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< Previous10 COVID-NET :: Entire Network :: 2020-21 :: Weekly Rate Figure 1. Laboratory-Confirmed COVID-19 Associated Hospitalizations Preliminary weekly rates as of March 5, 2022 COVID-NET: COVID-19-Associated Hospitalization Surveillance Network, Centers for Disease Control and Prevention. https://gis.cdc.gov/grasp/ COVIDNet/COVID19_3.html Accessed 3/1/2022. The Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) hospitalization data are preliminary and subject to change as more data become available. In particular, case counts and rates for recent hospital admis- sions are subject to lag. Lag for COVID-NET case identification and reporting might increase around holidays or during periods of increased hospital utilization. As data are received each week, prior case counts and rates are updated accordingly. COVID-NET conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in children (less than 18 years of age) and adults. COVID-NET covers nearly 100 counties in the 10 Emerging Infections Program (EIP) states (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) and four Influenza Hospitalization Surveillance Project (IHSP) states (IA, MI, OH, and UT). Incidence rates (per 100,000 population) are calculated using the National Center for Health Statistics’ (NCHS) vintage 2020 bridged-race postcensal population estimates for the counties included in the surveillance catchment area. The rates provided are likely to be underestimated as COVID-19 hospitalizations might be missed due to test availability and provider or facility testing practices. Average Weekly Rate, per 100,000 (December 2021-February 2022) White AmericansBlack Americans Cases Hospitalization Deaths 357.9 26.5 2.29 289.8 14.0 2.7011 If we are going to effectively address health equity among Black Americans, having access to the most precise data is vital. FOCUS AREAS The following section presents select areas for targeted solutions to drive equity in health outcomes and health status for Black Americans. Several opportunities remain to support Black Americans’ recovery from the disproportionate impact of the pandemic. The availability of data that accurately capture experiences that are important for equity monitoring and accountability is key to acting on the points outlined. 4 This includes access to reliable data on race, ethnicity, and other intersecting identities. Data collection Persistent inadequacies in the systematic collection of data on race and ethnicity suggests that the true burden among Black Americans is underestimated. Though data collection has improved over the course of the pandemic, significant disparities remain across the nation in the data systems that capture and report data by race. As of March 14, 2022, an average of 34.4% of COVID cases in United States were reported with an unknown race or ethnicity (See Figure 2). The ability to collect, disaggregate, analyze and disseminate data by race and ethnicity are essential to accurately measure the disparities present. If we are going to effectively address health equity among Black Americans, having access to the most precise data is vital. Boosters Forty-six percent of booster-eligible Black adults had received a booster dose compared to 61 percent and 56 percent among Asian and White adults respectively as of January 2022, with the lowest booster rates present among Black adults between the ages of 18–49. 41 Hispanic adults are the only group with a lower rate at 42 percent. Increasing booster uptake, particularly among older and medically-vulnerable Black Americans, must be a top priority. 41 Children and Adolescents Twenty-seven percent of children 5–11 years old and 58 percent of adolescents 12–17 years old are fully vaccinated across all groups. 52 The limited race and ethnicity data available for vaccination among 5–17 year-olds suggest Black children have the lowest vaccination rates. 52 Efforts should continue to focus on cross-sector partnerships, with local community- based organizations and those that predominantly serve children as key to increasing vaccination. TestingThe most recent surges underscored the importance of continued testing regardless of vaccination status. Equitable and affordable access to all testing modalities, including at-home testing, should continue to be prioritized. TherapiesBlack Americans have been less likely to benefit from novel therapies and treatments. 53 As we move forward, efforts are needed to ensure equitable and affordable access to all therapies. It is essential to require representation in the clinical trials that give rise to the scientific discoveries that should benefit all. Long COVID Solutions are needed to increase equitable and affordable access to Long COVID care and supportive resources. Efforts are also needed to ensure inclusion of Black Americans in Long COVID trials, treatment programs, and registries given the systematic biases that led to increased burden of infection and decreased access to the testing that can often be required as proof of prior primary infection. 12 Satcher Health Leadership Institute – Health Equity Tracker – Data as of March 14th, 2022 EducationStudies consistently project learning loss will be most significant among low-income, Black students who were less likely to have had access to high-quality remote learning, a conducive learning environment, high- speed internet, and parental academic supervision. 16,54,55 Resources to support districts that predominantly serve children of color and students with the greatest learning gaps should continue to be prioritized. In addition, innovative educational solutions are needed to ensure that Black children graduate with the necessary skillset as the pandemic effect on educational loss will continue to influence achievement for years to come. Community investmentThe historic and contemporary disinvestment in Black communities contributed to high rates of poverty and poor health, both factors that increase vulnerability to the adverse effects of COVID-19. Increased focus on partnerships and resilience will inspire community-driven solutions. Economic and health investments are key to addressing underlying social and structural contributing factors. Economic opportunityBlack Americans were more likely to report experiencing pandemic-related economic challenges. 2,10 Efforts will be needed to support workforce reentry and increase the availability of jobs with family-sustain- ing wages. Healthcare workforce The healthcare workforce, inclusive of community- based workers, should reflect the communities served. Investing in healthcare workforce diversity and providing educational opportunities across all health careers is paramount. Pandemic readinessThe pandemic revealed vulnerabilities of the existing public health infrastructure and the strained capacity to execute pandemic response activities. Continuing support for underfunded agencies is needed to sustain workforce and other capacity promoting changes implemented for pandemic response. Figure 2. Share of Total COVID-19 Cases with Unknown Race or Ethnicity by State Preliminary weekly rates as of March 5, 202213 Vigilance and intentionality remain critical to ensure an equitable recovery for Black Americans. ACTION STEPS Despite increasing optimism, the pandemic is not yet over. Vigilance and intentionality remain critical to ensure an equitable recovery for Black Americans and the establishment of an adequate, integrated, and sustainable community and public health infrastructure ready to respond to future public health crises. The specific recommendations below reflect the collective views of countless leaders advocating for COVID-19 equity, convened through the Black Coalition Against COVID (BCAC). We recommendthat all sectors of American society be held accountable for doing all in their power to engage Black people with fairness and respect. Given historical and contemporary racist practices in American medicine, this plea for humanism is especially urgent for all industries that provide health and medical care. There is a climate of distrust of American institutions in general, and of the health enterprise in particular. This distrust is pervasive and impacts the ability of civic and medical institutions to respond to community needs. We recommend that federal and local governments establish funding mechanisms that will facilitate the sustainable community infrastructures necessary to address the complex array of health and medically relevant social challenges. Specifically, we must confront the reality that Black medical, faith, and community-based organizations and local coalitions have traditionally been hampered by inadequate, episodic, and unstable funding. We further recommend that funding be made immediately available for organizing, scaling, and sustaining networks of faith-based organizations and other non- profit organizations that employ effective navigators and community health workers to address the social determinants of health and other contributors to health disparities. We recommend that local governments adopt a “Health Justice in All Policies” approach to governance, and that collaborative efforts be instituted to address key determinants—including education, housing, childcare, food insecurity, carceral system involvement, and transportation—across society, with a particular focus on supporting the needs of the most marginalized people to improve health equity. We recommend that local departments of public health provide the race and other demographic data and assessments necessary to identify high target priorities. They should also convene, with local Black community leaders, planning forums necessary to recruit and coordinate public, private, and philanthropic assets from across the jurisdiction. 14 We recommend that a more intensive research education and recruitment effort be conducted and funded in concert with Black scientists and academic institutions. The pandemic highlighted the importance of Black participation in clinical trials to realize necessary confidence in the safety and efficacy of new products. We recommend that Black fraternal, social, faith-based, and civic philanthropic organizations be funded to continue to advocate for up-to-date COVID-19 booster vaccination of the Black American community nationwide, with a special emphasis on pediatric vaccination. We further recommend that until hospitalization rates in our communities signify that viral spread is not a significant threat, Black Americans should continue consistent utilization of all mitigation tools (i.e., hand hygiene, indoor masking, and physical distancing). This framework will be essential to fighting disparities in the months to come. We recommend that a national campaign be launched, with the engagement of social media companies, to provide mechanisms and opportunities to bring trusted and expert voices to counteract COVID-19 misinformation targeted at Black Americans. We recommendthatscience and math teachers in Black and under-resourced communities be funded and supported to prepare students to participate as responsible adults in the modern healthcare system, which is grounded in genetics and other highly innovative science-based principles and discovery. We recommend that an urgent and well-funded campaign with federal and other resources be launched that builds upon proven models, especially in K-12 schools, to enhance the supply of the Black health professional workforce. We also recommend that federal dollars support medical schools and hospital systems to achieve levels of diversity that reflect the communities they serve. We recommendthe immediate expansion of the Black nursing workforce through enhanced recruitment in junior and senior high schools, fair admission policies into schools of nursing, and tuition support, especially for students interested in public health nursing, school nursing, and mental health services. We further recommend that nurses be supported in fully applying the expertise afforded to them through their licenses and professional training. We recommend that there be parity in compensation for telehealth services and that broadband capability and community training be augmented as necessary ingredients for success in health services availability and access. We recommendthe heightening of access to necessary health care and social resources to address current and future chronic health, psychological, and social needs.CONCLUSION This report is a call to action to address the continued COVID-19 burden and highlight the need for continued vigilance to ensure equity for Black Americans.Our reflection over the course of the COVID-19 pandemic revealed a myriad of challenges and disparities across several indicators of well-being. This was unsurprising since Black Americans experienced disproportionate disease burden prior to the pandemic, a result of longstanding social and structural inequities. The trajectory of the COVID-19 burden among Black Americans showed overall declines; however, Black Americans continued to experience disparate burden from infection, hospitalization, death, and incidence of long-COVID compared to other racial and ethnic groups. Other pandemic- related effects such as food and economic insecurity, loss of life, educational achievement gaps, behavioral health disorders, and increased need for mental health care services disproportionately affected Black Americans. Policy and practice interventions have emerged over the course of the pandemic to alleviate suffering experienced by Black and other communities of color. This report highlights ten focus areas and twelve action steps to support equitable COVID-19 care and sustain recovery efforts for Black communities. The work ahead will be more challenging than ever and requires well designed, adequately funded, and strategically coordinated efforts at the national, regional, state, and local levels. The time is now to recognize health equity is the work of everyone and for each one of us to do our part on the journey. 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