Contextualizing the United States Government’s Legacy of Combating Infectious Diseases: Offering a Renewed Analysis of COVID-19 Susceptibility in the African American Population

Joseph Bonjawo
Joseph Bonjawo
Opinion Writer

During the Civil War era’s smallpox epidemic, the federal government propagated a fallacious belief that the formerly enslaved population approached extinction. Due to the general public’s ambivalence to this belief, federal officials remained neglectful in their imposition of preventive measures. This inattention then culminated in immense casualties as the epidemic achieved nationwide proportions. As physicians documented the infected and the deceased, they observed that a significant majority were formerly enslaved Africans. Upon exploring recent developments in demographic figures of the United States, contemporary observers may determine that African Americans have endured similar affliction amid the COVID-19 pandemic. 

According to the Centers for Disease Control and Prevention (CDC), the first laboratory-confirmed COVID-19 diagnosis in the United States occurred on January 20th, 2020. Initially, the CDC identified the first COVID-19 casualty on February 29th, 2020. However, the Emergency Operations Center of Santa Clara County, California, later reported COVID-19 symptoms in individuals whose deaths occurred on February 6th and February 17th. Despite being active for less than 12 months, COVID-19 served as the third leading source of mortality in the United States by the end of the year. 

Figure 1. (The eleven leading causes of death in 2020).

As of April 26th, 2021, the CDC’s COVID-19 Data Tracker contains 31,883,289 cases and 569,272 casualties. These values reveal that regardless of the enormity of COVID-19 infections and related fatalities in 2020, COVID-19 transmission continues unabated in 2021. 

The CDC emphasizes that its demographic data strictly encompass geographic areas that contributed racial and ethnic figures. Therefore, its data tracker solely represents 15,610,410 cases and 369,838 casualties. As Figure 2 reveals, African Americans are 11.1% of cases and 12.54% of the U.S. population. By comparison, Caucasians comprise 50% of cases and 60.11% of the U.S. population.

Figure 2. (The percentage of COVID-19 cases by race and ethnicity as of April 26th, 2021).

According to Figure 3, African Americans are 13.6% of casualties while Caucasians amount to 58.5%. Considering the population proportions of both demographics, these figures indicate that COVID-19 infects a higher percentage of African Americans. 

Figure 3. (The percentage of COVID-19 casualties by race and ethnicity as of April 26th, 2021).

The CDC’s demographic data additionally represent individual age categories ranging from 0 to 85 and above. Of all African Americans in each age category, African Americans between the ages of 18 and 29 possess the highest percentage of casualties relative to their proportion of the U.S. population. As Figure 4 displays, 24% of African Americans in this age category succumbed to COVID-19 despite comprising 14.44% of the U.S. population. These percentages amount to a difference of 9.56%, the largest difference of all age categories in the mortality data of African Americans. By comparison, Caucasians between the ages of 18 and 29 constitute 28% of casualties while accounting for 53.54% of the U.S. population.    

Figure 4. (The percentage of COVID-19 casualties by race and ethnicity between ages 18 and 29 as of April 26th, 2021).   

Of all Caucasians in each age category, Caucasians aged 85 and above bear the highest percentage of COVID-19 casualties relative to their proportion of the U.S. population.

Figure 5. (The percentage of COVID-19 casualties by race and ethnicity for individuals aged 85 and above as of April 26th, 2021).

As the CDC specifies, adults aged 85 and above that contract COVID-19 are most susceptible to severe illness and mortality. Despite this declaration, African Americans between the ages of 18 and 29 appear to have perished most frequently.

The CDC may have solely published data representing 83% of its documented COVID-19 casualties. Regardless, its current demographic figures clearly demonstrate that the disease is most lethal towards African Americans. This disproportion, albeit unsettling, may have been inevitable since the onset of the pandemic. During the White House Coronavirus Task Force Briefing of April 7th, 2020, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), introduced predisposing conditions as the source of severe COVID-19 illness amongst African Americans. In particular, he specified that predisposing conditions result in frequent admission to intensive care units (ICUs) and elevated mortality rates upon contracting COVID-19. Additionally, he emphasized that chronic diseases such as diabetes, hypertension, obesity, and asthma disproportionately beset the African American population. Fauci then stated that the ideal procedure is to provide African Americans “the best possible care to avoid those complications”. 

Audiences of the briefing may have perceived such an objective as benevolent. However, the increased prevalence of predisposing conditions in African Americans is by no means accidental. In March of 2021, the National Low Income Housing Coalition (NLIHC) reported that African American households comprise 12% of all households while accounting for 26% of all extremely low-income renters in the United States. The respective percentages of Caucasian households are 64% and 43%. Additionally, 20% of all African American households are extremely low-income renters compared to 6% of all Caucasian households. These data indicate that a substantial proportion of African Americans reside in economically deprived habitats. As a result, African American households are often prone to a fundamental dilemma: limited access to food outlets that supply adequate nutrition. 

In 2006, Powell et al., researchers at the University of Illinois, published the results of a study examining the disparities in food store availability in the United States. During the study’s inception, a corporation known as Dun and Bradstreet (D&B) provided data illustrating the concentration of food outlets across 28,050 zip codes. Powell et al. included the following food outlets in their study: convenience stores, grocery stores, non-chain supermarkets, and chain supermarkets. They then collected Census 2,000 figures of neighborhood racial and ethnic characteristics, neighborhood socioeconomic status, and measures of population, urbanization, and region for all 28,050 zip codes. The complete sample of 28,050 zip codes represented a total population of 280,675,874 individuals. 

Figure 6. (The United States Census 2,000 data).

In their results, Powell et al. noted that chain supermarket availability in African American neighborhoods across all 28,050 zip codes was 52% of that in Caucasian neighborhoods. 

Figure 7. (Food store availability by race and ethnicity as compared to Caucasians).

In 2007, Powell et al. published the results of a similar study that prioritized restaurants as opposed to food stores. This study employed the Census 2,000 and D&B data of the prior study, and restaurants were either full-service or fast-food. As figure 8 indicates, full-service and fast-food restaurant availability in African American neighborhoods was 58.2% and 59.3%, respectively, of that in Caucasian neighborhoods.

Figure 8. (Full-service and fast-food restaurant availability by race and ethnicity as compared to Caucasians).

 In their discussions, Powell et al. specified the following limitations of their studies:

  • Possible measurement errors and food outlet misclassification (Powell et al., 2006a; Powell et al., 2007b). [1] [2] 
  • The food outlets Powell et al. examined exclude informal food distribution channels such as farm stands or markets (Powell et al., 2006a). [1]
  • Powell et al. have not documented the characteristics of adjacent zip codes (Powell et al., 2006a). [1]
  • Powell et al. have not addressed possible differences in zoning across zip codes (Powell et al., 2007b). [2] 
  • The association between fast-food restaurant availability and obesity rates does not account for possible selection effects (or selection bias) (Powell et al., 2007b). [2] 
  • The studies are subject to “spatiotemporal mismatches”, not accurately reflecting changes in space and time between data collection points (Powell et al., 2007b). [2] 

Regardless of their potential for invalidation, Powell et al.’s studies reveal that predominantly African American neighborhoods contain a higher percentage of fast-food restaurants despite their reduced chain supermarket and restaurant availability. Moreover, Powell et al. (2006a) [1] state that chain supermarkets typically offer reduced prices and food products of superior quality. Considering the distribution of extremely low-income renters in the United States, Caucasian households are likely to possess more accessible nutrition than African American households. 

Due to the disparities in food outlet availability, African Americans may often sustain themselves by purchasing products that are lacking in nutrition. As Powell et al. (2010c) [3] convey in a related study, U.S. adolescents ingest an excess of fat, sugar, and salt. The World Health Organization (WHO) recommends the following guidelines for the consumption of these ingredients: 

  • A total fat consumption below 30% of total energy intake to prevent obesity.
  • free sugar intake below 10% of energy intake to prevent obesity, tooth decay, and cardiovascular diseases.
  • A salt consumption below 5 grams per day to prevent hypertension, heart disease, and stroke in the adult population. 

During his segment of the White House Coronavirus Task Force Briefing, Fauci characterized the African American population’s chronic diseases as comorbidities to COVID-19. These diseases included hypertension and obesity, both of which are found in the WHO’s guidelines. Therefore, it is conceivable that the habitual consumption of fat, sugar, and salt may diminish one’s immunity to COVID-19. So long as the Coronavirus Task Force overlooks the nutritional deficits in predominantly African American neighborhoods, its subsequent prevention initiatives may remain ineffectual. 

Seeing as a sizable proportion of African American households are extremely low-income renters, the avenues for employment are likely to decline considerably. As a result, African Americans may often gravitate towards occupations in which exposure to COVID-19 is most probable. According to the Center for Economic and Policy Research (CEPR), African Americans account for 17% of all frontline industries despite comprising merely 11.9% of all workers in the United States. On the contrary, Caucasians are 63.5% of workers and constitute 58.8% of all frontline industry positions. The CDC’s Advisory Committee on Immunization Practices (ACIP) defines frontline essential workers (non-health care workers) as the subset of essential workers that is most susceptible to COVID-19 exposure while conducting its operations. Additionally, the CEPR and the ACIP classify the following non-health care essential workers as frontline workers: public transit, child care and social service, grocery store, and U.S. Postal Service workers. 

Figure 9. (The demographics of frontline industry workers). 

As figure 9 illustrates, African Americans represent a considerable share of these industries relative to their percentage of the entire U.S. workforce. Such a disparity may account for their overrepresentation in COVID-19 casualties. 

Between March 1st and May 31st of 2020, several states issued a compulsory stay-at-home order. This protocol dictates that all non-essential workers must remain in their residencies, whereas essential businesses must continue their operations. Additionally, its intended objectives were to limit COVID-19’s transmission and ensure the health care system’s stability. Despite these functions, the stay-at-home order may have offered little relief for African American households. 

According to the NLIHC, 70% of all extremely low-income renters are directing more than 50% of their income towards rent and utilities. Additionally, 36% of all African American renters have not satisfied their rent payments compared to 12% of all Caucasian renters. As figure 10 indicates, renters are considerably more prevalent in the African American population. The NLIHC then emphasizes that the burden of rent has been exacerbated by escalating unemployment rates in the COVID-19 era. 

Figure 10. (Percentage of homeowners, renters, and extremely low-income renters by race and ethnicity). 

The Bureau of Labor Statistics (BLS) provides the seasonally adjusted unemployment rates of all demographics between March 2020 and March 2021. The BLS defines seasonal adjustment as the removal of any fluctuations in data resulting from seasonal events. Additionally, it obtained its unemployment rates by dividing the unemployed population by the total civilian labor force and multiplying the quotient by 100. Between March 2020 and March 2021, the seasonally adjusted unemployment rate of Caucasians rose from 3.9 to 5.4. By comparison, African Americans possessed a rate of 6.8 in March 2020 and 9.6 by March 2021.  

Figure 11(Seasonally adjusted unemployment rates of March 2020 and March 2021).

As figure 11 reveals, African Americans possess the highest unemployment rate of all races and ethnicities documented by the BLS. Such unemployment, while accompanied by overwhelming rent obligations, is bound to cripple the extremely low-income renters in the African American population. The continued allocation of income towards rent may reduce the affordability of proper nutrition, consequently rendering African Americans more susceptible to COVID-19. Therefore, African Americans remaining in their residencies are every bit as disadvantaged as African American essential workers employed in the frontline industry. Assuming that the stay-at-home order’s function is to provide security as COVID-19 transmission escalates, perhaps state governors ought to consider the financial distress of African American households. Otherwise, the stay-at-home order may prove more discriminatory than preventive. 

 Between January 2020 and the present, the United States has endured an exponential surge in COVID-19 cases and fatalities. Despite the United States government’s attempts to counteract COVID-19’s dissemination, recent CDC data illustrate that the pandemic has and continues to devastate the African American population. This phenomenon reaffirms the severity of the racial inequities in the United States. Moreover, it serves as a testament to the United States government’s limited interventions in majority African American and destitute neighborhoods. Supposing that federal officials intend to enforce optimal COVID-19 countermeasures, they must address systemic complications such as resource denial, proximity of nutrition, continued unemployment, and racial discrepancies in frontline worker representation. So long as the United States government is impotent in mitigating the infection and mortality rates of the African American population, any potential resolutions to the COVID-19 pandemic may remain subject to uncertainty. 

References

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