Read on Twitter
I'll keep repeating this again and again, but the pandemic **DOES NOT** affect all equally. Especially to those in Canada, where data remains unavailable and where a provincial Chief Medical Officer basically said all lives matter when asked about racial disparities. Thread:
1. First, there are individual-level risk factors that make it hard to protect oneself, or increase chances of bad outcomes.
We all know of the biological risk factors - age, hypertension, chronic respiratory diseases, etc. which are associated with higher case fatality rates.
We all know of the biological risk factors - age, hypertension, chronic respiratory diseases, etc. which are associated with higher case fatality rates.
2. Then, your social and economic lives put you at risk. Were you able to work from home when all this started? Are you able to now? Do you have a car? Do the elevators in your buildings get cleaned regularly? Do you live with roommates? Can you isolate from your roommate(s)?
For social distancing, let's look at NYC as an example. Subway stations in higher-income neighborhoods saw faster and greater reduction in subway use (see map and graph). Social distancing is a privilege. https://www.nytimes.com/interactive/2020/04/03/us/coronavirus-stay-home-rich-poor.html
3. Our bodies embody our entire lives' material and social experiences. It's why income & life expectancy are closely linked. So, independent of how poverty can hinder self-protection, it is also associated with higher rates of the underlying conditions that make COVID-19 worse
4. The more disaggregated data that comes out from the US, the starker the racial disparities in COVID-19 burden become. In the 35 states that have released deaths by race, Black Americans represent ~13% of the population, but 34% of total Covid-19 deaths. https://coronavirus.jhu.edu/data/racial-data-transparency
On Twitter, I have seen some people (incl scientists) absurdly reach for biological explanations. This is truly enraging. The disparities are due to historical and present structural racism and inequality.
A country built on slavery, redlining, voter suppression, white supremacy, and locking kids up in cages (to name a few) will see COVID-19 disparities along racial lines. This is not "due to race", but due to racism. Reach for a history book first before other explanations.
To spell it out, due to racism at various levels, POC in general, Black and Indigenous people in particular, are more likely to be socially and economically disadvantaged. Higher risk of not being able to protect oneself, higher risk of poor COVID-19 outcomes due to reasons above
E.g. to list a few disparities, populations of color in the United States are more likely to experience unemployment, more likely to work in service and sales, more likely to use public transit to go to work, and are more likely to lack health insurance.
5. In addition to individual-level risks, there are neighborhood-level risks. Neighborhoods are unequal with regards to access to resources, and also compositions of their populations in terms of income, race, and employment. Thus some neighborhoods are at >> risk than others
6. But the risk at the neighborhood level is not just the sum of individual risks indicated above. With infectious diseases, the risk to an individual not only depends on their personal risks but also on the risks of those around them.
Neighborhoods that concentrate particular vulnerabilities and lack of resources may have COVID-19 risk above and beyond the sum of the risks of their individual residents.
A person unable to work from home, but living in a detached house in a wealthy neighborhood, has less exposure than someone who cannot work from home AND lives in an apartment building with limited cleaning and other essential workers as roommates & neighbors.
7. All of the threads above overlap in complex ways. E.g a middle-income black family is more likely to live in a low-income neighborhood than a low-income white family. The COVID-19 pandemic is bringing these disparities into relief. Already seen at individual, county, zip level
In some places, the disparities may not initially seem pronounced. Especially in places that do a good job of controlling the initial wave. But without a vaccine, there will be some relaxing of social distancing, & there will be more cases. Disparities will emerge.
Folks in Canada might think we haven't had it as bad. Maybe for now. But as a flood follows the path of least resistance, so we will see this virus wreak havoc in the most disadvantaged communities. With prolonged community transmission, an unequal terrain will emerge.
Already there are worrying signs from Ontario. See this thread from @AidaInMirror for some new Ontario data, and also context on the absurdity that we are literally getting only scraps of information. https://twitter.com/aidainmirror/status/1253828813148094464
The Ontario government released IDENTIFIABLE data to first responders, including to police, with no rationale. But refuses to collect race-based data, and to release any worthwhile data publicly. We can't even look at area-based socioeconomic measures.
Refs: Background on COVID-19 disparities in the US- https://www.medrxiv.org/content/10.1101/2020.04.08.20058248v1 . Initial Research on disparities - https://www.hsph.harvard.edu/social-and-behavioral-sciences/2020/04/24/covid-19-and-health-inequities-study-by-jarvis-t-chen-and-nancy-krieger/ , https://jamanetwork.com/journals/jama/fullarticle/2764789 . Research on NYC - https://ssaha.shinyapps.io/NYC_COVID19_v1/ inspired by this thread ( https://twitter.com/usama_bilal/status/1246219487910772740) by @usama_bilal
