New Article by Urban Studies Faculty Member, Professor Shiko Gathuo

Not in This Together: COVID-19 and People of Color 

by Shiko Gathuo, Ph.D.

Shiko Gathuo, Ph.D.
Professor and
Graduate Program Director of
Urban Studies

Presidents, prime ministers, royalty, celebrities. These and other rich, powerful and famous people have contracted COVID-19. When the pandemic first took hold, it was easy to throw around phrases like “we are in this together,” “the pandemic does not discriminate,” and “united in the fight.” These warm and comforting sentiments quickly became hollow as it became apparent that, in fact, the pandemic does discriminate and it has negatively affected the poor and people of color disproportionately and in many different ways. People of color are experiencing the health aspect of COVID-19 including infection, testing and treatment differently. The virus has also exacerbated other already existing conditions such as economic deprivation, food insecurity, and the education achievement gap. COVID-19 has also had a significant negative effect on the social life and everyday survival of people of color. 

Health 

Racial disparities and discrimination in healthcare – the precursor 

        Even before COVID-19, racial discrimination was rampant in the care of sick people of color. The virus has only highlighted this much researched and almost as often shrugged off topic. From maternal mortality to regular physicals, referrals, and the pain management, people of color experience systemic racism, bias and discrimination when they engage with the healthcare system. This discrimination happens across the board among people of color regardless of their income, education level or healthcare insurance. A study published in the American Journal of Emergency Medicine found that Black and Hispanic patients were less likely to receive pain medication. A 2019 CDC report indicates that Black, American Indian, and Alaska Native women were two to three times more likely to die from pregnancy-related causes than white women. Black and Latina women have reported not being listened to when they complain about pain or other medical symptoms. Widespread bias has also been acknowledged by doctors, including the California Surgeon General, who in the course of their work have observed disparate care of patients based on race. 

        Compounding the effects of bias in the healthcare system is the widespread health illiteracy among people of color. The inability to ask the healthcare provider questions, read studies that might help fill the gap left by inadequate information from doctors, read simple food labels, and understand medical consent forms including those used in clinical trials, are all factors contributing to poor health outcomes for people of color, and currently being magnified by COVID-19. 

Infections, Hospitalization and Death 

        To be clear, even before the onset of the virus, black communities lived under conditions that made for the terrible outcomes now being observed with COVID-19 – high levels of chronic diseases including diabetes, high blood pressure, asthma and obesity, as well as lack of access to quality healthcare. 

        Race data tracking by John Hopkins University shows that African-Americans and other historically disadvantaged groups are experiencing infection and death rates at a higher proportion than the rest of the population. For example, while Black Americans represent only about 13% of the population, in the states reporting racial/ethnic information, they account for about 34% of total Covid-19 deaths. 

        Similarly, data reported by the CDC indicate that among cases with known race and ethnicity, 33% were Hispanic, 22% were black, and 1.3% were American Indian or Alaska Native. The report notes that "these findings suggest that persons in these groups, who account for 18%, 13%, and 0.7% of the U.S. population, respectively, are disproportionately affected by the COVID-19 pandemic." 

        Medicare data also indicates the same: Black Americans enrolled in Medicare have been hospitalized with COVID-19 at four times the rate of their white counterparts while Hispanics on Medicare have been hospitalized roughly twice as much as white people. CDC data regarding the ages of those dying of COVID-19 between February and May 2020, revealed that Black and Hispanic Americans were dying at younger ages than white Americans. About 35% of Hispanic Americans and 30% of non-White Americans dying of COVID-19 were people younger than 65, compared to 13.2% among whites. The difference could be explained in terms of lower median age of Hispanics compared to whites, but it could also be explained in terms of underlying health conditions and access to healthcare. 

        Various analyses have also indicated that young people of color are more likely to be infected and hospitalized with COVID-19. This further exacerbates the community spread since young people of color live in crowded multi-generational homes. 

        Additionally, while women of color faced higher maternal mortality pre-COVID-19, a Chicago Tribune report in July 2020 found that of Black and Latina women constituted a whopping 70% of all pregnant women diagnosed with COVID-19 in Illinois. The virus has not spared the youngest people of color either. A CDC report indicated that the rates of hospitalizations among Hispanic and black children were nearly eight times and five times, respectively, the rate in white children. 

        In a Harvard Medical School study breakdown by race and ethnicity, there were disproportionate infection rates among Hispanics and Blacks.  Hispanics make up 18% of the population, but had 33% of infections. Blacks are 13% of the population and had 22% of the infections. Whites make up 60% of the population and had 36% of infections while Asians are 6% of the population, but had 4% of infections. 

        A USA Today analysis of COVID-19 spread by ZIP code showed that the highest rates of infection were in the more densely populated, lower income and nonwhite resident ZIP codes. Zip codes with median household income of less than $35,000 had an overall infection of more than twice that of those with a median household income greater than $75,000, while ZIP codes with majority nonwhite residents had five times more infection than those with less than 10% nonwhite residents. Infections were also highest in neighborhoods with overcrowded housing. An LA Times analysis based on LA County data showed that someone living in Pico-Union, a heavily immigrant neighborhood, was seven times more likely to be infected and 35 times more likely to die from COVID-19 than someone living in the affluent Agoura Hills. 

        A study published in the New England Journal of Medicine based on a study of data from a health delivery system in Louisiana in March and April, showed that among the 326 patients who died from COVID-19, 70.6% were black. 

Healthcare workers and COVID-19 

        Perhaps even more alarming was the effect of COVID-19 on healthcare workers of color. A study from Harvard Medical School indicates that Black healthcare workers were more likely to care for COVID-19 patients, to report inadequate Personal Protection Equipment (PPE), and twice as likely as white counterparts to test positive for the virus. In one analysis, 62% of healthcare workers who died were people of color. 

Testing 

        Right from the onset of COVID-19, the unavailability of testing has been an issue for the whole country. The shortages have meant that tests were only available to those who were critically ill. Although not at optimal levels, the testing capacity has improved with time. However, an analysis by fivethirtyfive.com found that “in many cities, testing sites in and near predominantly Black and Hispanic neighborhoods are likely to serve far more patients than those near predominantly white areas” and that “a similar disparity exists between richer and poorer neighborhoods.” Kevin Ahmaad Jenkins, a fellow at the University of Pennsylvania’s Leonard Davis Institute of Health Economics told the analysts that his team had found that testing sites in minority communities in large cities were fewer in number, had longer lines and “often run out of tests.” As the analysis points out, the disparity is far greater than can be inferred from the data since wealthier (mostly white) people can afford to get tested privately. 

Vaccines 

        As the scientific community and big pharma, with support and pressure from the Trump administration, rush to develop a vaccine for the novel coronavirus, the question of testing as well as access among people of color is salient. The historical abuse of the poor and people of color in clinical trials as experienced in the infamous Tuskegee and Guatemala studies, as well as the testing of HIV/AIDs drugs among disenfranchised communities in the U.S and around the world, makes it difficult to recruit study subjects. There is also a general distrust of the healthcare system among people of color, which is not unfounded – a recent report, for example, indicates the racial profiling of Native Americans in a hospital in New Mexico, where newborns were singled out for extra COVID-19 screening, leading to their temporary separation from mothers. This distrust leads to the underrepresentation of people of color in trials. For example, only 12% of participants in the late-stage trial of Remdesivir, currently used to treat COVID-19, were black. Yet, it is imperative that test subjects come from communities of color since they are disproportionately affected by the disease and will be receiving the vaccine once developed. 

Mental Health 

        The lockdown, the anxiety related to catching and dying of the disease, economic instability, childcare issues and a myriad other circumstances that have arisen with COVID-19 have all led to poor mental health in many people. For people of color, the situation is worse because of the disproportionate effects of the disease coupled with racial tensions in the country. In the course of their work too, low-wage essential workers have reported anxiety due to confrontations with customers on issues related social distancing and mask mandates. 

Economic Divide 

        An analysis by the Washington Post shows that despite the immense growth in the economy, the black-white economic divide is as wide as it was in 1968. COVID-19 has served in highlighting these differences, which show up in different economic indicators. Even in good economic times, Black people still find it difficult to meet common needs such as paying rent, according to a pre-COVID-19 survey by the Federal Reserve. The stock market has seen unprecedented growth in the last fifty years. Even after hits during the Great Recession, the market has rebounded and continues to rebound despite the COVID-19-related fall in March 2020. The stock market has therefore become one of the most assured way to build wealth. Black people, even those who have median level income, face many barriers to entry into the stock market and hence have a 10-times lower level of household wealth than their white counterparts. Even when they become homeowners (seen as a vehicle to the acquisition of wealth), a Washington Post analysis showed that Black families pay an astounding 13% more in property taxes each year than white families in the same situation. 

        More businesses have been lost through COVID-19 than by the Great Recession -and Black businesses have been affected the most. A demographic analysis of businesses lost between February and April shows that 42% of Black businesses were lost compared to 32%, 26% and 17% of Latinx, Asian, and White businesses, respectively. 

        Similarly, unemployment has hit people of color harder, and the signs of recovery do not seem to touch them. The “good” job report in May 2020, had unemployment going down for white workers from 14.2% to 12.4%, while it went up for Black workers from 16.7% to 16.8%. Asian workers also saw a rise in unemployment during the same month, from 14.5% to 15%. 

        From farms to food processing plants to grocery stores, hospitals to nursing homes, people of color, including immigrants, work in jobs that put them at higher risk of COVID-19 infection. There have been numerous reports of large and recurring outbreaks in meat processing plants as well as farms. According to the Maine Center for Disease Control and Prevention, for example, there have been outbreaks of COVID-19 in at least three farms in Maine. Similarly, in food processing plants across California, Latino workers have been infected at high rates, mostly due to crowded working and living quarters. Labor advocates have pointed out that the high levels of infections are also due to lack of federal protections for these workers. Worse still, the workers take the virus into their own crowded homes, further increasing the community spread. 

        And these workers are the lucky ones; they have been able to keep their jobs. Immigrant workers who do domestic work (nannies, housekeepers, personal care givers) have either lost their jobs or continued to work under unsafe conditions without Personal Protective Equipment (PPE). Further, according to a survey by the Institute for Policy Studies and the National Domestic Workers Alliance, many fear accessing government aid in case it works against them when they apply for permanent U.S. residency or naturalization. 

        Apparently, people of color cannot catch a break. The first stimulus bill enabled those receiving unemployment benefits to get an additional $600 a week. A perverse unintended consequence of this extra payment, which has kept many families afloat and the economy going, is that it has not been accessible to essential workers. These workers kept their minimum wage jobs and ended up earning less than those who did not have to work and are not at risk of workplace infection. Many of these essential workers are people of color. 

        For those infected by the virus, a new economic threat in terms of healthcare costs looms large. Although the Trump administration made the promise that all COVID-19 related healthcare costs would be covered, the reality is that those affected have reported receiving bills for conditions coded as non-COVID-19 related. Further, as the disease has progressed, it has become apparent that it causes long-term adverse health conditions, all of which will further economically burden those who are lucky enough to recover from it. 

Education 

        Education is recognized as an important function of social-economic mobility. Pre-COVID-19, a racial gap in education achievement already existed. The school closures and subsequent move to remote learning have likely increased the gap. A study by Common Sense Media shows that the tech essentials of virtual learning – computers and high-speed internet – are lacking in many households. Physical space, also essential, is lacking in those living in crowded housing situations. Thirty percent (30%) of all students and 10% of teachers lack devises and/or internet. Broken down by race, 35% of Native American, 30% of Black, 26% of Latinx and 18% of white children lack devises and internet access. Some school districts have tried to mitigate this by providing devises and even hotspots to those lacking access. But it’s a steep learning curve for those who have never used the devises and there was little time to prepare for remote learning. Yet, when polled about school reopening, there was a racial divide, with parents of color indicating they would prefer to reopen school later at a higher rate (76%) than white parents (51%). This difference may be explained by the fact that children of color attend less resourced schools and their parents are not confident that the children will be protected from infection. 

        Parents who are able to work from home have found it difficult to juggle their work with the needs of remote learning for their children. Yet these parents are the lucky ones who do have the option to help their children with schoolwork. Essential workers who must work outside the home are unable to do the same, leading to virtual drop-outs. In May 2020, for example, over 10,000 students, including a quarter of Black and Latino students in the Boston public school district did not log into their virtual learning portals. The fear of children falling behind has led to part of the push to reopen schools despite the raging pandemic. In Georgia, for example, parents who refused to take their children to school due to fear of the pandemic were threatened with suspension or expulsion. Living in crowded multi-generational homes, children of color may become a new source of infection in their communities as they attend school during this time. Meanwhile, as the debate on school reopening continues, wealthier parents are leaning toward private tutoring and so-called pandemic pods where a group of parents pool to pay for their children to learn together in mini home-based classrooms. This trend, a private solution to a public problem, is only likely to widen the education achievement gap between wealthy children and poor, often black and brown children. 

        COVID-19 has not spared Historically Black Colleges and Universities (HBCUs) either. The colleges, which educate mainly black students from predominantly poor backgrounds, had to provide tech resources to students as they moved to virtual learning. 

Food insecurity 

        Even before COVID-19, many children of color were living in food-insecure households. According to an analysis based on Census Data, 39% of Black children, 37% of Hispanic children and 22% of white children live in such households. Many of these children rely on the U.S. Department of Agriculture (USDA) National School Lunch Program, School Breakfast Program, and Child and Adult Care Food Program, which together serve nearly 35 million children daily. School closures have led to increased hunger and food insecurity for these children. The CARES Act provided EBT-COVID cards to all children from schools that receive subsidized lunches, but this money is no substitute for a regular ready-to-eat meal on every school day. Parents trying to put food on the table using federal aid also had to go to the store in person as most programs require a face-to-face cashier transaction – this despite the fact that many grocery stores have adapted to the pandemic by providing grocery delivery or curbside pickup. (In Massachusetts, EBT card holders have been able to shop online on Amazon and Walmart since May 2020). 

        Accessing government aid has proved to be difficult for poor people. The stimulus package provided direct payments of $1200 to those earning $75,000 a year or less with an additional $500 for each child. The money was distributed through direct deposit in bank accounts based on taxpayer information. Those without direct deposit received checks through the mail. Some people had to wait weeks and even months before receiving the relief money because they were unbanked or had no address on file with the IRS. 

Prisons 

        Prisons in the United States house over 3 million prisoners of which 56% are Black or Latinx. A research letter published by the American Medical Association showed that infections of COVID-19 among prisoners were 5.5 times higher than the general US population. In a Tucson Arizona prison, for example, 517 inmates, representing about half of the total population have tested positive for COVID-19. 

Everyday existence 

        Clearly, COVID-19 has affected people of color in many aspects of their lives. Their everyday existence has become harder to navigate as their outlets for recreation and wellness have shut down. A Pew Research Center survey indicates that about four in ten Black and Asian adults say that people have acted “like they were uncomfortable” around them because of their race or ethnicity since the outbreak. This is likely because of the disproportionate effects of the virus among Black people and the virus’s Chinese origins. 

        The church as an institution is at the center of African-American life. It is not just a place of worship, it is where many African-American families socialize, obtain information on social services and policies, and celebrate life in general. Unfortunately, as COVID-19 spread, churches become super-spreader venues. Church closures have created a great void in Black communities. Even after reopening, singing and chanting, which are core to church services, were banned in California, leading to some three churches suing the governor of that state. 

        The shooting of George Floyd highlighted the racial disparity in policing, thus increasing the stress on communities of color. The subsequent protests across the country also added to the possibility of higher infection rates in those communities. In addition, following partial reopening Black and Latino-involved gun violence spiked across the country. 

        As celebrities continue to detail their experiences with COVID-19 while safely cloistered in their vacation homes, it is clear that the virus can infect anyone. What is also clear is that the documented effects of the virus on people of color put a different complexion on the idea that it is an equal-opportunity offender.