The Year of Living and Dying Dangerously

I write amidst waves of new coronavirus cases in the United States and the world during the Summer of 2020.

As the COVID19 pandemic grew in March 2020 to an extent that made it undeniable, the nation soon came face-to-face with the fact that race and ethnicity (along with age) were central features of the virus's effects. The very short form of the story is that people of color (a term used here to encompass Black, Latino, and American Indian people in the U.S.) are at greatly elevated risk for morbidity and mortality from COVID19 relative to non-Hispanic Whites and Asians.*

Here in the United States, the social upheaval associated with pandemic-related shutdowns was bookended by nationwide protests, vigils, and political organization to fight police violence against people of color, with a strong emphasis on the experiences of Black men, however young or old. The movement has roots in a slightly older organized social movement, Black Lives Matter, and the ongoing struggle bears that name. This social movement, too, goes hand in glove with racial and ethnic inequities that continually keep people of color down—the systemic racism that has emerged into the view of many Americans, while before it was often apparent only to those who experienced it or made a close study of it.

The difficult job facing us and other journals, as well as journalists, is to jump at the opportunity to make these inequitable conditions and outcomes (including increased odds of death for people of color) more widely understood by the general population, now that COVID19 and Black Lives Matter have caught people's attention. We will be doing this through a series of papers on COVID19 and violence.

COVID19 and People of Color

First, we will consider COVID 19. In addition to work appearing in our May issue, this issue includes a Report from the Field from the University of Alabama at Birmingham, describing "the practices put in place to care for underserved patients with heart failure and lessons learned during the COVID-19 pandemic." Forthcoming COVID19 articles will appear on our PrePrint site once they have been thoroughly reviewed and made ready for publication.

The public health account of stark inequities in COVID19 morbidity and mortality is straightforward:

For as long as there have been Americans, there have been health inequities between non-Hispanic Whites and people of color. (For the definitive and encyclopedic history of this see Byrd and Clayton, Volumes I and II.*) Eliminating such inequities is at the root of all our work here at the J. of Health Care for the Poor and Underserved.

Health inequities grow primarily from many well-understood social and ecological differences in the lives of non-Hispanic White Americans and their fellow-citizens who are people of color (among the axes of difference: poverty, discrimination/racism in health care settings and biomedical research, exposure to toxins, injuries associated with certain occupations, access to healthy food, sound housing). The medical outgrowths of such conditions include far worse and more widespread incidence of conditions including cardiovascular disease, asthma, diabetes, and certain viral infections.

In this issue, as in every other, appear articles addressing these very conditions, inequities, and efforts at solutions.

It quickly became apparent as COVID19 deaths in New York City and elsewhere mounted in the Spring, that people were at greatly heightened risk of hospitalization and death if they had had pre-existing cardiovascular disease, lung conditions, diabetes, and immunocompromised systems. Of course, as we just saw, it is precisely people of color who disproportionately suffer from these conditions. So, we have one strong reason to expect the racial/ethnic inequities in COVID19 morbidity and mortality: many of the very conditions that disproportionately affect people of color also put anyone suffering from them at greatly heightened risk of serious effects from COVID19.

The second piece of the puzzle is the different occupational profiles of different racial and ethnic groups. People in lower-paying positions (which disproportionately include people of color) were far more likely than others to be deemed essential workers and to continue...