COVID-19 continues to ravage the USA.  The number of cases has risen to approximately 500,000 and the disease has claimed the lives of nearly 17,000 Americans. More cases have been diagnosed in the US than in any other country in the world.  As we have stated before, the developments around this disease continue to change minute by minute and we continue to learn about this deadly disease.

It has become clear that the death rate in the African American community is out of proportion to other populations.  As of today, every death from COVID-19 that has occurred in St. Louis, MO. has been an African American.  The following table demonstrates this staggering inequity:

Location                      % population              %COVID-19 deaths

Louisiana                            33                                       70                                                              

Michigan                             14                                       40                                            

Illinois                                 15                                       43                                           

Chicago                               30                                       70

Although testing for COVID-19 remains woefully inadequate, African Americans represent a higher percentage of the positive tests in NC, SC, CT, MN, and Las Vegas.

Even before this coronavirus came to the shores of the United States, it was known that people over 60 and those with pre-existing conditions were most likely to die from COVID-19 infection. It has now become clear that the underlying conditions that are most associated with these US deaths include hypertension, diabetes, obesity; chronic kidney, heart, and lung disease; dementia, and cancer.  These are the pre-existing diseases that have such a huge effect on the healthcare disparities of African Americans even before this coronavirus. 

COVID-19 has just exposed the ugly underbelly of health inequities between African Americans and the majority population. Unfortunately, it is not only health but also education, employment, housing, environment, criminal justice and every aspect of American life where these disparities exist and are magnified by this pandemic.  Although we are proportionately dying more, we are tested less and have less access to treatment because both are so dependent a referral from their primary care physician.  Although the US Congress passed legislation to pay for COVID-19 treatment, prior access to healthcare has been very dependent on health insurance and ability to pay.  The data shows that the number of uninsured Americans has begun to creep up over the last three years. There has been a sustained assault, including multiple court challenges, against the Affordable Care Act (Obamacare).  This law has been instrumental in expanding healthcare for all Americans and if it is eliminated, there will be worsening of disparities.

Every public health strategy being used to fight COVID-19 is affected by disparities. The “stay home” order, except for essential workers, policy leaves many vulnerable African Americans who are our grocery store and carryout restaurant workers, bus drivers, postal and delivery workers, healthcare workers, etc., does not prevent their need to go out in public.  Many depend upon public transportation making the “physical distancing” of 6 feet impossible or impractical.  “Wearing a mask” is less likely to be possible because of the continuing shortage and the making your own face covering raises more obstacles for any population living day to day. Indeed, handwashing is doable, even though hand sanitizer might be more of a challenge.

The challenges of COVID-19 require a focused approach to address those vulnerable due to healthcare disparities and to protect the entire population.  In the short term, we need to eliminate the shortfall on testing and upon gear up antibody testing in order to know those who have recovered. Data collection needs to be broken down by age, ethnicity, gender, and other demographics.  Our healthcare workers, first responders, and essential workers must have appropriate personal protective equipment. Since this pandemic has now focused attention on the impact of healthcare disparities, we must fight to fix the long ignored structural inequities in our healthcare system.