COVID-19 is not an equal-opportunity disease.
A recent Monroe County Department of Health analysis of local COVID cases, hospitalizations and deaths found that Black, Latino and Asian residents, who make up just over 29 percent of the county population, accounted for almost 23 percent of the 55,451 cases of coronavirus that were reported by April 1. Of the people of color who contracted the illness, 249, or 2 percent of those infected, died.
Forty-one percent of those infected with the virus self-identified as white; of that group, 4.1 percent died. But whites account for more than 70 percent of county residents.
Patients did not self-identify as members of any racial or ethnic group in 18,903, or 34 percent, of the cases examined. As a result, a precise comparison of whites and people of color is not possible.
Nonetheless, says Nana Bennett M.D., “there’s no question that people of color were impacted disproportionately.” Bennett is director of the Center for Community Health & Prevention at the University of Rochester Medical Center and head of the Finger Lakes COVID-19 Vaccine Hub. The county Health Department used Center for Community Health & Prevention data for its analysis.
Researchers and medical professionals have blamed the higher incidence of coronavirus infections among people of color on several risk factors. Nationally, more than four out of 10 are employed as grocery store clerks, health care workers, truckers, child care workers or in other positions that bring them in close proximity to others.
“Many of our Black and Brown folks are frontline workers, so were exposing themselves to the virus more,” says Yvette Conyers, a family nurse practitioner who co-founded and heads the nonprofit Rochester Black Nurses Association.
Vaccinating this population has proved to be a challenge for local health care providers. They have sought to overcome that hurdle with a combination of outreach and educational efforts.
People of color are more likely to be living in areas that have or are experiencing COVID outbreaks, and under conditions that support the disease’s spread.
“They (are) likely to live in crowded circumstances, as we know from lots of data in our community,” Bennett says.
Nationwide, 29.2 percent of Black households live in structures that contain five or more units, more than double the percentage of white households. Given that coronavirus is easily transmitted airborne, the close quarters could increase the chance of catching the virus in the hallways or common areas of such structures.
People of color who catch the virus are also more likely to lack the financial resources needed to obtain treatment for it. In comparison to white workers, Black workers are 60 percent more likely to be uninsured.
Members of minority groups are also more likely to have preconditions, such as chronic kidney disease, diabetes and serious heart conditions, that affect COVID’s course.
“We know that chronic disease is disproportionately high among people of color,” Bennett says.
In comparison to white Americans, the risk of being diagnosed with diabetes is 66 percent higher for those who identify as Hispanic and 77 percent higher for those who identify as Black. Chronic conditions of this kind have been shown to increase the severity of COVID, and the risk of dying from the illness.
Such conditions have raised the coronavirus mortality rate for people of color. When the COVID Tracking Project, an all-volunteer organization that was started by two journalists, ceased collecting data on the coronavirus pandemic in March, the death rate for Black Americans due to COVID was 178 per 100,000 people. Those who identify as Hispanic or Latino fared slightly better, at 154 deaths per 100,000 population. In contrast, whites suffered only 124 deaths by that measure.
As painful as the coronavirus pandemic has been communitywide, it spotlighted the hurdles that some residents of the Finger Lakes region must overcome to obtain health care.
“I think it did a real service to play out graphically what people who are in poverty, or whatever inequity they’re suffering in the health care system, what they’re dealing with,” says Sister Christine Wagner, executive director of St. Joseph’s Neighborhood Center.
People of color also might have to overcome a mistrust of health care systems that leaves them reluctant to seek medical care. Some of the St. Joseph’s Neighborhood Center’s Black and Latino patients have spoken of past incidents in which health care providers or medical researchers mistreated members of minority groups.
“People will still mention Tuskegee,” Wagner says. “That is an oral tradition that has just carried down.”
Tuskegee refers to the syphilis study at the Tuskegee Institute, which the U.S. Public Health Service initiated in 1932. Researchers spent years observing the progression of syphilis in almost 400 Black men who were living in Macon County, Ala. Over time, the sexually transmitted disease can damage the organs, or cause death.
The Public Health Service did not obtain informed consent from the subjects of its study, most of whom were sharecroppers, or use penicillin to stop their disease when that became the treatment of choice in 1943. By the time the research ended in 1972, syphilis had taken 28 of the participants, 100 more had died from complications of the disease, and at least 40 of the men’s spouses had contracted it.
After the Tuskegee study came to light, Congress established restrictions on medical research that are intended to prevent the abuses from being replicated. Despite that, some people of color are still less willing to put themselves in the hands of medical practitioners.
“We can’t just say, ‘Oh, that happened years ago,’” Conyers says. “The hesitancy is real.”
As a result, members of local minority groups may be reluctant to be vaccinated against coronavirus.
“My experience with people who are Brown or Black is there is a little more hesitancy than (with) people who are Caucasian,” says Robert Biernbaum M.D., former chief medical officer of Trillium Health.
The vaccination picture
The lightning-fast development of the three coronavirus vaccines currently available in the U.S. compounds the problem.
“People are not used to the way that this is being rolled out,” says Albert Blankley, chief operating officer at Common Ground Health.
In addition, misinformation regarding coronavirus vaccines has proliferated. Those who find information online might come away thinking that the vaccines will alter recipients’ DNA, make them infertile, cause them to contract COVID or have other undesirable effects.
“Once that type of information is in somebody’s head, if they’re predisposed to leaning in that direction anyway, it becomes very difficult to convince them about something else,” Blankley says.
Finally, people of color need to be able to reach places where they can be vaccinated.
“Overall, it’s really an issue of access, so we’ve to do work to bring vaccines to those communities,” Blankley says.
For the first few months that COVID vaccines were available locally, most inoculations were given at sites that were set up by the state Department of Health in the suburbs. Lack of transportation left some people of color unable to reach those sites. Conyers saw the effects of that problem while vaccinating people at the Dome Center in Henrietta.
“The people coming into the site to get vaccinations were mainly white folks,” she says. “The Black folks weren’t represented. The Brown folks weren’t represented.”
Local nonprofits and health care providers have worked to remedy the problems that can keep people from becoming vaccinated. Common Ground Health has hired seven “ambassadors” who speak to their communities about vaccination in return for a stipend.
“What we find is that (using) people from within communities that are credentialed, both sort of professionally and personally with the community they’re talking to, is really important to deliver some of the messaging,” Blankley says.
So far, Common Ground’s ambassadors have registered 1,000 people to be vaccinated. It hopes to eventually have a total of 23 ambassadors spreading the word in the region.
“We’re looking to expand that program pretty significantly, to bring on 15 more ambassadors,” Blankley says.
In order to reach out to local communities, RBNA joined Community Fighting COVID, an organization that also includes the nonprofit Black Physicians Network and the Race, Equity and Leadership Rapid Response Team. The REAL Team was created by the city of Rochester and Monroe County to help low-income people of color avoid COVID infection, and respond properly if they become infected.
Members of Community Fighting COVID go to churches and other sites in Rochester to test community members for coronavirus, and vaccinate them against the disease.
“We need to go to the community,” Conyers says. “No longer can we wait for community members to come to us.”
Trillium dispenses COVID vaccine at its treatment sites, and via its mobile access clinic, a large, two-roomed vehicle that provides primary care out in the community.
“We send our mobile access clinic to almost all of the housing complexes of the Rochester Housing Authority,” Biernbaum says. “We can deliver primary care—COVID testing or COVID vaccines.”
The Finger Lakes COVID-19 Vaccine Hub helps coordinate the efforts of the Finger Lakes region’s health care providers, community organizations and health departments to dispense coronavirus vaccines to all eligible recipients.
Those who visit the nonprofit’s website can obtain information on the virus, the vaccines that are used to fight it, the locations of vaccination sites, and transportation services that could be used to reach them. If homebound, they can sign up for FLVH’s Homebound Vaccination Program.
“We are sending folks out to the house to vaccinate people,” Bennett says.
Vaccination efforts have progressed in the Finger Lakes region since the vaccines became available locally. As of June 29, just over 63 percent of those in the region who are 12 years old and older had received at least one dose of coronavirus vaccine.
That’s good news, but some groups appear to have moved closer to immunization than others. White residents, who make up almost 82 percent of the region’s population, have received more than 76 percent of all vaccinations. By contrast, Black residents, who constitute nearly 12 percent of the region’s residents, have received only a little more than 6 percent of the shots. However, the COVID-19 Vaccine Hub cautions that because a high percentage of individuals queried did not answer the race or ethnicity questions, “comparisons cannot be drawn between the percentage of vaccinated individuals in any race or ethnicity group to the percentage of that group in the population.”
Local health care providers and others have suggested various measures that could increase the numbers of people of color who are immunized. Bennett says those advocating for vaccination should recognize the value of word-of-mouth information.
“One of the things that we’ve been doing is really encouraging people who have been vaccinated to discuss it with their friends and family,” she says. “We’re all influenced by our friends, and by the people we trust and care about.”
Conyers says physicians and other medical practitioners need to better understand the views and feelings of the people of color whom they treat.
“I think it’s important for providers to really start to do some anti-racist training,” she says. “Just like you educate yourself to learn about the new medical techniques, the new medications, make sure you grow and address your inequities.”
Mike Costanza is a Rochester Beacon contributing writer.