Assessing Black America's Experience During the COVID-19 Plague.

Abstract

Assessing Black America's Experience During the COVID-19 Plague William P. Brandon, PhD, MPH, CPH (bio) The Satcher Health Leadership Institute* at Morehouse School of Medicine and the Equity Research and Innovation Center at Yale School of Medicine recently produced a brief but useful compendium of published research on the multifarious ways in which COVID-19 has affected the Black community in the U.S.1,2 The State of Black America and COVID-19: A Two Year Assessment was commissioned by the Black Coalition Against COVID, which included the four historically Black medical schools—Howard, Meharry, the Charles R. Drew University of Medical Science, and Morehouse. In the early months of the pandemic, Blacks aged 65–74 faced a risk of dying that was five times greater than that of whites; the risk declined to four times for Black adults 75–84.1[p.5] While starting with the relevant comparative Black-White health data, the "State of Black America" also brings together relevant work on the financial, educational, social, health insurance, food security, and other impacts on Black people. An illuminating measure of COVID's differential racial impact with long-term psychological, social, and economic consequences is that one in 380 Black children experienced the loss of a parent or caregiver during fifteen months (April 2020–June 2021) in contrast to one in 738 White children. By organizing its data in two sections—"then" and "now"—the report recognizes the fact that this long-lived epidemic appears to drag on and on with changing impacts as the virus evolves and society responds. The first period covers the initial months roughly through the late spring and summer of 2020 and the second, from summer 2021 to February 2022. (The many articles providing the data vary in the periods covered.) The basic COVID morbidity and mortality data from the Centers for Disease Control and Prevention (CDC) show that morbidity was greater with the COVID variants that had become dominant in the U.S. population by the end of 2021, but that the death rates had declined between "then" and "now" by 41% for Blacks and almost 5.5% for Whites. The report does not delve deeply into causes, but we can presume that lower mortality was due to some mix of growing therapeutic knowledge (such as prone positioning, [End Page 1715] Click for larger view View full resolution Table 1. U. S. COVID-19 CASES, HOSPITALIZATION, AND DEATHS BY RACE, MARCH 2020–MAY 2020 AND DECEMBER 2021–FEBRUARY 2022 (AVERAGE OF WEEKLY RATES, PER 100,000 POPULATION) monoclonal antibodies, remdesivir, and dexamethasone), protection provided by the new vaccines, and declining virulence as new COVID variants became dominant. Unlike the declining death rates, COVID cases and hospitalizations remained high despite the many interventions. Moreover, Table 1 shows that on a population basis Black people exceeded White people in numbers of cases, hospitalization, and deaths in both time periods. As the ability to provide life-saving vaccinations expanded, the State of Black America is more favorable about the performance of the U.S. health care system, at least in that one measure. Despite a slow start, more recent CDC data showed a rough equivalency in immunizations between Blacks and Whites (Table 2). The report credits the health care system and Black leadership in overcoming initial widespread vaccine hesitancy and the legacy of mistrust in achieving this turnaround. Yet it also notes systemic barriers to testing and vaccination (such as choice of location and reliance on automobile accessibility of drive-through centers), especially when vaccines first became available. The authors emphasize a recurring caveat in regard to this data and throughout the report: the problem of missing racial identification. As late as mid-March 2022, "34.4% of COVID cases … were reported with an unknown race or ethnicity."1[p.11] Therefore, they make a strong case for action to improve collection and reporting of health data by race. A strength of the State of Black America is the amount of research that has been gathered and the way it is organized by the two time periods and by substantive topic. In a brief report it would not be reasonable to expect...