RACIAL DISPARITIES MAKE SCARE WORSE
Black and Hispanic residents more than three times as likely to test positive for COVID-19 as white people, records show
Amid persistent racial disparities in Connecticut’s COVID-19 outbreak, advocates worry the state will again struggle to protect Black and Latino residents during a potential second wave of the disease this fall.
According to state numbers, Black and Hispanic Connecticut residents are more than three times as likely to have tested positive for COVID-19 as white people, after adjusting for age. Black people are also more than two and a half times as likely to have died from the disease as white people, while Hispanic people are more than one and a half times as likely.
These disparities have not improved as the pandemic has progressed and by some measures have actually worsened. Black residents still account for about 18% of all positive COVID-19 tests, same as in early April, despite making up only 12% of the population. Meanwhile, rates of infection and death among Hispanic residents have shot up over the course of the pandemic.
“We reopened even in a phased way without a plan to address the disparities we already saw, and I’m not hearing one yet on how we’re going to deal with the ones that are still existing,” Tekisha Everette, executive director of Health Equity Solutions in Hartford, said Tuesday. “If we are going to continue along the path we’re on, we’re going to see the same exact outcomes in the fall.”
Black and Latino residents, experts note, are more likely to live in densely populated areas, more likely to work front-line jobs requiring in-person contact
“If we don’t disrupt the cycles of structural disadvantage that give rise to disparities in the first place, we can’t educate our way out of this issue.”
Wizdom Powell, director of the Health Disparities Institute at UConn Health
with others and more likely face pre-existing health conditions that increase their likelihood of serious symptoms. Those factors likely contribute to increased rates of COVID-19 infection and to severe outcomes, including death.
Asked about racial disparities in COVID-19, Gov. Ned Lamont said state officials had “focused like a laser beam” on Black and Latino communities, particularly with regards to testing. Paul Mounds, the governor’s chief of staff, said the state would continue efforts to educate and to test people in those groups.
“One of the things that we are doing is to increase the overall education within those communities that are affected so people know directly and understand what COVID-19 is and what it can be to them and their families directly,” Mounds said.
But Wizdom Powell, director of the Health Disparities Institute at UConn Health, warns that education, while important, isn’t enough.
“Health education is critical and necessary to moving the needle on outcomes, but it is not the only lever we should be using,” Powell said. “If we don’t disrupt the cycles of structural disadvantage that give rise to disparities in the first place, we can’t educate our way out of this issue.”
No easy fix
Racial disparities in COVID-19 aren’t just the result of recent policy decisions, experts say. Instead, they owe to decades and centuries of discrimination.
In a recent 47-page report, the New Haven-based group DataHaven described inequities in wealth, income, employment, education, nutrition, housing, obesity, diabetes and access to health insurance that have fueled disparate outcomes during the current pandemic.
“Disasters like the COVID-19 pandemic expose and exacerbate existing social inequities,” the authors wrote. “Prior to the pandemic, communities of color endured disproportionately worse health outcomes and increased mortality as a consequence of decades of structural inequality. The pandemic has made these disparities only more obvious.”
Powell, who chairs Hartford’s public health working group, proposes a scenario: Imagine a low-income family living in a multigenerational household with limited space. There’s no room to distance from a sick family member, and even holding a private telehealth doctor’s visit might be difficult. Several members of the household are “essential workers” who spend all day interacting with strangers at their jobs.
That family faces significantly enhanced risk from COVID-19, Powell said.
“Health is created largely outside of the health system,” she said. “It’s where people live and work and play that matter the most. So we have to look at where the systemic inequities lie in those systems that give rise to poor health, and we have to be aggressive and radical in our approach to rectifying them.”
Powell notes that disproportionate unemployment and under-employment among Black and Latino residents means they are less likely to have health insurance. Meanwhile, the concentration of affordable housing in cities means those same groups often live in densely populated, segregated areas where viral transmission occurs more easily.
Everette says the state must focus on short-term mitigation efforts and longterm structural change at the same time.
“We need to be thinking about what we’re doing at the larger, structural level about the racism that exists that is producing the inequities that we’re seeing,” Everette said, “while we’re also dealing with the emergency situation we’re seeing with the pandemic.”
Testing and communication
In the immediate future, experts say, Connecticut can chip away at the disparities through targeted testing and better communication about when to wear a mask, how to get tested, what to do if you or a family member tests positive and what resources are available for those at risk.
“I’ve observed local communities doing a really great job and some local activists and communitybased organizations doing a good job trying to get the word out,” Everette said. “I still have not seen, though there is a lot of talk about it, a real coordinated campaign from the state perspective in getting the word out.”
The state recently began a targeted effort to test city residents, beginning in Bridgeport and moving to Hartford. The program includes a marketing campaign and pop-up testing locations.
Dr. David Banach, epidemiologist at UConn Health, said the most immediate action the state can take is to focus on testing and contact tracing in Black and Latino communities, “to rapidly identify individuals and isolate them in order to reduce the amount of spread in those areas.”
The state does not provide testing data broken down by race or ethnicity, making it difficult to evaluate the success of testing outreach in Black and Latino communities. But Connecticut’s overall testing numbers have largely plateaued since May, leading officials to back away from once-ambitious goals.
State officials note they have encouraged everyone in densely populated cities to seek testing and have coordinated numerous testing sites in those places, often in partnership with local health providers. Lamont has often touted a partnership with CVS that has brought increased testing across the state, including in New Haven and Hartford.
Dr. Matthew Cartter, the state’s top epidemiologist, said the state is working to identify high-risk areas and to specifically focus testing there.
“Testing in those areas is something that has been a challenge,” Cartter said. “A lot of people drove up to testing sites, but a lot of people in those areas don’t have cars.”
Mounds said the state had increased its outreach to Black and Latino communities through public service announcements, as well as testing initiatives.
“These are generational problems,” Mounds said. “But we are looking to make generational change right away.”
A national problem
Connecticut, of course, isn’t alone in confronting racial disparities in COVID-19.
A recent New York Times analysis found that Black and Latinos nationwide have been three times as likely to be infected and twice as likely to die from the disease as their white neighbors, while Native Americans were also hit particularly hard. Disparities were evident not only in major cities but also in rural areas and suburbs.
Connecticut was not included in the Times study due to the state Department of Public Health not electronically reporting data to the federal Centers for Disease Control and Prevention. Still, state data shows similar patterns to those observed elsewhere, with Black and Latino residents at significantly greater risks than white ones.
As the Black Lives Matter movement has gained support and attention in recent months following the killing of George Floyd in Minneapolis, health equity advocates say they hope to see that momentum translate into a more thoughtful pandemic response.
“If you believe that Black lives matter,” Everette said, “you figure out how to put in place, before we do any further phasing of reopening, how you put in place the mechanisms to ensure that people of color in Connecticut have their health and social-care needs met.”