Making meaning of the COVID-19 race and ethnicity data: A conversation with our Health Officer and our Equity Director

A recent analysis of updated data by Public Health shows that in King County, COVID-19 is disproportionally impacting communities of color.

Our recent blog post dives into the data. We found rates of COVID-19 hospitalizations and cases that are significantly higher for Hispanic/Latinx, Native Hawaiian/Pacific Islanders and Blacks and higher for American Indian/Alaskan Natives (though not statistically significant due to the low population numbers) as compared to Whites.

To gain a better understanding of disproportionate impacts of COVID-19 by race, we sat down with Matías Valenzuela, Equity Director for Public – Seattle & King County and Director of COVID-19 Community Mitigation and Recovery, and Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County.

Q: What was most striking to you about the latest data findings?

MV: The latest data confirm what so many of us in Public Health and our communities have been concerned about—the tragic reality that this disease is exacerbating other inequities—putting people in harm’s way and at greater exposure to not just COVID-19 but to the social and economic impacts of the current crisis.

I find important how disparities become even more clear when we look outside of long-term care facilities, since this shows us who is being impacted by the virus in the community.  Early on a lot of concern has been on long-term care facilities, but now this is shining a light on the critical and growing needs in our communities of color. We need to continue to prioritize accessing the most robust data to understand and address the impacts within our communities as this pandemic evolves.

JD: The updated data is deeply concerning because we can clearly see the racial/ethnic disparities and the disproportionate impact on communities of color. In King County, many COVID-19 cases and deaths have been associated with skilled nursing facilities with residents who are more likely to be White, and in particular, at the beginning of the outbreak a larger proportion of all cases were from these facilities.

We recognized that the facility-based cases could be impacting how we understand the overall COVID-19 outbreak in the community, and we’ve also now analyzed the data excluding cases from skilled nursing facilities and assisted living facilities to get a better picture of community-acquired COVID-19.

When we did this, we found that the number of COVID-19 related hospitalization cases among Whites dropped by about half. In contrast, this analysis found that the number of cases dropped much less among those of Hispanic/Latinx, Black, and Native Hawaiian/Pacific Islander communities. Our interpretation is that cases in the community, outside of long-term care settings, are likely to be having a relatively greater impact on communities of color.

What are some possible reasons behind higher rates of cases, hospitalizations and deaths among some communities of color?

MV: We know there are health care, social and economic reasons for inequities from COVID-19, including structural racism. 

Health care: In terms of health care, there is a lack of access, coupled with the need for more culturally-responsive health services. Among many there is also an historical and very real distrust of the health system, leading to delayed care.

Households: When we look closer at the households themselves, more communities of color live in multi-generational households. This makes it harder to physically distance if a person is positive for COVID-19.

Underlying health conditions:  In these same places where many Black, Native and Indigenous people, and people of color live, there are less resources and historical under investments that leads to less access to healthy, affordable foods, walkable neighborhoods, and good schools and jobs. These contribute to more underlying and chronic health conditions that can put people at risk for severe complications from COVID-19. Public Health’s Community Health Indicators provide additional information on health and community conditions.

Essential workers: We have a large number of people of color who are essential workers, such as working in grocery stores and restaurants that deliver or do take out, transportation and those in service industries. They aren’t able to telecommute, and they fill critical jobs that increase potential for exposure during these difficult times.

On top of that, if you are undocumented, you are not able to access federal programs, such as the recent stimulus checks, that support staying home and physically distancing during these tough economic times. It’s tragic. This disease is exacerbating other inequities—putting people in harm’s way and at greater exposure to not just COVID-19 but to the social and economic impacts of the current crisis.

JD: No one should be surprised by these findings. It’s an ongoing national tragedy that communities of color remain at increased risk for a wide range of adverse health outcomes related to social and economic determinants of health, and COVID-19 is no exception.  Disadvantaged communities typically suffer to a greater extent during a wide range of health emergencies and natural disasters.

Q: What do we know about how limited testing may affect the data?

JD: We know that not everyone in King County has equal access to testing and therefore reported cases may not reflect the actual burden of disease in any racial or ethnic group. Different racial and ethnic groups may also differ in access to healthcare or in healthcare seeking behavior which would in turn affect whether they would be diagnosed with COVID-19 at all, or are perhaps diagnosed later in the course of illness when it is more difficult to treat.

Many cases have been identified through testing at long-term care facilities where residents are more likely to be White. Access to testing is greater for those with more access to healthcare, certain healthcare systems and drive through testing clinics. Without widespread testing, we do not know the full extent to which the virus may be impacting all of our communities.

For these reasons, the available data likely does not provide the full picture of COVID-19 impacts across King County’s population at this time.

MV: To this point, we know that testing has been limited outside of certain settings and many communities of color have barriers to health care. For this reason, we are working with Community Health Clinics to expand their capacity to test patients who normally attend their clinics as well as reach out to communities they aren’t currently serving. Given their relationships in the community plus their geographic location in places where we have the greatest needs, these clinics are now being prioritized for testing supplies and personal protective equipment.

Q: What are actions we can take based on the latest findings?

JD: First of all, we need to continue to improve our data quality and completeness and to repeat our analyses as we get more and better data.  This will allow us to have an increasingly accurate picture of our local outbreak and it’s impacts across all communities.  At the same time, we need to work with community partners to help us understand the risk factors leading to increased rates of COVID-19 and identify steps we can take to address these problems. 

We must improve access to testing for all of our community. We also need to understand the barriers to rapid testing and safe isolation or quarantine of people with COVID-19 and their household members and community contacts in order to prevent spread of infections and resulting illnesses, hospitalizations and deaths.

MV: It’s critical to have the data so we know where and how to focus our work. Though, given our knowledge of which communities are disproportionately impacted by COVID-19 we need to redouble our efforts.

There is urgency to support our communities that are on the frontlines, so our residents have the resources and information they need to stay healthy. Many of our residents, community organizations and partners are doing amazing work. In King County we have task forces and teams to support. But we need more. This needs to be a community-wide effort of unprecedented proportions, or the effects of COVID-19 will be devasting for our communities of color for a long time to come.

Originally posted 5/1/2020