The COVID-19 virus is ruthlessly contagious and, at the same time, highly selective. Its capacity to infect is universal, but the consequences of becoming infected are not. While there are exceptions, children are less likely to show symptoms, older adults and those with pre-existing medical conditions are the most susceptible, and communities of color in the United States are experiencing dramatically higher rates of hospitalization and death. As we all come together around the world to halt the spread of this brutal pandemic, it’s critical to understand why some of us are more likely to be affected than others, and what all of us can do about it. Every person’s health is intertwined with the health of everyone else—especially when dealing with such a highly infectious virus. Because COVID-19 is a new disease, scientists are just beginning to learn about its distinctive features. We know that its greatest harm is inflicted on the respiratory system, so people with impaired lung function or a compromised immune system are at greatest risk for more severe illness. Certain pre-existing medical conditions are also associated with increased risk, with hypertension, obesity, heart disease, and diabetes (conditions that are more prevalent among African Americans) among the most worrisome. And while the continuing inadequacy of current COVID-19 testing and tracking data in the U.S. makes definitive conclusions particularly challenging at this point in time, it’s likely that people of color are being tested at lower rates, thereby undercounting the already disproportionate numbers of those most affected.
Put simply, the structural legacies of racism and other cross-generational traumas may be linked to levels of chronic stress that increase susceptibility to the kinds of health impairments that result in greater risk of harm from COVID-19.Much of the current discussion about racial and ethnic differences in the risk for serious illness or death from COVID-19 in the United States is focused on socioeconomic conditions that make it more likely that people of color will be exposed to the virus. An equally important, but different, question that also requires attention is why people of color are more likely to need hospitalization and, tragically, more likely to die, regardless of income. Both require thoughtful reflection.
- Higher rates of exposure to the virus are associated with employment in “essential” services without adequate protection from infection, residing in tight quarters, and hourly wage jobs without paid sick leave or the ability to work from home, among other risk factors. These conditions are much more likely to be experienced by African Americans, Hispanic Americans, and Native Americans. Extensive evidence from the social sciences has documented highly inter-related, structural inequities that have led to these conditions and been sustained through multiple policies and service systems over a long period of time. For example, residential segregation driven by legal and financial barriers, greater exposure to air pollution and environmental toxins, and less access to affordable, nutritious food and green space for exercise and stress reduction are all the result of a complex web of zoning regulations, economic policies, and social marginalization that could be changed. These deeply embedded, discriminatory policies, compounded by unconscious biases, also result in many people of color having less access to high quality health care (exacerbated by language barriers) and higher rates of unequal treatment in the health care system.
- The explanation for why people respond differently to COVID-19 can be found in the growing scientific understanding that variability in susceptibility is a common feature of many diseases and is highly influenced by the environments in which we live. For example, there is increasing evidence that health-threatening conditions early in life—including poor nutrition, exposure to pollutants, and excessive family stress associated with poverty, racism, and other forms of economic or social disadvantage—can have disruptive effects on developing immune and metabolic systems that lead to greater risk for a variety of chronic health impairments well into the adult years (with cardiovascular diseases such as hypertension and heart conditions, as well as diabetes, near the top of that list). Put simply, the structural legacies of racism and other cross-generational traumas may be linked to levels of chronic stress that increase susceptibility to the kinds of health impairments that result in greater risk of harm from COVID-19. Evidence is also mounting that the origins of these common diseases are affected by significant adversity during the prenatal period and first 2-3 years after birth.