Early counts from Los Angeles, Louisiana, Michigan and other parts of the country suggest that black Americans are experiencing a disproportionate rate of death from COVID-19 compared to other races.
Members of the Trump administration addressed the issue last week, referencing higher rates of underlying conditions such as diabetes, asthma and hypertension, which can make complications and death due to COVID-19 more likely.
In California, early racial data from the state health department shows infection and death rates are roughly in line with the diversity of California overall. The latest reports account for 62 percent of COVID-19 cases and 86 percent of deaths, but experts suspect more concerning trends will emerge as the pandemic continues to spread and we learn more about its effects.
Meanwhile, black and Latino Californians make up a larger portion of the state’s working poor, and could be at higher risk of contracting the illness if they’re unable to shelter in place.
We asked two public health minds who focus on disparities what they’re seeing in the Golden State.
Flojaune Cofer is an epidemiologist and senior director of policy for Public Health Advocates, a Sacramento-area nonprofit that works to build healthy communities. Cofer focuses on adverse childhood experiences and how trauma impacts health.
Dr. Efrain Talamantes is medical director for AltaMed, a Los Angeles-area clinic serving low-income and uninsured patients. He is also former associate director for the Center for Reducing Health Disparities at UC Davis.
What are you hearing from communities you serve in terms of how they’re reacting to the shelter-in-place order?
Cofer: “Sheltering in place is not possible for people who don’t have a stable home, and people are certainly worried that if this extended on and they didn’t have rent protections and the things that are slowly coming together now, that they'd be put out of a place to shelter.”
As long as we’re still requiring people to exchange money for goods and services, making a livelihood is still going to factor into peoples’ thoughts and feelings and decisions. Until we make it possible for people to give primacy to our public health recommendations, some people are not going to be able to, and it is going to be a matter of privilege who’s able to better adhere to things than others.”
Talamantes: “Many of the folks we care for are essential workers in the truest sense that they have to continue going to work, and oftentimes in their workplaces they’re caretakers or they’re grocery workers or they’re working construction and no one is really taking the time to help them understand how to protect themselves. The disparities we’re seeing with COVID-19 are really exacerbating a history of many inequities.”
What racial or economic disparities do the current health recommendations bring up?
Cofer: “Certainly an example of that is basketball courts. While we wouldn’t want neighborhood folks all getting together and playing a game, an argument could be made that physical distancing could be maintained if one person was out on the basketball court at a time or a family was out. But right now the public health decision has been ‘that’s a risk we don’t want to assume.' But then the same exists for golf, and golf was exempted from our list of places that need to close. When we see things like that, you begin to look at who are the demographics of people who are playing these different sports and what ties might they have to decision makers? How often might they be the decision makers?”
Talamantes: “Most of the testing has been skewed, has been mainly in more affluent communities. We also understand that more affluent communities have better hospitals and hospital systems, there’s more intensive care unit beds.”
It was really heartbreaking to have people who work as caretakers or grocery workers tell me they couldn’t go back to work to make a paycheck unless they had proof that they were tested and they were negative. That is unacceptable. We have to make sure we don’t leave these communities behind given the challenges. Not just health care access, but also the social challenges they face on a day-to-day basis.”
What about masks?
Talamantes: “It’s easy for us to ask people to wear masks, knowing it’s a public health ask, and it’s an effective way to protect ourselves and others. But if you’re an underrepresented minority in a community where there’s violence and you’re wearing a mask, people may be afraid of you. So, those are things that community [members] can really help us understand, so we don’t take for granted many of the recommendations we make that may fall short or flat or even cause more disparity.”
Cofer: “This is now a question of who has the freedom in a community to follow certain directions? When we’re asking people to put on masks, and saying those masks could include cotton and repurposed household items, we are at least increasing access to the mask. But the question is, ‘do I feel safe exercising the recommendation?’ Many black and Latinx and brown men and women, and our nonbinary and transgender folks, are not going to feel comfortable walking into spaces with a bandana covering our faces. We’re not going to be received as having the same positive intentions of just coming in and protecting ourselves as our lighter skinned or white friends are going to. That’s just not something that’s going to be received well.”
What can local or state officials do to help low-income communities of color at this time?
Cofer: “It would alleviate a lot of people’s general concerns if we were able to completely wipe out rents and mortgages for the time being, so that they won’t be due in arrears in the future. Another thing that would alleviate some concerns is offering payments on a regular basis. $1,200 per adult is not going to go very far.”
Note: The federal government has approved a stimulus package that would give individuals a $1,200 check to help cope with COVID-19 financial loss. The allocation is smaller for people with higher incomes.
Talamantes: “I would emphasize the need for partnership across multiple sectors, making sure that as health care agencies we are working with the business community, our community-based organizations, our local news agencies, to ensure we’re all sharing messages that really resonate. We can’t forget that they are resilient. They want to be part of the solution. So let’s not leave them out. It’s really including community and community members to help us understand what we could do better so that we can deliver on our promise to keep them healthy.”
These interviews have been edited for brevity and clarity.
Correction: A previous version of this story incorrectly identified Dr. Efrain Talamantes. He is a former associate director with the Center for Reducing Health Disparities.
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