Making sense of COVID-19 mortality disparities

Why do some groups experience higher COVID-19 mortality rates than others? NCSE Executive Director Ann Reid explains in ways that anyone—including students—should be able to understand.

COVID-19 mortality chart

Courtesy of APM Research Labs

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To follow along with this article, you’re going to need a set of Pick-Up Sticks. Or, in a pinch, a bunch of toothpicks or bamboo skewers. (One commercial Pick-Up Sticks game has 41 sticks with different colors that earn different numbers of points. If you want to decorate your toothpicks accordingly, I can’t stop you.)

Pick Up Sticks

Photo by Mokkie - Own work, CC BY-SA 4.0

Here’s how we’re going to play: Divide your class, if you’re still teaching, into teams of 3-4 students—you’ll need a set of Pick Up Sticks for every two teams. Or divide your family into teams. If you’re all by yourself, you can just consider the first round practice. You’ll divide yourself into two teams for the second round.

Round one: Flip a coin. The winner goes first. Take turns picking up one stick at a time, without causing another stick to move, otherwise you lose your turn, until they’re all picked up and tally the score—one point for each stick removed.

Round two: The team that won the first round gets to go first. The losing team now has to play using their non-dominant hand. Right-handers must use their left hand, left-handers their right. If you’re playing alone, divide yourself into Team Right Hand and Team Left Hand.

Round three: The winning team goes first again. The losing team now has to play using their non-dominant hand and with one eye closed.

Round four: The winning team goes first again. In this round, the winning team gets two chances to remove a stick should they move a stick on their turn.

How’s it going? Is everyone having fun? Does this game seem fair?

Not fair at all, right?

Playing this new version of Pick-Up Sticks is one way to understand why some groups of Americans are being infected by and dying of COVID-19 at so much higher rates than other groups: some groups face considerable disadvantages when it comes to risk factors for serious illness or death. The numbers are grim.

As reported by the APM Research Lab, which aggregated data from all 50 states and the District of Columbia, as of June 10, 2020:

  • 1 in 1,625 Black Americans has died (or 61.6 deaths per 100,000)
  • 1 in 2,775 Indigenous Americans has died (or 36.0 deaths per 100,000)
  • 1 in 3,550 Latino Americans has died (or 28.2 deaths per 100,000)
  • 1 in 3,800 Asian Americans has died (or 26.3 deaths per 100,000)
  • 1 in 3,800 White Americans has died (or 26.2 deaths per 100,000)

In other words, Black Americans are more than two times more likely to die of COVID-19 than White, Asian, or Latino Americans, and Indigenous Americans are nearly 50% more likely to die than White, Asian, or Latino Americans. Experts point out that although the overall mortality rate among Latino Americans is similar to that among Asian and White Americans, Latinos are disproportionately likely to become infected (in 14 states, Latinos represent three times more cases than their share of the population; in another 17 states, Latinos represent twice as many cases than their share of the population). The Latino population is significantly younger than the other groups, so there are fewer individuals in the highest-risk age groups, which leads to the lower mortality rate.

Why is this happening? It’s kind of like that game of pickup sticks we began with. It’s hard to win a game with even one disadvantage, like never getting to go first. Playing with your non-dominant hand makes it even harder. If you have a lot of disadvantages, winning becomes practically impossible.

When it comes to dying of COVID-19, there are distinct disadvantages that increase your risk.

First, factors that increase your risk of being infected by SARS-CoV-2:

  • Being an essential worker who cannot work at home
  • Working under crowded conditions
  • Sharing living quarters with many people, especially of multiple generations
  • Living in a dense community
  • Relying on public transport
  • Lacking access to public health information in your native language
  • Lacking access to running water

Then, factors that increase the risk of serious illness or death if you are infected:

  • Age—the older you are, the higher the risk
  • Pre-existing conditions such as heart or lung disease, high blood pressure, diabetes, obesity, or suppressed immunity
  • No health insurance
  • No paid sick leave
  • Lack of proximity to healthcare services or essential businesses like grocery stores or pharmacies
  • Poor air quality

When you consider this list of factors, it becomes pretty clear why the mortality rates are so different—Black, Indigenous, and Latino Americans are much more likely to fall into at least one, if not many, of these categories. I’ll give a couple of examples, but it would be illuminating for your students to divide up into teams to research the percentage of people in different groups who fall into each category.

While every Black or Latino American doesn’t have every risk factor, on average they are likely to have more of them than White Americans.

For example, Black Americans are over-represented among essential workers. While comprising only 12.5% of the U.S. population, Black Americans make up 26% of the public transit workforce, 17.5% of health care workers, and almost 20% of child care and social services workers. Black workers are also less likely than White workers to receive paid sick leave or to be able to work from home. Black Americans have higher rates of all of the pre-existing conditions that contribute to COVID-19 risk; for example, they are more than 50% more likely to have diabetes or hypertension than White Americans. Black workers are 60% more likely to be uninsured. (All statistics from the Economic Policy Institute.)

Like Black Americans, Latinos are over-represented among front-line workers. In particular, Latinos make up over 44% of meatpacking workers, an industry that has among the highest rates of coronavirus infection. Latinos are more likely to live in multi-generational housing and less likely than any other racial or ethnic group in America to have health insurance. In the San Francisco Bay Area, over 150,000 Mexican immigrants speak neither English nor Spanish and are thus cut off from vital public health information; a community radio station is providing coronavirus information in several indigenous languages to fill this gap.

According to New Mexico’s state epidemiologist, Michael Landen, Native Americans in New Mexico are dying of COVID-19 at 19 times the rate of all other populations combined. They make up only 11% of New Mexico’s population, but represent 57% of its COVID-19 cases. 175,000 Native Americans live in Navajo Nation, which spans Arizona, New Mexico, and Utah. In a territory about the size of West Virginia, there are just four hospitals and seven outpatient centers. According to a recent report, there are only 13 grocery stores in Navajo Nation, while 15% of Navajo Nation homes have no running water and about 50% of households include multiple generations.

You can see the pattern. While every Black or Latino American doesn’t have every risk factor, on average they are likely to have more of them than White Americans. The exact set of risks is different for Latino and Indigenous Americans, but they are also more likely to fall into more of the high-risk categories than White Americans. Taken together, these risk factors go a long way towards explaining the differences in mortality rates.

Let me just say one more thing. You might have noticed that I didn’t discuss any genetic factors that might put one group at higher risk than another. That’s because, as of right now, no genetic factors have been identified that affect risk from coronavirus, much less genetic factors that are over-represented in a particular ethnic group or race. Over time, genetic factors will probably emerge—differences in expression of the cellular receptor the virus attaches to, or gene variants that affect a patient’s’ immune response, for example—and such discoveries may be very important in treatment strategies or drug development. But for now, genetic differences do not seem to be nearly as important as what people do, where they live, and what services they have access to.

It’s as if some are playing the coronavirus game with one eye closed and their good hand tied behind their backs.

NCSE Executive Director Ann Reid
Short Bio

Ann Reid is a former Executive Director of NCSE.