Throughout the Thomas Jefferson Health District, African Americans have tested positive for COVID-19 and required hospital care at disproportionate rates, according to the data released Friday.
The data mirrors an emerging national trend and is an example of how, in the four weeks since the first case was reported in Charlottesville, the health district is still struggling to overcome testing obstacles to get a sense of the virus’ spread throughout existing fault lines.
“We know that African Americans have less access to health care, and that African Americans are more likely to be in our frontline jobs that put them at highest risk,” said Dr. Denise Bonds, the director of the health district, which covers Charlottesville and the counties of Albemarle, Fluvanna, Greene, Louisa and Nelson.
African Americans make up 32% of the confirmed cases and 63% of the 27 people hospitalized.
Four people have died from the disease, caused by a novel coronavirus, but none of those individuals were African American, according to officials.
The health district released demographic information about positive COVID-19 cases, which so far number 124, for the first time Friday during a virtual town hall with local and university officials. More than 4,500 people have tested positive in Virginia.
Statewide, African Americans make up 15% of cases, but the race for half of all cases is unknown. State officials said this week they are working to improve the data collections to better report on the demographics of those with the disease.
Health experts have said that African Americans, particularly those working in the service industry, are at a higher risk of being exposed to the virus, have a higher likelihood of health conditions that make the virus’ impact worse, and have a higher likelihood of being without health insurance.
“I think we really need to get to the underlying cause of all of that, and that is that our country and our state have a long history of racism and policies that have generated these racial inequities,” Bonds said during the town hall. “And that’s a conversation that we have been struggling with as a community and will continue to struggle with. And I think that this disease has just brought that out even further.”
The Thomas Jefferson Health District reported its first confirmed case March 16, and numbers have steadily climbed since. Officials also said they know they are not catching everyone who has the disease.
“We certainly have community spread,” Bonds said. “We know that there are individuals that are getting the disease and we can’t always trace it to a particular source. That’s an important message to get out to the community. There are lots of places that you can get it and really that’s why we need you to stay home.”
About 21.7% of those diagnosed have been hospitalized; 63% are people 59 years or younger.
The health district currently is not focusing available COVID-19 tests on the African American population, but Bonds said she’s considering it.
Right now, officials are testing people with symptoms of the disease, people in long-term care facilities and health care employees and first responders.
About 1,400 individuals have been tested in the health district, Bonds said.
Availability of test kits and supplies have hampered efforts to expand testing to more people.
“Now that we have more widely-available testing, we’re in a position where we can really begin to target this particularly vulnerable group and now that we have statistics showing that I think that’ll help bring the pressure that we need to really begin to focus on this,” Bonds said.
Bonds said officials need to start planning for how to help individuals in high-density housing isolate and quarantine if they are either showing symptoms or diagnosed with the disease.
“Those are all conversations that we need to have and frankly we need to be having them right now,” she said.
Dr. Costi Sifri, director of hospital epidemiology at the University of Virginia Medical Center, said during the town hall that a group of UVa experts are working on access to testing in communities of color.
“That is something that at UVa we’re very concerned and cognizant about too,” Sifri said about testing and social inequities.
National data shows that COVID-19 is hitting black Americans particularly hard; an early snapshot of confirmed cases by the Centers for Disease Control and Prevention shows that, while the highest overall percentage of hospitalized patients were white, at 45%, the percentage of black patients, 33% was much higher than the percentage of African-Americans in the population as a whole.
Gov. Ralph Northam highlighted the need for better data on how the virus is affecting different communities.
"We know that longstanding racial inequities in things like access to health care, education and economic opportunities lead to differences in underlying health conditions," Northam said during a press conference Wednesday. “… It is difficult, but important for everyone to be reporting the same types of data, so we have a better picture of what this virus looks like here in Virginia. That obligates us to do a better job of tracking racial demographic data of confirmed cases”
Bonds said the district will not release demographic details that would identify an individual who has tested positive, and won’t share any data points unless there are five or more cases.
“Even in a pandemic situation such as this, people deserve privacy, and we have already notified those individuals who would be at risk,” Bonds said.
Additionally, in order to compile Friday’s report, health district staff members have to get caught up on data entry and collect missing demographic information.
The lack of widespread testing is a hindrance to the health district’s understanding of COVID-19, Bonds said in an interview before the town hall.
“I would love for [testing] to be more widespread,” she said. “I ordered test kits from one of the major testing companies to provide to nursing homes to test. We’ll order 100 and get five kits.”
UVa developed its own test last month, which Bonds said has helped.
Overall, Bonds said communities are heeding the call to stay at home. Hospitals also aren’t exceeding their capacity yet.
“Certainly there is a strain on the health care system, but we’re not seeing the overload that you might see on the news and in other areas,” she said.
Health district staff members try to investigate every positive case, contacting the individual and tracking where they went and who they came into contact with, as a way to contain the virus.
An expanded team of about 10 people are doing those investigations. The district’s highest daily number of new cases has been 11, which Bonds said is still within the staff’s capability to handle and track.
“If we started to get upwards consistently in the 20s, that would be a strain for us here,” Bonds said in an interview.
Bonds said investigators have linked many of the individuals who have COVID-19 to church gatherings and proceedings such as funerals.
“Although we all have the best intentions with social distancing, in those high-emotional situations, we reach out to each other, we shake each other’s hands, we hug and we get close to each other because people want that comfort,” she said. “Unfortunately, what we’re finding is that’s also transmitting the disease.”
There is still some variability in how positive cases are reported by locality, particularly if a person lives in a ZIP code along the Albemarle-Charlottesville boundary.
The district reports positive cases by locality, based on a person’s residence, but hasn’t reported deaths by locality because of limited numbers so far.
“I think we’d have to see a pretty significant increase before we broke it down by locality and providing much, if any, in the way of demographics,” Bonds said.