Made with FlowPaper - Flipbook Maker
THE STATE OF Black AMERICA AND COVID-19 A TWO-YEAR ASSESSMENTCarol R. Oladele, PhD, MPH Equity Research and Innovation Center (ERIC) Yale University School of Medicine Tonyka L. McKinney, DrPH, MPH Satcher Health Leadership Institute (SHLI) Morehouse School of Medicine Destiny Tolliver, MD National Clinician Scholars Program Yale University School of Medicine Reed Tuckson, MD Black Coalition Against COVID Daniel Dawes, JD Satcher Health Leadership Institute (SHLI) Morehouse School of Medicine Marcella Nunez-Smith, MD, MHS Equity Research and Innovation Center (ERIC) Yale University School of Medicine Report Sponsored by The Black Coalition Against Covid: A special thanks to Real Chemistry and 21GRAMS for their kind support in producing this report.3 In April 2020, a group of Washington DC community activists came together to mount a grassroots campaign to support local government efforts to combat the COVID-19 pandemic. Shortly thereafter, they helped to create a national effort with the leadership of Howard University; the Morehouse School of Medicine; the Meharry Medical College; the Charles R Drew University Medicine of Science; the National Medical Association; the W. Montague Cobb Institute of the NMA; the National Black Nurses Association; the National Urban League; and BlackDoctor.org. In addition, this coalition of health advocates and institutions regularly coordinated their work with partners from the faith community such as Choose Healthy Life and The Values Partnership, in addition to Black fraternal, sorority, and civic philanthropic organizations such as The Links, Incorporated. Acting individually and collectively over the past two years, these deeply committed organizations mounted numerous educational forums and town halls; conducted vaccine clinical trials enrollment and administration programs; sponsored COVID-19 testing centers; disseminated masks and other personal protective equipment; and led advocacy efforts for the federal and local government financial and programmatic support necessary to protect the lives of the Black community. As of this report’s release, we understand that there remains unfinished work yet to do to save and protect our communities from the COVID-19 pandemic. We commissioned this two-year report because we believe it is important to examine the consequences of the pandemic for Black America. However, because we have a profound respect for Black life and survival, and indeed for all life, we understand that even after the pandemic resolves, the disparities in health status experienced by the Black community prior to the pandemic must be urgently addressed. In fact, as this report documents, those disparities have actually worsened over the past two years. All of the organizations that have come together under this coalition are committed to working tirelessly until this pandemic ends as well as vigorously addressing the preexisting health challenges that have plagued our community for far too long. On behalf of the sponsors of the report, I take this opportunity to thank Dr. Tonyka McKinney from the Satcher Health Leadership Institute and Drs. Carol Oladele and Destiny Tolliver from Yale School of Medicine for their tireless efforts to bring the report to fruition. On Behalf of the Black Coalition Against COVID Reed Tuckson MD Washington, DC We commissioned this two-year assessment because we believe it is essential to examine the consequences of the pandemic for Black America. 4 We are pleased to share this report about the state of the Black community amid the COVID-19 pandemic from the Black Coalition Against COVID (BCAC), the Equity Research and Innovation Center at Yale School of Medicine, and the Satcher Health Leadership Institute at Morehouse School of Medicine. The BCAC—under the leadership of Dr. Reed Tuckson—commissioned this report in recognition of the fact that in January of 2022, rates of COVID-19 hospitalization for Black Americans were the highest they have been since the pandemic’s start. We hope to bring attention to the continued burden of COVID-19 in the Black community, even as we as a nation have made incredible progress overall. Even as we celebrate achievements towards COVID-19 equity, we know there is more work to do. As we reflect on two years of lived experience and myriad data sources, we know COVID-19’s toll on Black Americans is ongoing. This report draws attention to the continued disproportionate burden experienced by members of the Black community and will help guide advocacy and policy efforts to address these inequities—both during the current pandemic and beyond. This report shares the arc of the pandemic for Black Americans, highlights areas for immediate focus and attention, and presents a set of expert-generated recommendations for action. Given generations of systemic disinvestment in the health of Black communities in the United States, the starkly disproportionate rates of COVID-19 illness and death are not surprising. This report situates alarming pandemic-related disparities within these deeper societal inequities, and provides guidance to move towards sustained change. It was an immense honor to serve as Chair of the historic Presidential COVID- 19 Health Equity Task Force. We worked urgently to answer our charge and provided a final report inclusive of recommendations, an implementation plan, and an accountability framework as a roadmap for every sector and every level of government. It is also an honor to be commissioned by the Black Coalition Against COVID (BCAC) to produce this brief report and continue to shine a light on the path to health justice. I want to extend my deep appreciation to the Black Coalition Against COVID (BCAC), the Satcher Health Leadership Institute at Morehouse School of Medicine, and my colleagues here at Yale for their continued commitment to improving the health and wellbeing of the Black community, and of all those experiencing health inequities, and the ongoing work of this coalition to close the equity gap in our great nation. Forward We hope to bring attention to the continued burden of COVID-19 in the Black community, even as we as a nation have made incredible progress overall. Marcella Nunez-Smith MD, MHS C.N.H. Long Professor of Internal Medicine, Public Health, and Management Associate Dean, Health Equity Research Director, Office for Health Equity Research and Equity Research and Innovation Center, Yale University Chair, Presidential COVID-19 Health Equity Task Force 5 THEN Black Americans experienced a disproportionate COVID-19 burden in the early months of the pandemic and beyond. Data available in the early months of the pandemic indicated age-adjusted COVID-19 rates of infection, hospitalization, and death were highest among Black Americans. 1,2 Also striking was the limited data available on COVID-19 outcomes by race/ethnicity across the country. 3,4 Over time, the quality and completeness of race/ethnicity data improved and revealed a disproportionate pandemic burden across all structurally marginalized and minoritized groups. 5,6 The risk for severe and negative impacts from COVID-19 remained high for Black Americans. 7,8 Beyond the burden of infection, hospitalization, and death, Black Americans experienced significant economic, social, educational, and behavioral health crises. Black communities were disproportionately impacted by financial strain, loss of caregivers and elders, deficiencies in educational learning, and food insecurity. Half of Black respondents included in one 2020 survey reported experiencing financial challenges. 9 More than one in six Black workers lost jobs between February and April 2020, and less than half of Black Americans were employed in April 2020. 10 A September 2020 analysis found that 13 percent (two million) fewer Black Americans were predicted to be enrolled in employer- based health insurance. 11 Older Black Americans (65-74) were five times more likely to die compared to White Americans. 12 Those 75-84 years died almost four times as often as their White counterparts. 12 One in 310 Black children lost a parent or caregiver, compared to one in 738 White children between April 2020 and June 2021. 13 Relevant to the substantial loss of life, Black Americans reported pandemic-related mental health concerns at a rate approximately 10 percentage points higher than White Americans. 14,15 Learning loss among Black and other students of color was estimated to be 12 months compared to 4-8 months for White students. 16 Twenty-one percent of Black Americans experienced food insecurity, making them twice as likely as White Americans to experience food insecurity. 17,18 Those who experienced food insecurity prior to the pandemic experienced more severe food insecurity. 19,20 The confluence of these factors contributed to the extraordinary COVID-19 related burden faced by Black Americans. One in 310 Black children lost a parent or caregiver, compared to one in 738 White children between April 2020 and June 2021. COVID-19 by the Data: Then and Now 6 The severity of COVID-19 among Black Americans was the predictable result of structural and societal realities, not differences in genetic predisposition. Black Americans are overrepresented in essential worker positions which increased their risk of getting COVID-19. 21-23 For example, 25 percent of employed Black Americans work in service jobs compared to 16 percent of White Americans. 23 They account for 30 percent of licensed practical and vocational nurses. 23 Black Americans are also more likely to live in multi-generational homes, live in crowded conditions, be incarcerated, and reside in densely populated urban areas compared to White Americans, which made social distancing difficult. 23-26 Pre-existing structural and social inequities that have long driven disparities were key risk factors for COVID-19. Those factors included exposure to environmental toxins, obesity, hypertension, diabetes, and chronic kidney disease—contributing to greater risk for infection and serious illness. 8,27-29 The higher prevalence of these risk factors is a result of differential access to high quality care and health promoting resources necessary to prevent, diagnose, and appropriately manage chronic conditions. 30-33 Black Americans faced discrimination and bias when seeking COVID-19 related health care.In the earliest days of the pandemic, Black Americans faced structural barriers to testing and quality care for COVID-19. Drive-up testing launched in many areas of the country limited access to individuals with vehicles. Many testing locations were not accessible to Black Americans without transportation, those living in rural communities, and people living with disabilities. 34-38 Results from a 2020 national poll of Black Americans showed that most respondents anticipated experiencing discrimination and receiving disparate treatment when seeking care for COVID-19.39 Sixty-three percent of respondents agreed that Black American patients with COVID-19 would be less likely to have everything done to save their lives. 39 Evidence subsequently demonstrated Black Americans seeking care at emergency departments were less likely to be given a COVID-19 test when indicated, less likely to be admitted when diagnosed, and less likely to receive emerging therapies. 39 COVID-19 Cases, Hospitalization, and Deaths rates per 100,000- March 2020 to May 2020 Average Weekly Rate, per 100,000 (March 2020-May 2020) White AmericansBlack Americans Cases Hospitalization Deaths 42.7 12.6 4.47 15.8 4.0 2.26 Pre-existing structural and social inequities that have long driven disparities were key risk factors for COVID-19. 7 Early vaccination eligibility guidelines threatened equitable access for Black Americans. There was a consistent 10-percentage point gap between Black and White adults in the initial months following the availability of vaccines. 40 This was largely fueled by deep seated historical and contemporary mistrust of American government, political, social and medical institutions as well as disjointed policy guidance and misinformation. In addition, differences in approaches to vaccine rollout across states added yet another layer of access challenges for Black Americans. Vaccination rates from May 2021, 5 months into vaccine rollout, showed that Black Americans were less likely to be vaccinated compared to their White counterparts. 41 The harsh realities of COVID-19 were superimposed upon generational systems of disadvantage. The deep-seated history of marginalization and discrimination against Black Americans underlie inequities in education, employment, housing, nutrition, credit markets, health care, and the carceral system. The COVID-19 pandemic took advantage of these cross-sectoral inequities to hamper health- promoting resilience in the face of the global pandemic. 53% 1 dose 2 doses 63% 44%56% Vaccination Rates (May 2021) Eligible Black AmericansEligible White Americans The COVID-19 pandemic took advantage of these cross-sectoral inequities to hamper health-promoting resilience.8 NOW The primary series fully vaccinated rate for adult Black Americans is on par with other racial/ethnic groups.Since September 2021, the gap in adult vaccination rates has narrowed. The gap for Black Americans 65 and older closed prior to September 2021. Based upon the most recent available data, the rate of vaccination against COVID-19 among adult Black Americans is 80 percent. 41 Concerted efforts and targeted partnerships, often lead by Black Americans, resulted in more equitable access to COVID-19 resources. Cross-sector coordination, across levels of government, with public-private partnerships, community and faith-based organizations at the fore were critical to advocacy efforts and tangible support for Black Americans. Partnerships were crucial to gains made in accessible testing and vaccination locations, ensuring access to personal protective equipment, therapies, and adequate representation in COVID-19 clinical trials. Organizational trustworthiness served to build confidence across the communities served, which resulted in thousands more people of color making the decision to become vaccinated. 83% 80% 84% 83% 1 dose 2 doses Vaccination Rates (January 2022) Eligible Black AmericansEligible White Americans Organizational trustworthiness served to build confidence across the communities served.9 Educational and economic interventions strive to limit longer-term harm from COVID-19 for Black Americans. Several interventions target educational and economic recovery to counter the unequal pandemic toll on Black and other communities of color. Resources directed to schools to support safe reopening narrowed racial gaps in opportunities for in-person instruction. 42,43 This also slowed the widening achievement gap observed for Black American children attributable to prolonged virtual learning. The temporary expansion of the Child Tax Credit is an economic intervention estimated to reduce poverty among Black children by 50%. 44,45 This also supported guardian families of Black children, who were 2.4 times as likely as White children to be orphaned because of the pandemic. 13 Inequities in Long COVID are emerging for Black Americans. COVID-19 infection has been linked to long-term symptoms that can emerge weeks to months after primary infection. 46 There is anticipation of racial and ethnic disparities in Long COVID given the higher burden of COVID-19 infection among Black Americans. There is already evidence of disparities in diagnosis and access to treatment, which suggests increased likelihood of future disparities. 46,47 Black Americans recently experienced the highest rate of hospitalization for any racial/ethnic group since the inception of the pandemic. (Figure 1) During the week ending on January 8, 2022, the hospitalization rate for Black Americans was 64 per 100,000. 48 This was the highest weekly rate of any race and ethnicity at any point during the pandemic. This is more than double the highest weekly rate (26 per 100,000) seen in January 2021. 48 This occurred during a time when major media messages touted that the COVID-19 variant was significantly less severe than previous versions. Contributing factors are likely multifactorial. Lagging rates of booster uptake and pediatric/adolescent vaccination present opportunity for additional public health interventions. 49 The rate of hospitalization for Black Americans has dramatically declined in the two months following the January 8, 2022 peak. 41 Black Americans are facing significant behavioral health challenges as a result of COVID-19. Greater experiences of pandemic stressors such as job loss and economic insecurity are correlated with sharp increases in anxiety, depression, and substance use. 14,15,50 Evidence shows Black Americans are more likely to report experiencing anxiety and/or depression because of the pandemic compared to White Americans. 14 Substance use disorders have also increased due to pandemic stressors, especially among those with existing disorders. One study identified that opioid overdoses increased among Black Americans by as much as 52.1 percent while it decreased 24 percent among White Americans.51 Other studies are consistent in demonstrating higher increases among Black Americans. 50 Stressors responsible for these behavioral health challenges are likely to have continued influence. There is already evidence of disparities in diagnosis and access to treatment, which suggests increased likelihood of future disparities.Next >