Racial/Ethnic Differences in COVID-19 Transmission Networks

All across the country a significantly higher percentage of diagnosed COVID-19 cases, hospitalizations, and deaths are occurring among African Americans (Black, Non-Hispanics) than would be expected based on the percentage of African American in the US.  These disparities extend to Black, Hispanics. The findings of national case surveillance data and CDC’s national surveillance of COVID-19 hospitalizations provide support for these regional patterns. 

When race/ethnicity is linked to a health outcome, as it is being done here, there is a tendency to dismiss its significance because it overly focuses on one group at the expense of others or blames the victim.  Instead, we need to address why some may be slipping through the cracks not just for their sake but to strengthen our response for all.  Infectious diseases are transmitted from person to person without regard to an individual’s race/ethnicity, so we gain insight from investigating risks for transmission and acquisition that can help all individuals.  If an infectious disease persists in one population, it can easily jump to and cause outbreaks in other populations and have an outsized impact in communities having characteristics similar to those observed in the African American community.

So far, much attention in the media has focused on the potential causes of the higher hospitalization and death rate among African Americans.  The widely accepted explanation being that the chronic health conditions such as high blood pressure, diabetes, and heart disease are a major contributor to the development of complications and death due to COVID -19 and that these conditions are more common among African Americans.

There has much been less discussion of the causes of racial/ethnic differences in COVID-19 infections. It would be wrong to attribute differences in infection to racial/ethnic differences in the personal choice to take precautionary actions such as handwashing and social distancing.  Rather, factors beyond an individual’s control, i.e., structural factors, are at the root of the racial/ethnic disparity in COVID-19 infections.

Exposure has been observed to be the key to the risk of infections.  African Americans are more likely to be employed in jobs where working from home is not an option, exposing them to other workers who may be infected. According to the Bureau of Labor Statistics, African American and Latinos were more likely to work in the service industry where remote participation is less possible compared to other racial/ethnic groups. 

Another structural factor affecting exposure might be the fact that many African Americans live in dense, segregated neighborhoods. We know the number of COVID-19 cases vary by neighborhood in most urban cities and are higher in African American and Latino neighborhoods, which often have high population density and limited community resources.  The population density of a neighborhood creates a situation where residents are more likely to come into close contact with an infected person for an extended period of time increasing their risk of infection.  Couple this with limited access to protective masks, it’s easy yet again to see that once the virus is introduced into the community, structural features of the neighborhood contribute to greater risk of transmission.

This link between neighborhood structural factors and racial/ethnic health disparities has already been demonstrated for other infections such as sexually transmitted infections (STIs).  There are large racial/ethnic differences in the rates of STIs.  Our research as well as that of many others has shown that, all other risk factors being equal, residents of high poverty urban neighborhoods are at much greater risk for STIs than residents of other neighborhoods. Combine this finding with the fact that the residents of many of these high poverty urban neighborhoods with high crime rates and limited resources are African American, racial/ethnic difference in STIs can be traced to racial/ethnic differences in who resides in these high poverty neighborhoods—a structural factor.

To the extent that these characteristics of African American neighborhoods contribute to higher rates of COVID-19 transmission and cases diagnosed than residents of other neighborhoods, local leaders must pay special attention to addressing the structural features of neighborhoods that foster transmission. One solution is for community leaders to work with local governments, as we did with STDs, and rapidly develop and implement a strategic plan to address these structural COVID-19 risk factors at the neighborhood level.  The plan may include the initiation and promotion of a face mask distribution program, establishment of neighborhood testing sites, or support for the use of information technology to allow face-to-face activities to become virtual.

It’s important to look at the structural features of neighborhoods that create and perpetuate the COVID-19 transmission.  As long as there continues to be racial/ethnic disparities in cases (and in hospitalization and deaths), we must address these structural features through thoughtful strategic planning to reduce the number of cases diagnosed.  As we relax our current strict mitigation approach (shelter in place) to the pandemic and move to a containment (social distancing, masks and test and treat), it’s important that public officials attend to residents of these neighborhoods not only for their own sake but for the benefit of all.