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UVa doctor: Historic inequality behind more serious COVID impact on poor, minorities

The novel coronavirus fueling the global pandemic can affect anyone, regardless of race or social economic background, but that doesn’t mean the virus offers everyone an equal opportunity for infection, hospitalization and death.

From Central Virginia to the state to the nation, non-whites are more likely to be hospitalized after contracting COVID-19 and far more likely to be seriously sickened or die from the disease, according to figures released by the Centers for Disease Control and Prevention, Virginia Department of Health, Thomas Jefferson Health District and other agencies across the country.

Medical and social researchers say the rates of illness and death reflect historic inequality in income, housing and economic opportunities. That history created the current economic situation where minorities are more likely to live with multi-generational families in smaller homes.

The inequality also led to a larger percentage of minorities working lower-paying, service-related jobs at hourly wages with little or no sick time and often in close quarters with other employees.

University of Virginia Medical Center doctors working in COVID care units say patients are nearly equally divided between whites, Latinos and Blacks. That doesn’t mean that they’re being affected equally, however.

“We’re seeing disproportionate numbers, high numbers of African American and Latinos in our ICU and regular COVID units,” said Dr. Taison Bell, a specialist in critical care and pulmonary medicine who has been working in the units since the virus struck in March.

“We’re kind of divided into thirds as far as cases go. About 30% are African American, 30% are Hispanic and about 33% are white,” Bell said. “That may seem balanced, but it’s not. African Americans don’t make up 30% of the population and neither do Latinos.”

Bell said minorities are not only more likely to be infected — they’re more likely to die from the virus.

“Across the country, African Americans are dying at higher rates than any group — up to four times as much in some areas — yet they make up about 8% to 10% of the population,” he said.

According to the COVID Tracking Project, which gathers and tabulates statistics from each state, Hispanics were most likely to contract the virus per capita in Virginia, followed by Blacks and American Indians. Blacks were most likely to die from the disease.

National figures from the project show native Hawaiians and Pacific Islanders in the U.S. were the most likely per capita to contract COVID. They are followed by American Indians, Latinos and Blacks. All four groups were more than twice as likely to contract the virus as whites.

Again, Blacks were the group most likely to die from the virus, the study showed.

In the Thomas Jefferson Health District, Blacks comprise 35% of patients hospitalized for COVID-19 and 23.4% of deaths despite being only 13.7% of the district’s population.

Latinos are about 4.7% of the district population but make up 17.3% of the reported COVID cases, 14.8% of the hospitalizations and about 4% of deaths.

Whites are 81% of the district population but make up 51% of COVID cases, 45.74% of hospitalization and 70.13% of deaths.

In the past several months, numerous studies have indicated that the coronavirus is easily transmitted simply by being in a room with people talking, laughing, singing and shouting. Those activities create an aerosol spray of tiny viral water drops that can remain airborne for hours, the studies show.

“If you spend time close together in enclosed rooms, you have more chance to absorb more of the virus — what we call the inoculum or infectious dose that it takes to get COVID,” Bell said. “The farther apart you can be, the more social distanced and the less time spent in close quarters at home or at work, the less inoculum you receive, so the more mild your case.”

That’s problematic, according to health officials.

“Our poor communities and our communities of color live in more crowded conditions and that increases exposure to COVID-19. It’s one of the reasons for the higher case rates,” said Guleer Shahab, data analyst for the Virginia Department of Health and the TJHD. “The higher hospitalization and death rates are likely influenced by social and economic disparities.”

Low-income workers are more likely to have less healthy diets and have chronic medical conditions such as diabetes or high blood pressure, studies show.

“The more chronic health problems you have, what we call co-morbidities, the more likely to have a serious COVID case,” Bell said. “Now, if you look at a health standpoint, separate from the virus, the Black and brown communities have most of the comorbidities disproportionately represented; high blood pressure, diabetes, heart disease, kidney disease, obesity.”

Bell said COVID-19 uses a body’s weaknesses and chronic conditions to create medical complications in patients.

“It enters your lungs, but it goes through your whole body. You’re more likely to recover if you go into it with all of your guns, all of your defenses. You’re much better off with a good immune system and healthy body,” Bell said.

Bell said those chronic issues are directly related to diet and exercise. He noted that minority communities are less likely to have access to fresh foods and more likely to buy cheaper, more processed foods.

“There is less access to grocery stores in those neighborhoods, so you are less likely to have access to healthy foods. Plus, healthy and fresh foods cost more,” Bell said. “You can ask, ‘why is that?,’ and to find out, you have to go back to the era of segregation and the practice of redlining.”

Redlining is the name given to the practice of targeting specific neighborhoods based on the predominate race, religion or social status of its population. Neighborhoods that were redlined often were blacklisted by financial companies, retail and grocery stores and other services.

“Segregated neighborhoods did not see the property values rise. Parks were less often built and people were crowded into multi-family and multi-generational housing by urban renewal,” Bell said.

Bell said his family was affected by those exact issues.

“You could own your home, but if you couldn’t get financing, you couldn’t improve or fix it and then buy another or sell yours. The same economic forces that would increase home values for houses in white neighborhoods didn’t impact us,” he said. “I grew up with four generations under the same roof. That’s what we had to do.”

Research conducted on behalf of the National Institutes of Health in September found Blacks and Latinos/Hispanics across the country are more likely to live in densely populated areas, in multi-generational households and be essential workers.

“Those in essential roles are less likely to have paid leave, and not having paid leave makes it difficult to self-isolate,” Shahab said. “These are not often high-paying jobs. People are less likely to get a COVID test because if it’s positive, you have quarantine for 14 days, and they can’t afford to go two weeks without a paycheck.”

That means that those who seek treatment are often further into the illness, she said.

“They’re more likely to be sicker and more likely to need care,” Shahab said. “The disparity in care and access to care is always there, but COVID is making it clear.”


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