In the article below, Dr. Clarence Spigner, an epidemiologist and professor in the School of Public Health at the University of Washington, assesses the early African American responses to COVID-19.
COVID-19, the highly infectious respiratory pandemic disease, stands for coronavirus disease, 2019. Symptoms for possible presence in the human body include a cough, fever, and lung infection, generally leading to a shortness of breath. Unlike the common flu to which it is often compared, COVID-19 has a significantly higher death rate since, as of this date, there is no vaccine. The practice of social distancing, frequent hand washing, wearing a mask to reduce passing the virus on, and maintaining social distancing can help prevent acquisition and transmission.
The COVID-19 disease started in Wuhan, China in December 2019. The first case in the United States was registered on January 21, 2020 and the first death on February 6. As of May 26, 2020, worldwide confirmed cases of the respiratory disease stood at 5,683,802 with 352,200 deaths and 2,430.517 having recovered. In the United States, there were 1,725,275 confirmed cases and 100,572 deaths with 477,969 having recovered. COVID-19 is a moving target and statistics like these will change daily. (To see the most recent statistics go to Worldometer: COVID-19, Coronavirus Pandemic, https://www.worldometers.info/coronavirus/). Older populations seem more at risk due to the natural aging process, which brings diminished immunity. Also at risk are people with obesity, heart disease, diabetes, cancer, hypertension, lung disease, and other conditions that compromise the body’s immune system.
Today there is overwhelming evidence of the disproportionate impact of COVID-19 on communities of color, including especially African Americans. Black Americans comprise 13% of the U.S. population but so far have accounted for 25% of the deaths. While COVID-19 does not discriminate, the social determinants of health do. According to the Centers for Disease Control (CDC), those social determinants are defined as poverty, exacerbated by limited access to health insurance, poor housing, environmental toxins near or in African American communities, homelessness (Blacks are 13% of the general population but 40% of the homeless), and even limited access to healthy foods. All these factors make African Americans particular targets of the novel (new) coronavirus.
The United States has had a long history of providing inadequate heath care to people of color and especially African Americans. The most notorious example is the Tuskegee Syphilis Studies that began in Alabama in the 1932 and ended 40 years later in 1972, but only after most of the 299 of black men intentionally allowed to catch the disease had died, along with wives and children who were infected as well.
Black American distrust of the medical profession began with inadequate healthcare during slavery, was reinforced by the Tuskegee experiment, and continues into the contemporary era despite the CDC finally recognizing in 2017 that health disparities disproportionately affect African America. Despite that recognition and recommendations to address these disparities, much of this information continues to be ignored by significant segments of the health care community. The health of African Americans was compromised long before COVID-19 ever reached the United States.
Mass media initially focused on the Chinese as harbingers of the disease. This epidemiological tracking approach is normal, but it appeared initially that mostly middle- or upper-class white people were deemed more at-risk for COVID-19, since those were the people who had visited China or knew or encountered people from China who had possible contact with the virus. Black people within the United States were less likely to have visited China or to know anyone who had. As COVID-19 cases grew, however, the media focus remained mostly on infected white people, reinforced by a growing myth spread on social media in the early weeks of the pandemic that black people were immune to the disease.
Myth-making about black immunity to disease has had a long and tragic history in the United States. When an outbreak of Yellow Fever hit Philadelphia in 1792, Dr. Benjamin Rush and other medical leaders in the city initially believed African Americans were immune to the disease. Rush enlisted two black community leaders, Richard Allen and Absalom Jones, to treat the sick. As they cared for the fever’s white victims, they found numerous black residents were infected as well.
Unfortunately, this myth of black immunity continued into the Reconstruction Era, particularly around smallpox, and even into early 20th century as reflected in the notorious Tuskegee Syphilis Study. Paradoxically the immunity myth stood side-by-side with the equally pernicious idea that the black race was dying from disease. In 1896 Frederick L. Hoffman, a statistician for the Prudential Life Insurance Company, published a 336-page study that falsely claimed freedom brought the onset of various diseases among the ex-slaves which would soon make African Americans extinct. Hoffman, the author of “Race Traits and Tendencies of the American Negro” summarized his findings this way: “Negroes died because they were inferior, and they were inferior because they died.” Hoffman’s study concluded that race traits rather than life conditions (what we now call the social determinants of health) caused the excessive death rate among African Americans. The most immediate consequence of the study was that Prudential and other major insurers stopped selling insurance to African Americans.
The AIDS pandemic swept the United States and the world in the early 1980s and again the process of misinformation spread with the lethal disease. In the earliest days of the health crisis, AIDS was considered the “Gay” disease which suggested to many in the African American community that it was a “white” disease. Numerous black religious and civil rights leaders denied the presence of a significant homosexual segment of African America. Had information about the disease been disseminated across black America earlier, numerous lives might have been saved.
AIDS eventually devastated black communities across the nation as it rapidly spread through sexual activity and the exchange of infected needles among the large black drug-using population. By 1996, 41,699 people died from AIDS, the peak year for the disease’s death toll in the U.S. African Americans, 13% of the population, accounted for 38% of the total number of deaths. In 2017, long after AIDS has been controlled by therapies and treatments, blacks still accounted for 44% of the 16,350 AIDS deaths. Far from being a “white Gay” disease, AIDS continues to wreak disproportionate havoc on a small segment of African America.
H1N1, or the swine flu which emerged in 2009, was the next pandemic to hit black people particularly hard. Compared with white patients, black patients got sicker faster, recovered more slowly, and died at higher rates. Underlying conditions including diabetes, asthma, hypertension, and even HIV, all of which occur in higher rates in black communities, helped explain why the H1N1 influenza was more lethal for black Americans. From April 15 to August 31, 2009, blacks accounted for 35% of those hospitalized in 13 major metropolitan areas but only 16% of those living in those areas. While no figures are available for the number of black deaths nationwide during this pandemic, they were likely disproportionately high as well. Ironically, the U.S. Congress discussed addressing these disparities in 2009 but no action was taken. Even a 2012 retrospective report from the U.S. Department of Health and Human Services recognized the greater impact of the swine flu on black people but concluded that “the reasons were unknown.”
Early in 2020 some African Americans boldly asserted that melanin, the dark brown-to-black pigment in the skin, was a counter agent to COVID-19. Among the first to sound a needed alarm against this irresponsible propaganda was African American cable news commentator Van Jones. In early April, while making his regular appeal as a prison reformer, Jones appeared on cable news and reported how African American prisoners and staff in U.S. correctional facilities were being put at extraordinary risk for the highly infectious COVID-19 disease due to required proximity of inmates and guards. In passing, Jones also mentioned that some blacks believed they were immune to the disease.
Around the same time, Trevor Noah, the black South African comedian and political commentator, unveiled the origin of this myth on his The Daily Show. Noah featured disturbing film footage of African Americans making statements cloaked in a tone of authority, asserting that black people could not catch the disease due to the melanin in their skin. “Name one,” posed a confident young black male with dreadlocks, somehow as evidence there were no black victims of COVID-19. The absence of blacks as COVID-19 victims in the media was deemed by many African Americans as prima facie evidence of black immunity.
The very fact that African Americans have always been more at risk for disease, disability, and early death than whites somehow escaped the logic of those promoting this hypothesis. According to medical historians and now the CDC, African Americans have experienced higher rates of morbidity, disability, and mortality from obesity, heart disease, cancer, accidents, chronic lower respiratory disease, stroke, hypertension, diabetes, influenza and pneumonia as long as health records have been available. Since the beginning of the pandemic it has been known that COVID-19 disproportionately affects individuals with these conditions. The “name one” declaration of the myth makers came from appalling ignorance, misinformation, illogic, and media bias.
Like a bush fire in a dry forest, the number of COVID-19 deaths among African Americans began to mount from February to the present and it will continue to rise. The Centers for Disease Control (CDC) admitted that initially racial data on COVID-19 was not being kept, an amazing admission since such statistics are kept on every other disease or condition. It is those statistics that provide the evidence of huge and longstanding health disparities by race.
By April 10, only BuzzFeed among the white-dominated news outlets reported the disproportionate rates of deaths among African Americans from COVID-19. Their statistics were shocking. In Chicago, blacks make up 30% of the population but 70% of the COVID-19 deaths. In Louisiana, blacks are 32% of the population and 70% of COVID deaths. In Michigan, blacks comprised 14% of the population but 52% of deaths. In Mississippi, blacks comprise 38% of the population and 71% of the deaths. This disproportionality extends to virtually every state in the U.S.
The United States’ market-oriented health care system has proved to be a breeding ground for COVID-19, especially among poor people who could not afford health care. This disparity is precisely what former President Barack Obama’s Affordable Care Act of 2010 attempted to address. African Americans and others with underlying or pre-existing conditions exacerbated by social inequalities suffer and die at disproportionately higher rates under our present health care system. That reason, rather than race, underlies the explosion of COVID-19 in African American communities across the nation.
With no vaccine, accurate knowledge and individual behavior are the only ways to prevent COVID-19. Maintaining social distance at six feet or more is critical, but for African Americans, this is not as feasible as it sounds. Many are forced to take public transportation to work in low-paying food service, factory, and health care support jobs, all of which put them directly in harm’s way of contracting the virus. Staying at home and sheltering in place is an insult since many low-income African Americans are least likely to own a home and the apartments and public housing projects that provide shelter for them are almost always crowded environments. Wearing a face mask helps lower transmission, but it also puts black men at greater risk for racial profiling. Many African Americans lack the health insurance to pay for the virus test which, if available, is not always free. COVID-19 is not responsible for these socioeconomic inequalities, but it has exposed them to the world.
Initially America’s corporate media, whether CNN, MSNBC, or Fox News, provided little to no reporting regarding the racial dynamics inherent in COVID-19. Commentators claimed the virus does not discriminate as if this was an affirmation of equal opportunity across the nation. A few cable T.V. personalities such as Van Jones and Trevor Noah wisely used their platforms to expose how COVID-19 does impact some racial and ethnic communities more than others. Their early reporting eventually forced CNN, MSNBC, and other networks (but not Fox News) to follow this story of inequality. By early April, more than 10 weeks into the COVID-19 pandemic, there finally was widespread and systematic focus on race. Typical of this approach was the CNN news program titled The Color of COVID in mid-April, featuring CNN host Don Lemon and Van Jones.
COVID-19 continues to expose deep racial divisions in U.S. society. Since April, a growing number of political conservatives have launched a push back against shelter-in-place orders by state governors calling them unconstitutional infringements on the right to assembly and unnecessary restrictions on their ability to operate their businesses. Initially encouraged by tweets from President Donald Trump, armed protests mounted across the nation forcing (or encouraging) some governors to open factories, stores, beaches, bowling alleys, barber shops, and hair salons. In Georgia, where blacks are already disproportionately killed by COVID-19, opening many of these establishments forced the most vulnerable back to work, including African Americans who have to choose between the safety of themselves and their families and need for a paycheck. These people, not the protesters, will pay the greatest price for prematurely reopening the economy.
Staying informed with correct information and behaving appropriately is the only line of defense against the ravages of COVID-19. This rule especially holds true for African Americans who are some of the most vulnerable people facing this pandemic currently sweeping the nation.