Virus killing blacks disproportionately in cities

As Florida health officials began to release racial data on COVID-19 victims this week, a new and sobering picture of the crisis has emerged showing that African Americans are dying in disproportionately higher numbers in many major metropolitan areas — including Orlando, Fort Lauderdale and Miami.

Although the data is still limited, especially for Florida as a whole, counties with the largest coronavirus caseloads have been reported for the first time in recent days, following pressure by public health advocates and at least one state representative for more transparency.

The evidence so far shows whites and Hispanics in more urban counties are often under-represented among the coronavirus fatalities as blacks there account for one-fourth to more than one-third of the dead. Duval and Palm Beach counties were the lone exceptions.

In hard-hit Dade County, for instance, where nearly

5,500 people have tested positive for the virus, black residents account for 23 percent of those hospitalized and 27 percent of the dead — even though they’re less than 18 percent of the population.

In Orange County, where black residents are nearly 23 percent of the population, they make up just 12 percent of identified cases but account for five of the12 deaths — or 42 percent, figures released late Friday show.

In Broward, black residents are 30 percent of the population, but they account for 35 percent of the dead.

“What’s happening with this virus is a mirror of the inequity that has been going on for a long time,” said Beverlye Colson Neal, president of the NAACP’s Orange County Branch. “The whole community has been neglected in terms of health care and [health] insurance.”

The data was made public this week as national leaders, including President Trump and Surgeon General Jerome Adams, who is African American, sounded an alarm over the virus’ sometimes dramatically uneven impact.

“This epidemic is a tragedy,” Adams said at a briefing Friday, “but it will be all the more tragic if we fail to recognize and address the disproportionate impacts on communities of color.”

In the District of Columbia, for instance, blacks make up 45 percent of the population but 59 percent of deaths. In Louisiana, blacks are 32 percent of the population but a staggering 70 percent of COVID-19 deaths — roughly similar to the disparities in Chicago and Milwaukee County, Wisc. In Michigan, where blacks make up 14 percent of the state’s population, they accounted for 33 percent of confirmed cases and 41 percent of deaths.

“This is a real problem,” Trump told reporters on Tuesday. “Why is it three or four times more so for the black community as opposed to other people? … It doesn’t make sense, and I don’t like it.”

Public health officials have long known that blacks have higher rates of asthma and high blood pressure, and they are more at risk for dying of heart disease — all of which make them more vulnerable to becoming seriously ill or dying from COVID-19, the infection caused by the coronavirus.

But that is likely only part of the explanation.

Black Americans also have higher rates of poverty, are more likely to be uninsured or under-insured and often live in crowded urban areas and in households with more people. They disproportionately work in both front-line health and public safety roles as well as food service positions that are still on the job.

“This population is more likely in the second wave … based on exposure, work [and] public transportation,” said Dr. Cheryl L. Holder, an associate professor at the Florida International University Herbert Wertheim College of Medicine. “We are the communities that are going to intersect with groups who have it.”

Early in the pandemic, there was a rumor spread through social media that blacks were somehow immune to the virus — based apparently on the lack of reported cases in Africa.

Some say that led African American communities to tune out the precautions.

“I would definitely say there is a lack of [information] in the black community and a lack of [information] communicated to the black community as far as what they can do to protect themselves and keep their families safe,” said Dr. Sarah St. Louis of Orlando, president of the Central Florida Medical Society, an organization of African American doctors. “That has to be communicated [better].”

Then there’s the long history of bias in medical treatment.

Last year, a study by pub lic health and emergency medicine researchers found that a widely used commercial health-care algorithm that helps determine which patients would benefit most from additional treatment had a significant racial bias, favoring white patients over blacks ones who were sicker and had more chronic health conditions.

“We’ve heard more and more researchers and doctors speak to the fact that it’s not necessarily race but racism within different institutions that have led to people of color in particular not being able to access health care,” said Florida Rep. Anna Eskamani, D-Orlando. “Just look at the testing sites, many of which are drivethrough in Florida. So you have to have a car. You also have to be able to afford gas. And if you’re someone struggling to pay rent right now, the chance of you being one of those individuals at a drive-through test site is pretty slim.”

To date, the federal Centers for Disease Control and Prevention has not released racial data on the pandemic’s cases, prompting calls from the NAACP, doctors and prominent Democratic lawmakers to do so.

Similarly, in Florida, the Department of Health had not made racial and ethnic information available until Tuesday evening, and initially a breakdown of statewide cases listed race as “other/unknown” for a hefty 41 percent of all cases and even 15 percent of the dead.

A day later, those figures had dropped to 32 percent of cases and 11 percent, and they have continued to improve, giving a more robust picture of the problem.

But large gaps still exist in the state’s database, and for most Florida counties, there is no racial or ethnic information available.

“There’s no way you can identify the problems and have interventions to address them until you know where they are,” said health care policy analyst Anne Swerlick of the Florida Policy Institute, an independent, nonprofit and nonpartisan social justice organization. “And it’s difficult to discuss this issue without addressing the 8,000-pound gorilla in the room — which is the fact that Florida refuses to expand its Medicaid program.”

Florida has more than 800,000 uninsured adults who could be covered if the state expanded Medicaid up to 138 percent of the federal poverty level, as 36 other states and the District of Columbia did following the passage of the Affordable Care Act.

Nearly half of those 800,000 are black or Hispanic.

Neal of the NAACP said the state’s position on Medicaid expansion is now “slapping us in the face” as uninsured Floridians with COVID-19 symptoms may be reluctant to seek medical care they can’t afford.

At 72, Neal knows she is doubly at risk.

“My doctor had her nurse call me and tell me to stay in the house and take care of myself because she knows I’m diabetic, and I’m active in the community,” she said. “But how many African Americans have that kind of a relationship with a primary care doctor?”