Why hasn’t the CDC acknowledged that African Americans are at higher risk for severe COVID-19 illness and death and why isn’t that reflected in its updated COVID-19 Guidelines? It is no secret that simply being African American in the United States is bad for one’s health. Early data also suggest that you’re more likely to die if you get COVID-19—and you’re African American. The CDC has a responsibility to speak to what the emerging data say about the health of African American communities. Help is needed NOW.
As COVID-19 has claimed lives in cities across the U.S., a disproportionate number of those lives continue to be African American. As of April 28, there were 981,246 reported COVID-19 cases in the U.S. and 55,258 deaths. However, data on race was only present for 43.2 percent of the total number of cases. There was no racial data for 56.8 percent of the people who tested positive for COVID-19. Currently, about 35 states are capturing and reporting racial data. That data shows that although African Americans make up only about 13 percent of the population in the United States, they account for more than twice as many deaths from the virus as compared with Whites, Latinos and Asians.
The Issue: COVID-19 and African Americans
The CDC updated its COVID-19 website in the last week. The CDC has compiled a list of People Who Are at Higher Risk for Severe Illness from COVID-19. I was surprised to discover that the list does not include African Americans as part of the ‘at higher risk’ group, although numerous data has shown that this racial group has been observed to have more COVID-19 cases and more deaths than other racial groups. It is extremely concerning that the CDC did not do so. Instead of using the data from more than half of U.S. States to raise the concern that there is a particular at-risk population, the CDC chose to include ‘minorities and people of color’ in a category titled Other Populations related to COVID-19 exposure. This is particularly concerning because listing in the ‘at higher risk’ category recognizes that this is a major concern for African Americans and should be a public health focus. Listing African Americans in the ‘minorities and people of color’ does not signify that same importance.
So, what will it take for the CDC to acknowledge that African Americans are at higher risk for severe illness from COVID-19, not because of genetic variations, but because of structural vulnerabilities within our society, particularly exposure to pollution? In a previous blog, I compared some of the characteristics of ‘higher risk’ groups to adverse health effects affecting African American communities. In that blog, I pointed out that African Americans are three times more likely to die from asthma than White Americans, and that increases to 10 times for African American children. African Americans also have the highest rate of deaths from heart disease. African American women and low-income women have an increased risk of premature births and infant deaths compared with their white counterparts, and premature babies have a greater incidence of chronic health issues, including lung and breathing problems. These are all identified as risk factors in the CDC guidelines.
But maybe the correlation between adverse health conditions in the African American population, where people are disproportionately exposed to environmental hazards, and data from more than half of the country showing that African Americans make up the majority of the population with COVID-19 – and are more likely to die from it – is not enough proof for the CDC to warrant an ‘upgrade’ from ‘take extra precautions’ to ‘are at high risk.’ Well, there is more.
A recent analysis by the Kaiser Family Foundation indicated that, as of April 15, 32 states, and the District of Columbia, reported data showing that the virus IS disproportionately affecting communities of color. As of April 27th, that number increased to 39 states and the District of Columbia.
Last week, in an April 24 article published in The Guardian, scientists from Italy released a preliminary, though not yet peer-reviewed, study that examined whether the virus responsible for COVID-19 was present on particulate matter, specifically PM10. As the authors pointed out, this study is the first preliminary evidence that COVID-19 can be present on outdoor particulate matter, although they caution that no assumptions can be made between the presence of the virus on particulate matter and COVID-19 outbreak progression.
In a similar study in Beijing, China, published in the Journal of Infection, the researchers found a common link between the countries with the highest number of COVID-19 infections (China and Italy), topography and very high levels of air pollutants, which suggests a potential correlation between the distribution of severe COVID-19 outbreaks and the pollutants resulting from a combination of specific climate change conditions, local pollution emissions and geography.
Dr. Gretchen Goldman, research director at UCS, interviewed one of the authors of an important Harvard Study, Dr. Francesca Dominici. That study was important as it found that a small increase in long-term exposure to PM2.5 leads to a large increase in the COVID-19 death rate. In addition, the authors specifically noted the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis.
In my interview blog with Dr. Sacoby Wilson, we discussed the possible relationship between the air pollution exposure and increased risks for those contracting the virus. Dr. Wilson, an environmental health scientist who works with environmental justice communities, explained how air pollution attacks your respiratory system, decreasing lung capacity and causing lung scarring, among other impacts.
Even in the face of this widely known data, some preliminary and some peer-reviewed, the CDC is not following the Precautionary Principle. It seems that the CDC does not consider that it should take a much closer look at what is happening in the African American community related to their disproportionate rates of COVID-19 illness and death.
This is a concern when signs point to a growing mistrust of the CDC by the public generally, due in large part to their reported mishandling, retractions and corrections regarding COVID-19. As former acting CDC Director Richard Besser stated, “Trust is the critical factor. You develop trust by being transparent, by explaining on a daily basis what you do know, don’t know and what you are doing to get more information.”
In the World Health Organization’s (WHO) report on the Precautionary Principle, the definition states that “in the face of uncertain but suggestive evidence of adverse environmental or human health effects, regulatory action should prevent harm from environmental hazards, particularly for vulnerable populations.”
The recognition by the CDC that African Americans are at increased risk–mostly because of their proximity to polluting facilities and exposure to air pollution–is important in creating impetus for public policy around testing and prevention as well as in planning how to prioritize treatment protocols.
That is why a number of groups, including black scientists, elected officials, and other leaders have spoken out about disproportionate impacts of public health threats on black communities, predicting that the same would be true for coronavirus without good data and an appropriate response.
Under the leadership of Rep. Ayanna Pressley and Sen. Elizabeth Warren, congressional Democrats sent a letter to Health and Human Services Secretary Alex Azar, calling for the Department of Health and Human Services to monitor and address racial disparities in testing, treatment, and other actions relating to COVID-19.
The Lawyers’ Committee for Civil Rights Under Law and hundreds of doctors joined a group of Democratic lawmakers in a letter demanding that the federal government release daily race and ethnicity data on coronavirus testing, patients, and their health outcomes.
According to these individuals, data on racial disparities in testing are needed to ensure that African Americans and other people of color have equal access to health care. Just as important, these data are invaluable in helping to develop a public health strategy to protect those who are more vulnerable.
As Rep. Pressley pointed out, “ Without demographic data, policy makers and researchers will have no way to identify and address ongoing disparities and health inequities that risk accelerating the impact of the novel coronavirus and the respiratory disease it causes.”
In the words of Jeffery Flier, former Harvard Medical School Dean, “everyone has a hunger for what’s going on. If you aren’t going to trust the CDC, FDA [Food and Drug Administration], or the president—and in many cases you shouldn’t—you are kind of in a bind.”
What Makes African Americans Communities More at Risk? Racism and Economic Oppression
African Americans are at higher risk because of structural practices. In the United States, communities of color, particularly African Americans, have been forced to live within certain boundaries, both real and imaginary. Policies and systems have existed that were designed to protect white privilege at the expense of communities of color, including actions where local, state and federal policy mandated segregation.
Redlining, a common practice that began in the 1930’s, occurred with federal banks refusing to insure mortgages in and near African American communities. Neighborhoods in almost 240 cities across the country were mapped and color-coded, based on desirability for residential use, racial and ethnic demographics and home prices, as well as existing amenities. They were either green for “best,” blue for “still desirable,” yellow for “definitely declining” and red for “hazardous.”
The practice continued with Expulsive Zoning – where facilities that polluted the environment were intentionally sited in or near areas inhabited by people of color, guided by the NIMBY–Not In My Back Yard–stance held by those living in more desirable areas in suburbia, where the educational system was better, as was access to healthy foods and greater wealth.
Disease-causing air pollution remains high in pockets of America — particularly where many low-income and African-American people live. See my colleague Maria Cecilia Pinto de Moura’s blog. Recent studies have shown that air pollution levels and income levels are linked. Poorer communities suffer from bad air more than wealthy communities. Air pollution is still about environmental justice as minority communities often bear the burden of “hosting” pollution.
People living near hazardous facilities experience adverse health effects from exposures, including respiratory effects, like asthma or chronic obstructive pulmonary disease, increased cardiac disease and others. These are the communities breathing air that is almost two times as contaminated as that of white communities.
Fine particulate matter (PM2.5) air pollution exposure is the largest environmental health risk factor in the United States and high concentrations of particulate matter is associated with adverse health outcomes. PM10 is particulate matter 10 micrometers or less in diameter. PM2.5 is 2.5 micrometers or less in diameter and is generally described as fine particles. For example, human hair is about 100 micrometers, so around 40 fine particles could be placed on it, while only 10 particles the size of PM10 could be.
We have had unequivocal evidence for years that simply being black in the United States is bad for one’s health. Those same adverse health conditions are now making African Americans more at risk for COVID-19’s worst health outcomes. Our countries’ leading health agencies need to call it like it is – African Americans are at a higher risk. It is incumbent on the Department of Health and Human Services, particularly the CDC, to step up and fearlessly name this very real and very lethal relationship and call for a national response.