The Daily Tar Heel

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Thursday May 26th

Column: For many Black Americans, COVID-19 is like falling off of a cliff

<p>Devon Johnson, opinion editor.&nbsp;</p>
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Devon Johnson, opinion editor. 

Nobody is 'making' the coronavirus about race. In this chicken-or-the-egg scenario, COVID-19 is exposing racial inequities that already existed, not creating them. In short, the fact that African-Americans are contracting and dying from the novel coronavirus at higher rates is not due to a genetic predisposition, biological difference or individual behaviors. 

The rampant fatalities in Black communities in the U.S. are the result of years of systematic disenfranchisement, leaving many falling off of a cliff with no safety net to catch them.

Even before the COVID-19 pandemic, there were competing, contradicting views about African-Americans. We are said to be both biologically predisposed to being stronger, faster and more fit to fight disease, but also inherently less healthy as a consequence of our race. We are either naturally impervious to pain or genetically predisposed to have heart conditions. We win the race because of an 'extra muscle,' or lose it because we're more likely to have asthma.

These racialized associations to Black super- and sub-humanness have been corrected by scientific literature, and the fact that there is no significant biological basis for race. In fact, there is more genetic variation within racial groups than between them. So any real differences are socially constructed, or made up. This also means that there is no biological motivation for why African-Americans are dying from coronavirus at higher rates. 

So, let's talk about the real reason why Black Americans have fallen victim to higher rates of COVID-19 hospitalizations and deaths than other racial groups. To do so, I'd like to use Dr. Camara Jones' Cliff Analogy as a tool to walk us through it.

Hopefully you've watched the short video clip above for some helpful explanatory context. In the case of COVID-19 in the United States, it's important to outline the key components of this analogy to understand why more African-Americans are dying from the novel coronavirus.

Firstly, Black communities are more likely to be close to the edge of the cliff, meaning they're at a high risk of contracting the virus. This increased risk is due to the fact that African-Americans are more likely to be working in service sector jobs, less likely to own their homes and less likely to own a car — all of which increase contact with others and risk of contracting COVID-19. 

This increased proximity to the edge of the cliff means that African-Americans are more likely to fall off of it, or to contract the coronavirus, too.

Hypothetically, once you contract COVID-19 you'll be able to see a healthcare provider and receive treatment that's covered by insurance. This would be the net that catches you. However, African-Americans have high uninsured rates, a large population in the ACA coverage gap, and lower access to healthcare, so we're less likely to have a net. 

Even if we are fortunate enough to be caught by a net, many Black folks are still slipping through. This can largely be attributed to pre-existing conditions and historically-lower quality of care. 

African-Americans are more likely to have pre-existing comorbidities like hypertension, diabetes, asthma and other underlying conditions that make the novel virus more deadly — all of which are 'cliff-acquired' conditions that are socially-patterned in a similar way to COVID-19.

Comorbidities aside, quality of care also varies by race. Even when controlling for confounding factors, African-Americans receive worse information, care and treatment than whites. When presenting with the same symptoms, for example, Black patients are less likely to receive treatment for cardiovascular disease and more likely to have an unnecessary limb amputation for a vascular condition.

With such close proximity to the edge, a disproportionate lack of nets and larger holes to slip through, it's no wonder we're seeing such high coronavirus morbidity rates among Black communities. 

Sadly, people in my community are not the only ones who are falling without a safety net. American Indian and other indigenous peoples are falling. Undocumented people are falling. Low-income people are falling. People living in rural communities are falling.

When the dust settles and the data are published, we'll wish we had strung up more nets, built more fences and walked more vulnerable communities away from the edge of the cliff. If we don't make these changes soon, the same folks will still be the first to fall when the next pandemic comes.

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