The coronavirus pandemic is having an impact all over the world, but a disturbing trend is evident in the U.S.: People of color, particularly African Americans, are experiencing more serious illness and death due to COVID-19 than white people.

Why is this happening? Sherita Golden, M.D., M.H.S., a specialist in endocrinology, diabetes and metabolism, and chief diversity officer at Johns Hopkins Medicine, provides insight into this complex issue.

Disproportionate Rates of COVID-19 Illness and Death in Black Communities

According to media reports, in Chicago, where African Americans comprise a third of the city’s population, they account for half of those who have tested positive for the coronavirus, and almost three-quarters of COVID-19 deaths.

Likewise, in Milwaukee County, Wisconsin, African Americans make up 70% of deaths due to the coronavirus, but just 26% of the county’s population.

These examples are not exceptional, and the trend is not limited to African Americans. Golden says, “While much of the focus has been on African Americans disproportionately contracting and dying from COVID-19, other minority populations are also adversely affected, including Latinx/Hispanic and Native American communities.”

Coronavirus Risk Factors and People of Color

“These communities share common social and economic factors, already in place before the pandemic, that increase their risk for COVID-19,” Golden says. Those factors include:

Living in crowded housing conditions. “Crowded living conditions are a difficult challenge that is the result of longstanding racial residential segregation and prior redlining policies,” Golden says. “It is difficult for 10 individuals living in a three-room apartment to appropriately physical distance.” She says advocacy on these broader policy issues could help prevent future disparities in disease outcomes.

Working in essential fields. Golden notes that people working in environmental services, food services, the transportation sector and home health care cannot work from home. These positions put workers in close contact with others.

Inconsistent access to health care due to lack of insurance or underinsurance. Being able to afford doctors’ visits, medications and equipment to manage chronic disease is essential to lowering the risk of death from COVID-19 and other conditions. For instance, a patient with badly controlled diabetes or asthma due to inconsistent treatment is more at risk for severe, even deadly, coronavirus infection.

Chronic health conditions. Golden points out that people of color have a higher burden of chronic health conditions associated with a poor outcome from COVID-19, including diabetes, heart disease and lung disease. In a study cited by the U.S. Centers for Disease Control and Prevention (CDC), about 90% of those hospitalized with severe COVID-19 had at least one of these underlying medical conditions.

Stress and immunity. Studies have proved that stress has a physiological effect on the body’s ability to defend itself against disease. Income inequality, discrimination, violence and institutional racism contribute to chronic stress in people of color that can wear down immunity, making them more vulnerable to infectious disease.

How to Fight Racial Disparity in the COVID-19 Pandemic

Instituting fair housing policies, improving employment opportunities and taking other steps to mitigate economic inequality will benefit people of color in the next health emergency, but Golden says there are ways to reduce sickness and mortality in vulnerable populations right now.

Targeted COVID-19 Messaging

“Because there is currently not a vaccine or anti-viral treatment for COVID-19, physical distancing, hand-washing and wearing masks are crucial public health interventions to prevent the spread of the disease to these vulnerable populations,” Golden says. This message is straightforward, but how it’s delivered makes a difference.

“We need to use some novel approaches to promoting physical distancing messages through social media campaigns. Physical distancing messages should be translated into multiple languages in a culturally sensitive manner, and at a literacy level that allows all at risk to understand the information,” Golden says. (Golden has driven efforts at Johns Hopkins to collaborate with language services to translate coronavirus materials into Spanish.)

She adds that messaging should address and discourage the stigma associated with COVID-19, which she says prevents symptomatic people from seeking medical attention until they are dangerously ill.

“Of particular concern in the immigrant community is the myth that seeking medical attention will make it more difficult for people to obtain a green card in the future. This is not true, and that message needs to be communicated,” Golden says.

Coronavirus Testing for People of Color

“We need to ensure that all symptomatic individuals are referred for COVID-19 testing, particularly African American, Latinx/Hispanic and Native American individuals,” Golden says.

She says anecdotal data suggest that people from vulnerable populations who have COVID-19 symptoms may not be referred for testing as frequently as their white counterparts. Lack of testing could mean further spread and more patients not seeking medical help until they are seriously ill.

“Any person who believes that he or she has COVID symptoms and has not been referred for testing should advocate and persist to have it done,” Golden says.

Making COVID-19 testing available for those who do not have primary care physicians or transportation is a must. “That effort would involve organization of public health approaches to provide transportation to existing testing sites, and setting up testing sites directly in community hot spots so that symptomatic individuals and their contacts can be tested,” Golden says.

At the state and federal level, leaders like Golden are uncovering more factors behind racial health disparity in general, and in the COVID-19 pandemic in particular. One key to improving equity is gathering more accurate race-, ethnic- and neighborhood-specific data. Knowing who is affected by the coronavirus and who is bearing the most burden is critical to addressing imbalances in testing and treatment.