Ethnicity, race, and the COVID-19 pandemic

When COVID initially made headlines in early 2020, one of the first things we learned was that it was especially dangerous to older adults. It quickly became apparent, though, that people of all ages could get very sick and die from the virus.

Soon, however, another clear pattern emerged. COVID infections and deaths were disproportionately affecting certain communities of color—particularly American Indian/Alaska Native (AI/AN), Pacific Islanders, Black, and Hispanic people. By July 2020, adjusted for age, people in these groups were at least three times as likely to die of COVID than white people.

This gap shrunk as the years went on. But the larger trend held through most of the pandemic. When adjusted for age, overall rates of COVID infection and death remained higher for Black, Hispanic, Pacific Islander, and especially AI/AN people compared to other racial and ethnic groups.

Why do these disparities exist?

Biologically, it makes sense that older adults would be more susceptible to severe cases of the disease. Our immune systems weaken as we age and at the same time, our underlying health problems—which can make COVID more dangerous—multiply.

The reasons why the pandemic hit some communities of color so hard, on the other hand, are more complex. They’re also likely more about social and economic issues than purely physical ones.

Understanding social determinants of health

To make sense of these issues, it’s important to first understand a concept known as social determinants of health (SDOH). These are the conditions where people work, live, worship, and learn that can affect health risks, healthy outcomes, and quality of life.

For example, people living in poor areas are less likely to have access to healthy foods. And while eating more fruits and vegetables (and less fatty, sugary, and processed food) may not directly protect you against a global pandemic, it can reduce your risk of chronic health problems—like obesity, diabetes, and hypertension—that make COVID more dangerous.

Some minority racial groups are more likely to experience poverty than white people. They’re also more likely to have lower education levels, higher rates of unemployment, and worse physical health.

These disparities between races are related to multiple factors, says Monica Webb Hooper, PhD, a licensed clinical health psychologist and deputy director of the National Institute on Minority Health and Health Disparities. They include longstanding problems such as institutional racism, discrimination, and other barriers to preventive medicine and quality health care.

“A health disparity is one that adversely affects people who have experienced various forms of social disadvantage and greater obstacles to having optimal health,” says Webb Hooper. “It’s not just about individuals making bad choices or living a certain lifestyle. There are larger factors beyond those individuals’ control that affect their functioning.”

COVID’s impact on minority communities

In many ways, COVID is just a very recent example of how social and economic issues contribute to gaps in health care, and overall health, among people of color.

“Unfortunately, I was not surprised that we are seeing health disparities as it relates to COVID-19,” says Webb Hooper. “I think that this virus simply highlighted the existing disparities that you find across many different health conditions.”

Still, there are some factors specific to COVID that made the crisis particularly lethal for some minorities. For example, a 2023 systematic review and meta-analysis published in The Science of the Total Environment suggests that people who live in areas with high levels of air pollution are more likely to be infected, become severely ill, and die of COVID than people who live in areas with less pollution. And according to the American Lung Association, people of color are more likely to live in places with high levels of air pollution.

Before vaccines were widely available, staying home and social distancing were two of the best ways people could protect themselves against COVID. But depending on a person’s living situation, that can be very difficult. While many people were able to work from home or could afford a furlough from work, others did not have these opportunities.

Many people of color are more likely to live in densely populated areas and work necessary, “frontline" jobs, such as public transportation operators, grocery store employees, and warehouse distribution workers. Access to telework continues to be limited for some groups. As of August 2023, just 9.9 percent of Hispanic and 15.4 percent of Black workers telecommuted, compared to 31.2 percent of Asian and 19.3 percent of white workers, according to the U.S. Bureau of Labor Statistics.

“When you think about who is most likely to be exposed to COVID-19, you’re looking at factors that disproportionately affect racial and ethnic minorities and poor people in general,” says Webb Hooper. It’s important to look at the bigger picture, she adds.

“Groups who experience health disparities are sometimes blamed for their problems,” Webb Hooper notes. “But if they have to make a living and they’re not able to take appropriate precautions on the job—or if they’re living in a homeless shelter or in a crowded, multigenerational household—there’s little they can do about those factors.”

These same groups of people are also more likely to be uninsured or underinsured, and therefore may be hesitant to see a healthcare provider if they do get sick. Research suggests minority communities are less trusting of the health care system in general, because of issues such as language barriers, lack of diversity among medical staff, and experiences of discrimination. When people of color do seek care, their symptoms may not be taken as seriously as those of white patients.

Reducing racial health disparities

To help protect people of color during future health crises, the racial and ethnic disparities made evident during the COVID pandemic must be recorded, studied and addressed.

For example, in May 2020, members of the Association of Black Cardiologists published an essay in the journal Circulation offering several recommendations for dealing with COVID in communities of color. These solutions included more readily available disease testing and “relentless” contact tracing, to let people know how to manage illness and slow the spread of infection. Paid sick leave, more funding for community food banks, and suspensions of foreclosures and evictions were also recommended to help soften the blow. And while these steps were proposed during the height of COVID, they could broadly apply to outbreaks down the road.

Whatever health emergencies may lie ahead, a key to reaching vulnerable communities is paying attention to and addressing their unique challenges. “Broad, uniform public health recommendations will need to consider the needs of disadvantaged populations to avoid unintended consequences,” Webb Hooper says. “It’s important that we find solutions, in ways that are responsive, in order to really create lasting change.”