For weeks, it was suspected that African Americans and people of African descent in the United States might be disproportionately impacted by the COVID-19 pandemic. But data collection and dissemination have been mostly anecdotal, from frontline health care workers, a few local health departments, and reportage by the press. The coronavirus pandemic has followed along the course of existing racial disparities—but this has been difficult to prove with little direct evidence.
This week, amfAR changed that. The HIV research and advocacy organization just released the findings from its own study ahead of peer review, demonstrating the disproportionate impact of COVID-19 on Black communities in the U.S. The data was presented yesterday on a webinar for some Black public health advocates, journalists, and service providers, including a link to the newly launched COVID-19 dashboard, a website that will be updated to continuously track the COVID-19 pandemic in the U.S. and to look at how it progresses. Their analysis showed that in counties with higher proportions of African Americans (compared to their overall population), there were higher rates of COVID-19 diagnoses and deaths.
“Many people have observed large and consistent disparities in COVID-19 cases and deaths among Black Americans, but these observations have largely been anecdotal or have relied on incomplete data,” said amfAR vice president and director of public policy Greg Millett, the study’s lead investigator. “This analysis proves that county-level data can be used to gauge COVID-19 impact on Black communities to inform immediate policy actions.”
Millett and the other investigators looked at data on April 13, when there were 547,390 COVID-19 diagnoses and 21,634 deaths in the U.S. Looking at reported diagnoses and deaths in each county in the United States, they compared those data points in all counties against “disproportionately Black counties” and found that “while disproportionately Black counties constitute only 22% percent of U.S. counties, they account for 52% and 58% of COVID-19 cases and deaths, respectively,” according to an amfAR press release.
Additionally, the study found that that nearly every disproportionately Black county (97%) had one or more COVID-19 diagnoses compared to only 80% of all other counties, and almost half of disproportionately Black counties had at least one COVID-19 death compared to 28% of all other counties. It also didn’t matter whether those counties were large or small, urban or rural—the same racial disparities in COVID-19 diagnoses were found—but they were overwhelmingly in the Southern states, as 91% of disproportionately Black counties are located in the Southern U.S. Several advocates confessed their frustration to TheBodyPro that much of the media coverage of COVID-19 in “rural” America has been primarily focused on white rural communities.
“My family, like so many others in the Black community, has been ravaged by this coronavirus, said Ace Robinson, M.H.L., M.P.H., director of strategic partnerships and the Training Center to End the HIV Epidemic in America with NMAC. Robinson’s family is from the Albany, Georgia, area, which was one of the first Black small cities and rural communities to be hard hit by COVID-19 deaths, several of whom were Robinson’s family members. “I couldn’t be happier that amfAR released this dashboard based on available surveillance data,” he said.
Researchers, while presenting their findings on the invite-only webinar, were quick to note that clearly Black people are more disproportionately impacted, and these disparities in COVID-19 exist due to systemic racism that impacts Black people’s living conditions, low-wage employment in the service economy, lack of access to health care, and other underlying health disparities. The researchers found that not having health insurance coverage, along with living in crowded households, were correlated with higher COVID-19 diagnoses in these disproportionately Black counties.
Millett noted in the webinar presentation that living with HIV was not a risk factor for COVID-19 in these counties. People who were unemployed had less risk for COVID-19, which may demonstrate what some Black public health advocates have suggested, that the high concentration of Black people in jobs that involve lots of contact with the public in the service industry, as home health aides, or in meat and food processing factories in the South, may explain the high rates of COVID-19.
Also, most of these counties are in non–Medicaid-expansion states, which means fewer people have health care to manage some of the underlying health concerns that are known risk factors for COVID-19 illness and death, such as obesity, diabetes, hypertension, and asthma. amfAR has created a dashboard where anyone can track these data, and Millett noted that they will be adding other components to the dashboard to analyze some of the environmental factors, such as whether there are prisons, meat processing plants, or other venues known to be great facilitators of COVID-19 transmission in each county.
“These study results arise from more than health system shortcomings,” said Millett, in the press release. “Greater efforts are needed to eliminate structural racism and address broader social, environmental, economic, and other inequities. And additional analyses exploring disparities in COVID-19 among Latino, Native American, and other populations are needed.”
Black HIV Activists Are Key to the COVID-19 Response
In addition to some of the calls to have the Centers for Disease Control and Prevention release national demographic data, Black HIV activists and service providers have also been calling for more than just the data. Many see the importance of publicizing the data to describe which communities are most impacted by COVID-19 as a means to make further demands on how funding and other resources will need to be directed, including testing; personal protective equipment for providers, first-responders, and essential workers (including those in grocery stores, factory workers, and other service employees); and health care coverage in heavily impacted communities.
Some Black public health providers and advocates are mobilizing various responses to this crisis. The Counter Narrative Project in Atlanta recently sent a letter to Surgeon General Jerome Adams, M.D., M.P.H., to challenge his rhetoric that Black people’s behaviors were somehow to blame for the disparities in COVID-19 illness and deaths, calling on him to engage more deeply with Black doctors, nurses, researchers, and public health activists who are directly responding to the crisis. The Human Rights Campaign has partnered with Native Son and Color of Change to call on federal authorities to release more race-specific data on COVID-19 to help describe where resources should be directed. And some community-based HIV organizations that are led by and serve Black communities in the South have expressed their desire to play a role in the COVID-19 response.
The Black AIDS Institute is also hosting several webinars and virtual townhalls on COVID-19 in Black communities in Southern cities and towns in the coming weeks.
“There are immediate actions that can be taken to change the course of the epidemic,” said Raniyah Copeland, president and CEO of the Black AIDS Institute. “Increasing testing with high-quality tests in predominantly Black communities, increasing information dissemination in Black communities to support social distancing, and expanding Medicaid now so uninsured can have access to health care. We must mobilize to advance the dismantling of the structural underpinnings (mass incarceration, structural racism, poverty) that are literally fueling this pandemic in Black communities. It is going to take a mobilization from the entirety of Black communities in way that we’ve never seen before to confront the immediate changes that can change the course of the epidemic and long-term structural changes that have made this pandemic pervasive in Black communities.”
But as states, including many in South, are beginning to lift shelter-in-place restrictions, calling people who work in service industries (who can’t work from home) back to work, and suggesting that workers who are too afraid to do so will also lose the ability to collect unemployment, anger and frustration continue to rise.
“My anger continues to grow as states like Georgia where my family lives are lifting safety restrictions even though we don’t know how badly the epidemic is killing our communities,” said Robinson. “Forcing people to choose between starvation by being kicked off of unemployment because businesses are opening prematurely or risking possible infection is nothing short of depravity. COVID-19 is showing us the absolute worst side of humanity. The absolute worst.”
To view the amfAR COVID-19 dashboard, visit https://ehe.amfar.org/disparities.