Data on the over 3.5 million confirmed coronavirus cases in the US is still spotty, but one clear and alarming trend has emerged: across the country, Black, Latinx, and Indigenous communities have been hit the hardest. According to CDC data made public by the New York Times, Black and Latinx people are three times as likely to contract the virus as white people. They are also nearly twice as likely to die from it. A figure from the America Public Media Research Lab shows that Indigenous people have the second-highest death toll in the US, after Black people, and in mid-May, the Navajo Nation had the highest infection rate in the US, though Navajo officials say that strict lockdown measures and high testing rates have since helped to slow the spread.
These numbers give a disturbing look at the "concrete way" that systemic racism is playing out in the healthcare system, said Anne Liu, MD, an infectious disease doctor and immunologist at Stanford Health Care. Many factors play into this, she said.
"After decades, if not centuries, of unequal housing opportunities, people of color might be more likely to live in places where physical distancing is not an option," Dr. Liu said, a point that the CDC has noted as well. They may also be more likely to occupy jobs as essential workers who don't have the option of working from home, or in jobs where personal protective equipment is not as widely-provided (as opposed to essential workers in the medical field, for example.) Data from the Economic Policy Institute, for example, shows that people of color account for the majority of essential workers in food and agriculture and in industrial, commercial, residential facilities and services.
"Systemic racism has also likely contributed to differences in food resource availability," Dr. Liu added. She explained that in the US, "less healthy food, more processed food is cheaper and more accessible," resulting in "food deserts," or areas where healthy food isn't as available. Research has shown that this is often the case in Black and Latinx neighborhoods, and "has probably fed a health crisis of obesity, hypertension, and diabetes," Dr. Liu said. These are among the health conditions listed by the CDC as risk factors for severe COVID-19.
For Indigenous communities in particular, lack of funding and local access to healthcare can also play a role. And according to the Indian Health Service, indigenous people in the US die at higher rates than other Americans from conditions like diabetes and chronic lower respiratory diseases (such as asthma), which are also severe COVID-19 risk factors.
Dr. Liu noted that there are "layers and layers" behind the racial disparities in coronavirus infections and outcomes. "This is a story that will continue to get sorted out over time," she said, as more information becomes available. What's clear, though is that the pandemic has shined a spotlight on the existing inequality in the American healthcare system and the urgent need to address the systemic racism behind it.