Thursday, June 25, 2020

Who's Getting Sick - Race Matters

On April 10, 2020, the CDC posted a report that discussed the geographic variations in the spread and mortality rate of COVID 19. These included the following differences in location that might be influencing the pattern of disease incidence occurring across the United States:
  • the timing of COVID 19 introduction into an area
  • the relative population density of cities compared to rural areas
  • demographic values such as prevalence of different age groups and those with existing conditions
  • the timing and extent of government recommendations to diminish public interaction
  • diagnostic testing capacity in different jurisdictions
  • the level of public health reporting consistency and prioritization.
I have written about several of these in my posts, but there is one that now intersects with current events in a significant way  beyond the issues of health and economic upheaval: the demographics of race. In the midst of this global pandemic, an event occurred that burst into the fore front of the daily news cycles, moving COVID 19 updates into the background. George Floyd was living in Minneapolis, Minnesota, when on May 25, 2020, he was arrested by police after having been identified by a store clerk as having paid for his purchase with counterfeit money. Seventeen minutes later, Mr. Floyd was handcuffed and on the ground, held down by three police officers, one with a knee on Mr. Floyd's neck. At that point, after 8 minutes and 46 seconds of being held in that position, George Floyd had become unresponsive. An ambulance arrived a few minutes later and took Mr. Floyd to the hospital where he was declared dead.

It was not just because George Floyd was black that this story resonated so strongly around the world. As Sherrilyn Ifill, president of the NAACP Legal Defense fund, said in an interview with CBS's Bill Whitaker, "one of the reasons why the George Floyd video set us off so much was the realization that it's not different. We've-- we've seen the videos. And the videos seem not to make a difference. And that's why that officer could look like that. He wasn't afraid of being videotaped. He wasn't trying to hide what he was doing."

As Ms. Ifill said, we have seen this all before, many times. If we look at the numbers of men at risk of being killed by police, the imbalance between ethnic groups is overwhelming.

Adding insult to injury, George Floyd was tested for COVID 19 after his death and was found to be positive, though asymptomatic. That African Americans are victims of police brutality is bad enough, they are also almost five times more likely than white people to be hospitalized for COVID 19.

As can be seen in the two graphs above, it is not just blacks who are being treated more harshly by the  police and the pandemic - all minorities are suffering at a greater rate than whites. While density of the population in urban places plays a role in increased rates of infection, it really comes down to whether you are rich enought to "shelter in place", or, if you are not, being forced to go out to work at frontline service jobs in close proximity to others. The maps below show that, even before the pandemic in 2015, minorities were less likely to find work than whites.

The values that are represented in these maps are based on the ratio between the rate of unemployment for the minority and the rate of unemployment for whites. The rate of unemployment is calculated by dividing the number of a group who are unemployed by the total labor force of that group. The "labor force" is defined as those currently employed or who are not working, but who are actively looking for work. The areas for which the values are aggregated are congressional districts.

When the rates of COVID-19 deaths for different races are compared to each group's proportion in a state and then combined, the result can be used to show how far variances in racial deaths diverge from the entire state population death rate. A map of these divergences was developed by the University of California, Berkeley.

A cursory examination of the map above and the ones of unemployment show a probable cause-effect relationship between deaths and unemployment rates for certain states: Arizona, Georgia, Nevada, Michagan, Florida, and Missouri. In others, however, there seems to be no relationship: California, Texas, Oregon, and Wyoming. The unemployment rate itself is partly a function of a racial bias, which also reinforces several other circumstances that increase susceptibility to infection.

The CDC lists a number of race-related influences that affect health:
  • residential segregation that creates denser populations and greater distances to groceries and health care;
  • higher employment in essential industries requiring working outside the home and less paid sick leave;
  • poorer underlying health conditions like lack of health insurance and serious pre-existing illness
The inequality that exists in our society has made a difficult situation even worse for those who, for no reason other than the color of their skin, face so many injustices already.

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