Why We Need Race and Ethnicity Data to Beat COVID-19

April 22, 2020 | Melissa Lewis

The novel coronavirus, COVID-19, shows no bias—it has infected people of all ages, genders, races, and ethnicities. However, racial and ethnic disparities in rates of infection and deaths have emerged. There is growing evidence that COVID-19 is disproportionately impacting communities of color, although not all jurisdictions report race as part of their surveillance. State and territorial health officials can and must emphasize the necessity for data on racial disparities as this pandemic unfolds.

All states and most territories publicly share the total number of cases and deaths from COVID-19 and most share variables including age, gender, and locality. A few states also report pre-existing health conditions. After early data highlighted disparities, more than half of state and territorial public health agencies now publicly display COVID-19 data by race and/or ethnicity. Among the states currently releasing race data, early reports highlight inequities in communities of color and a disproportionate impact of COVID-19 on African Americans.

• Forty-one states and territories (AL, AK, AR, AZ, CA, CO, CT, DC, FL, GA, IA, ID, IL, IN, KS, LA, MA, MD, MI, MN, MO, MS, MT, NC, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, VT, WA, WI, WV, WY, and Guam) publicly display race and/or ethnicity data.
• In Michigan, African Americans lead in the number of cases--33 percent and deaths, 40 percent. Although African Americans constitute 14.1% of the Michigan population.
• In Louisiana, 56.3 percent of COVID-19 deaths are African Americans although they account for 32 percent of the state’s population.
• African Americans account for 63.9 percent of the Mississippi COVID-19 deaths but make up 38 percent of the state’s population.

Data collection issues make accurate reporting of race and ethnicity challenging. All states note incomplete data reporting from health care providers and laboratories. Data from a few states shows a significant percentage of records designate patients’ race as “unknown,” limiting the utility of the data for public health planning and response.

There are several factors contributing to racial disparities among COVID-19 cases. For instance, African Americans in their 20s, 30s, and 40s are more likely to live with or die from comorbidities including heart disease, stroke, and diabetes at an earlier age than white Americans. According to CDC, “health differences are often due to economic and social conditions that are more common among African Americans than whites.” Overall, disparities point to a legacy of disinvestment in communities of color. The disparities are also attributed to historical health and social systemic inequities, with COVID-19 worsening those existing inequities.

Lastly, Black and Hispanic workers in the United States are less likely to work from home because of prevalent occupational segregation by race and ethnicity. Members of Black and Brown communities are often essential workers in food services, healthcare support, public works, and public transportation. This translates to an increased risk of exposure to COVID-19.

Looking Ahead at Equitable Solutions

Publicly reporting COVID-19 cases by race and ethnicity will be crucial for resource allocation in ensuring access to health services and economic relief during the remainder of the pandemic response and recovery. Just as geographically reported data can help with identifying hot spots of infection, public health should use race and ethnicity data to inform decision-making and ensure the use of culturally and linguistically appropriate messaging and response efforts. Examples of using data for action include:

• Applying a health equity lens in recovery planning and addressing the health-related social needs. For example, conducting contact tracing in a manner that is not stigmatizing to potentially exposed individuals.
• Prioritizing and directing the allocation and distribution of resources, testing, and funding to areas with the greatest need and to serve the most vulnerable populations.
• Mitigating barriers to seeking care or testing such as inability to pay or access to transportation.
• Engaging other sectors and funding local partners such as faith-based communities, community-based organizations, and diverse ethnic media in inclusive outreach efforts.
• Communicating data and resources across literacy levels and translating information into multiple languages to reach all communities.

COVID-19 is exposing structural racism in America. Reporting COVID-19 data by race and ethnicity will inform state and territorial leaders as they rebuild and broaden their understanding of the disproportionate impact of this pandemic for communities of color. We call on all state and territorial leaders to let equity guide their recovery efforts so we can bounce forward to more equitable conditions.