Medical Examiner

Why the Coronavirus Is Hitting Black Americans Hardest

Men in masks wheel a patient wearing a mask on a stretcher.
Emergency medical technicians bring a patient into Wyckoff Heights Medical Center in Brooklyn, New York, on Monday. Bryan R. Smith/AFP via Getty Images

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When cities started collecting COVID-19 infection rates in their areas, some started breaking the data down by ZIP code to see who was most at risk. Then they went even further to break down the caseload by race. What they found was that, contrary to the oft-repeated maxim that the coronavirus is “the great equalizer,” not everybody is affected the same way. Akilah Johnson, a narrative health care reporter at ProPublica, has been looking into the data, which shows that the coronavirus has hit black communities hardest. She says we need to have this conversation if we actually want to help those suffering—and stem the death rates across the country.

On Wednesday’s episode of What Next, I spoke with Johnson about what we know—and don’t know—about the coronavirus and race, and why public health experts are saying we can’t afford to take a race-neutral approach to this pandemic. Our conversation has been edited and condensed for clarity.

Mary Harris: In the past few days, we’ve been getting more information that points in the same direction: In both Louisiana and Chicago, 70 percent of recorded COVID-19 deaths were black patients. I know you took a really close look at Milwaukee. Why did you want to go there?

Akilah Johnson: Milwaukee was interesting because it was so transparent with the data about who was dying and why people were dying. It was listing racial and ethnic demographics and also various comorbidities—if people also had diabetes, hypertension, chronic heart disease, lung disease. The city was listing those factors in addition to age, race, and ethnicity. It was like a case study and a window to a municipality that was trying to be cleareyed about what was happening and the way it was approaching it when there were so few areas that were doing that at the time.

What were the numbers like in Milwaukee?

The city was finding early on that, at first, everybody who died in Milwaukee was black: The first 10 deaths were black residents. After that, there were disproportionate numbers—I believe the city of Milwaukee is 38 percent black and the county is 26 percent black. Yet a disproportionate number of the infection rates were African Americans. And as the number of cases has grown, that disparity has persisted. Not everybody who’s died in Milwaukee now is African American. However, they still make up a disproportionate number of deaths.

There are layers upon layers of history making it harder for black communities to defend themselves against this virus. In Milwaukee, that looks like access to quality health care and housing. Home ownership is quite low in black communities. What that means is black individuals might be living in a situation where they are running up against other people just by default.

In Milwaukee, 7 percent of the black community owns a home, compared with over 80 percent of the white community. That speaks to generational wealth, but that also speaks to your autonomy to control your environment. When you have a home, not only can you shelter in place, but you can determine how long you can be there, how many people are going to be there with you. And it also speaks to your income level and status, to be able to make sure there’s food in that house and the water is running and there are cleaning supplies. The significance of home ownership has been very much the gateway to the American middle class, to some financial stability and wealth in this country. And here is a community for which, largely through no fault of its own, that’s not a possibility.

I imagine you could go right down the line, looking at car ownership rates and whether you’re reliant on traveling with other people on a subway or a bus, and health insurance rates, like whether you feel comfortable walking into a medical facility in Milwaukee. There’s even some evidence that pollution might make people more vulnerable to infection, and there’s years of reporting showing that communities of color are more likely to live in places that are more polluted.

Yes, through historic redlining and residential segregation. Name almost any American city and you’ll see similar things: gaps in wealth, in home ownership, in access to insurers, in access to medical care, in access to clean air. Our country’s history of discriminatory policies, when it comes to economics, housing, health care, and education—that creates the types of conditions and breeding grounds that result in this impact when it comes to managing pandemics.

I want to spend a little bit of time talking about something else, which is who is considered an essential worker. Do we have any good information about the racial breakdown of essential workers?

To be honest, I don’t know if anybody’s collecting statistics along those lines. Traditionally we think of essential workers as law enforcement and firefighters. But this pandemic has widened the aperture of that lens to include folks in food chain supplies, your grocery store workers, your MTA workers, your transportation workers. It also includes government workers, like at the post office. Traditionally, these roles and jobs have been the pathway for African Americans to the middle class. And if you look at specific industries, there are large numbers of African Americans and brown and black folks who hold those positions. Their exposure risk is higher from a pandemic because these are people who can’t work from home.

To understand how this virus is disproportionately affecting people around the country, there has to be data: about these essential workers, about everyone who’s getting sick. The CDC is collecting information about race and ethnicity but hasn’t been releasing it. Some say the data is incomplete and not comprehensive, so it isn’t reliable. But other lawmakers and public health officials disagree. They say even some information is better than nothing.

One of the more powerful arguments I saw for releasing this data just right away was that we learned with Hurricane Katrina and the financial crisis that if we don’t understand who’s most affected, we’re not going to be able to put in place the policies that help the people who need it.

That’s the argument you’re hearing from public health officials. What have we learned from history? Why are we not applying those lessons to our current crisis? Why make these things an afterthought? There is an increasing national push and an alarm is being sounded from federal lawmakers, national civil rights organizations, and physicians on the ground to release this data so that resources can be deployed adequately in places where they are most needed. And then mitigation strategies can begin in earnest.

I keep thinking about the delicacy of this data and how it needs to be handled with such care. Because in the wrong hands, it could be used in a toxic way where people could say, “Oh, this is a disease of certain people,” or “Certain people are sick.” I feel deeply divided because of the world we live in right now.

That’s not an unrealistic concern. Things we should be conscious of as we report on this issue include making sure we’re not unnecessarily or unfairly racializing a disease—like “This is something that only black people get or more black people get, period.” There are myriad circumstances that are responsible for where we’re at now. I think what we are beginning to see, as more people tell this story and as different municipalities share this information, is that it is needed information. These conversations are never easy, but they are necessary and they are nuanced.

I was just listening to a radio interview by Sen. Bill Cassidy, a Republican, and he did exactly as I feared: He looked at the information and apparently said there was some kind of physiological difference that was causing black patients to die with more frequency from COVID-19.

It’s a similar debate that you hear sometimes people talk about personal responsibility and personal choice. Take, for instance, the issue of African Americans being disproportionately affected by diabetes. The conversation can quite often distill to this thing of “Control your diet. Go exercise more. It’s a matter of personal responsibility. If you stopped eating these things and doing these things, your health would improve.” But how does one buy healthy food if they can’t afford it? Where will they buy fresh produce if they live in a food desert? It is not neatly wrapped up in quick sound bites and discussions.

And too often, conversations stop at the surface level. So the quickest thing for people to wrap their minds around is this false concept of “Well, it’s a personal choice.”

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