice, in 2018, the imprisonment rate among black men was 5.8 times that of white men, while the imprisonment rate among black women was 1.8 times the rate among white women.^[17] This overrepresentation of African Americans in US jails and prisons is another indicator of the social and economic inequality affecting this population.

According to the Committee on Economic, Social and Cultural Rights’ General Comment 14, “states have an obligation to ensure medical care for prisoners at least equivalent to that available to the general population.^[18]”

However, there has been a very limited response to preventing transmission of the virus within detention facilities, which cannot achieve the physical distancing needed to effectively prevent the spread of COVID-19.

Low-wage jobs[]

Around the country black people make up a higher proportion of some low-paid professions that have elevated risks of virus exposure.^[19]

The types of work where people in some racial and ethnic groups are overrepresented can also contribute to their risk of getting sick with COVID-19.

Nearly 40% of African American workers, more than seven million, are low-wage workers and have jobs that deny them even a single paid sick day. Workers without paid sick leave might be more likely to continue to work even when they are sick. This can increase workers’ exposure to other workers who may be infected with the COVID-19 virus.^[19]

Similarly, the Centers for Disease Control has noted that many African Americans who hold low-wage but essential jobs (such as food service, public transit, and health care) are required to continue to interact with the public, despite outbreaks in their communities, which exposes them to higher risks of COVID-19 infection. According to the Centers for Disease Control, nearly a quarter of employed Hispanic and black or African American workers are employed in service industry jobs, compared to 16% of non-Hispanic whites. Blacks or African Americans make up 12% of all employed workers but account for 30% of licensed practical and licensed vocational nurses, who face significant exposure to the coronavirus.

In 2018, 45% of low-wage workers relied on an employer for health insurance. This situation forces low-wage workers to continue to go to work even when they are not feeling well. Some employers allow their workers to be absent only when they test positive for COVID-19. Given the way the virus spreads, by the time a person knows they are infected, they have likely already infected many others in close contact with them both at home and at work.^[20]

Housing[]

Staying home is not an option for the homeless. African-Americans, despite making up just 13% of the US population, account for about 40% of the nation’s homeless population, according to the Annual Homeless Assessment Report to Congress.^[19] Given that people experiencing homelessness often live in close quarters, have compromised immune systems, and are aging, they are more vulnerable to communicable diseases—including the COVID-19.^[21]

Segregation affects people’s access to healthy foods and green space. It can also increase excess exposure to pollution and environmental hazards, which in turn increases the risk for diabetes and heart and kidney diseases.^[22] African Americans living in impoverished, segregated neighborhoods may live farther away from grocery stores, hospitals, and other medical facilities.^[23] To this effect, sociologist Robert Sampson states that the coronavirus is exposing class and race-based vulnerabilities. He says that African Americans, even if they are at the same level of income or poverty as white Americans or Latino Americans, are much more likely to live in neighborhoods that have concentrated poverty, polluted environments, lead exposure, higher rates of incarceration, and higher rates of violence.^[24] Many of these factors lead to long-term health consequences.

The pandemic is concentrating in urban areas with high population density, which are, for the most part, neighborhoods where marginalized and minority individuals live. Strategies most recommended controlling the spread of COVID-19—social distancing and frequent handwashing—are difficult to practice for those who are incarcerated or who live in highly dense communities with precarious or insecure housing, poor sanitation, and limited access to clean water.^[9]

Household finances[]

Pre-pandemic, African-American people had the highest unemployment rates in the country. African-American households earned 59 cents for every dollar White households earned. For every dollar of personal savings that white households have, black households have 10 cents. Black job losses and reduced work hours have been as high as twice that as white people. Black households reported that their personal savings were depleted by the pandemic or that they had fallen behind on housing payments or have had problems paying debts and/or utility bills.^[13]

Federal support for families from the CARES Act has expired and Congress continues to debate the funding many families desperately need. Black people and Latinos were hit especially hard when stay at home orders were put in place as well as social distancing mandates because they are over-represented in the leisure and hospitality industries with jobs at hotels, restaurants, retail and construction.^[13]

Comparison with other pandemic and environmental catastrophes on African-Americans[]

HIV/Aids[]

African-American people account for a higher proportion of new HIV diagnoses and people with HIV, compared to other races and ethnicities. In 2018, Black/African American people accounted for 13% of the US population but 42% (16,002) of the 37,968 new HIV diagnoses in the United States and dependent areas. In 2018, there were 6,678 deaths among Black and African-American people with diagnosed HIV in the US and dependent areas. These deaths could be from any cause.^[25]

According to CDC, many reasons could explain this phenomenon:^[25]

• Some African American people with HIV are unaware they have it : people who don’t know they have HIV can’t get the care and treatment they need and may transmit HIV to others without knowing.
• HIV stigma is common among people with HIV and negatively affects their quality of life. Stigma and fear of discrimination may prevent African-American people with HIV from getting the care they need or disclosing their status.
• Racism, discrimination and mistrust in the health care system may influence whether African American people seek or receive HIV prevention services. These issues may also reduce the likelihood of engaging in HIV treatment and care.
• Homophobia can make it difficult for some African American people to be open about risk-taking behaviors, which can increase stress, limit social support, and negatively affect health. These factors may prevent some African American people from accessing HIV prevention and care services.
• African American men and women have higher rates of some sexually transmitted diseases (STDs) than other racial/ethnic communities. Having another STD can increase a person’s chance of getting or transmitting HIV.
• African-American people experiencing poverty may find it harder to get HIV prevention and care services. The social and economic issues associated with poverty—including limited access to high-quality health care, housing, and HIV prevention education—directly and indirectly increase the risk for HIV and affect the health of people with and at risk for HIV. These factors may explain why African American people have worse outcomes on the continuum of HIV care, including lower rates of viral suppression.

Hurricane Katrina[]

On August 29, Hurricane Katrina descended upon the Gulf Coast of the United States and devastated the communities that were affected by this force of nature. Hurricane Katrina would become the costliest tropical storm to have struck the United States. It would add up to $125 billion in damages as neighborhoods were destroyed and flood waters rose.^[26]

The poverty rate of African-Americans was high in the area, which made many of those unable to live in areas safe from floodwaters and were resorted to live in areas that were not well maintained by the local government, as many levees did not hold out. Many African Americans in New Orleans were impoverished and due to the continuing trend of racism in the area, they were most vulnerable to the effects of Hurricane Katrina. 60.5% of New Orleans' population is composed of African-Americans, which many suffer through the difference in wealth in the area. Due to this, minority communities opt to live in cheap neighborhoods that are susceptible to flooding.

These observations have led to a demand of environmental justice by some members of civil society: "Environmental justice is the name of the social movement that emerged in response to this problem to address a wide range of issues and communities. Most of the problem of Hurricane Katrina was that it revealed how racial discrimination before the natural disaster helped contribute to the damages and heavy effects it had on the communities of the Gulf Coast, who were mainly people of color",^[26] said Julie Sze in her publication Noxious New York: The Racial Politics of Urban Health and Environmental Justice.

Comparison with countries having a grand Black diaspora: the link between race and access to healthcare[]

Caribbean countries[]

Although many Caribbean countries have established physical isolation measures to reduce infection and prevent health systems from collapsing, the region’s structural problems have made it more complex to mount an immediate response to the crisis. A report from the Economic Commission for Latin America and the Caribbean (ECLAC) demonstrated that COVID-19 is exposing social inequalities of all kinds and the overrepresentation of Afrodescendants among the group living in poverty who are employed in informal and caregiving jobs.^[27]

As Afrodescendants have worse indicators of well-being than their non-Afrodescendant peers, they are seen as one of the groups most vulnerable to the COVID-19 pandemic in the Caribbean countries, in terms of both infection and mortality.

Various agencies and institutions, including the Pan American Health Organization, the United Nations Population Fund, the Office of the United Nations High Commissioner for Human Rights and the Inter-American Development Bank, have already pointed out that the Afrodescendant population is more vulnerable to COVID-19 owing to the structural inequality and racial discrimination to which it is subjected.

These institutions highlighted the importance of addressing health from a comprehensive perspective that considers emotional, physical and social well-being, as defined by the World Health Organization (WHO), where the relationship between health and its social determinants is taken into account. They urge countries to eliminate disparities in health status which might result from racism.^[27]

Black minorities in Europe[]

France[]

An INSEE study shows that the excess mortality from all causes is, for March and April 2020, twice as high among people born abroad in France.^[28]

In 2020, excess of mortality primarily affected people born abroad : increase in deaths increased by 36% for people born in Africa outside the Maghreb, by 29% in Asia and by 21% in the Maghreb, while the increase in deaths of people from Europe, Oceania and America has been similar to that of people born in France.

In France, people of foreign origin have held more positions, so-called "essential" occupations, and have had to continue to go to work during the lockdown. In addition, people from sub-Saharan Africa live in the most cramped housing, which can promote transmission, especially between different age groups.^[28]

England[]

Data on ethnicity in patients with COVID-19 in the published English medical literature remains limited. Future research on this topic is of urgent public health importance according to a research paper from The Lancet^[29].

The Lancet shows that individuals from African and Asian communities are at increased risk of infection from SARS-CoV-2 and worse clinical outcomes including hospitalization, ITU admission and mortality, compared to White patients^[29].

European Commission[]

COVID-19 has shown the impact on Black and Asian people in Europe.^[30]

The Council of Europe’s anti-racism commission (ECRI) in its 2020 annual report published in March 2021, ahead of the International Day against Racial Discrimination marked on 21 March, identified four key challenges Europe was facing last year. These are:

• mitigating the disproportional impact of the COVID-19 pandemic on vulnerable groups,
• tackling deep-rooted racism in public life,
• combating anti-Muslim racism and antisemitism in the face of terrorism,
• addressing the backlash against the protection of human rights of LGBTQI people.^[31]

Even if many European countries avoid breaking down data along racial or ethnic lines out of concern over privacy or discrimination, COVID-19 data shows well ethnic inequalities in healthcare access.^[30]

Comparative conclusion[]

A comparison with Katrina, HIV epidemic and COVID pandemic shows the ongoing racial discrimination and inequality faced by African-American in the US, which have higher risks to be affected by economic, health and weather disaster. Comparing rates of mortality of Afrodescendants in other countries demonstrates that race is still a systemic continuum in the Western world.

See also[]

• COVID Tracking Project
• COVID-19 pandemic by country and territory
• COVID-19 pandemic in North America
• Misinformation related to the COVID-19 pandemic
• Statistics of the COVID-19 pandemic in the United States

Further reading[]

• Annual report on ECRI's activities 2020
• COVID-19, economic mobility, racial justice, and the middle class
• Katrina to COVID: New Orleans’ Black community pounded again

External links[]

Health agencies[]

• U.S. Department of Health & Human Services
• Site of the US government
• Agency for Healthcare Research and Quality
• OECD

Data and graphs[]

• Our world in data : Coronavirus
• Institute for Health Metrics and Evaluation

Medical journals[]

• U.S. Centers for Disease Control and Prevention
• Nextstrain : Mutation tracker

References[]