The Faces of COVID-19

Carl Sandburg famously wrote that “fog comes in on little cat feet”, it is silently, suddenly around us. A virus is much like fog; it gives no warning, does not signal its arrival nor does it indicate when it is gone. In New York City its’ presence was noted by the silencing of a busy metropolis, broken only by the omnipresent wail of ambulance sirens and the beeping of the machines keeping patients alive in ICUs and Emergency Departments. It was also known by the faces of those whose lives it took away from our families, nursing homes, neighborhoods, country lanes and city streets. Those faces are old, their heads are gray, they may occasionally be immigrants or young, but most often they are people of color. The statistics are startling.

Another study with partial data indicates Black Americans are approximately 13% of the total population, but are accounting for 27% of the deaths. American Public Media (APM) also reports: “White Americans are dying at elevated rates in eight states (Oklahoma, Rhode Island, Connecticut, Idaho, Texas, Washington, Minnesota and Delaware); Asians in Alaska alone; and Latinos in New York, Missouri and New Hampshire.” A third of all deaths are from people who resided in nursing homes or assisted living facilities. The United States currently has about 1.5 million people living in nursing homes. The variability of care in these homes is a topic for another time.

Research by APM research documents deaths per 100,000 population by the following percentages: (note – not all states are reporting cases with a breakdown by race; Native American deaths will be noted below.)

Asian - 18.4%

Black - 42.8%

Latino - 19.1%

White – 16.6 %

Currently COVID-19 deaths in the United States are right around 90,000 as of this weekend; the number of confirmed cases here is about 1.52 million, making the US total about one-third of all cases in the world.

Last week Maryland (where I live) noted 29,374 cases with 1401 deaths; this week the totals are still rising with the latest reports noting 37,968 total cases with 1957 deaths.

Other studies have looked at Native American deaths in the southwest, primarily in Arizona, Utah and New Mexico and found that social cautions such as hand washing and social distancing do not work well on reservations where fresh water or hand sanitizer is not readily available and social distancing is very difficult in a small dwelling or trailer. Currently the Navajo nation is reporting deaths of 30 per 100,000 in those areas. New Mexico has noted that of the 23 tribal nations in the state, (which comprise 11% of the population), Native Americans account for 42% of the infections in that area.

Immigrants who come to America often take jobs that are less desired by local citizens. That is why meat packing and processing plants are often staffed by new arrivals, some of whom have no work permits. The lack of access to health care, which is often denied to those who do not have documents and passports, means that when they get sick they do not go to the hospital, because they cannot afford it; they stay at home until it is often too late to benefit from care. The clusters of cases around these plants was made worse when the President deemed them essential and decreed that, even in the face of mass outbreaks, these plants must stay open. The inability to understand healthcare warnings for communities with poor English is also another concern seen in these immigrant populations.

Many African Americans, Latinos and Native Americans have high rates of diabetes, obesity and hypertension which leads to other complications when trying to fight a respiratory or systemic disease.  One common factor in the treatment of disease in minority communities is the lack of adequate health care, whether it is on a reservation, an inner-city Hispanic neighborhood or a poor Black community in Mississippi; access to affordable services, follow-up care and medication is often lacking. Several of the states that did not expand Medicaid or placed restrictions on qualifications for its’ services are now seeing disproportionate illness in these communities across many healthcare fronts. Generally, most Americans are unaware that immigrants, or those without documentation, are denied legal access to Federal or State services, except in emergencies.

Black communities, especially, are seeing incidence of COVID-19 both in rural and urban centers, far greater than the proportion of their presence in these counties. The Commonwealth Fund noted that in the higher incidence counties mentioned above that Blacks accounted for one-third of the population, but 53% of the cases and 63% of the deaths. The authors of the study conclude that the United States needs to mandate collection of information about the race of the patients with COVID-19 and then determine how to adequately allocate resources to those affected communities.

Of course, much of this goes back to the absolute mismanagement of this health care pandemic crisis. The President noted we are testing too much as he realized that higher case numbers and continued closed businesses reflected badly on his happy talk agenda. He took none of the blame for his continued fight against the Affordable Care Act (ACA, also known as Obamacare) which has knocked many off the enrollment lists, either from closed clinics, reduced services and lack of access or increased costs, so lack of affordability. The Kaiser Family Foundation noted that the U.S. has now tested 10.7 million people, (not counting the daily tests for those in the White House, of course). We still have to go a long way to meet necessary international standards and do contact tracing and follow-up.

I have been lucky enough, through this crisis, to work from home. I do not have to work in food service, janitorial services or in a nursing home, where I must be exposed to a hostile environment, possibly without adequate protective gear. I do not have to leave my home and take public transportation to arrive at my city job. So, my exposure to COVID-19 is limited, while those mentioned above might have maximum exposures. Is it any wonder then, that one might fall ill?

My state has only opened some areas, my county is not among them, so I am not concerned about crowds of people suddenly streaming by my home or nearby parks and recreations centers, not to mention bars and restaurants. However, I remain concerned about those states that have opened up everything, where people are not wearing masks and some are putting the lure of the dollar for a few, over the health and safety for many.

Well, time to say good evening for now – so many topics I did not get a chance to cover tonight, but there is always next week.  Hope to see you back here and hope to hear from you.  Loved President Obama's remarks on Saturday, so much more to day; stay tuned as they say.