Black people in New Jersey are dying at alarming, disproportionate rates after contracting the coronavirus, thrusting long-term health care inequalities front and center in the crisis.
The state’s fatality figures reveal a stark disparity along racial lines: 21.3% of COVID-19 deaths involve African American patients, although they make up just 14% of the Garden State’s population.
“On race, the number that jumps out for me continues to be the African American number,” Gov. Phil Murphy said Monday during his daily media briefing. “It’s still about 50% more than the representation of the general population. That’s something that we’re looking at very carefully.”
But experts say the numbers do not surprise them, and could be even higher due to some people dying at home without being tested. It’s a cruel trend rippling across the nation: Travelers from abroad brought the virus from Asia and Europe, but minority communities now shoulder the brunt.
“It really does go back to the ways in which discrimination are built into our institutions, our policies and the ways we relate to one another,” said Giridhar Mallya, senior policy officer at the Robert Wood Johnson Foundation. “It’s hard for people to grasp that discrimination in all its forms is really at the root of this. That’s the only logical explanation for why these disparities are inclusive across health issues.”
Trends such as a lack of health care options and a higher rate of underlying medical conditions have resulted in lower average lifespans for African Americans and concerned public health experts for years. Coronavirus has only exacerbated those trends.
“You look at a population that starts out with a chronic disease burden that is greater when compared to the white counterparts,” said Dr. Denise Rodgers, vice chancellor of interprofessional programs at Rutgers Biomedical and Health Sciences. “You add on a disease that with these underlying chronic illnesses leads to higher rates of complications. Those complications then lead to death.
"You layer on top of that, that African Americans and Latinos are disproportionately represented in service jobs, where they don’t have the same options to work from home.”
On Monday, Health Commissioner Judith Persichilli said 51.2% of people who died are white, 18.6% are Hispanic and 6% are Asian. According to Census estimates, 54.9% of New Jersey residents are white, 20.6% are Hispanic or Latino and 10% are Asian.
New York City has documented higher death rates among Latinos, although those numbers have yet to appear in the New Jersey data.
By Monday, the state had at least 64,000 cases of COVID-19 and 2,443 confirmed deaths.
Mallya said three factors have led to the disparity in black communities: increased exposure to the virus, underlying susceptibility and limited access to health care and testing.
Many essential workers, including those in service or grocery store jobs, are not white and must continue reporting to work, while those in office jobs are working remotely. African Americans then may end the day by returning to multi-generational homes, bringing the virus back to older and vulnerable family members.
In black communities, there are also higher rates of underlying conditions, like asthma, diabetes and high blood pressure. They can lead to severe symptoms and fatalities for people who contract the coronavirus.
And people of color have less access to testing and medical care.
While some of those persistent underlying factors will take years of policy change to overcome, experts say there are more immediate steps officials can take to balance the inequality — and having the racial data on cases will help.
The state Senate and Assembly Monday to pass a bill (S2357) that would require hospitals to report demographic data on coronavirus patients to the state Department of Health, whether they tested positive, died, sought treatment or were admitted to the hospital.
The data would include the patient’s age, ethnicity, gender and race, the number of times a person tried to get tested and were turned away and the county and municipality in which they live.
The health department would then have to publish the data daily to its website. The bill still must get the governor’s signature before taking effect.
“Are we seeing real disparities? That kind of implies maybe mechanisms of how people are getting sick, or their exposure, is differing by racial groups,” said Sze Yan (Sam) Liu, a professor of public health at Montclair State University. “That’s really important information to know, if nothing else, for us to help personalize the message.”
Rolling out widespread testing in communities is another step. When officials set up drive-thru testing sites, they failed to consider many city residents do not have cars.
Community health providers must be equipped with tests and treatments for COVID-19 to reverse the trend, experts say. Instead of placing testing sites wherever they can be set up quickly, officials must target the communities in need.
“We’ve been using a one-size-fits-all approach in terms of testing and resources across all the state,” Liu said. “By not strategizing a way where we’re recognizing differences by communities, we’re really missing a huge opportunity to reduce what we know will be disparities.”
Education and outreach — how the message is sent and through what channels — must be focused and nuanced.
Public health recommendations on preventative measures like social distancing and face masks must be dolled out through trusted community sources and local leaders, Mallya said, rather than directly from the government, which minority communities might distrust after generations of discrimination. Rodgers said it can come from social media, too, targeted in ways that are culturally appropriate and resonate.
But mere testing will do little to curb the uneven mortality rate. Hospitals and care clinics that service communities of color must have sufficient resources, like the coveted personal protective equipment, ventilators and medications, to treat patients effectively.
“Those are things that people don’t choose,” Mallya said. “Those are things that people experience based on the decisions that we make as a society, on who matters most, who matters less. I think what this pandemic is revealing is the social inequalities that we’ve lived with for a long time, but chosen to not pay attention to.”
For black residents, the disparities may exist beyond socioeconomic status, as other health outcomes often do, Rodgers said. But it’s not clear because the state has not tracked such coronavirus data.
To fix the disparity in the long run, communities and leaders will have to have real conversations about racism, opportunity and access to readily available, quality health care, she said.
“That is, at the very core of why we allow these disparities to continue to exist, decade after decade after decade,” Rodgers said. “If we don’t name it, then we will not work on it. If we don’t work on it, we won’t fix it.”