How we are monitoring COVID-19 preliminary data by race, ethnicity

Public Health – Seattle & King County is releasing preliminary data of COVID-19 cases, hospitalizations and confirmed deaths by race/ethnicity. This preliminary data shows COVID-19-related deaths and hospitalizations are impacting people of all races and ethnicities. Additional data is needed to be able to draw conclusions about the impact COVID-19 is having across racial/ethnic groups in King County.

Of the 274 people who have died after contracting COVID-19 in King County, 74% were White non-Hispanic, 15% Asian, 4% Black, 5% Hispanic or Latino, 1% Native Hawaiian or Pacific Islander, 0% American Indian or Alaskan Native. (Data as of 4/10/20)

“Many diseases, including COVID-19, have the potential to disproportionately impact people with serious underlying health conditions and those who are socially and economically disadvantaged,” said Dr. Jeff Duchin, Health Officer, Public Health –Seattle & King County.  “In addition to interviews with people who test positive, we’re looking at other data sources to get better understanding of the potential disproportionate impacts of COVID-19 across our community. This can help us determine if additional actions are needed.”  

The outbreak is still in a relatively early stage, and testing has not been widespread throughout the community. For these reasons, the available data likely does not provide the full picture of COVID-19 impacts across King County’s population.

For example, many cases have been identified through testing at long-term care facilities and among patients admitted to hospitals. Access to testing is greater for those with more access to healthcare. This is likely to skew the racial/ethnic data that we do have towards a higher-income and whiter population.  

As part of the COVID-19 response, Public Health – Seattle & King County is working to address gaps in access to testing for high priority groups including safety net populations.

Data sources: race/ethnicity

Washington State Department of Health attempts to contact every person who tests positive for COVID-19 for a case interview, during which they ask about race and ethnicity. However, DOH is not able to reach and conduct full interviews with everyone. Currently, King County has race/ethnicity information for 51% of confirmed cases.

Locally, PHSKC is augmenting this data to have a more in-depth understanding of how COVID-19 is impacting our community. Epidemiologists interview family members of people who’ve died, and they analyze other complementary databases such as Medicaid data, some hospitalization data, syndromic surveillance system data, and King County Medical Examiner’s data.

A major challenge is that virtually all COVID-19 case reports come through laboratory reporting systems that do not have information on the patient’s race/ethnicity.  Public Health currently recommends healthcare providers report race for all notifiable disease cases across health conditions; however, there is inconsistent collection of this data by healthcare providers.

The Washington State Board of Health is currently reviewing the reporting requirements for all notifiable conditions–providing an opportunity to require reporting of race/ethnicity data statewide. King County strongly supports this change. Requiring this reporting by laboratories and health care providers, along with the necessary information system support, could potentially improve completeness of reporting. 

Reaching communities of color

Even without full information about race/ethnicity on all positive COVID-19 cases, we know the communities that have been historically marginalized and currently experience inequities are at higher risk from a range of health impacts, and this is likely true for COVID-19.

We have been working to engage cultural and linguistically diverse communities to reduce that risk. Our language access team has worked with community leaders to translate materials into 21 languages (see right-hand side of Public Health’s COVID webpage) and has developed video PSA campaigns in 11 languages.

Public Health has convened task-forces to reach sectors and organizations so they have the tools and resources to manage the novel coronavirus when people are exposed, implement physical distancing, and address emerging issues such as mental health or economic impacts. Public Health works with the task force sectors – faith communities, small businesses, homeless services providers, home childcare facilities – to tap into these communities’ networks and resilience and to adapt our guidance accordingly.

Public Health has also joined with partners to identify funding for community organizations who are on the frontlines of informing our communities and addressing the COVID-19 impacts.

While these efforts are underway, Public Health will continue to strengthen how we are working with communities of color and limited-English speaking populations.

Originally posted 4/10/20