Blacks and COVID

Blacks and COVID

For many members of the Black community, the decision to reopen — despite the alarming data that shows they are disproportionately suffering from the disease (Black people make up 30 percent of coronavirus cases, according to the Centers for Disease Control and Prevention (CDC), even though they represent just 13 percent of the US population) — fuels the community’s distrust of government and health leadership. It is a somber reminder of cruel historical practices that used black bodies as scientific fodder. 

It is widely recognized that the novel coronavirus is far more unpredictable than a simple respiratory virus. Often it attacks the lungs, but it can also strike anywhere from the brain to the toes. Many health care professionals choose to focus on treating the inflammatory reactions it triggers and its capacity to cause blood clots, even as they struggle to help patients breathe.

SARS-CoV-2 attacks the heart, weakening its muscles and disrupting its critical rhythm. It ravages kidneys so badly some hospitals have run short of dialysis equipment. It creeps along the nervous system, destroying taste and smell and on occasion has reached the brain. It creates blood clots that can kill with sudden efficiency and inflames blood vessels throughout the body.

It can begin with a few symptoms or none at all, then days later, squeeze the air out of the lungs without warning. It picks on the elderly, people weakened by previous disease, and, disproportionately, the obese. It harms men more than women, and there are also signs it complicates pregnancies. And just when we thought the young people were safe, Multisystem Inflammatory Syndrome in Children (MIS-C) reared its head and the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs of children exposed to COVID-19 are in danger. The syndrome has now been reported in nearly half the nation's states, including North Carolina. 

When an infected person expels droplets and someone else inhales them SARS-CoV-2 enters the nose and throat. It finds a home in the lining of the nose, through a receptor called angiotensin-converting enzyme 2 (ACE2). Throughout the body, the presence of ACE2, which normally helps regulate blood pressure, marks tissues vulnerable to infection, because the virus requires that receptor to enter a cell. Once inside, the virus hijacks the cell’s machinery, making myriad copies of itself and invading new cells.

As the virus multiplies, the infected person sheds copious amounts during the first week or so. Symptoms may be absent at this point, or the virus may cause a fever, dry cough, sore throat, loss of smell and taste, or head and body aches.

But others people suddenly deteriorate, resulting from a condition called acute respiratory distress syndrome (ARDS). Oxygen levels in their blood plummet and they struggle for every breath. Images of their lungs show areas riddled with white opacities where black space—air—should be. Commonly, these patients end up on ventilators. Many die.

How the virus attacks the heart and blood vessels is a mystery, but common. A 25 March paper in the Journal of the American Medical Association documented heart damage in nearly one quarter of patients out of those hospitalized for COVID-19 in Wuhan, China. The problem seems to affect the blood itself. Among 184 COVID-19 patients in a Dutch ICU, approximately 40 percent had blood that clotted abnormally, and almost one-third already had clots. Blood clots can break apart and land in the lungs, blocking vital arteries—a condition known as pulmonary embolism, which has reportedly killed COVID-19 patients. Clots from arteries can also lodge in the brain, causing stroke. 

Hypertension, kidney (renal) disease and failure, obesity, lung disease, systemic inflammation…it’s like running down a list of “things that affect the poor and minority populations” in a Jeopardy category. 

Research indicates Blacks account for 33 percent of COVID hospitalizations, largely because Black people have high rates of chronic health conditions—called comorbidities—that weaken the immune system and make them more vulnerable to the virus. But much less discussed is how food, class, and race have intersected in ways that perpetuate the health disparities and social inequities unfolding today.

“Outside of being Black, obesity, diabetes, and hypertension have been identified as the comorbidities that make coronavirus more deadly amongst anyone worldwide,” said Daphene Altema-Johnson, the food communities and public health program officer at John Hopkins University’s Center for a Livable Future. “When you look at the United States, Blacks have higher rates of these chronic conditions and the reasons they have those comorbidities are … driven by poverty and by food insecurity.”

Here we are, in Phase 2 of reopening the state of North Carolina. The state reported its highest one-day spike in new COVID-19 cases just one day after the state entered its second phase of reopening. Tuesday, the South Carolina Department of Health and Environmental Control (DHEC) announced 253 new cases of the novel coronavirus COVID-19 and 6 additional deaths.

Reopening for the sake of the economy doesn’t address the systemic racism that created inequity and disparity that heightens the risk to Black bodies and Black lives. The risk to Black families and communities is not mitigated or lessened because people want to get out of the house, get their children back into a school house, and their lives back to normal. 

There is no question: among laboratory confirmed cases of COVID-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes. If we are going to address the issues - we have to start by looking at how we come back into our community meeting spaces without continuing to ask Black lives to bear the risk and to stand in as guinea pigs for what may come next. 

We have done enough of that. 

May 26, 2020

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