DANIEL CHANG AND C. ISAIAH SMALLS II
(BlackPR Wire) MIAMI, FL -- African Americans with COVID-19 are dying at a higher rate than white people and others who have tested positive for the disease in Miami-Dade County — a key finding buried in the Florida health department’s daily reports on the coronavirus pandemic, but one that experts say should help drive the state’s response in minority communities.
In Miami-Dade, the county with the most confirmed COVID-19 cases in Florida, African Americans who tested positive for the disease have died at a rate of 4.6 percent compared to a rate of 3.1 percent for white people and 1.7 percent for people whose race is classified as “other,” according to data provided in Friday’s health department report.
“That’s a huge difference,” said Shannon Monnat, a social demographer and researcher at Syracuse University who studies social inequality. “If these numbers start to scale up, we’re talking about almost twice as many excess deaths from this [COVID-19] among blacks.”
Similar findings in Chicago, Detroit and New York City also have shown that African Americans are dying of COVID-19 at higher rates than whites and other races.
The differences aren’t as stark in Miami-Dade, at least so far. But Roderick King, a physician and professor in the department of public health sciences at the University of Miami Miller School of Medicine, said the rate of deaths among Miami-Dade African Americans with COVID-19 is “significant” — even if it’s not explicitly reported by the state.
“That’s not something that can be hidden,” he said.
HOW THE HEALTH DEPARTMENT REPORTS DATA
Florida’s health department does not calculate the disease’s impact within racial groups. Instead, the agency presents total cases, hospitalizations and deaths by race — a method that shows African Americans made up 12% of the 8,742 cases in Miami-Dade yet 24% of hospitalizations and 26% of deaths. The county’s population is 18% black.
This analysis also reflects a disproportionate impact in hospitalizations and deaths among Miami-Dade African Americans with COVID-19, Monnat said.
But she said examining the rate at which African Americans are dying as compared to whites and others — they are dying at a rate that is 50 percent higher than whites — offers a deeper look at the impact of the virus on Miami’s black community.
“When you present it that way, you’re able to see disparities much more clearly,” she said. “When you present it the way they’re showing, it looks like it’s worse among whites. There are more cases among whites, but that’s because whites represent a larger share of the population or at least a larger share of the cases.”
The Florida Department of Health said it uses demographic data such as race to gain insight into the disease’s effect on all communities and to ensure that it is able to target resources where they are needed most.
“It’s more beneficial to that mission to look at the data in the context of the whole picture,” said Alberto Moscoso, press secretary for the health department. “That helps us know who’s being impacted as a whole in the community as opposed to which specific group is being impacted.”
He said people self-report their race and ethnicity during testing and some may choose not to provide that information, which also may be missing from tests processed by commercials labs. But the demographic data may be updated later as the state performs epidemiological investigations.
Florida, like the rest of the nation, does not know the true magnitude of the coronavirus pandemic because there is no widespread testing.
The state has reported conducting more than 240,000 tests, or about 1.1% of Florida’s population, and has confirmed more than 24,000 cases of COVID-19 statewide as of April 17. But those numbers are likely to be a significant undercount because they do not include a testing backlog from private labs, which process more than 90% of tests in Florida and have taken as long as two weeks to deliver results.
Florida did not start reporting race and ethnicity data for persons who tested positive for the coronavirus until April 4. The health department’s data also does not include demographic information for the 687 residents of other states who have tested positive while in Florida. Additionally, race is classified as “unknown” in 28% of positive cases statewide and 40% of cases in Miami-Dade.
The state’s numbers for Miami-Dade deaths also don’t completely agree with the county’s. Late Friday, the county’s medical examiner reported 197 deaths due to COVID-19, including 47 African Americans. At the same time, the Florida health department reported 195 deaths in Miami-Dade, including 50 African Americans.
County and state data also differ on the number of people who died whose race is unknown. Miami-Dade’s medical examiner lists 29 deaths with no race information; Florida reports 17 in the county.
Though the data is imperfect, Monnat said it’s all researchers currently have to track the coronavirus’s impacts on minority and low-income communities.
“This is a story that’s just repeating itself across the country,” Monnat said.
WHY IS THE DEATH RATE HIGHER FOR AFRICAN AMERICANS?
Social scientists say it’s important to understand that the coronavirus pandemic did not create a health crisis for African Americans. The disease has only magnified a high rate of chronic illness that is a legacy of generations of unequal access to jobs, education and healthcare.
“African Americans live sicker and shorter lives than the average American,” said David Williams, a social scientist and professor at the Harvard T.H. Chan School of Public Health.
African Americans are more likely to have jobs that do not allow them to shelter in place and work from home, Williams said, and they are over-represented in high-density, urban areas where social distancing can be a challenge. Black Americans also more likely to use public transit, and to live with a chronic illness such as diabetes, hypertension and asthma than their white counterparts, all of which increase their risk of dying from COVID-19.
“You’re compounding the fact that these folks have all these chronic diseases — diabetes, hypertension, cardiovascular disease – which is putting them in the high-risk category,” said Cheryl Brewster, a professor and associate dean at Florida International University’s Wertheim College of Medicine. “And then you’re saying ‘You still have to go to work because you’re not able to stay [home]. You don’t have that luxury because you’re living paycheck to paycheck’.”
These are the same issues that worry Cheryl Holder, a South Florida physician who recently wrote an opinion piece in the Miami Herald calling for more access to testing for the coronavirus in African American communities.
“If you use an equity lens, that definition of who’s at risk will drive different testing criteria,” said Holder, who is president of the Florida State Medical Association. “... Not that black folks are special, but their circumstances require... more immediate results.”
Florida’s expanded testing has relied in large part on drive-thru sites that require a car, with no walk-up testing sites anywhere in the state. Gov. Ron DeSantis announced this week that the first walk-up testing sites will open in Fort Lauderdale and Pompano Beach.
The state has also limited who can be tested due to shortages, and CDC guidelines restricting testing eligibility by age, symptoms and international travel. All of those factors created barriers for many African Americans to be tested early during the pandemic, Holder said. The delay in diagnoses could have contributed to further spreading of the disease and more severe outcomes.
Holder said she believes Florida’s reporting on COVID-19 has not yet caught up with the extent of the disease’s impact on the black community.
“We’ll start seeing the black population reflected higher in the numbers in the next few weeks,” she predicted.
‘WISDOM AND KNOWLEDGE IN THE COMMUNITY’
As Florida’s data captures the extent of the coronavirus’s impact on African Americans, Williams, the Harvard professor, said it’s important for the state to act on that information and reach out to faith-based and civic leaders who can help build the community’s trust in some of the same institutions that have contributed to a legacy of inequality for black persons.
“There’s a lot of wisdom and knowledge in the community,” Williams said.
Moscoso, the health department press secretary, said the state surgeon general and others in the agency have maintained relationships with faith leaders and elected officials in the African American community, holding conference calls with Florida’s Democratic Black Caucus when invited and participating in local radio programs.
“We make our leadership available to hear their concerns and make sure they’re being addressed,” he said. “That happens on a regular basis and it certainly plays a big factor in our planning. We have regular calls with faith-based leaders, too, statewide.”
Moscoso also said health department websites and informational material has been translated into Haitian Creole. He said the agency has funded and partnered with local organizations in Miami-Dade that address needs in the African American community, such as the Consortium for a Healthier Miami-Dade.
Holder, the Miami physician who has provided care in local inner cities for decades, said the African American community would benefit from more outreach and resources to help those who have contracted COVID-19, lost jobs or need childcare due to shelter-in-place orders.
But Holder said the state has not yet established relationships in ways most likely to reach South Florida’s African American community, such as radio stations and church pulpits.
After years of cuts at Florida’s health department, particularly in county offices, the state likely lacks resources to launch a comprehensive outreach and testing and surveillance campaign for COVID-19 in Miami-Dade’s African American communities, said King, the UM physician who is also CEO of the Florida Public Health Institute, a nonprofit that promotes healthy communities.
“I don’t think it’s a lack of wanting to do something,” King said. “It’s a lack of bandwidth. This isn’t something you start doing when the epidemic comes. You have to have a history of working with these communities.”