Across the country, stark racial disparities are being revealed in the coronavirus pandemic’s death toll. Black residents of Louisiana and Chicago are dying at much higher rates compared to other racial groups. The same is true in Illinois and Michigan. New York City’s Latinx population is disproportionately dying from the virus.
“It’s not surprising that we’re seeing reports of inequity in terms of testing, diagnosis and disparities in terms of who will die,” said Sandra McCoy, associate professor of epidemiology and biostatistics at UC Berkeley. “We’re basically layering a pandemic on top of entrenched inequities defined by race and socioeconomic status.”
At this point, we don’t know how these entrenched health disparities are impacting how the coronavirus is hitting the Bay Area. Except for San Francisco, local county health authorities haven’t published information about the race and ethnicity of COVID-19 patients. Reporting has been inconsistent across the board, with some counties providing more information than others.
The Alameda County Public Health Department activated a data dashboard on Wednesday afternoon, but it doesn’t include racial and ethnic information about coronavirus patients. Some of the information on the dashboard also appears to be out of date, including counts of confirmed cases at Santa Rita Jail and the number of cases in Berkeley. In response to a public records request from Berkeleyside, county health officials declined to provide more detailed data, saying the public interest served by disclosing race-specific data right now is outweighed by their need to focus on other work.
McCoy understands that counties are scrambling in the face of a world-changing emergency. “I think the public health workforce is in crisis mode right now in tracking the epidemic and where it’s moving,” she said. But she stressed the importance of having a full understanding of the crisis for an effective response. “Data is incredibly important in making evidence-based decisions,” she said.
Finer-grained data about how local communities are being impacted by the coronavirus could shape the public-health response, ensuring that it is more agile and better able to communicate with different populations who face different threats right now, such as homeless people, grocery store workers, delivery drivers, frontline healthcare workers, and diverse racial and ethnic groups.
“My understanding is we’re doing well in aggregate as a county because we got on top of things early,” said District 6 Oakland City Councilmember Loren Taylor. District 6 reaches from High Street to 82nd Avenue in East Oakland and includes some of the lowest-income neighborhoods in the Bay Area. “But we don’t have enough data sample size yet to observe the trends we’re seeing in other parts of the country.”
In Oakland, known racial health inequities include higher rates of asthma and diabetes among Black residents — two conditions that make contracting the coronavirus much more dangerous. Latinx, Black and Asian residents also have less access to preventative healthcare and are less likely to have health insurance, putting them at greater risk during the pandemic.
Taylor said he’s concerned about his East Oakland district’s population, which is majority non-white, including many low-income and elderly residents and recent immigrants. “We know African Americans have a higher percentage of asthma, diabetes, hypertension and many are immunocompromised individuals,” said Taylor. “Those are all things we need to be cognizant of. It leads to more sensitive support for the Black community that has these problems.”
When “swine flu” and tuberculosis hit Alameda County, residents of color suffered worst
While it’s unclear at this point how exactly the coronavirus pandemic is affecting different populations in Oakland, past outbreaks of communicable disease in Alameda County have done disproportionate harm to communities of color.
On April 30, 2009, Alameda County recorded its first case of the novel H1N1 “swine flu” virus. In May, the county’s Board of Supervisors declared a local emergency because of the virus’s rapid spread and higher fatality rate compared with other flu strains.
Public health authorities tracked H1N1’s impact over the course of the next year and found that Alameda County’s death rate of 2.25 people per 100,000 was 50% higher than the rest of the state. By April 2010, a total of 516 county residents had been hospitalized, 129 people required intensive care in a hospital, and 33 people had died from the H1N1 virus. Ultimately, Alameda County health officials coordinated 17 mass vaccinations to prevent further spread of the swine flu.
According to the California Department of Public Health, Black people experienced the highest rates of severe illness during that pandemic, and many of those who required intensive care or died had an underlying health condition such as diabetes, heart disease, obesity, or weakened immune systems. Alameda County’s public hospitals, including Oakland’s Highland Hospital, were ground zero for the H1N1 virus in California.
National studies of the 2009 swine flu concluded that Latinx people were disproportionately at risk of exposure to the virus, and that Black people were most susceptible to hospitalization and death.
Part of the reason Black people are at much higher risk is the prevalence of asthma and diabetes, two health conditions related to poverty and residential segregation in neighborhoods with more polluted air.
Michael Lenoir, an Oakland-based allergist and pediatrician with 35 years experience, said no one should be surprised to see Black people suffering worse outcomes during pandemics. “This just amplifies an issue that’s been present a long time,” he said. “Health equity for African Americans has long been a disgrace in this country.”
Public health campaigns focused on the vulnerabilities and needs of specific racial groups have made a difference. Between 2012 and 2014, 56% of all new HIV cases in the county were among Black people, most of them in Oakland. Today, Black people comprise 36% of all new HIV diagnoses, followed by Latinx residents at 32%. For years, Oakland had a disproportionate share of HIV cases, but numbers are declining.
Other contagious diseases continue to inflict larger tolls on non-whites, due to the persistent health impacts of entrenched poverty and inadequate funding. In 1990, Oakland had the third-highest rate of tuberculosis cases in the nation, following federal cuts to monitoring and treatment programs in the 1980s. Over the next two decades, the vast majority of people infected and killed by the highly contagious bacteria that causes tuberculosis were Asian, Black, and Latinx.
Last year, 114 people contracted tuberculosis in Alameda County, about one-third of them in Oakland, according to a county report published last month. The majority of current tuberculosis patients are immigrants who were born in the Philippines, India, China, Mexico and Vietnam.
It’s possible the Bay Area’s early shelter-in-place orders has not only prevented an overall surge in COVID-19 cases, but also slowed the spread of the virus among more vulnerable groups.
“I live in the flatlands, and I have had four heart procedures, and I’m a diabetic,” said East Oakland’s District 7 Councilmember Larry Reid, who is Black. “I’m at the age where I’m in the at-risk group, but we’re fortunate that a lot of the people out here, by and large, are taking this really seriously.”
Reid worries, however, that his district could still be hit extra hard by the pandemic. Despite efforts by local clinics like Roots Community Health Center to educate people about the virus, and plans to use two hotels and several dozen trailers to house homeless people in East Oakland, more may be needed.
Reid and District 6 councilperson Loren Taylor both said they’d like to see more access to testing in East Oakland to ensure coronavirus infections aren’t being undercounted in the city’s majority Black and Latino neighborhoods.
Alameda County offers more data than before, but not the full picture
On Wednesday, Alameda County launched a new online dashboard displaying the total number of coronavirus cases in the county, deaths, and breakdowns by gender, age, and the city of residence for people who test positive.
As of Wednesday, the dashboard showed 127 COVID-19 cases in Oakland, about 21% of the county’s total and a little under the city’s 25% share of the county’s total population. Numbers may be unreliable at this point, however, due to ongoing shortage in testing kits and differences in access to testing for residents of different cities.
The dashboard doesn’t list cases at more specific geographic levels such as zip code or census tract, and it doesn’t include any data about race or ethnicity, information that other cities and states have been supplying for days and weeks, even in regions hit much harder by the pandemic.
“The county hasn’t shared those numbers,” said District 7 councilmember Reid about the need for race-specific data about coronavirus patients. “I’d like to understand where the bulk of those folks are located.”
On Wednesday, Governor Gavin Newsom said the state health department’s data about the racial and ethnic makeup of coronavirus patients is incomplete, and cautioned people not to try to draw conclusions yet. Only about 54% of the state’s 18,309 cases have any racial data associated with them, and a team of at least ten state workers are currently following up with local health departments, hospitals and coroners to collect more information.
Still, Newsom said the roughly 6,000 cases that include racial data don’t appear to show the severe racial disparities that are being seen in other parts of the country.
Samantha Artiga, director of the Disparities Policy Project at the Kaiser Family Foundation, said race and ethnicity data will be crucial for guiding both the healthcare response to the pandemic and shaping policies that will soften the economic impact of people getting ill, losing jobs and income, or having their businesses closed for weeks or months at a time.
“Having data publicly available does provide a greater understanding in the community of who is being more impacted, and it allows community-based organizations to better respond,” said Artiga.
Sandra McCoy, the professor of epidemiology and biostatistics at U.C. Berkeley, agreed that more data about who is most vulnerable to the coronavirus threat is key in this moment. But she stressed that better dashboards won’t fill the gap. “We have systemic racism and injustice baked into our healthcare system that communications tools are unlikely to dismantle,” said McCoy. “That means we need funding and leadership around removing disparities.”