COVID-19 DIARIES, WEEK OF 20 NOVEMBER 2020

Two COVIDs

Income, race, and ethnicity have outsized effects on outcomes

As we prepare for a coronavirus-truncated Thanksgiving this is a good a time to note that those less fortunate — especially those in poverty and people of color — suffer far worse consequences from the pandemic than relatively affluent whites.

As this graphic from the COVID Tracking Project shows, there are strong correlations between race and ethnicity and COVID-19 deaths. African-Americans, Native Americans, and Hispanic/Latino people are significantly more likely to die than whites or Asians.

I’m grateful to Andy Slavitt, a former insurance company executive and the top public-health official in the Obama administration, for his rant on COVID-19 inequality, which is well worth reading in full.

The coronavirus continued to rage out of control in the US, with all major indices rising sharply. New cases and hospitalizations are at record highs, and deaths — a trailing indicator — also rose 31% this past week.

California saw sharp increases this past week in new coronavirus cases and deaths, up 56% and 55% respectively. With more than 1 million cases in the state, infections are now at a record level.

At least thirteen states now have more than 1,000 infections per million people, by far the highest number of states at that level since the virus began. Kansas shows no cases due to a reporting gap; a week ago it had more than 2,000 cases per million and is likely the 14th state in the most infectious tier.

For those relatively well off, COVID-19 means working and shopping from home. White-collar employment has largely recovered over the past six months. Housing prices are higher. And after a sharp drop this spring, the Dow Jones index rebounded and is now around 850 points higher than in January.

It’s a very different picture for less affluent Americans. Some are classified as essential and have to work, often in places with less physical distancing — and that’s for those who have jobs.

As of mid-October, about 12.6 million Americans were out of work. Eight million Americans have fallen below the poverty line since May. With another COVID-19 relief bill unlikely before January, extended unemployment benefits and rent relief protections will end in December, if they haven’t already.

Because of inadequate housing and access to healthcare, the pandemic hits lower-income areas the hardest. A study published this summer in the Journal of the American Medical Association found significantly higher rates of COVID-19 infections and deaths in metropolitan areas where a high proportion of the population lives below the poverty line.

This pandemic has strong racial and ethnic divides as well as economic ones. African-Americans are hit hardest, with per-capita death rates about 2.1 times greater than those for whites, according to the COVID Tracking Project.

Native Americans are next hardest-hit. Science journalist Laurie Garrett notes the devastating effect on native American tribes across the Southwest, particularly the Navaho, Hopi, and Zuni nations. And the most infectious places in the world right now — the Great Plains states, especially North and South Dakota — are also home to sizable Native American populations.

Garrett notes that access to health care is a particular challenge on reservations, where long drives just to buy a gallon of milk are common. Access to adequate healthcare has been a challenge for decades. Providing enough hospital beds during a pandemic is a big enough problem; storing and distributing vaccines in places without sufficient cold storage may further extend the virus’ lifetime.

Latinos and Hispanics are the third major group suffering disproportionately. In California, these groups represent about 39% of the population, but account for 60% of coronavirus cases. Nationally, Latinos/Hispanics are 42% more likely to die of the virus than whites.

Public-health officials have said for decades that poverty and racism are health crises in and of themselves; COVID-19 brings those claims into sharp focus.

I’m a privileged white guy in an affluent suburb. It would be easy for me to say “that’s too bad for Those People, but what do I care? It won’t happen to me.”

There are two problems with that mentality, notes Dr. Abraar Karan, an infectious disease specialist at Harvard Medical School.

First, it’s wrong. We are all interdependent, regardless of race and economic status. When farmworkers in Oxnard get sick because of overly dense housing and inadequate medical care, there’s a real danger it will affect my food supply, and the nation’s.

And while Oxnard has far higher infection rates than Thousand Oaks, where I live, our numbers are still substantial, and growing.

Second, Dr. Karan notes, when you scale up that can’t-happen-to-me assumption into the millions, the errors represent what we’re seeing right now around the nation, and here in California.

In other words, even if “it won’t happen to me” were mostly true, even if it were wrong only a few percent of the time, the consequences would still be disastrous.

I hope everyone has a safe and happy Thanksgiving, and does something positive — supporting a local business, contributing to a food bank, keeping a safe distance, and wearing a mask — to help everyone in our community, including those hardest hit by the virus. We only get better when we all get better — all of us.

Here are this week’s coronavirus stats, all sourced from covidtracking.com.

US stats for the week ending Friday, November 20 (with % change from previous week):

Total tests (positive, negative, pending): 11,843,672 (+16%)
New cases: 1,167,945 (+18%)
Cumulative US cases: 11,927,256
Confirmed COVID-19 hospitalizations: 83,227 (+20%)
Confirmed COVID-19 ICU: 16,054 (+20%)
Deaths: 10,077 (+31%)
Cumulative US deaths: 247,043

CA stats for the week ending Friday, November 20 (with % change from previous week):

Total tests (positive, negative, pending): 1,252,051 (+16%)
New cases: 73,770 (+56%)
Cumulative CA cases: 1,072,272
Confirmed COVID-19 hospitalizations: 5,497 (+33%)
Confirmed COVID-19 ICU: 1,332 (+29%)
Deaths: 420 (+55%)
Cumulative CA deaths: 18,557