Racial and Ethnic Disparities
This article by Figueroa et al. analyses racial and ethnic disparities in COVID-19 rates in Massachusetts, which has had one of the highest incidence rates in the U.S. The disparate impact of the pandemic on Black and Latinx populations to date has been well-documented, and this article explores specific factors associated with these disparities in hopes of pinpointing potential areas of public health and policy interventions to mitigate the spread of the disease among disproportionately affected communities by addressing specific systemic inequities. Analyzing data from 351 cities and towns, the study identifies foreign-born non-citizen status, household size, and job type as possible factors explaining higher rates among Latino communities, as these may make community members less able to avoid exposure at work due to employment in essential public-facing services, less able to effectively isolate or quarantine, and less able to access health care. Disparities among Black communities, in contrast, do not appear to be explained by such factors, indicating that other structural inequities that lead to disparities in health care access and exposure to environmental hazards may be more relevant among this population.
Among other disproportionately affected populations, this MMWR weekly report identifies disparities in the incidence, severity, and outcomes among American Indiana and Alaska Native persons in the 23 states with adequate data. Incidence in these populations was 3.5 times higher than among white populations, and the report identifies possible contributing factors including reliance on shared transportation, limited access to running water, household size, and other factors that may increase community transmission, as well as historical trauma and persistent racial inequities that contribute to health and socioeconomic disparities.
These disparate impacts of the pandemic on racial and ethnic minority groups are a key point underlying this NEJM perspective by Chastain et al. The authors note that COVID-19-related drug trials for remdesivir includes sites where Black, Latinx , and Native American populations were overrepresented among cases and deaths but nevertheless underrepresented in the study samples. There are a variety of reasons why this may occur (including long-standing medical distrust within some communities due to past mistreatment), but the authors argue that particularly in light of the disproportionate impact of the disease on these populations it is essential that they be represented in research that offers the potential to improve treatment and ensure that results are generalizable to these populations.
Health Care Workers
This MMWR early release assesses COVID-19 seroprevalence among frontline health care workers in the U.S., finding that among the observed personnel 6% had evidence of previous infection. Among those with antibodies indicating prior infection, 29% were asymptomatic and 69% had not been diagnosed with infection. Among the relevant differences between groups, seroprevalence was lower among those who reported always wearing a face covering while caring for patients (6%) compared to those who did not (9%). However, lack of PPE has been a longstanding issue during the pandemic, which may contribute to inconsistent use. A recent survey of 21,000 nurses by the American Nurses Association indicated that 42% were still experiencing widespread or intermittent PPE shortages and that a majority reporting reusing single-use PPE for multiple days (with over 2/3 reporting reuse indicating that this was required by facility policy)