Outbreak apparently taking heavier toll on blacks

Scant information about the race of those affected undermines efforts to identify risks and devise remedies, experts say.
A Marta customer wearing a mask waits for a train during an afternoon rush hour at the Five Points MARTA station in March. Those who rely on mass transit may face a higher risk of exposure to the coronavirus, a factor that disproportionately affects low-income and minority residents in Georgia. (Hyosub Shin / Hyosub.Shin@ajc.com)

A Marta customer wearing a mask waits for a train during an afternoon rush hour at the Five Points MARTA station in March. Those who rely on mass transit may face a higher risk of exposure to the coronavirus, a factor that disproportionately affects low-income and minority residents in Georgia. (Hyosub Shin / Hyosub.Shin@ajc.com)

At 67, his age alone put him at risk from the coronavirus, but his chronic lung disease may have been his death sentence.

COVID-19 is known to be a significant threat for older people and those with underlying health conditions. So the death of the Marietta man in March, as Georgia’s first known victim of the infection, underscored the particular danger to those at-risk groups.

Now, health experts are acknowledging another factor may have put him in peril. He was African American.

» COMPLETE COVERAGE: Coronavirus in Georgia

Data available so far on the race of victims indicates that the infection is taking a disproportionate toll on blacks in Georgia and around the nation. National concern over racial disparity boiled over this week after reports about the impact in a handful of cities and states. Agencies in Chicago reported that while less than a third of Chicagoans are African Americans, they made up 68% of the city’s deaths from coronavirus. Nationwide, the Associated Press reported that demographic data shared by officials indicate that 42% of victims were black, although African Americans make up only about 21% of the population in the areas represented.

Dr. Stephanie Miles-Richardson is the associate dean for graduate education in public health at Morehouse School of Medicine. She’s also a professor in the department of community health and preventive medicine. Photo contributed.

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But the trickle of data available means researchers, medical experts and community leaders cannot completely determine the severity of the pandemic among African Americans and devise actions that might target the causes. In Georgia, the Department of Public Health only has information on the race of about 40% of confirmed cases. And the state’s very limited testing means many more cases never got diagnosed or reported, scientists say.

“Data is important,” Dr. Stephanie Miles-Richardson, associate dean of the Morehouse School of Medicine, said in a telephone interview. “Absent the data, the ability to see where the virus is limits our ability to be responsive.”

Still, the uneven impact is no surprise to her or other experts. She had suspected the coronavirus pandemic would disproportionately impact African Americans due to historic disparities in income and employment that have resulted in gaps in health insurance and medical care. Blacks in Georgia are much more likely to suffer from diabetes, hypertension, obesity and asthma, all of which are also risk factors for more severe cases of COVID-19.

» MAP: Coronavirus deaths and cases in Georgia

» MORE: The COVID-19 dashboard

Dr. Anthony Fauci, the infectious disease expert who is closely involved in the federal government’s response to the pandemic, said this week African Americans are suffering disproportionately. Health disparities, he said, have always existed for African Americans. “But here again, with this crisis, …it’s shining a bright light on how unacceptable that is,” he said.

Lab workers blamed

To analyze the disproportionate impact, disease experts want not only the race of those who are infected and those who die, but also information on where victims live and their underlying health conditions.

The form hospitals, clinics and others fill out to report coronavirus cases to Georgia DPH asks for patients’ address, age, race and if the patients had pre-existing medical conditions, among other details.

On its website, DPH lists if those who died were known to have had an underlying health condition. But it doesn’t identify what that condition was, information that would be helpful in assessing risks.

"Data is important. Absent the data, the ability to see where the virus is limits our ability to be responsive." —Dr. Stephanie Miles-Richardson, associate dean of the Morehouse School of Medicine

DPH said the reason it lacks information on the race of a majority of those infected is because lab workers aren’t completing that part of the required reporting form.

Georgia Public Health Commissioner Kathleen Toomey said the state this week recognized the problem. It’s working with the labs and health workers who do testing to make sure they note the patient’s race on the form.

But DPH also said it could not provide a racial breakdown by zip code, cities or counties, information that could show if the number of cases among African Americans was disproportionate to the overall population. That makes it more difficult to gauge the impact on blacks in Georgia.

The limited data it has on race indicates that African Americans make up 48% of confirmed cases statewide. The pandemic hasn’t hit some areas of Georgia, though, while it has devastated others, particularly the city of Albany and Dougherty County.

Blacks make up 71% of the population in the county, while information from the Dougherty County coroner shows they make up 79% of those who have died from the outbreak there.

Fulton and DeKalb counties lack information on race for the vast majority of people tested, said Dr. S. Elizabeth Ford with the counties’ boards of health. But for the cases where race is known, in Fulton County blacks account for 74% of positive tests while they make up about 44% of the population. In DeKalb County, blacks make up about 75% of the cases where a person’s race was identified while they make up about 55% of the population.

Government leaders in DeKalb held a virtual town hall meeting Thursday evening to discuss racial disparities in infection rates and deaths, “Much to my surprise, when I asked about this over the weekend, we do not have racial data collected for all cases,”Ford said. “Interestingly enough, the only racial data we had were on the cases that we were actually investigating.”

Professor Jose Cordero, head of the University of Georgia’s department of epidemiology and biostatistics, said that the information available on the race of those infected is insufficient.

“It is very important to know if there are groups that are more affected and to understand, ‘What is the underlying reason the rates are higher in a group?’ By knowing what may be the underlying reasons, then we can address them,” he said.

Meanwhile, 21 Democratic state lawmakers wrote a letter Thursday to DPH and Gov. Brian Kemp asking state government to compile and release COVID-19 infection and death data by race and zip code.

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» MORE: Amid coronavirus pandemic, African American mistrust of medicine looms

“If we do not share this information with our constituency, we are leaving Georgians out on their own to solve this crisis,” the letter says. “Without this information we are putting people in danger and creating further health and economic crises.”

Also this week, seven major advocacy groups representing hundreds of thousands of doctors released a letter to the Trump administration urging officials to collect that data. “We have seen these trends in previous pandemics,” the doctors wrote. “Without the data, we cannot apply a full science-based approach to inform decisions that may save lives.”

Social factors

Another complicating factor in understanding racial disparities with the outbreak is the virus travels from social contact and simple physical proximity, and so the disparate impact may reflect larger racial divides in society.

Blacks are over-represented in low-paying service jobs, such as retail work, that bring a higher risk of exposure, and in the Atlanta area rely more on crowded mass transit.

Clusters of cases also have been traced to social gatherings that weren’t diverse. The outbreak overtaking the Dougherty County area has been tied to two Albany funerals with attendees who were largely African American.

The picture is more complex in neighboring Lee County, which is 73% white but in the top 10 Georgia counties for number of cases, with 222 as of Friday noon. However, in the county is Lee State Prison, where two inmates have died and at least seven other inmates are infected, along with nine staff members.

In Bartow County, a church whose congregation is predominately white has been tied to an outbreak that has claimed at least four lives and affected a dozen others.

The lack of testing further muddies the picture about how the disease is affecting various communities. Shortages of test kits have been so severe that the tests have been rationed, limited largely to those who already are severely ill. That distorts the picture of who has become infected and hamstrings disease detectives trying to identify tools to address the outbreak.

“As we have increased our testing capacity and recognized that this is a deficit we will get better and better data as we go along,” Toomey said.