Disparities in COVID-19 infection

On-Site Staff

June 23, 2020

Disparities in health care are not a new topic in the US, but they became more visible in the light of the coronavirus pandemic. The COVID-19 crisis showed again how health disparities influence public health.

The spread of COVID-19 became one of the top topics in the media due to multiple deaths recorded among the US and other countries, numerous closings, and lockdowns of entire communities. It has been known that there are severe disparities in access to health care in the USA, but is it also true with COVID-19? This article will look at data regarding vulnerable populations and their health outcomes battling COVID-19. According to the CDC, there is a racial and ethnic disproportion of the COVID-19 illness and death among minorities (1). Some experts even say that COVID-19 is a disease of "primarily racial disparities" (2). Nevertheless, we will look at possible explanations of this phenomenon in different minority groups, which will be followed by a discussion of what can be done.

Low-socioeconomic status
It has been known that representatives of lower socioeconomic status lack access to health care, have worse outcomes, and are underserved, often living in worse conditions, lacking sanitization, and knowledge about their health. According to the University of Southern California, individuals from low socioeconomic status and those with lower-paid jobs report more health and financial stressors in comparison to those from higher socioeconomic groups (3). Low paying jobs mean higher risk for chronic conditions, higher exposure to environmental toxins, worse diet, lack of insurance, fear of medical costs, or lack of paid sick leave (4), which all are important factors in fighting the novel coronavirus. Because of these factors, heart disease, stroke and diabetes are well-known problems in Georgia and have contributed to the disproportionate effect of the virus there, among those who were already vulnerable to chronic conditions (low-income racial minorities), sources say (2). According to Science Daily, low-income workers are disproportionately affected by the pandemic because they face higher income loss in comparison to higher-paid individuals, and it's more difficult for them to work from home (5). These factors will create more health disparities in the future for these populations because they will lack resources to seek medical help when needed.

People of different colors, races
The media have noted that disparities are not only still prevalent in the US, but they are more visible when the country tries to battle the coronavirus crises. According to JAMA Network, African Americans are contracting SARS-CoV-2 at higher rates and are more likely to die (6). Data shows that in some cities, up to 60% of COVID-19 cases and deaths are among people of color (7). For example, in Chicago, more than 50% of COVID-19 cases and nearly 70% of COVID-19 deaths involve black individuals, although black people make up only 30% of the population (6). According to the NPR and the data collected on disparities in COVID-19, in total, "race or ethnicity is known for around half of all cases and 90% of deaths" (8). The infection rate of COVID-19 is threefold higher, and the death rate is six-fold higher in predominantly black counties in the United States relative to predominantly white counties (9). Because of the preexisting health disparities that resulted in black populations having higher rates of comorbid conditions in the first place (such as hypertension, obesity, diabetes, and heart disease), they develop complications and die from the virus more often (9).

Navajo population
The Navajo population is a perfect example of how underserved communities, with limited access to health care, have more chronic conditions than upper-class counterparts and score worse in the war with COVID-19. The Navajo Nation is a Native American Reservation that spans three states (Arizona, Utah, New Mexico) and includes 173,000 people (10). Because the poverty rate in this particular population is high, their health outcomes were poor before the COVID-19 pandemic. One-third of its residents don't have access to running water, have limited access to the internet, and lack medical infrastructure. The entire reservation is a so-called food desert (limited access to fresh produce). Additional risk factors among the Navajo population are high rates of diabetes, lung disease, hypertension, and heart disease (11). Therefore, the rates of their coronavirus infections are the highest in the US, equaling 177 per 100,000 (the confirmed deaths 322 as of 6/17/20) (12). Hopefully, there will be something done to prevent the spread of COVID-19 further to save many vulnerable lives in this tribe.

What can be done regarding disparities and COVID-19 cases?
Disparities in health care are not a new topic in the US, but they became more visible in the light of the coronavirus pandemic. The COVID-19 crisis showed again how health disparities influence public health. The disparities resulting in adverse health outcomes noted in racial and socioeconomic populations are clear, and medical professionals continue to attempt to solve the problem (9). Tackling the social and structural determinants of health should be a long term goal for public health policymakers to end health disparities. At the same time, the US healthcare system should focus on social isolation, bringing resources to those in need, including point-of-care testing for COVID-19 at their towns, as proposed by the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health (NIH) (4).

1. COVID-19 in Racial and Ethnic Minority Groups [Internet]. CDC. 2020 [cited 2020 Jun 16]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html
2. Disparities Shape COVID-19 Caseload in Georgia [Internet]. Medscape. [cited 2020 Jun 16]. Available from: http://www.medscape.com/viewarticle/932253
3. Individuals with Low Incomes, Less Education Report Higher Perceived Financial, Health Threats from COVID-19 [Internet]. USC Schaeffer. 2020 [cited 2020 Jun 16]. Available from: https://healthpolicy.usc.edu/evidence-base/individuals-with-low-incomes-less-education-report-higher-perceived-financial-health-threats-from-covid-19/
4. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and Racial/Ethnic Disparities. JAMA [Internet]. 2020 May 11 [cited 2020 Jun 19]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2766098
5. Low-income workers disproportionately affected by COVID-19 [Internet]. 2020 [cited 2020 Jun 19]. Available from: https://www.sciencedaily.com/releases/2020/04/200430191258.htm
6. Yancy CW. COVID-19 and African Americans. JAMA. 2020 May 19;323(19):1891.
7. Why Are Minority Populations More at Risk for COVID-19? [Internet]. Medscape. [cited 2020 Jun 16]. Available from: http://www.medscape.com/viewarticle/932325
8. What Do Coronavirus Racial Disparities Look Like State By State? [Internet]. NPR.org. [cited 2020 Jun 19]. Available from: https://www.npr.org/sections/health-shots/2020/05/30/865413079/what-do-coronavirus-racial-disparities-look-like-state-by-state
9. Will COVID-19 Finally Trigger Action on Health Disparities? [Internet]. [cited 2020 Jun 19]. Available from: https://www.medscape.com/viewarticle/929505
10. Cheetham J. The people battling America’s worst coronavirus outbreak. BBC News [Internet]. 2020 Jun 16 [cited 2020 Jun 16]; Available from: https://www.bbc.com/news/world-us-canada-52941984
11. Navajo Nation Has Highest Covid-19 Infection Rate in the U.S. [Internet]. EcoWatch. 2020 [cited 2020 Jun 19]. Available from: https://www.ecowatch.com/navajo-nation-covid-19-infection-rate-2646033759.html
12. Lackhani Nina. Navajo nation reinstates lockdown as COVID-19cases surge near reservation [Internet]. 2020 [cited 2020 Jun 16]. Available from: https://www.theguardian.com/us-news/2020/jun/18/navajo-nation-coronavirus-lockdown-arizona

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