The early refrain that “coronavirus doesn’t discriminate” has by this point been thoroughly debunked: City data show that black and Hispanic New Yorkers are dying from COVID-19 at about twice the rate of white New Yorkers.
“The reality of COVID is that it has exposed and exacerbated certain health inequalities,” said Diana Hernandez, an assistant professor of sociomedical sciences at Columbia University, during a discussion Columbia hosted with public health experts Thursday on the disparate impacts of the virus. “The color line has existed historically in this country.”
In New York City, health outcomes are heavily tied to zip code and socioeconomic status. In investigating why some communities are more burdened by coronavirus, public health experts have pointed to some of the factors contributing to health inequality: access to adequate food and housing, the impact of immigration status on health care access, and the health risks of being over-policed and incarcerated.
These factors mean that some New Yorkers are more likely to suffer from the underlying health conditions associated with more severe cases of COVID-19.
Hypertension, for instance, is more prevalent among black and Hispanic New Yorkers than among white or Asian New Yorkers, and is also more common in neighborhoods with higher poverty rates. (Notably, asthma, a respiratory disease whose burden is also heavily tied to socioeconomic status, is not among the 10 chronic conditions most frequently associated with severe cases of coronavirus, according to state data.)
A recent study of patients hospitalized for COVID-19 in the New York City area found that 56.6 percent had hypertension, 41.7 percent were considered obese, and 33.8 percent had diabetes.
Socioeconomic disparities don’t explain everything. For instance, Corona, Queens, has a much higher rate of coronavirus infection than neighboring Flushing, despite similar socioeconomic profiles—something that may be linked to Flushing’s large Chinese population heeding early warnings about the virus from overseas.
Mayor Bill de Blasio has sought to acknowledge the inequities by creating a Fair Recovery Task Force that aims to build “a stronger, safer, and fairer economy and society” once the worst of the pandemic has passed. But experts said some of the solutions being used to contain the virus already fail to take into account the needs of those it impacts the most, and in some cases, may actually be making things worse.
For instance, in an effort to prevent the spread of the virus and avoid overburdening the health system, Governor Andrew Cuomo and other government officials have encouraged people not to seek in-person care whenever possible and to instead rely more heavily on telemedicine. Some have started to speculate that increased reliance on telemedicine will become the new norm even after the virus is contained.
While telemedicine can increase access to care for some people, the shift has exposed the fact that a gap in digital access persists, and that remote doctors’ visits have their limitations.
“So far we have observed in the Bronx issues with video-based visits,” Dr. Carmen Isasi, an associate professor of epidemiology and population health at the Albert Einstein College of Medicine, testified at a City Council hearing last week. “Some families don’t have the infrastructure or their Wifi connection is poor, or adults are not tech-savvy.”
She added that it’s harder to incorporate on-site translation services into video calls and noted that health care professionals cannot provide all the services of an in-person visit, such as drawing the blood of someone with diabetes to check their glucose levels or giving a child a vaccination.
“We have to look at some of the strategies of delivering health care that are being posited as novel,” Isasi said. “They may, in fact, exacerbate disparities further.”
Many people who are undocumented were already afraid to seek medical care unless it was an emergency before the pandemic and now that tendency seems to be heightened, Maya Clark-Cutaia, an assistant professor of nursing at NYU Rory Meyers College of Nursing, said at the hearing.
“Fear to seek care has been an issue as long as I’ve been a provider but it’s definitely worse now,” Clark-Cutaia said. “They’re dying. They’re not doing well and we’re definitely getting them [when they’re] much more ill than I would like to see them.”
Meanwhile, Chandra Ford, director of the Center for the Study of Racism, Social Justice and Health at UCLA, told City Council members that government officials should try to ensure that communities suffering from COVID-19 don’t become subject to higher levels of policing and arrest as a collateral consequence of the virus—something there’s already evidence of in the disparities in who’s getting punished by the NYPD for social distancing violations.
“[Over-policing] could be considered an issue on its own but to the extent it then places people in congregate housing or other places that are higher-risk for infection, that could then become an issue,” she said.
Many public health experts have emphasized that as the city expands access to testing, communities that have been hit the hardest should be prioritized–something de Blasio has acknowledged as well.
But Ford said she is concerned that the disparity in how the virus has impacted different communities has already made the path forward more challenging by making people more distrustful of the health system and authorities.
“To this day HIV prevention workers are still trying to battle conspiracy beliefs about whether or not the government put HIV in certain communities and whether folks were able to get the same quality of care,” she said. “These kinds of concerns are exacerbated when the rollout of prevention efforts are so uneven. Even if there’s no conspiracy whatsoever, the very nature of the underlying inequalities might look like some communities are being targeted.”
Moving forward, she said, “Building trustful relationships is going to be essential.”
Some local elected officials are urging the federal government to take racial disparities into account in more concrete ways as they carve a path out of the pandemic.
“We reject the simplistic notion that pre-existing health problems solely account for the increased number of documented COVID-19 infections and deaths in minority communities,” local elected officials from New York, including NYC Public Advocate Jumaane Williams, and other cities wrote in a letter to the Department of Justice this week. “Rather, we believe that longstanding discrimination has served to reinforce vulnerabilities in these communities.”
The letter calls for the U.S. Department of Justice to investigate “the failures that led to the disparate impact of Coronavirus Disease 2019 (COVID-19) on communities of color.”