The Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted and devastated the world. As the infection spreads, the projected mortality and economic devastation are unprecedented. In particular, racial and ethnic minorities may be at a particular disadvantage as many already assume the status of a marginalized group. Black Americans have a long-standing history of disadvantage and are in a vulnerable position to experience the impact of this crisis and the myth of Black immunity to COVID-19 is detrimental to promoting and maintaining preventative measures. We are the first to present the earliest available data in the peer-reviewed literature on the racial and ethnic distribution of COVID-19-confirmed cases and fatalities in the state of Connecticut. We also seek to explode the myth of Black immunity to the virus. Finally, we call for a National Commission on COVID-19 Racial and Ethnic Health Disparities to further explore and respond to the unique challenges that the crisis presents for Black and Brown communities.Support from the NIH BUILD Award 1U54MD009476 and The Connecticut Legislative Black & Puerto Rican Caucus is gratefully acknowledged.https://doi.org/10.1007/s40615-020-00756-0https://doi-org.proxy-um.researchport.umd.edu/10.1007/s40615-020-00756-

Laurencin, Cato T

McClinton, Aneesah

English

Digital Repository at the University of Maryland

RESEARCH ARTICLEThe COVID-19 Pandemic: a Call to Action to Identify and AddressRacial and Ethnic DisparitiesCato T. Laurencin1,2 & Aneesah McClinton1Received: 2 April 2020 /Revised: 2 April 2020 /Accepted: 3 April 2020# W. Montague Cobb-NMA Health Institute 2020AbstractThe Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted and devastated the world. As the infectionspreads, the projected mortality and economic devastation are unprecedented. In particular, racial and ethnic minorities may be ata particular disadvantage as many already assume the status of a marginalized group. Black Americans have a long-standinghistory of disadvantage and are in a vulnerable position to experience the impact of this crisis and the myth of Black immunity toCOVID-19 is detrimental to promoting and maintaining preventative measures. We are the first to present the earliest availabledata in the peer-reviewed literature on the racial and ethnic distribution of COVID-19-confirmed cases and fatalities in the state ofConnecticut. We also seek to explode the myth of Black immunity to the virus. Finally, we call for a National Commission onCOVID-19 Racial and Ethnic Health Disparities to further explore and respond to the unique challenges that the crisis presentsfor Black and Brown communities.Keywords Coronavirus . COVID-19 . Pandemic . Race . Ethnicity . DisparityThe Black Immunity MythBlack American history is rooted in racial injustice and thereare countless efforts made to counteract a legacy of oppres-sion. Blacks are disproportionately affected by poverty [1],mass incarceration [2], infant mortality [3], limited health careaccess [4], and health-related conditions including heart dis-ease [5], diabetes [6], stroke [7], kidney disease [8], respirato-ry illness [9, 10], and human immunodeficiency virus (HIV)[11]. Many are well versed in this marginalized status andpossess first-hand accounts of the devastating impact of socialinjustice that permeates through communities. The continentof Africa has also known the impact of inequity and maintains25% of global disease burden [12]. Perhaps these unique so-cial conditions led numerous individuals in Black communi-ties in America and the world over to accept the myth of Blackimmunity to Coronavirus disease 2019 (COVID-19); the po-tential for immunity against a global crisis presented one lessstruggle amongst the many formidable challenges.The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) virus was first identified in late 2019 inWuhan, China, after health officials identified a perplexingtrend of pneumonia of unknown etiology amongst citizensthat eventually lead to researchers identifying the new virus.During the outbreak, a young Cameroonian student who re-sided in China was infected and became the first African tocontract the virus. He received treatment for the illness inChina, and within a few weeks, he recovered from the condi-tion [13]. Subsequently, various unsubstantiated reportsemerged declaring that the genetic constitution of Blacks oreven the presence of melanin rendered Blacks immune to thevirus. The news spread via social media and in social settingseven as prominent Black figures reported that they contractedthe virus [14].The unproven claim is not inconsequential as many maydisregard vigilant action to protect against the disease whichmay result in unpredictable social and health consequences,the most alarming of which is the uncanny similarities to theHIVepidemic in which some Blacks did not consider that theycould be affected by a disease that initially emerged amongstgay White men in America. Today, HIV has ravaged Black* Cato T. Laurencinlaurencin@uchc.edu1 Connecticut Convergence Institute for Translation in RegenerativeEngineering, UConn Health, Farmington, CT 06030, USA2 The Africana Studies Institute, University of Connecticut,Storrs, CT 06269, USAJournal of Racial and Ethnic Health Disparitieshttps://doi.org/10.1007/s40615-020-00756-0communities by disproportionately affecting Blacks whomaintain the highest rates of infection amongst all racialgroups [15]. Furthermore, while there are countless reportson the ages of those affected and the greater tendency formen to succumb to the disease, there is an unmistakable lackof reported and accessible data on the racial and ethnic com-position of those infectedwith COVID-19. The scarcity of thisinformation generates a more substantial concern in whichinsufficiently identifying the affected may ultimately resultin historically marginalized groups shouldering the greatestburden of disease and disproportionately bearing the socialimpact.An Emerging TrendInitially, numerous individuals racialized COVID-19, contro-versially declaring it the “Chinese virus,” viewing it as aninfectious agent that would only spread in a distant foreigncountry and could be properly mitigated with travel restric-tions. By the end of January 2020, the first US case wasreported in Washington state and was identified in a manwho had returned from Wuhan; by the end of March, the USbecame the epicenter of the pandemic accounting for the mostreported cases worldwide. While New York harbored thegreatest number of cases, concerning trends began to arise justweeks into the enforcement of social distancing guidelineswith news reports outlining the rapid spread of the disease incities that could potentially become the next hot spots includ-ing Boston, Chicago, Detroit, New Orleans, and Philadelphia.A larger proportion of Black Americans reside in these citiescompared with the overall US population of 13.4%.According to the US Census, Black people consist of 78.6%of the population in Detroit, 59.7% in New Orleans, 47.4% inPhiladelphia, 30.1% in Chicago, and 25.3% in Boston. Theconcern is that Blacks tend to live in close communities and aninfectious agent has the ability to spread amongst this groupdue to proximity. The culmination of Blacks maintaininggreater disease burden, higher poverty rates, limited healthcare access, higher rates of jobs in service industries wherethey are less able to work from home [16] with a subsequentincreased exposure risk, and the unfolding spread of the virusin cities with larger Black populations is a forewarning that ifdisregarded may constitute imprudent action.The State of Connecticut ExperienceIn many ways, Connecticut is a microcosm of America.According to the US Census, the state is comprised of66.5% White, 12% Black, 4.9% Asian, 0.6% AmericanIndian/Alaska Native, and 16.5% Hispanic/Latinx. A signifi-cant proportion of the Black population (at least one-third)resides within only a few cities and towns in Connecticut (astate that has over 150 cities and towns) [17]. The state ofConnecticut currently has over 3000 confirmed COVID-19cases with a total of 96 deaths to date (as of April 1, 2020).The top 3 counties with the most cases include Fairfield, NewHaven, and Hartford counties. The racial and ethnic break-down of those diagnosed with COVID-19 in the state wasobtained upon request from the Connecticut StateDepartment of Public Health. As of now, this is the earliestdata available (as of April 1, 2020) on the race and ethnicitydistribution of COVID-19 diagnosis and death in the state ofConnecticut.The data includes a total of 3141 cases with over 50% of thedata missing on race and ethnicity on the COVID-19 laboratorycase reports received by the Department. The Department con-veyed that there is not a geographic pattern to the missing dataand reported that data is missing for approximately more thanhalf of cases in all counties. Missing data on race and ethnicitymay be related to the testing site, such as tests obtained in theoutpatient setting. Furthermore, data obtained on other report-able diseases follows a similar trend in which there are missingrace and ethnicity data on laboratory reports.The distribution of men and women diagnosed is 1528(48.9%) men and 1599 (51.1%) women with a total of 14(0.4%) cases missing gender information. Race and ethnicityinformation was missing for a total of 55% of the cases. Thetotal confirmed cases are 60.8% White, 17.2% Black, 2.9%Asian, 15.9% Hispanic/Latinx, 0.2% American Indian/Alaska Native, and 2.9% other (Table 1).As for those who succumbed to the illness, we obtained thefollowing data upon request from the Connecticut Office of theChief Medical Examiner. There are 96 reported deaths with sixcases missing race and ethnicity information. The total deathsare 69 (76.7%) White, 13 (14.4%) Black, 6 (6.7%) Hispanic/Latinx, and 2 (2.2%) Asian (Table 2). The average age of thedeceased is 81 years for Whites, 72 years for Blacks, 62 yearsfor Hispanic/Latinx, and 76 years for Asians. As of now, thenational data on race and ethnicity is not readily accessible.Table 1 The total confirmed cases by race and ethnicityRace Case (%) Population in CT (%)White 60.8 66.5Black 17.2 12.0Asian 2.9 4.9Hispanic/Latinx 15.9 16.5American Indian/Alaska Native 0.2 0.6Other 2.9 –Confirmed COVID-19 cases based on race and ethnicityData as of April 1, 2020Source: Connecticut Public Health DepartmentJ. Racial and Ethnic Health DisparitiesA Request for DataIt is often claimed that the pandemic has exposed the deficien-cies of the American health care system, and perhaps thiscrisis has already begun to reveal an engrained racial bias thatmay further disempower racial and ethnic minorities includingBlack, Native American, Hispanic/Latinx, and AsianAmericans. At the end of March, news quickly spread thatDemocrats are requesting data from the federal governmentthat outlines the racial disparities in the country’s response tothe crisis [18]. They emphasize that the existing and pervasivedisparities will likely ensure that a national response will notimpact American communities equally. The importance of theracial and ethnic breakdown of those affected cannot beoveremphasized and may also impact philanthropic initiativesreaching communities [19]. The concern is that while there isan existing threat of an infectious disease that has the potentialto infect and devastate many, the particularly vulnerable willexperience a greater proportion of disease burden and socialupheaval that includes increased mortality, limited health careaccess, economic collapse with loss of wages and housing,and an overall lack of resources and equity to sustain in adynamic crisis.A Call to ActionWhen COVID-19 arrived in the US and progressed to infecthundreds of thousands of Americans, it was evident that allinstitutions and industries were not prepared for the crisis.Although the medical community has experienced surpriseand adverse events in the past [20], the unprecedented natureof this crisis is a complete shock to the system. In particular,the health care system quickly realized that the rapid influx ofailing citizens would outpace the available supplies from per-sonal protective equipment to ventilators, and even personnel.The economic collapse is unimaginable and continues to un-fold. A great concern is that by not systematically identifyingthe affected, we may repeat similar acts of unpreparednesswhen addressing the racial and ethnic disparities of the dis-ease. Therefore, all measures taken must entail concerted anddeliberate efforts that incorporate the expertise of leaders inthe field to address high-priority issues, and any haphazardattempts will not suffice and may even exacerbate the feebleconditions of the most vulnerable. First and foremost, data andtrends on numbers from racial and ethnic groups affected byCOVID-19 must be provided by the state and national healthdepartments. Second, we must prospectively understand andrespond to the specific challenges taking place with people ofcolor and the SARS-CoV-2 virus. We call for a NationalCommission on COVID-19 Racial and Ethnic HealthDisparities, a dedicated body to envisage essential recourseand mobilize to action the necessary safeguards. Deployinga National Commission exhibits prudent action that protectsthe many racial and ethnic minorities who at baseline do nothave a safety net; they are the unprotected who are brandedwith an imposed status as the first to endure impact.ConclusionOur review of the preliminary data explodes the myth of Blackimmunity to COVID-19 and demonstrates that Blacks have ahigher rate of infection and death in comparison to their pop-ulation percentage in the state of Connecticut. To our knowl-edge, this is the first paper to present data on race and ethnicityin the peer-reviewed literature for those in America affectedby COVID-19. Our conclusions are limited by the missingrace and ethnicity data and the fact that this is the earliest dataavailable. We recognize that this crisis is ongoing, and we willcontinue to follow the trend of infections and mortality withthe intent to publish a follow-up perspective as the informa-tion becomes available.COVID-19 as a disease may potentially have devastatingeffects on communities of color. While the virus does notdiscriminate, America’s history of discrimination creates po-tential longer-term scenarios akin to our experience with HIV,influenza, and other infectious diseases in Black and Brownpeople. We call for action to identify and address racial andethnic health disparities in the COVID-19 crisis.Added in ProofWe requested data from the Department of Public Health onMarch 31, 2020. After frequent inquiries for the race andethnicity data for the COVID-19 cases and deaths in the stateof Connecticut, we are pleased to report that the Departmenthas now tabulated and presented their data on their website asof April 3, 2020, and is presented in Fig. 1 [21].Table 2 The total deaths by race and ethnicityRace No. of deaths Deaths (%) Population in CT (%)White 69 76.7 66.5Black 13 14.4 12.0Asian 2 2.2 4.9Hispanic/Latinx 6 6.7 16.5Total 90Confirmed COVID-19 death based on race and ethnicityData as of April 1, 2020No American Indian/Alaska Native and other race deaths reportedSource: Connecticut Office of the Chief Medical ExaminerJ. Racial and Ethnic Health DisparitiesFig. 1 Connecticut State Department of Public Health first report on COVID-19 cases and deaths based on race and ethnicity as of April 3, 2020J. Racial and Ethnic Health DisparitiesFunding Information Support from the NIH BUILD Award1U54MD009476 and The Connecticut Legislative Black & Puerto RicanCaucus is gratefully acknowledged.Compliance with Ethical StandardsConflict of Interest The authors declare that they have no conflict ofinterest.Ethical Approval This article does not contain any studies with humanparticipants or animals performed by any of the authors.Informed Consent Not applicable.References1. Firebaugh G, Acciai F. For blacks in America, the gap in neighbor-hood poverty has declined faster than segregation. Proc Natl AcadSci U S A. 2016;113(47):13372–7.2. Western B, Wildeman C. The black family and mass incarceration.Ann Am Acad Pol Soc Sci. 2009;621(1):221–42.3. Collins JW, David RJ. Racial disparity in low birth weight andinfant mortality. Clin Perinatol. 2009;36(1):63–73.4. Copeland VC. African Americans: disparities in health care accessand utilization. Heal Soc Work. 2005;30(3):265–70.5. Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM,Bertoni AG, et al. Cardiovascular Health in African Americans: ascientific statement from the American Heart Association.Circulation. 2017;136(21):e393–423.6. Marshall MC. Diabetes in African Americans. Postgrad Med J.2005;81(962):734–40.7. Kissela B, Schneider A, Kleindorfer D, Khoury J, Miller R, AlwellK, et al. Stroke in a biracial population: the excess burden of strokeamong blacks. Stroke. 2004;35:426–31.8. Laster M, Shen JI, Norris KC. Kidney disease among AfricanAmericans: a population perspective. Am J Kidney Dis.2018;72(5):S3–7.9. Barnes KC, Grant AV, Hansel NN, Gao P, Dunston GM. AfricanAmericans with asthma: genetic insights. Proc Am Thorac Soc.2007;4(1):58–68.10. Ejike CO,DransfieldMT,Hansel NN, PutchaN, Raju S,Martinez CH,et al. Chronic obstructive pulmonary disease in America’s black popu-lation. Am J Respir Crit Care Med. 2019;200(4):423–30.11. Laurencin CT, Christensen DM, Taylor ED. 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Not everybody can work from home: Blackand Hispanic workers are much less likely to be able to telework[Internet]. Economic Policy Institute. 2020 [cited 2020 Mar 30].Available from: https://www.epi.org/blog/black-and-hispanic-workers-are-much-less-likely-to-be-able-to-work-from-home/17. Percent African-American or Black population by town [Internet].The Connecticut General Assembly. 2010 [cited 2020 Apr 1].Available from: https://www.cga.ct.gov/red2011/documents/popmap/Pop_Percent_AA_2010(2).pdf18. Silverstein J. Democrats demand data on racial disparities inAmerica’s coronavirus response [Internet]. CBS News. 2020 [cited2020 Mar 31]. Available from: https://www.cbsnews.com/news/democrats-demand-data-on-racial-disparities-in-americas-coronavirus-response/19. Villarosa L. COVID-19: using a racial justice lens now to transformour future [Internet]. NonProfit Quarterly. 2020 [cited 2020 Mar30]. 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The COVID-19 Pandemic: a Call to Action to Identify and Address Racial and Ethnic Disparities

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The COVID-19 Pandemic: a Call to Action to Identify and Address Racial and Ethnic Disparities

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