October 13th will mark seven months since the United States declared a national emergency concerning the COVID-19 outbreak, and what a historic seven months these have been. No matter identity or background, the lives of each and every individual have been touched by the pandemic. Certain lives, however, have been disproportionately affected. In schools, the word inequality is often represented by an image of an overworked factory employee in China or a malnourished child in Africa. Students are taught that people are struggling in other countries. They should be grateful for the food on their plates and the beds they have to sleep in because someone on the other side of the world isn’t as fortunate. However, they are often not taught that inequality and inequity exists within their own country, and even within the very classroom in which they were being taught. Many people growing up in the U.S, take for granted that their doctors believe their declarations of pain, or their teachers believe in their potential. However, some students quietly live a different experience.
Yes, COVID-19 has deeply affected individuals on the other side of the world: Bangladesh refugee camps are struggling to provide needed medical care; grim economic pressures have been placed on forcibly displaced peoples; refugees in Uganda are suffering from negative psychosocial implications – all horrible occurrences deeply worthy of our time and attention. Many Americans may feel more comfortable believing and accepting these realities when they are so far from home. Conversely, many are unaware of the ways COVID-19 has exacerbated the already hushed burdens faced everyday by minorities in our own country and in our own communities. We must initiate this conversation in order to address the ongoing crisis.
May 2020: “Without full data on the racial and ethnic backgrounds of coronavirus patients, it will be hard to effectively respond to the pandemic.” Source: Bebeto Matthews / Associated Press
In March 2020, the beginning of COVID-19’s spread to the U.S., the CDC reported an overrepresentation of Black Americans in hospital admissions compared to other racial groups. Among a study of 305 hospitalized COVID-19 patients, more than 80% were Black. In April, New Orleans, Louisiana health officials realized that their drive-through testing strategy was failing because the majority of COVID-19 cases were in low-income Black American neighborhoods where most individuals lacked cars. In May, it was determined that Black American deaths were nearly two times greater than what would be expected given their share of the population. Data also shows that Hispanics/Latinx made up a greater portion of cases relative to their population in 42 states, with their numbers being four times higher than expected in eight states. In September 2020, these trends continue.
Some individuals argue that minority communities are disproportionately affected by COVID-19 because they are more likely to have underlying medical conditions, such as heart disease or diabetes. In this way, underlying conditions are weaponized in order to place the blame on the minority group themselves, rather than addressing the root cause of higher rates of COVID-19 in minority communities.
In fact, the primary COVID-19 risk factors for minority communities is discrimination. Racial discrimination is ingrained in systems such as healthcare, education, and criminal justice. Discrimination against people of color places them at a disadvantage in terms of both COVID-19 exposure and treatment. Furthermore, the general stress of constantly facing racial discrimination has been linked to early aging, and consequently influences the likelihood of developing underlying health conditions associated with COVID-19 aggravation. Health care access is another principal risk factor for racial minorities. Members of minority communities are often less likely to have health insurance. Cultural or language barriers, lack of transportation and inability to take time off of work are additional risk factors. Racial minorities may avoid seeking help from healthcare providers due to a lack of trust stemming from historic medical abuses through medical research. A prime example of such abuse is the Tuskegee Syphilis Study, a 40-year experiment in which the effects of untreated syphilis was observed in 600 rural Black men unaware of their diagnosis. According to a 2017 CDC study, only 6% of non-Hispanic white individuals are uninsured, whereas 18% of Hispanics are uninsured. In Tennessee specifically, undocumented immigrants are more impacted by the pandemic as health insurance is unavailable to them.
May 2020: “A registered nurse draws blood to test for COVID-19 antibodies at Abyssinian Baptist Church in the Harlem neighborhood of New York City. Churches in low income communities across New York are offering COVID-19 testing to residents.” Source: Angela Weiss/AFP via Getty Images
Occupation, education, and consequential income gaps are dominant risk factors as well. Minority groups are disproportionately represented in essential work settings such as public transportation, construction, agriculture production, or public sanitation. These individuals are thus placed at a higher risk of contracting COVID-19 due to increased exposure to the public, inability to work remotely, and a lack of sick days. Nearly 25% of employed Hispanic and Black individuals work in the service industry, compared to 16% of employed white individuals. Additionally, minority women are disproportionately represented in fields that cannot operate remotely such as hospitality, food services, and retail. The CDC states that, “Inequities in access to high-quality education for some racial and ethnic minority groups can lead to lower high school completion rates and barriers to college entrance.” This results in lower-paying wages and fewer job prospects in general for these groups – a particularly debilitating reality in the era COVID-19. As a result, these individuals are unable to leave jobs that might place them at a higher risk of contracting the disease, and are sometimes even unable to stay home from these jobs during sickness because they need to maintain their income. They are being forced to make a choice between the ability to place food on tables and protecting their own health and safety.
May 2020: “Nurses and health care workers mourn their colleagues who died during the Covid-19 outbreak at Mount Sinai Hospital in New York.” Source: Johannes Eisele / AFP via Getty Image
Lastly, an individual’s housing or living conditions greatly influence their risk of COVID-19. Members of minority groups are more likely to live in multigenerational homes or cramped living spaces. Further, these groups of people may be more likely to suffer from homelessness or dense living conditions due to the disproportionate unemployment rate amongst minority groups during the pandemic. These factors result in additional barriers to practicing COVID-19 prevention strategies like social distancing.
In Nashville, the 37211 zip code, home to the city’s largest international community, has been the hot spot for new cases. This is due to many of the risk factors previously discussed. In an average refugee family living in Nashville, one or both parents work in an industrial environment. These are considered essential jobs, and there have been high rates of COVID-19 transmission and even death in several of these places of work. Limited access to protective equipment and information about COVID-19 translated into the appropriate languages heightens these individuals’ risk level at work. Because parents work as frequently as possible, they may choose to send their children to school in-person. This puts children at risk of contracting COVID-19 at school and spreading it to older, more vulnerable individuals living in close quarters in their home.
Recently, Nashville released a list of 49 COVID-19 cluster sites. Few, if any, of the sites were surprising considering the cited trends.The list includes primarily warehouses, correctional facilities, and congregate living facilities. Notably, these are all facilities primarily populated by black and brown individuals.
As an organization founded and led by refugees and immigrants, NICE is deeply invested in the fight against inequity. We stand with immigrants and all minority communities and recognize that these conversations must be had in order to achieve progress. Perhaps this pandemic and the conversations that emerge because of it will foster the staying power that induces meaningful changes for health and wealth inequities the United States has faced for generations.