Health disparities intensified by the COVID-19 pandemic and efforts to mitigate
This year, National Minority Health Month -- an effort to raise awareness of health disparities across different populations -- falls squarely within a pandemic that, according to new data from a number of cities, counties, and states, disproportionately impacts minority racial and ethnic groups. At Verily, we are working with public and private entities to expand access to COVID-19 testing for everyone. This month, we are launching multiple new community-based testing sites with the state of California, the Rockefeller Foundation, and Community Organized Relief Effort (CORE) -- a nonprofit relief organization founded by Sean Penn that is dedicated to saving lives and strengthening communities affected by or vulnerable to crisis -- to extend testing to rural and under-resourced communities.
The disproportionate impact of COVID-19 on minority populations
In New York City, preliminary data shows that the novel coronavirus is killing black and Latino people at twice the rate of white people, though each comprises less than half the population. Eighty one percent of COVID-19 deaths and nearly half of all cases in Milwaukee County, Wisconsin are occurring in the black community, just 26% of the population. Similarly, in Louisiana, black people account for 70% of COVID-19 fatalities while representing 33% of the population.
These early data indicate a troubling pattern emerging around COVID-19 hospitalizations and deaths. It is important to note that we don't yet have a full picture of COVID-19's impact on communities of color. In many cases nation-wide, the data are preliminary, and racial and ethnic data aren’t available for all confirmed cases. Because public health departments may collect and report data differently, not all are tracking hospitalizations and mortality by race. Additionally, across the United States, efforts are underway to scale testing more broadly to provide more equitable individual care and to improve visibility into public health. However, the current evidence of disparities is unsurprising to most health experts based on well-known historical disparities in disease burden and health outcomes across the U.S.
Why are we seeing more severe disease among people of color?
The common chronic diseases that confer increased risk of severe outcomes for those infected with COVID-19 are much more common in people of color. These common chronic diseases, including cardiovascular disease, chronic lung disease and kidney disease, lead to much higher rates of intensive care unit admission, need for ventilator support and death in people who are infected with the novel coronavirus. The disease burden in minority communities is also related to less wealth and lower education levels, factors that make social distancing more difficult.
Individuals from minority groups also comprise a large portion of the services industry and frontline workers -- potentially contributing to increased negative health outcomes. While people of color make up a quarter of the U.S. workforce, they represent a high proportion of "essential workers." The majority of nursing assistants in care homes -- where numerous outbreaks have occurred -- are people of color, and more than a third are black. In New York City, now considered the epicenter of COVID-19 in America, 75% of all frontline workers, including people working in healthcare, transit, trucking, and grocery, are from minority backgrounds. With greater risk of exposure to the virus, first responders are at increased risk of contracting COVID-19. Likewise, the shuttering of the services industry may lead to widespread loss of insurance within communities of color, along with disproportionate economic impacts, which are associated with poor health outcomes. Due to decreased job security and lack of access to care, these communities may now be even more vulnerable.
When it comes to health, location plays an important role. Even within the same city, a study by the National Institutes of Health found that life expectancy can vary widely from one neighborhood to the next. Black Americans are almost twice as likely to live in areas expected to be most affected by COVID-19.
Taking steps toward mitigation
In this acute stage of the pandemic, we're still at the beginning of the journey to fully understand and contend with COVID-19's effects on our communities. As health officials respond to its complex and wide-ranging impacts, we're starting to see interventions take shape that can benefit high-risk populations. Examples include:
1. Expanding testing - Testing is critical to containing and understanding COVID-19, and will be key to reducing the risk and severity of future outbreaks. The California community-based testing program is open to Californians regardless of insurance status, is free of charge, and occurs under physician supervision. The program's goal is to rapidly screen and test high-risk individuals, including frontline workers and other groups as defined by state guidelines, who do not need immediate medical attention.
The California testing program is supported by Verily's Baseline COVID-19 Testing Program, which provides a secure, connected platform to simplify the testing process, from screening through return of results. In order to expand testing as widely as possible while meeting the needs of different communities, we're collaborating with both public and private partners. With the state of California, the Rockefeller Foundation, and CORE, we are launching six new sites beginning in Napa, Bakersfield, and Oakland to ensure better access to testing for farmworkers and communities of color.
Expanding testing capacity in partnership with community-based organizations that have built trust among historically marginalized groups will be crucial to ensuring members of these populations get the testing they need. CORE's outreach to farmworkers represents an important milestone in increased testing availability in rural areas, which are often isolated from major medical centers.
Improving the accessibility of our Baseline COVID-19 Program's website and screening platform is also a top priority. The Program is available in Spanish, and we are working on additional languages. We are working to continually enhance access for diverse groups, including people with visual disabilities, mobility limitations, cognitive disabilities, and those who are deaf or hard of hearing. The website has gone through a comprehensive accessibility assessment and testing, with the support of user experience designers and engineers who specialize in inclusive design in accordance with web content accessibility (WCAG) guidelines.
2. Local support programs for underserved populations - Many local and state officials are creating programs to assist those most impacted by COVID-19, including halting evictions, expediting access to unemployment benefits, and more. These resources are generally available through local health department websites. The state of California has launched a number of relief initiatives to expand protections for the most vulnerable, including programs focused on immigrant and undocumented workers, as well as childcare for essential workers. More information is available at covid19.ca.gov.
3. Improving information access - With the continuously-evolving nature of the crisis, organizations like the Centers for Disease Control and Prevention are regularly updating recommendations. However, for millions of Americans without reliable access to the internet, it's difficult to stay up-to-date on new health information. More than 700 broadband services providers and associations have signed the Federal Communication Commission's "Keep Americans Connected Pledge" to expand connectivity. This pledge includes opening Wi-Fi hotspots to any American who needs them for 60 days.
To further assist with the challenge of connecting people with reliable, current health information, Verily recently announced the COVID-19 Pathfinder. This digital toolkit enables people to access relevant information on-demand from their providers' websites. The Pathfinder has been deployed by leading hospital and health systems including San Joaquin General Hospital, Western Wisconsin Health, Morehouse School of Medicine and Morehouse Healthcare and is available in multiple languages, such as Haitian Creole, for broader accessibility.
Among communities that have historically experienced more severe health outcomes, COVID-19 is having outsized impacts. As we weather the course of the pandemic, it will be important to continue gathering information on how COVID-19 is spreading, how to identify people who are at risk and become infected, and how to most effectively treat and prevent the disease in order to inform the public health response.