From our good colleague Ben (@USMortality on Twitter) we now have some very strong evidence and...
BY EMILY BURNS
Lockdown-dependent public health policies to handle COVID-19 represent the most racist public policy since Jim Crow.
The systemic racism that infects public health is exacerbating health outcomes during the pandemic, but not in the way that is getting traction in the media. Because public health officials simply expect minorities will fare worse, they chalk up higher death rates to past injustices. It is not ever seriously considered that our current public health response to the crisis may be directly responsible for the asymmetrical distribution of infection and death across communities and races.
Upon closer inspection, though, the unequal disease burden amongst races appears to have far more to do with lockdowns that privilege the rich–and predominantly white and Asian people–over other races and classes.
If the problem were a long-standing one of past “systemic racism” rather than a direct result of our lockdown-dependent public “health” policy, we would expect to see higher mortality rates amongst infected individuals of disadvantaged races, i.e. the same number of people infected, but the disadvantaged group is dying at a higher rate. If, on the other hand, the unequal disease burden being borne by minorities is instead due to current public health policies, we would expect to see minorities being infected at higher rates and, as a result, dying at proportionally higher rates.
So the question is, “Are minorities being infected at higher rates, too?” According to the CDC, the answer is “yes.” The following figure is taken from the CDC’s web site.
Figure 1: COVID-19 Cases, Hospitalizations and Deaths by Race/Ethnicity
For every minority group above, you can see that if death rates are higher, case rates are also higher–in some cases significantly higher than the death rates. In the case of African Americans, their case rates are 2.6x higher, but their death rates are only 2.1x higher than whites. That actually translates to a lower case fatality rate than that observed for whites. The same is true for Hispanics. They have a slightly higher death rate (1.1x), but they are infected at nearly 3x the rate.
This pattern is repeated throughout the U.S. in every major city. But on closer inspection, higher infection rates amongst minorities appear to be more tightly linked to class than race. The table below shows infection rates by zip code in Boston, as well as the percent of each zip code that is college-educated. We can see that the range goes from 0.4% of the population having been infected to 3.1%, a nearly 8-fold increase. The less education, the more infection.
Table 1: Boston COVID-19 Case Data as of May 18, 2020
The following chart, which plots the over- or under-representation of infection based on population against % population with a Bachelor’s or more, puts the chart above into starker relief. East Boston, which has the second-highest levels of infection, is a predominantly white area, while the other 5 highest infection areas are predominantly black, but all have the lowest levels of education, giving credence to the idea that race may be more of a proxy for income.
Chart 1: Geographic Breakdown of COVID-19 Infections vs. Education in Boston
In New York, we seen the same race- and class-stratified distribution of cases and of deaths. There are more deaths in poorer areas and amongst minority populations, but there are also more cases. Significantly wealthier Manhattan fares better across cases and deaths. Even aging neighborhoods, like the upper east and west sides, fare better than poor neighborhoods. This has been routinely cited as an indication of the inequities in our healthcare system. It is indeed indicative of an inequality, but it is not a past wrong. Rather, it is due to a specific policy in place right now that we have the ability, if not the will, to change right now. We know this is the case because cases are higher in the exact same places, and the cases are in proportion to the deaths. Poorer people of all races are dying at higher rates because our public health policy forces them to bear the brunt of exposure. This is a story of inequality being created in real-time by public health policies that leave the poor exposed, while making it legally incumbent on the wealthy to stay home and protect themselves, under the fig leaf of “stopping the spread.” This is the nature of systemic inequality–the people responsible are unaware of the harms they are causing, often believing they are helping.
Figure 2: Deaths by Borough, per 100,000
Figure 3: Cases by Borough, per 100,000
Figure 4: Death Rates by NYC Zip Code
If lockdowns do in fact shunt the virus to minorities, we would expect states that relied heavily on lockdowns as a method of control to see greater discrepancies in infections between races. Red states have been pilloried in the media for their more “lax” approach to managing the virus, while blue states that have relied on widespread and extended lockdowns have been praised. Thus, red state/blue state analysis should provide us with some indication of how heavily reliant a state has been on lockdowns. For this analysis, red state/blue state was defined by how the state voted in the 2016 presidential election. The reason for choosing this metric, rather than the governor, is that the political persuasion of the populace seems to have as much to do with “compliance” as the governor. I say this coming from Massachusetts, where we have a Republican governor who is representing a very blue populace that is continually demanding tighter restrictions.
Table 1, below, shows the aggregated case and death data for all observed cases and recorded deaths, along with race data. Looking at Table 1, it starts to look as though there is a significant under-representation of whites in cases, relative to Blacks and Hispanics. Table 2 shows proportionally how great the disparity is.
Table 1: COVID-19 Cases & Deaths by Race and by 2016 State Electoral Elections, as of 9/14/20
Table 2 below shows that, yes, minorities have higher death rates relative to whites, but as with the CDC data shown in Figure 1 above, the cases for each ethnic group are also higher, in some cases, and in the case of Hispanic population, significantly higher.
Table 2: Population-adjusted Multiple of White Infections & Deaths for Differing Races
But what is particularly interesting about Tables 1 and 2, above, is how much greater the discrepancy is between races in blue states than in red states. Notice that in blue states, cases amongst African Americans are more than 30% higher than in African Americans in red states. Amongst Hispanics, the difference is even greater, with Hispanics in blue states 3.4x more likely to be infected than whites, vs. 2.3x in red states. This would seem to lend credence to the idea that protracted lockdowns protect the rich and infect the poor. Thus, minorities and the poor in states pursuing such policies are at a greater disadvantage than minorities in states with public health policies that distribute the burden more evenly, by allowing individuals to make their own decisions.
But the true test really is, how deadly is the disease? Table 3 makes it clear that blue states’ hard lockdown policies have been worse across the board for all races. The average case fatality rate is 3x worse for every single race in blue states than for red states. This once again gives the lie to the idea that extremely-restrictive lockdown policies provide protection to anyone.
Table 3: Case Fatality Ratio by Race for COVID-19 Cases & Deaths for which Race Data is Available.
The other thing that you might notice from Table 3, above, is that the CFR for whites and Asians is actually higher than that of both Blacks and Hispanics–which would suggest that COVID is more deadly for these races. This goes against the prevailing narrative being peddled by public health officials. But if you look more closely at those claims about “increased mortality amongst minorities,” every single one of them points to the deaths amongst minorities relative to their populations, not relative to their rates of infection. Looking at death rates relative to infection rates shows that minority case fatality rates are not, in fact, higher. It shows, rather, that they are lower–in the case of Hispanics, substantially lower.
Why would that be? Well, the one thing that we know impacts COVID-19 mortality more than anything else is age, and particularly age coupled to multiple serious co-morbidities. If the majority of Asians and whites who are being infected (and tested) live in nursing homes, then the white and Asian mortality rates are going to be very high. By the same token, if large numbers of younger Hispanic and Black workers are exposed due to working in “essential” jobs, then their mortality rates will be lower.
This would mean that lockdown-reliant policies for mitigating the spread of COVID-19 are DIRECTLY responsible for increasing the exposure of minorities to COVID-19 and hence driving the unequal mortality rates we have seen in this country, by driving unequal infection rates across races–but probably more importantly, across classes. What’s more, our public health officials are aware that this is happening. When you couple these facts with the fact that minorities are twice as likely as whites in the U.S. to live in multi-generational homes, this kind of public “health” policy starts to look more like, well, a genocide. Let’s say “no” to genocide.
Now, do I really think that our public health officials are trying to wage a genocide? No, I don’t. Why, then, are they pursuing policies that are clearly having asymmetrical impacts on minority communities? I believe this is because they have taken up “following the science” as a mantra, not as a practice. Their mantra has become “flatten the curve,” and they are just going to keep bludgeoning it until it gets flatter than was ever intended, no matter what the consequences. In truth, it is clear that the goals of our public health officials have morphed from trying to “flatten the curve” to trying to eradicate the disease. In trying to achieve this ever-receding goal, our public health officials appear willing to accept ever-higher death tolls amongst minorities, the poor, and the elderly, simply as unfortunate collateral damage. It’s almost as if they have said that we have to accept this as part of the greater good of eradicating COVID-19. I wonder if the groups who are being sacrificed are ok with it? Or if they might perhaps like a little more evenly shared disease burden?
Infection and higher levels of mortality are, of course, just the first blows that were landed on the poor and minorities by lockdown-dependent public “health” policies. The next, and the one that will likely have much more long-range consequences, will be the refusal of school districts to teach in-person in jurisdictions with lockdown-dependent public health policies. The two maps below show the disconnect between in-person learning and case growth. The graph on the left also shows very clearly how tightly linked in-person learning is to political persuasion. Even within red states and blue states, there is a sway towards remote learning in blue-leaning cities of largely red states and towards in-person learning in red-leaning areas of blue states.
Figure 5: % In-person Learning and New Cases/Day/100K by County as of 11/30/20
I do not believe that this is because people who are “blue leaning” want to sacrifice the welfare of children, and particularly poorer, minority children. I believe it is directly tied to lockdown-dependent public health policies. Lockdown-dependent public health policies effectively decide who will be shielded from the virus and who will not. Localities that have relied on these policies as their primary mitigation tool have leaned heavily on stoking fear to drive compliance with such policies. Thus, people in these localities are honestly, and seriously, frightened of their risk from the virus. As a result, people don’t want to be exposed. This includes teachers. Like it or not, the only way to create a sense of fairness is to open all of the economy and allow people to make their own decisions. Anything short of that creates an honest and reasonable feeling amongst teachers and others groups that they are being unfairly exposed to a deadly virus.
We cannot continue to add injury to injury when it comes to minorities and the poor during this crisis. Our public health policies have already resulted in greater exposure and loss of life in these most vulnerable parts of our communities during the pandemic. We cannot allow the next generation to continue to suffer as well, allowing this systemically-racist policy to perpetuate and systematically deepen inequality for a generation.
The only way to stop doing this is to begin following the science. Heretofore, this phrase has been used as a mantra to provide cover for our politicians. I am fearful now that it is being used as a shield by our public health officials to spare them from criticism for past efforts.
If, instead of using “Follow the science” as a slogan, mantra, or shield, our politicians and public health officials were to take up this phrase and use it as a tool, we might have some success. The wonderful thing about science is that it is self-correcting. If you perform an experiment and it proves your hypothesis wrong, then you adjust your hypothesis and try another experiment, or, ideally, several. We have the benefit of having had these experiments performed for us–all we need do is look to the data. If, on the other hand, you follow the science down the wrong path and it leads you to death and destruction, and you keep going down the same path again and again, because you are certain you’re right, you’re no longer a scientist.
Let’s stop holding up the New York massacre as a model. Let’s start looking at the data; let’s start following the science down a better path, or, better yet, using it as the powerful tool it is to cut a new path. There are many options open to us. Let’s stop insisting on the one that has created the greatest man-made public health catastrophe in American history. Let’s choose a public health policy that takes account of the public it is meant to support. It’s time for American public health officials to stop blaming the failures of their policies on the American public. We are not the problem; your policies are.