This Viewpoint discusses the long history of racial inequities that cause black populations in US cities to bear a disproportionate burden of COVID-19 illness and mortality and calls for a renewed commitment to eliminating disparities that have been made so starkly visible by the pandemic.

The Johns Hopkins University and American Community Survey indicate that to date, of 131 predominantly black counties in the US, the infection rate is more than 3-fold higher than that in predominantly white counties. Moreover, this death rate for predominantly black counties is 6-fold higher than in predominantly white counties. The author suggests that some, if not most, of these differences in disease rates and outcomes will be explained by concomitant comorbidities, including hypertension, diabetes, obesity, and the higher prevalence of cardiovascular disease among black persons in the US. However he also argues that the “pernicious influence of adverse social determinants of health” also plays a role. For example, social distancing is a privilege that is not accessible to some communities.

The author concludes with a call to action, or commitment, for the nation to combat this inequity and the health care disparities that exist in the US.