COVID-19 ‘joins a long list’ of conditions that disproportionately impact minority groups
Numerous studies have shown that racial minority groups have been disproportionately affected by the COVID-19 pandemic. Experts at IDWeek said this has a lot do with history.
“We all watched in horror at the beginning of last year when data began to emerge about the disproportionate impact that COVID-19 was having and continues to have on racially minoritized groups,” Matifadza Hlatshwayo Davis, MD, MPH, the newly appointed director of the St. Louis Department of Health, said in a presentation during the conference’s 24-hour “Chasing the Sun” event.
“Is it important for us to understand the history of where we came from in order to get a full understanding of how best to approach these groups in a way that is impactful and effective,” she said.
History creates hesitancy
Human experimentation is as old as slavery, Hlatshwayo Davis said.
“The bodies of black and brown people were considered property used without consent because these folks, our ancestors, were not believed to have any legal rights,” she said, adding that there are many examples of such experiments happening in the name of science.
She cited Thomas Hamilton, a physician known to conduct experiments to see how long slaves could be forced to work in high temperatures before passing out or succumbing to severe conditions. Marian Sims performed experiments repairing fistulas in slaves without anesthesia although it was available at the time, Hlatshwayo Davis said.
She mentioned Henrietta Lacks, who died in 1951 of cervical cancer at the age of 31 and whose cells were removed and used for research post-mortem without consent or compensation, and the Tuskegee Experiment, during which Black men with syphilis were given placebo treatments under false pretenses, leading to “significant morbidity and mortality.”
“This is very much still relevant,” she said, adding that patients often cite these examples when discussing their medical hesitancy.
These events and others affecting Native Americans, Pacific Islander groups and people from Puerto Rico, “negatively impact preventable differences in the burden of disease, injury, violence and opportunities that then limit the ability to achieve optimal health for socially disadvantaged racial, ethnic and other populations,” Hlatshwayo Davis said.
According to data she shared during her presentation, national surveys of vaccination attitudes sent out in late 2020 “overwhelmingly” showed that people in the Black community were most likely to say they would not get vaccinated for COVID-19.
In April of 2021, after several vaccines became available, a similar survey was conducted. According to Hlatshwayo Davis, data showed that only 25% of Black Americans responded that they would not get vaccinated. However, they still significantly trail in COVID-19 vaccinations across the country.
COVID-19 and racial disparities
There are additional factors contributing to the disproportionate burden of COVID-19 among racial minority groups.
According to Dial Hewlett, Jr., MD, FIDSA, medical director in the division of disease control at the Westchester (New York) County Department of Health, data over the last year show just how COVID-19 has impacted these communities disproportionately.
One study referenced by Hewlett showed that 76% of patients hospitalized with COVID-19 in Louisiana — and 70.6% of those who died — were Black, despite Black people comprising only 31% of the study population. A study in Atlanta produced similar findings: 79% of hospitalized patients were Black and only 13% were white.
A study from early in the pandemic showed that 33% of COVID-19 cases in the United States occurred among Hispanics or Latinos of any race. Making matters worse in this population, 38% are Spanish speaking and 60% are foreign born, creating formidable barriers, Hewlett said.
“This creates additional layers of confusion in a rapidly changing informational landscape and will require ongoing, aggressive action,” Hewlett said.
He said additional confounding factors include obesity and diabetes, which disproportionately affect Black and Latino populations and are underlying conditions that can cause more severe illness.
The path forward
“I think we can say that there needs to be a national call to action,” Hewlett said. “We need to have a strong, well-resourced public health system that’s essential.”
Hlatshwayo Davis said the path forward will require better access and more competent care.
“We need to give folks the opportunity to tell us where they are and ask open-ended questions and listen to them so you know what you are actually responding to,” she said.
She said if a patient is from a racial minority community with concerns about historical and current structural and institutional racism, which have created barriers to accessing health care, “it takes nothing for you to acknowledge that what they’re saying is valid and to apologize as a current member of those very institutions.”
She said sharing personal experiences about getting vaccinated, including any side effects, and describing clinical data is a good way to respond to concerns and address misinformation.
“I watched us go through last year in regards to COVID-19 when these statistics came out and we acted like this was new, that it was shocking, when in reality, COVID-19 joins a long list of heath conditions for which Black and brown communities have experienced similar disparities and have been left behind,” Hlatshwayo Davis said.