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Adding to the Growing Knowledge of COVID-19 Racial Disparities

JUL 06, 2020 | BRIAN DUNLEAVY
Those of you who have been following the coronavirus 2019 (COVID-19) pandemic’s effect on the United States—and who hasn’t been?—surely know about the impact of the virus on communities of color.

A new analysis published on June 25 in The New England Journal of Medicine paints a stark picture of the racial disparities in COVID-19 cases and deaths, focusing specifically on a “hotspot”—the New Orleans area.

The findings suggest that Black Americans are more than twice as likely to be infected with the new coronavirus, SARS-CoV-2, than their white counterparts. They are also more than twice as likely to be hospitalized and more than twice as likely to die from COVID-19, the disease caused by the new coronavirus.

“The racial differences in the frequency of COVID-19 observed in the study population are probably multifactorial,” wrote the authors, who were unable to respond to requests for comment on their findings on deadline. “They may reflect underlying racial differences in the types of jobs that may have an increased risk of community exposure—[for example] service occupations.”

Indeed, the authors of the analysis cite data from the state’s Workforce Commission, which suggests that nearly half of all Louisianans working in the service sector—including healthcare, “protective” services (eg, police, firefighters), and food preparation—are minorities.

The authors, from the Ochsner Health system, found that among 3,481 patients in the region who tested positive for SARS-CoV-2 between March 1 and April 11, 70.4% were black. Of the 39.7% of COVID-19–positive patients who were hospitalized, 76.9% were black. Finally, of the 326 patients who died from COVID-19 in the study population, 70.6% were black.

This despite the fact that black Americans just 31% of the population served by Ochsner, which includes New Orleans and much of southern Louisiana.

Perhaps not surprisingly, prevalence of obesity, diabetes, hypertension, and chronic kidney disease was higher among Black Americans in the study compared with white patients—and these comorbidities have been linked with increased risk for serious illness and/or death from COVID-19.

However, the authors also identified some unique trends. As with most studies of the virus to date, while hypoxic respiratory failure and pneumonia coinfection were the most common acute medical conditions during hospitalization (25.3% and 37.8%, respectively)—and frequent laboratory abnormalities included leukopenia and thrombocytopenia with elevated levels of creatinine, aminotransferases, and markers of inflammation—there were racial differences in several laboratory results. For example, a higher percentage of black patients than white patients were febrile on hospital admission, but a higher percentage of white patients than black patients presented with low white-cell, lymphocyte, or platelet counts; low sodium levels; or elevated levels of brain-type natriuretic peptide.

Finally, a higher percentage of black patients than white patients presented with elevated levels of creatinine, AST, procalcitonin, and C-reactive protein.
“This difference in clinical presentation may reflect a longer wait to access care among black patients, resulting in more severe illness on presentation to health care facilities,” the authors wrote. “However,… whether there were racial differences in the receipt of care remain unclear.”
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