In the midst of pandemic, New York magazine's Andrew Sullivan sarcastically tweeted Monday, the "most urgent task, apparently, is to prove that the coronavirus is a function of white supremacy." A few hours later, he appended a qualifying thread to the now-deleted post, which had linked to an Ibram X. Kendi piece at The Atlantic collating evidence that COVID-19 is disproportionately affecting minorities, especially black Americans.
"Of course it matters if one segment of the population seems to be affected disproportionately," Sullivan conceded in the new tweets, "especially if we can figure out why a virus has such an effect. But we don't know yet, and politicizing this as a function of white supremacy, seems to me to be the wrong emphasis," he continued, concluding that the proper focus is "prevention and treatment and humanity right now, rather than race."
Is it true, though, that "we don't know yet"? I'm duly skeptical of the available coronavirus data — at this stage, it's misleading and incomplete more often than not. But what racial data has been collected so far shows pre-existing disadvantages have been exacerbated by the pandemic's strain on our health-care system, and the result in multiple areas around the country is a disproportionate infection and death rate for African Americans.
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Sullivan's argument seems to be informed by a fear that unwarranted focus on race for the sake of politics (indeed, though he didn't use the phrase, for political correctness) will result in misallocation of limited medical resource. But if we have good reason to believe that race correlates with outbreak severity, then race may be a useful data point to produce more efficient resource distribution. In fact, if the available evidence reliably suggests predominantly black areas are at greater risk, refusing to use that evidence to adjust our response to coronavirus is the real unjustified politicization.
So do we have reason to believe racial data tells us something important about the shape of this pandemic? I think we do.
Multiple data sets see disproportionate representation of black people among coronavirus cases relative to their share of local populations. Kendi listed several examples of this in the Atlantic story that prompted Sullivan's first tweet. "In Illinois, the infection rate among black Americans is twice their percentage of the state population," he wrote, while in "Milwaukee, black Americans make up 26 percent of the county, but nearly half of the infections and a maddening 81 percent of deaths as of Friday." Similar numbers are coming in from Michigan, Chicago, North Carolina, and elsewhere.
None of these figures show a simple cause and effect relationship between this illness and race. To say there's a correlation here is not to suggest a straightforward explanation like genetic predisposition or racial animus among health-care workers. Rather, it's a tangled twine of factors that produce different pandemic outcomes for different populations.
Some of those factors are explicitly race-related. Research has found many health-care workers believe old myths about black people's bodies, for instance, including that they have higher pain tolerance than white people, and a study published last year using data from thousands of emergency room patients showed nonwhite patients received less pain relief than their white counterparts. Likewise, some black Americans have expressed unwillingness to wear homemade face masks out of fear that it will result in police attention. "We have a lot of examples of the presumed criminality of black men in general," Ohio State professor Trevon Logan, who is black, said on CNN. "And then we have the advice to go out in public in something that ... can certainly be read as being criminal or nefarious, particularly when applied to black men." If store-bought masks are in short supply, that fear could lead to faster transmission rates in black communities.
But most of the factors leading to racial disparities in COVID-19 infections and deaths are, at the surface level, more about class and urbanization than race proper — but in the United States, class and urbanization are both strongly tied to race. "When you look at being black in America, number one, people unfortunately are more likely to be of low socioeconomic status, which makes it harder to social distance," said Surgeon General Jerome Adams on CBS Tuesday. (Compared to white Americans, black people are less likely to be able to work from home, for example, and minorities are more likely to live in multigenerational households.)
"Number two, we know that blacks are more likely to have diabetes, heart disease, lung disease — and I've shared, myself, personally, that I have high blood pressure, that I have heart disease and spent a week in the ICU due to a heart condition, that I actually have asthma, and I'm pre-diabetic," Adams continued. "And so I represent that legacy of growing up poor and black in America, and I and many black Americans are at higher risk for COVID."
Comparative lack of access to medical care compounds that risk. (One data set of medical billing information found "an African American with symptoms like cough and fever was less likely to be given one of the scarce coronavirus tests," NPR reports.) So does skepticism of the health-care system produced by our history of state and private medical abuse of African Americans, perhaps most famously the Tuskegee syphilis experiment.
So it looks like a disproportionately poor, sick, imprisoned, and underserved demographic is disproportionately suffering in this pandemic. Well, of course. It would be surprising were that not the case.
Much of this can't be changed during the pandemic, if at all. But we can and should take this racial data into account while crafting our response to the novel coronavirus. That's not politicization. It's public health.
