As America takes to the streets to express its anger and frustration over the deaths of its black citizens, COVID-19 continues to kill. Cruelly, the pandemic appears to pick its victims based on the color of their skin.
A recent analysis from the 28 states that provide COVID-19 mortality data on race found that African Americans are dying at three times the rate of white Americans. But why? Viruses do not discriminate, but the conditions that put people at risk divide America along racial lines.
A study just released from Mt Sinai Medical School looked at factors associated with ZIP code areas in New York City and COVID-19 infection and mortality rates. The researchers found that rates rose, not only with lower neighborhood income and with the rate of unemployment, but also with the probability of being an essential worker or of not having health insurance. By far the strongest association with mortality rates is the average household size. A second, less-detailed study released on the same day from researchers at Columbia University, found similar results.
The Mt. Sinai study created an index of risk based on your ZIP code. A map of that risk index (left) closely tracks a map of COVID-19 cases (right) as shown below.
One might conclude that the increased mortality occurs because diseases that increase the risk of death from COVID, such as diabetes, hypertension, and kidney disease, occur twice as often in blacks as in white Americans, but these differences appear to have more to do with poverty than race..
In other words, SARS-CoV-2 is absolutely color blind, but it has the nose of a bloodhound when it comes to inequality. The pandemic has cast a bright light on the fundamental unfairness that increasingly permeates American society as we shred the social safety net while giving massive tax breaks for those at the top, rather than supporting health care and education for those trying to escape from the bottom. Imagine the challenge of trying to rise up as a member of a low-income household in a neighborhood with underfunded schools and high unemployment. Now add a deadly virus. Then remove your health insurance so you avoid seeking medical care, not only for an infection, but also for the chronic conditions that make it worse. Then ensure that a disproportionate share of the available jobs put you at high risk of exposure to the virus. Finally, crowd that household so that any new infection has an increased potential to spread. Put all of that together and what was simply an economic prison has become a deathtrap. Literally.
The index generated to predict the risk of COVID-19 does a remarkable job of predicting the color of one’s skin. As shown in the figure below, the ZIP code areas in the top quartile of risk have three times the number of Hispanics and five times the number of Blacks as the lowest quartile.
The systemic inequity that puts Black lives at risk from the pandemic is even more deadly than the racism and police brutality that puts Black lives at risk in the streets. Anger and frustration at this inequality is at the core of the protests taking over the streets of America. Now is the moment for all of us to demand a government based on elevation, compassion, and inclusion, not disdain, coercion and division. Those in power must either lead us there or get out of the way.