US Senate panel considers racial and ethnic disparities in COVID-19 cases

• Alanna Elder/WITF
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  Alanna Elder was a Report for America corps member who covered Latinos in central Pennsylvania and the 2020 election.

(Washington) — As Congress debates another round of coronavirus relief, a Senate committee on Tuesday focused on the disproportionate impact of COVID-19 on older adults of color. The Special Committee on Aging heard testimony from four public health experts on factors behind the disparities and ways to address them.

Rodney Jones is CEO of a Federally Qualified Health Center in Pittsburgh — which provides care regardless of a patients’ ability to pay.

In his testimony, he said COVID-19 exposed racial and ethnic disparities that have long existed and are linked to social factors like access to healthy food, socioeconomic status, and local environment.

“We need to take care of this pandemic, it needs to be a federal, global approach. But once we get on the other side of this we need to peel it all the way back, and it’s about people not having equity and equality in accessing jobs, education and health care,” he said.

Jones added these social factors contribute to many of the underlying health conditions in the patients his organization treats, who are 66% Black, 57% below the poverty line, and 80% lacking insurance.

“The virus has become a flashpoint on racial inequities, financial inequities and social determinants of health,” he said.

Jones called for stable funding for health centers like the one he directs, arguing that these institutions are entwined with the communities they serve.

“We’ve got to build trust in an urgent situation”

Mercedes Carnethon is an epidemiology professor at Northwestern University.

She testified the medical field has not earned much trust in communities of color, mentioning past wrongs like the Tuskegee Study, in which researchers tracked hundreds of Black men with syphilis without treating or informing them of their condition. Others legacies of the 20th Century, like the forced sterilization of Puerto Rican, Mexican, and Native American women, have been described as contributing to distrust, along with racial biases that pervade the health care industry.

She noted, for tools like contact tracing and, eventually, vaccines to be successful, health care professionals need to step up their outreach.

“One of the most challenging features of this is that we’ve got to build trust in an urgent situation where the very individuals who are experiencing the worst outcomes are the most concerned about trust within the healthcare system,” she said. “So I think this can best be done through community partnerships.”

She added, conducting outreach in the language spoken by the community is critical.

Eugene Woods, CEO of a Charlotte, North Carolina hospital network called Atrium Health, described a mobile testing program his company implemented after its data scientists learned which zip codes were seeing higher rates of infection.

“The reason we knew where to go is really working with the faith community and with community leaders,” he said.

Dominic Mack is director of the National Center for Primary Care at Morehouse School of Medicine. The school will receive $40 million from the federal Department of Health and Human Services to improve access to testing, care, and information in communities around the country.  He called for greater investments in Historically Black Colleges and Universities and emphasis on boosting diversity among doctors.

The witnesses also promoted greater investments in telehealth and research into the long-term and disproportionate impacts of COVID-19.

 “Hard-won gains”

A primary focus for the Pennsylvanians in the hearing – Jones and Democratic U.S. Senator Bob Casey – was health insurance. Casey is a ranking member of the committee, which is chaired by Susan Collins of Maine, a Republican.

The Pennsylvania lawmaker defended the 2010 Affordable Care Act in closing ethnic and racial insurance gaps, citing a study from the Commonwealth Fund, which reported that between 2013 and 2016, the disparity in insurance coverage between Black and white patients was 4.1% smaller, and the gap between Latino and white patients decreased by 9.4%.

“Unfortunately, the pandemic is wiping away some of these hard-won gains,” he said. “With job loss that so many Americans are experiencing right now, the millions and millions of people that have lost their jobs. We also know that has an impact on healthcare.”

A May report from the Kaiser Family Foundation estimated that 27 million people would lose their insurance after becoming uninsured, 1.5 million in Pennsylvania. The study also reported that 5.7 million people nationwide would be ineligible for coverage under the ACA.

“Standard items you include”

Reporting of racial and ethnic data for COVID-19 cases have been inconsistent. But data from the Centers for Disease Control and Prevention has shown Black and Latino people nationwide are contracting the virus and dying at higher rates.

These groups are about three times more likely to get coronavirus and twice as likely to die from it as white people, according to government data analyzed by the New York Times. Reporters mapped county-level case counts with racial and ethnic data, noting which groups were contracting the virus at higher rates.

In seven Pennsylvania counties, Latinos had the highest rate of infection. In 11 others, Black Pennsylvanians contracted the virus at higher rates. Although cities like Philadelphia and Reading have majority Black or Latino populations, all counties except Philadelphia County are majority white.

Cases per 10,000 residents

Data from The New York Times

Counties with highest case counts among Latino residents	Latino	Black	White	Asian	Percent of cases with race/ethnicity data
Franklin	125	—	22	—	55
York	50	17	5	—	46
Lebanon	42	17	12	—	26
Berks	47	26	12	—	24
Lehigh	111	81	37	4	60
Montgomery	79	61	16	8	33
Luzerne	60	31	27	—	40

Counties with highest case counts among Black residents	Black	Latino	White	Asian	Percent of cases with race/ethnicity data
Allegheny	23	—	11	6	78
Huntington	160	—	9	—	44
Dauphin	32	6	15	16	41
Lancaster	36	36	13	30	35
Chester	74	43	27	2	61
Delaware	131	27	58	25	66
Philadelphia	45	21	31	19	39
Bucks	66	17	21	20	32
Northampton	80	59	41	—	50
Monroe	53	—	20	—	31
Pike	35	—	6	—	8

Nationwide, the gap is wider for younger people and for elders living in nursing homes, where the New York Times found facilities where at least a quarter of residents are Black or Latino have been twice as likely to have COVID-19.  The investigation included 17 states, but not Pennsylvania.

Sen. Casey recently signed onto a letter to the CDC and the Centers for Medicare and Medicaid Services asking for racial and ethnic data on workers and residents of nursing homes who test positive.

The CARES Act will require testing labs to report such information for all cases starting August 1st.

“How that’s actually going to be implemented and reported remains to be seen,” said Nancy Krieger, a Harvard Professor who led early studies using zip codes to analyze the disproportionate impact of COVID-19. She said, from the beginning, the CDC’s coronavirus report forms always had spaces to list demographic information like race, ethnicity, age, and zip code.

“They are standard items that you include,” she said. “But they weren’t being filled out; they’re still not being filled out. So this is now saying you have to do it, and there are financial consequences if you don’t.”

She explained, the purpose of racial and ethnic categories in medicine has evolved.

“It is a category that was born out of oppressive relations of both enslavement and colonialism. However, it’s been moved because of social movements, particularly in the 1960s, to become a category by which you can understand inequity, and by which you can demonstrate harm, and you can advocate against it.”

Krieger emphasized that her research supports the hypothesis that exposure – at work and at home – is a key factor in understanding COVID-19 disparities.